Early diagnosis and resection of right atrial mass in a neonate

Primary intracardiac tumors are an infrequent occurrence during infancy and childhood and the most common amongst the primary cardiac neoplasms are myxomas, which have an estimated incidence of approximately 2-3 per 100,000 population. The atrial myxoma has a preponderance to occur in the left atrium with only a 25% incidence in the right atrium. Depending upon the site and the size of the neoplasm, the clinical picture varies and may range from no significant symptoms to cardiac arrest. Hence, the diagnosis and management of this condition requires highly specialized multidisciplinary input by the perioperative caregivers including cardiologists, cardiothoracic surgeons, anesthesiologists and the nurses specialized to deal with this unique population. There is a dearth of available literature on the anesthetic management of these primary intra-cardiac tumors with reports of neonatal right atrial myxoma excision a true rarity. We report the successful anesthetic management of one such case of a right atrial mass in an 18 days old female child

Comparison of spinal anesthesia dosage based on height and weight versus height alone in patients undergoing elective cesarean section / 대한마취과학회지

BACKGROUND: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens. METHODS: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted according to height and weight, and in the other, the dose was adjusted according to height only. RESULTS: Sixty women with a singleton pregnancy were included. Of the factors that could affect dose and blood pressure, including age, weight, height, and dose, only height differed between the groups. Mean heart rate was similar between the groups. Hypotension was significantly more frequent with dosage based on height alone than with two-factor dose calculation (56.7% vs. 26.7%; P = 0.018). CONCLUSIONS: Adjusting the dose of isobaric bupivacaine to a patient's height and weight provides adequate anesthesia for elective cesarean section and is associated with a decreased incidence and severity of maternal hypotension and less use of ephedrine.