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Volatile Sedation in Reversible Cerebral Vasoconstriction Syndrome: A Case Report
Michael Ramming1, Joachim Bansbach, Christopher Beck
1From the *Department of Anesthesiology and Critical Care, University of Freiburg Medical Center, Freiburg, Germany; and †Department of Neuroradiology, University of Freiburg Medical Center, Freiburg, Germany.
A & a Case Reports
|April 15, 2017
Summary
Reversible cerebral vasoconstriction syndrome (RCVS) can cause severe complications, including acute respiratory distress syndrome. This case highlights a novel sedation technique for prone positioning in RCVS patients with ARDS.
Area of Science:
- Neurology
- Critical Care Medicine
- Obstetrics
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) presents with thunderclap headaches and reversible cerebral artery narrowing.
- RCVS frequently occurs during the peripartum period, posing unique management challenges.
- Optimal treatment strategies for RCVS, especially with concurrent critical illness, are not well-established.
Observation:
- A 31-year-old primigravida developed intracranial hemorrhage, followed by RCVS and acute respiratory distress syndrome (ARDS).
- The patient's condition was further complicated by uterine atony and septic shock, indicating severe systemic illness.
- This complex presentation necessitated innovative management approaches for respiratory support.
Findings:
- The study reports the first use of short-acting volatile sedation for prone positioning in a patient with ARDS secondary to RCVS.
- This technique facilitated safe and effective prone positioning, crucial for managing severe hypoxemia in ARDS.
- Successful management of ARDS in the context of RCVS and other critical complications was achieved.
Implications:
- This case demonstrates a potential therapeutic option for managing ARDS in patients with RCVS.
- The use of volatile sedation for prone positioning may offer a viable strategy in complex obstetric and neurological critical care scenarios.
- Further research is warranted to evaluate the safety and efficacy of this approach in a broader patient population.