RESUMO
Providing sedation for patients with compromised upper airway is challenging. A 19-year-old female patient with huge maxillofacial tumor invading the whole pharynx scheduled for elective tracheostomy under local anesthesia due to compromised airway. The patient had gastrostomy tube for feeding. Venous cannulation was totally refused by the patient after repeated trials for exhausted sclerosed veins. Pre-operative mixture of dexmedetomidine with ketamine was administered through the gastrostomy tube with eutectic mixture of local anesthetics cream application over the planned tracheostomy site. The patient was sedated with eye opening to command. Local infiltration followed by tracheostomy was performed without patient complaints or recall of operative events
Assuntos
Humanos , Feminino , Manuseio das Vias Aéreas , Sedação Profunda , Cirurgia Bucal , Traqueostomia , Gastrostomia , Neoplasias Maxilares/cirurgia , Neoplasias Faciais/cirurgia , Ketamina , DexmedetomidinaRESUMO
A 7-year-old boy, weighing 18 kg, was diagnosed with maple syrup urine disease [MSUD]. He suffered from spasticity of the lower limbs and pain that did not respond to oral medications. Injections of botulinum toxin A [BTX-A] at 10 sites and epidural analgesia with 0.125% bupivacaine were used to treat spasticity with good results. We conclude that BTX-A combined with epidural analgesia may be a useful treatment option for incapacitating, painful spasticity related to MSUD. This treatment modality allowed a comprehensive rehabilitation program to be completed and it lasted longer than 9 months
Assuntos
Humanos , Masculino , Toxinas Botulínicas , Bupivacaína , Analgesia Epidural , Espasticidade Muscular/prevenção & controle , Dor/prevenção & controleRESUMO
This is a rare case of broncho-pleuropericardial fistula in a 12-year-old female who presented with fever, painful joint swelling, and pleural and pericardial effusion secondary to disseminated methicillin-sensitive Staphylococcus aureus infection. The pleural and pericardial effusion were drained, however, air leak was observed from both tubes and was synchronous with mechanical inspiration. A broncho-pleuropericardial fistula was suspected and confirmed with computed tomography. This case report demonstrated that disseminated S. aureus bacteremia could result in broncho-pleuropericardial fistula. The ability of disseminated staphylococcal infection to produce pnemopericardium should be added to the list of other complications associated with disseminated staphylococcal sepsis