Prolonged apnea after succinylcholine

Succinylcholine drip is used for forty-five minutes without the use of a nerve stimulator. The patient will not breathe after conclusion of the surgery.

1. What is your differential diagnosis?

2. What is your management?

3. Is it important to establish the diagnosis? Why or why not?

Anaphylaxis

A 45-year old male is undergoing a lumbar laminectomy in the prone position. The surgeons finish irrigating the wound prior to closing. The blood pressure drops from 120/70 to 40/0 mmHg, and you hear expiratory wheezes through your esophageal stethoscope.

1. What is your differential diagnosis?

2. What is your management?

Epidural blood patch

The surgeon is performing trans-sphenoidal surgery, and inserts a subarachnoid catheter at the beginning of the procedure. At the end of the case, the surgeon requests an epidural blood patch to prevent headache.

1. What is your response?

2. What are alternative treatments?