ABSTRACT
Compression of the airway is relatively common in pediatric patients, although it is often an unrecognized complication of congenital cardiac and aortic arch anomalies. Aortopexy has been established as a surgical treatment for tracheobronchial obstruction associated with vascular anomaly, aortic arch anomaly, esophageal atresia, and tracheoesophageal fistula. The tissue-to-tissue arch repair technique could result in severe airway complication such as compression of the left main bronchus which was not a problem before the correction. We report three cases of corrective open heart surgery monitored by intraoperative bronchoscopy performed during prebypass, and performed immediately before weaning from bypass, to evaluate tracheobronchial obstruction caused by congenital, complex cardiac anomalies in the operating room.
Subject(s)
Humans , Airway Obstruction , Aorta, Thoracic , Aortic Coarctation , Bronchi , Bronchoscopy , Esophageal Atresia , Operating Rooms , Thoracic Surgery , Tracheoesophageal Fistula , WeaningABSTRACT
BACKGROUND: Although water chambers are often used as surrogate blood-warming devices to facilitate rapid warming of red blood cells (RBCs), these cells may be damaged if overheated. Moreover, filtered and irradiated RBCs may be damaged during the warming process, resulting in excessive hemolysis and extracellular potassium release. METHODS: Using hand-held syringes, each unit of irradiated and leukocyte-filtered RBCs was rapidly passed through a water chamber set to different temperatures (baseline before blood warming, 50℃, 60℃, and 70℃). The resulting plasma potassium and free hemoglobin levels were then measured. RESULTS: Warming RBCs to 60℃ and 70℃ induced significant increases in free hemoglobin (median [interquartile ranges] = 60.5 mg/dl [34.9-101.4] and 570.2 mg/dl [115.6-2289.7], respectively). Potassium levels after warming to 70℃ (31.4 ± 7.6 mEq/L) were significantly higher compared with baseline (29.7 ± 7.1 mEq/L; P = 0.029). Potassium levels were significantly correlated with storage duration after warming to 50℃ and 60℃ (r = 0.450 and P = 0.001; r = 0.351 and P = 0.015, respectively). CONCLUSIONS: Rapid warming of irradiated leukoreduced RBCs to 50℃ may not further increase the extracellular release of hemoglobin or potassium. However, irradiated leukoreduced RBCs that have been in storage for long periods of time and contain higher levels of potassium should be infused with caution.
Subject(s)
Erythrocytes , Hemolysis , Hyperkalemia , In Vitro Techniques , Plasma , Potassium , Syringes , WaterABSTRACT
Resection of large sacrococcygeal teratomas (SCTs) in premature neonates has been associated with significant perinatal mortality, making this a high risk procedure requiring careful anesthetic management. Most deaths during resection of SCTs are due to cardiac arrest caused by electrolyte imbalances, such as hyperkalemia, and massive bleeding during surgery. We describe two premature neonates who experienced cardiac arrest, one due to hyperkalemia and the other not due to hyperkalemia, during excision of large, prenatally diagnosed SCTs. We present here the considerations for anesthesia in premature neonates with huge SCTs.
Subject(s)
Humans , Infant, Newborn , Anesthesia , Heart Arrest , Hemorrhage , Hyperkalemia , Perinatal Mortality , TeratomaABSTRACT
BACKGROUND: Perioperative respiratory adverse events remain a major cause of postoperative morbidity and mortality during pediatric anesthesia. This multicenter study was designed to evaluate the incidence of perioperative respiratory adverse events during elective pediatric surgery and to identify the risk factors for these events. METHODS: Pediatric patients undergoing elective surgery under general anesthesia in 11 hospitals were randomly selected for this prospective, multicenter study. Preanesthetic assessments, anesthetic and surgical conditions were recorded by anesthesiologists in charge. Adverse respiratory events were registered. RESULTS: Eight hundred and twenty-three patients were included. The overall incidence of any perioperative respiratory adverse respiratory event was 15.1%. The incidences of perioperative bronchospasm, laryngospasm, coughing, desaturatioin (oxygen saturation or =2, OR 1.62. CONCLUSIONS: Multiple attempts for airway device insertion, recent URI, induction with intravenous anesthetics, airway related surgery and ASA class > or =2 were associated with increased risk for perioperative respiratory adverse events.
