ABSTRACT
We report the perioperative airway management in a 7-year-old boy suffering from Cherubism who was scheduled for endoscopic sinus surgery under general anesthesia. Cherubism is a rare, hereditary disorder of the jaws characterized by expansion of the maxilla and mandible. A difficult airway was encountered during induction of general anesthesia, nasal and oral mask pitting ventilation was hard for first attempts due to facial bony abnormality. At second attempt, we tried only oral mask pitting ventilation and it was successful.
Subject(s)
Child , Humans , Airway Management , Anesthesia, General , Cherubism , Jaw , Mandible , Masks , Maxilla , Stress, Psychological , VentilationABSTRACT
We performed a prospective cohort trial on 220 patients undergoing elective off-pump coronary artery bypass surgery and taking aspirin to evaluate the effect of aspirin resistance on myocardial injury. The patients were divided into aspirin responders and aspirin non-responders by the value of the aspirin reaction units obtained preoperatively using the VerifyNow(TM) Aspirin Assay. The serum levels of troponin I were measured before surgery and 1, 6, 24, 48 and 72 hr after surgery. In-hospital major adverse cardiac and cerebrovascular events, graft occlusion, the postoperative blood loss and reexploration for bleeding were recorded. Of the 220 patients, 181 aspirin responders (82.3%) and 39 aspirin non-responders (17.7%) were defined. There were no significant differences in troponin I levels (ng/mL) between aspirin responders and aspirin non-responders: preoperative (0.04 +/- 0.08 vs 0.03 +/- 0.06; P = 0.56), postoperative 1 hr (0.72 +/- 0.87 vs 0.86 +/- 1.10; P = 0.54), 6 hr (2.92 +/- 8.76 vs 1.50 +/- 2.40; P = 0.94), 24 hr (4.16 +/- 13.44 vs 1.25 +/- 1.95; P = 0.52), 48 hr (2.15 +/- 7.06 vs 0.65 +/- 0.95; P = 0.64) and 72 hr (1.20 +/- 4.63 vs 0.38 +/- 0.56; P = 0.47). Moreover, no significant differences were observed with regard to in-hospital outcomes. In conclusion, preoperative aspirin resistance does not increase myocardial injury in patients undergoing off-pump coronary artery bypass surgery. Postoperative dual antiplatelet therapy might have protected aspirin resistant patients.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Aspirin/administration & dosage , Cohort Studies , Coronary Artery Bypass, Off-Pump/adverse effects , Coronary Disease/surgery , Drug Resistance , Myocardial Infarction/etiology , Myocardial Reperfusion Injury/prevention & control , Platelet Aggregation Inhibitors/administration & dosage , Postoperative Hemorrhage/etiology , Preoperative Care/methods , Prospective Studies , Stroke/etiology , Troponin I/bloodABSTRACT
HELLP syndrome (Hemolysis, Elevated Liver enzymes, and a Low Platelet count) is a severe complication of preeclampsia or eclampsia, and is associated with a high risk of maternal and neonatal morbidity and mortality. In cases of delivery management in patients with HELLP syndrome, general anesthesia is required for cesarean sections in the presence of severe thrombocytopenia. These patients have a high risk of uncontrollable hypertension under stressful conditions, such as laryngoscopic intubation, surgical incision, and delivery. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action. In addition, remifentanil has a potent analgesic effect and provides cardiovascular stability during surgery. This paper reports a 33-year-old patient with HELLP syndrome, who was referred to our hospital for a cesarean section. The procedure was performed under general anesthesia with remifentanil being used as an adjunct for cardiovascular stability.
Subject(s)
Adult , Female , Humans , Pregnancy , Anesthesia, General , Blood Platelets , Cesarean Section , Eclampsia , Emergencies , HELLP Syndrome , Hypertension , Intubation , Liver , Piperidines , Pre-Eclampsia , ThrombocytopeniaABSTRACT
Although there are no verified relationship between ICH and spinal anesthesia, there has been a few articles that report ICH after spinal anesthesia. We report a parturient with postpartum headache, nausea and vomiting which were diagnosed as symptoms of intracerebral hemorrhage, later. She had received a cesarean section under the spinal anesthesia, and developed a light headache, nausea, and vomiting at the ninth hour after the operation.She presented a generalized tonic seizure two hours later, and had other seizure on the day after operation. A brain computed tomography was performed and it revealed an intracerebral hemorrhage. She discharged 16 days after the surgery, without any sequelae. Parturients are prone to develop PDPH after spinal anesthesia, and other diseases with symptoms of headache, nausea, and vomiting may be misdiagnosed as PDPH. A cautious diagnosis should be made when one confronts a headache after spinal anesthesia, especially with a parturient.
Subject(s)
Female , Pregnancy , Anesthesia, Spinal , Brain , Cerebral Hemorrhage , Cesarean Section , Headache , Light , Nausea , Post-Dural Puncture Headache , Postpartum Period , Seizures , VomitingABSTRACT
In two female siblings, growth and developmental retardation, poor sucking, anorexia, floppiness and respiratory difficulty developed around 2 and 4 monthes of age in each, and the respiratory symptoms rapidly aggravated to comatose states and finally into death one month later. On admission at emergency room, severe acidosis and high lactate and pyruvate levels in serum and cerebrospinal fluid were revealed in one. Brain computed tomography and magnetic resonance imaging revealed identical bilateral involvement of putamen in both of the sibs, which made the diagnosis of Leigh disease(subacute necrotizing encephalomyelopathy) possible. There is also a family history of early death in infancy period; an elder sister and a brother of mother died with unknown cause at their 5 and 10 months of age. Mitochondrial enzyme functions could not be assayed.
Subject(s)
Female , Humans , Acidosis , Anorexia , Brain , Cerebrospinal Fluid , Coma , Diagnosis , Emergency Service, Hospital , Growth and Development , Lactic Acid , Leigh Disease , Magnetic Resonance Imaging , Mothers , Putamen , Pyruvic Acid , SiblingsABSTRACT
Fetal hydrops describes the infant who has generalized edema due to accumulation of exess fluid, in serious case, ascites and pleural and pericardial effusions are commonly combined. The chorioangioma is considered the most common primary tumor of the placenta, which is about 1% of all pregnancy. However, the majority of the cases are asymptomatic but larger ones, usually more than 5cm in diameter, are commonly associated with maternal and fetal complications. We report a case of nonimmune hydrops fetalis due to large chorioangioma with associated polyhydramnios. The newborn infant was managed conservatively and had excellent outcome.
Subject(s)
Humans , Infant , Infant, Newborn , Pregnancy , Ascites , Edema , Hemangioma , Hydrops Fetalis , Pericardial Effusion , Placenta , PolyhydramniosABSTRACT
Fetal hydrops describes the infant who has generalized edema due to accumulation of exess fluid, in serious case, ascites and pleural and pericardial effusions are commonly combined. The chorioangioma is considered the most common primary tumor of the placenta, which is about 1% of all pregnancy. However, the majority of the cases are asymptomatic but larger ones, usually more than 5cm in diameter, are commonly associated with maternal and fetal complications. We report a case of nonimmune hydrops fetalis due to large chorioangioma with associated polyhydramnios. The newborn infant was managed conservatively and had excellent outcome.
Subject(s)
Humans , Infant , Infant, Newborn , Pregnancy , Ascites , Edema , Hemangioma , Hydrops Fetalis , Pericardial Effusion , Placenta , PolyhydramniosABSTRACT
No abstract available.