ABSTRACT
Objective: There are several physiologic advantages to early tracheal extubation and spontaneous ventilation following surgery for congenital heart disease [CHD]. In order for early tracheal extubation to be feasible, effective reversal of neuromuscular blockade is mandatory. Sugammadex reverses neuromuscular blockade with a mechanism that differs from acetylcholinesterase inhibitors. We aimed to study the effect of sugammadex on the fast track extubation
Methodology: We retrospectively reviewed our experience with the use of sugammadex to reverse neuromuscular blockade following cardiac surgery for CHD in infants and children, during a pediatric cardiac surgical trip of Heart Care International to Tuxtla, Mexico. Demographic data collected included age, weight, type of CHD, and the surgical procedure. Intraoperative data included sugammadex dose, outcome [successful tracheal extubation], and adverse effects, which could be attributed to sugammadex. Sugammadex was administered to 14 patients, who ranged in age from 1 to 16 years of age and in weight from 7.6 to 57.7 kilograms. Statistical analysis was done
Results: All 14 patients underwent successful tracheal extubation in the operating room within 15 min of completion of the surgical procedure. No patient required reintubation of the trachea during the postoperative course. No adverse effects related to sugammadex were noted
Conclusions: Our preliminary experience demonstrates that sugammadex effectively reverses neuromuscular blockade and allows for early tracheal extubation in pediatric patients following surgery for repair of CHD. Prompt and effective reversal of neuromuscular blockade allows for effective fasttracking with early tracheal extubation
ABSTRACT
Glutaric aciduria type-1 [GA-1] is an autosomal recessive metabolic disorder due to the deficiency of the enzyme glutaryl-CoA dehydrogenase. The enzymatic defect leads to secondary damage to the central nervous system due to the accumulation of glutaric acid. Progressive neurologic effects with spasticity and orthopedic deformities necessitate frequent surgical and anesthetic care. We present a 13-year-old girl with glutaric academia type-1 who required anesthetic care for posterior spinal fusion. Previous reports of anesthetic care for these patients are reviewed, the end-organ involvement discussed, and options for anesthetic care presented
Subject(s)
Female , Humans , Adolescent , Brain Diseases, Metabolic , Glutaryl-CoA Dehydrogenase/deficiency , Perioperative CareABSTRACT
Peripheral regional anesthesia in children has had a recent surge in popularity among pediatric anesthesia providers. The increased prevalence is at least in part explained by the proliferation of ultrasonography in the perioperative arena. Ultrasound-guided peripheral nerve block techniques have given pediatric anesthesiologists confidence to approach the diminutive structures that are in close approximation to sensitive areas. The three major categories of pediatric peripheral nerve blocks are upper extremity, truncal, and lower extremity. The indications, ultrasound anatomy, ultrasound-guided technique, and potential complications of the nerve blocks in each category are reviewed
ABSTRACT
The neuronal ceroid lipofuscinoses [NCL] are a group of inherited, autosomal recessive, and progressive neurodegenerative diseases, which result from an enzymatic defect or the deficiency of a transmembrane protein, leading to the accumulation of lipopigments [lipofuscin] in various tissues. NCL results in the impairment of function in several end-organs including the central nervous system with loss of cognitive and motor function, myoclonus, and intractable seizures. Additional involvement includes the cardiovascular system with arrhythmias and bradycardia as well as impairment of thermoregulation leading to perioperative hypothermia. Given the complexity of the end-organ involvement and the progressive nature of the disorder, the anesthetic care of such patients can be challenging. Till date, there are a limited number of reports regarding the anesthetic management of patients with NCL. We present an 18-year-old patient with NCL who required anesthetic care during replacement of a vagal nerve stimulator. Previous reports of anesthetic care for these patients are reviewed, the end-organ involvement of NCL discussed, and options for anesthetic care presented
Subject(s)
Humans , Male , Neuronal Ceroid-Lipofuscinoses/diagnosis , Perioperative CareABSTRACT
Postoperative pain and the associated potential adverse effects have been a major concern for the anesthesiologists since the advent of the practice of anesthesiology. The optimal means of providing postoperative analgesia in the pediatric patient has been a challenging task, and various combinations have been tried to lessen the side effects. Regional techniques in pediatric population have seen some crests in popularity in the past but the use of ultrasound and MRI guidance has added precision in the techniques and boosted confidence of the anesthesiologists. Transversus abdominis plane or TAP block has now made its way into the pediatric population and this editorial provided a supplementary source of information to the a review article and two case reports on similar topic in this issue of Anesthesia, Pain and Intensive Care
ABSTRACT
Despite the successful palliation of patients with complex CHD, long term consequences may occur related to the chronically elevated venous pressures or failing ventricular function following total cavopulmonary anastomosis in patients with single ventricle anatomy. We present a 33-year-old adult woman with Fontan physiology who presented with recurrent ascites requiring insertion of a tunneled abdominal drain. Given her co-morbid conditions, the procedure was accomplished using a transversus abdominis plane [TAP] block placed with ultrasound guidance. Although generally used for the provision of postoperative analgesia following lower abdominal procedures, the TAP block may also be used in specific scenarios instead of general anesthesia in high risk patients. The anatomy of the TAP block is reviewed, its perioperative applications discussed, and its potential use instead of general anesthesia presented