Gender effect on the preoperative cardiovascular responses in pediatric patients undergoing two-stage ear reconstruction surgery for microtia

BACKGROUND: The hemodynamic reactions to psychological stress were different between adult genders. Our aim was to investigate the hypothesis that preoperative cardiovascular responses in children undergoing ear reconstruction surgeries will be different according to gender. METHODS: We obtained data from children, aged 7-16 years, undergoing reconstruction surgeries for microtia during 2005-2009. Number of boys receiving primarily rib cartilage graft (RCG) surgery and secondarily ear elevation procedure was 121 and 83, respectively, and girls 48 and 28, respectively. Preoperative systolic (S), diastolic blood pressure (DBP) and heart rate (HR) on each surgery were compared between genders, and within genders. RESULTS: Boys were younger than girls by one year at first and second admission. Boys showed significantly lower preoperative DBP than girls (mean difference [MD]: -3.7 mmHg, 95%CI: -6.1 to -1.3, P = 0.032) before RCG, whereas significantly higher SBP (MD: 21.5 mmHg, 95%CI: 16.6 to 26.4, P < 0.001), and DBP (MD: 10.2 mmHg, 95%CI: 6.0 to 14.4, P < 0.001) before ear elevation. Comparison between the two surgeries within the same gender indicated that boys demonstrated significantly higher SBP (P < 0.001) and DBP (P < 0.001) before ear elevation than before RCG; however SBP was comparable and DBP was significantly lower (P = 0.035) before ear elevation than before RCG in girls. CONCLUSIONS: Gender impact on the preoperative cardiovascular reactions was evident in children undergoing microtia surgery.

Experience of endotracheal intubation using video styletscope in a patient with mucopolysaccharidoses: A case report

Mucopolysaccharidoses (MPSs) are a group of inherited heterogenous metabolic disorders, caused by deficiency of an enzyme involved in the degradation of mucopolysaccharides, and thus deposition of mucopolysaccharides in all connective tissue. MPS type III is heparan sulphate storage disorder, especially marked central nervous system involvement. As with all the MPS disorders, this patient with MPS III presents coarse outlook features, such as macrocephaly, macroglossia, prominent mandible, short neck, and unstable atlantoaxial joints, as well as tracheal abnormality. These clinical findings give significant challenges to the anesthesiologist for adequate airway management and tracheal intubation. Recently, a number of new devices have been developed to facilitate intubation. We report an experience of facilitated tracheal intubation using video styletscope (OptiScope PM201(R), Pacific Medical, Seoul, Korea) in a 16 year old male patient with MPS III, who was undergoing inguinal hernia repair.