Background Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. Methods A retrospective cohort study of patients ≥ 18 years who underwent emergent craniotomy for TBI at Harborview Medical Center (level-1 trauma center) between October 2007 and January 2010. Demographic, clinical and radiographic characteristics, hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records. Hypotension was defined as systolic blood pressure (SBP) < 90 mmHg. Univariate analyses were performed to compare the clinical characteristics of patients with and without IH and multiple logistic regression analysis was used to determine independent risk factors for IH. Results Data abstracted from 113 eligible patients aged 48±19 years was analyzed. Intraoperative hypotension was common (n=73, 65%) but not affected by the choice of anesthetic agent. Independent risk factors for IH were multiple Computed Tomographic (CT) lesions (AOR 19.1 [95% CI: 2.08–175.99]; p=0.009), SDH (AOR 17.9 [95% CI: 2.97–108.10]; p=0.002), maximum CT lesion thickness (AOR 1.1 [95% CI: 1.01–1.13]; p=0.016), and anesthesia duration (AOR 1.1 [95% CI: 1.01–1.30]; p=0.009). Conclusion Intraoperative hypotension was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion and longer duration of anesthesia increase the risk for IH.

Coronavirus disease 2019 (COVID-19) can present with abdominal pain in children and adults. Most imaging findings have been limited to characteristic lung findings, as well as one report of bowel-ischemia-related findings in adults. We report a case of COVID-19 in a healthy teenager who initially presented with isolated mesenteric adenopathy, typically a self-limited illness, which progressed to severe illness requiring intensive care before complete recovery. The boy tested negative for COVID-19 twice by polymerase chain reaction (PCR) from upper respiratory swabs before sputum PCR resulted positive. A high index of suspicion should be maintained for COVID-19 given the continued emergence of new manifestations of the disease.

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