Subject(s)
Child , Humans , Airway Obstruction , Anesthesia , Anesthesia, General , Anesthetics, Intravenous , Bronchial Spasm , Cough , Fees and Charges , Incidence , Laryngismus , Multivariate Analysis , Odds Ratio , Prospective Studies , Risk FactorsABSTRACT
A 4-year old boy with supravalvular ascending aortic stenosis underwent sliding aortoplasty. After cardiopulmonary bypass weaning, aorta suture site was torn accidentally and the patient was in hypovolemic shock. Emergency cardiopulmonary bypass was reinstituted and the aorta was repaired. After removal of the aortic clamp, bradycardia and hypertension were noted. We suspected increased intracranial pressure due to hypoxic brain damage after massive blood loss and the patient was treated to lower the intracranial pressure. Physicians should be aware of the significance of the hemodynamic change associated with increased intracranial pressure to prevent further neurologic damage.
Subject(s)
Humans , Aorta , Aortic Valve Stenosis , Bradycardia , Cardiopulmonary Bypass , Emergencies , Hemodynamics , Hypertension , Hypoxia, Brain , Intracranial Pressure , Shock , Sutures , WeaningABSTRACT
BACKGROUND: The femoral arteries (FA) and femoral veins (FV) are useful access sites for diagnostic and interventional procedures. In adults, the usual puncture sites are 1-3 cm distal from the inguinal crease. In children, however, the optimal puncture site vessels are not known. The aim of our study was to assess the number of branches and bifurcation sites of the femoral vessels in children by using ultrasonography. METHODS: Color Doppler ultrasonography was used to determine bifurcation sites of the FA and FV, relative to the inguinal crease, in 48 children (median age, 4 yr; median weight, 18.7 kg) with American Society of Anesthesiologists (ASA) Physical Status (PS) score 1-2 and who were scheduled for general anesthesia. RESULTS: The numbers of FAs and FVs at the inguinal crease were 1.83 +/- 0.39 and 1.08 +/- 0.29, respectively, in infants, and 1.83 +/- 0.58 and 1.0 +/- 0.0, respectively, in 10-year-old children. The bifurcation site of the FA in infants and those aged 10 years was 0.78 +/- 0.30 cm and 1.47 +/- 0.27 cm proximal to the inguinal crease, respectively (P < 0.05), whereas the bifurcation site of the FV in these two age groups was -0.96 +/- 0.27 cm and -2.29 +/- 1.09 cm distal to the inguinal crease, respectively (P < 0.05). CONCLUSIONS: In children, the FA frequently bifurcates proximal to the inguinal crease, whereas the FV bifurcates distal to the inguinal crease. However, there are anatomical differences among age groups, so care should be taken to avoid complications during femoral vessel cannulation.
Subject(s)
Adult , Aged , Child , Humans , Infant , Anesthesia, General , Catheterization , Femoral Artery , Femoral Vein , Glycosaminoglycans , Punctures , Ultrasonography, Doppler, Color , VeinsABSTRACT
Spinal muscular atrophy (SMA) is a rare lower motor neuron disease in which anesthetic management is often difficult, because the patients usually have muscle weakness and hypersensitivity to muscle relaxants. We describe the anesthesia for a 8 year-old girl with type II SMA who presented for a lower lid epiblepharon repair. We chose to use intravenous anesthesia based on propofol and remifentanil without any muscle relaxants. The peri-operative course was completely uneventful. We consider that intravenous anesthesia without muscle relaxants could be a good anesthetic choice for a patient with SMA undering general anesthesia.
Subject(s)
Child , Female , Humans , Anesthesia , Anesthesia, General , Anesthesia, Intravenous , Hypersensitivity , Motor Neuron Disease , Muscle Weakness , Muscular Atrophy, Spinal , PropofolABSTRACT
Difficulties in ventilation are sometimes encountered in intubated patients. In these cases, endotracheal tube kinking, or an obstruction by secretion or foreign bodies should be considered. We experienced an endotracheal tube obstruction by a foreign body. The patient was a 36 year old woman who had a traffic accident. She had already been intubated when entering operating room. However, ventilation was difficult, which was presumed to be caused by an endotracheal tube obstruction. The endotracheal tube was examined by fiberoptic bronchoscopy and the patient's broken tooth was found inside the endotracheal tube. The endotracheal tube was exchanged and ventilation was normalized.
Subject(s)
Adult , Female , Humans , Accidents, Traffic , Bronchoscopy , Foreign Bodies , Operating Rooms , Tooth , VentilationABSTRACT
During general anesthesia, intubation with kink-resistant armored tubes permit the anesthesiologist to work some distance from the surgical field during operation on the head and neck or with patients whose unusual position may kink and obstruct a tube not so reinforced. But armored tubes are still subject to number of hazards, including herniation of the intra-luminal cuff or layer into the lumen of the tube. So extra care is required in their use. We report a case of intraluminal herniation of armored tube accompanied with peak inspiratory pressure during general anesthesia.