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Hi SDN Anesthesiologists, I hope you are doing well.
Here is a weird case.
50 years old female
For D & C (Dilitation and Curetage).
Past Medical History : Hypertension and on Amlodipine. Had her medication in the morning 4 hours prior to the procedure.
Done under Mask Ventilation General Anesthesia (Decadron, Ketamine, propofol, Plasil '' metoclopramide''- only meds given - and then isoflurane); at the beginning the mask was not fit, then I tried to make it fit on her face, and succeeded (big face like, large and wide mandibles), then I by myself handled the mask, not the tech) - the reservoir bag works well (I mean good in and out), no spasm at all - put cudel airway also to enhance breathing. I noticed a neck movement towards the right side - spastic (like latricollis - dystonia if I am truly fancy guy to say it), very weird, very resistant to my hands to make her (even) straight head !!! I resist the contraction three times and made her in plane and continued my mask ventilation. I opened her eyes to see if it was oculogyric reaction, nothing both eyes are OK, equal pupil size.
At the end, tried to wake her up by jaw thrust as she was sleepy, and she starts to spasm her jaw like preventing good breathing after removal of the airway device, I did larison maneuver fearing of laryngospasm, and then CPAP.
She was then OK, nothing happen later - woke up and responds to talk, then discharged well to the ward.
Almost one hour later, patient relatives complained of unilateral parotid - submandibular swelling happened to their patient (mom).
I went to see her and examined her 3 times on 30 minutes interval. Swelling was Obvious in the soft tissue. Jaw movement was fine and only pain - tenderness - bilaterally on parotid submandibular region, worse on the right side where the swelling, no redness or any discoloration.
Treated with icebag, pain killers paracetamol, and advised for ponstan NSAIDs on discharge... Etc and follow up.
Last visit to asses her, she was better with ice bag, swelling was a bit better, but tender...
Your thoughts?
Differential Diagnosis?
Thanks
Amir
Here is a weird case.
50 years old female
For D & C (Dilitation and Curetage).
Past Medical History : Hypertension and on Amlodipine. Had her medication in the morning 4 hours prior to the procedure.
Done under Mask Ventilation General Anesthesia (Decadron, Ketamine, propofol, Plasil '' metoclopramide''- only meds given - and then isoflurane); at the beginning the mask was not fit, then I tried to make it fit on her face, and succeeded (big face like, large and wide mandibles), then I by myself handled the mask, not the tech) - the reservoir bag works well (I mean good in and out), no spasm at all - put cudel airway also to enhance breathing. I noticed a neck movement towards the right side - spastic (like latricollis - dystonia if I am truly fancy guy to say it), very weird, very resistant to my hands to make her (even) straight head !!! I resist the contraction three times and made her in plane and continued my mask ventilation. I opened her eyes to see if it was oculogyric reaction, nothing both eyes are OK, equal pupil size.
At the end, tried to wake her up by jaw thrust as she was sleepy, and she starts to spasm her jaw like preventing good breathing after removal of the airway device, I did larison maneuver fearing of laryngospasm, and then CPAP.
She was then OK, nothing happen later - woke up and responds to talk, then discharged well to the ward.
Almost one hour later, patient relatives complained of unilateral parotid - submandibular swelling happened to their patient (mom).
I went to see her and examined her 3 times on 30 minutes interval. Swelling was Obvious in the soft tissue. Jaw movement was fine and only pain - tenderness - bilaterally on parotid submandibular region, worse on the right side where the swelling, no redness or any discoloration.
Treated with icebag, pain killers paracetamol, and advised for ponstan NSAIDs on discharge... Etc and follow up.
Last visit to asses her, she was better with ice bag, swelling was a bit better, but tender...
Your thoughts?
Differential Diagnosis?
Thanks
Amir
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