Intraoperative ST segment, T wave changes in two infants during general anesthesia

When compared to the adult population, intraoperative cardiac events related to coronary ischemia are uncommon in the pediatric population. However, continuous electrocardographic [ECG] monitoring is still recommended in infants and children. The authors report two infants who developed intraoperative ST-T wave changes during routine surgical procedures. The role of intraoperative ECG monitoring in infants and children is discussed, the etiology of ST-T wave changes is presented, and previous reports of such events are reviewed?

case report of a retained and knotted caudal catheter

Caudal catheters advanced to the lumbar and thoracic regions can be used to provide excellent analgesia for pre-term neonates undergoing major abdominal and thoracic procedures. Despite their frequent use, attention to detail is mandatory to avoid complications related to the medications used or the placement technique. We present a 2-day-old, 2 kg, pre-term infant who was born at 32 weeks gestational age with a tracheoesophageal fistula. Following anesthetic induction, a caudal epidural catheter was placed with the intent of threading it to the mid-thoracic level. The intraoperative and post-operative courses were uneventful with the epidural catheter providing adequate analgesia without the need for supplemental intravenous opioids. During catheter removal, resistance was noted and it could not be easily removed. With repositioning and various other maneuvers, the catheter was removed with some difficulty. On examination of the catheter, a complete knot was noted. Options for catheter advancement from the caudal space to the thoracic dermatomes are reviewed and techniques discussed for removal of a retained epidural catheter

Anesthesia in a pediatric patient with systemic mastocytosis

Systemic mastocytosis is a rare disorder of mast cells which carries considerable risk in the perioperative period

Unintended release of mast cell mediators has the potential to cause signi! cant hypotension, multi-system organ dysfunction, and death. Many factors have been implicated in mast cell degranulation including heat, stress, and many medications that may be commonly used anesthetic care. We present the case of a 10 year old girl with systemic mastocytosis who required general anesthesia for reduction of a dislocated elbow

The perioperative care of such patients is reviewed and strategies for intraoperative anesthesia are discussed

Perioperative management of an adolescent with transposition of the great arteries, status post Senning procedure, for posterior spinal fusion

With advances in surgical techniques and perioperative care, the survival rate of patients with congenital heart disease continues to increase

As such, patients with palliated or corrected congenital heart disease may present for major surgical procedures

Although alternative techniques are now available for the anatomic repair of patients with transposition of the great arteries [TGA], an atrial level [Mustard or Senning procedure] was previously performed

As these patients age, long-term adverse effects may occur including myocardial dysfunction, rhythm disturbances requiring pacemaker placement, pulmonary hypertension, and baf" e obstruction

We present a case report of a 14 year old girl with TGA, who underwent a Senning procedure during infancy and now presented for posterior spinal fusion in the treatment of kyphoscoliosis

The perioperative care of such patients is discussed