ABSTRACT
A 16-month-old baby with myotonic dystrophy underwent an open Nissen fundoplication and gastrostomy insertion under general anesthesia with an epidural. Postoperative care was managed on the pediatric intensive care unit for the first 6 h. She was then discharged to the ward, where she continued to make an uncomplicated recovery. Other anesthetic management that has been used in children with myotonic dystrophy is discussed.
Subject(s)
Anesthesia, General/methods , Fundoplication/methods , Gastrostomy/methods , Myotonic Dystrophy/surgery , Analgesia, Epidural/methods , Analgesics, Opioid/therapeutic use , Anesthetics, Inhalation/therapeutic use , Anesthetics, Local/therapeutic use , Atracurium/therapeutic use , Bupivacaine/therapeutic use , Female , Humans , Infant , Intubation, Intratracheal , Methyl Ethers/therapeutic use , Monitoring, Physiologic/methods , Morphine/therapeutic use , Neuromuscular Nondepolarizing Agents/therapeutic use , Nitrous Oxide/therapeutic use , Oxygen/therapeutic use , SevofluraneABSTRACT
BACKGROUND: Use of the sitting position for neurosurgery is controversial. The main concern is the risk of venous air embolus (VAE) and its sequelae. METHODS: The paediatric neurosurgeons at our institution routinely use the sitting position for posterior fossa and pineal surgery, and a retrospective audit of the incidence of VAE from 1982 to 1998 has been performed. RESULTS: Venous air embolism, defined as a fall in end-tidal carbon dioxide pressure >0.4 kPa, was detected in 38 of 407 operations (9.3%). A fall in systolic arterial pressure >10% accompanied the VAE in nine out of 43 episodes (20.9%); this represents 2% of all operations. All VAE episodes responded promptly to treatment and there was no perioperative morbidity or mortality directly attributed to it. CONCLUSIONS: This is the largest study of the incidence of VAE in children undergoing neurosurgery. Our results suggest that the sitting position can be used safely for neurosurgery in children.
Subject(s)
Brain Diseases/surgery , Embolism, Air/etiology , Intraoperative Complications , Neurosurgical Procedures/methods , Posture , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Medical Audit , Retrospective Studies , Risk FactorsABSTRACT
Epidural anaesthesia in Familial Dysautonomia (FD) or the Riley Day syndrome has not previously been reported. Three children with FD presenting for redo Nissen fundoplication were managed with epidural anaesthesia. Cases 1 and 2 had had their original Nissen fundoplication without epidural anaesthesia. In Case 3, FD had not yet been diagnosed when she had her first operation, and it was performed with epidural anaesthesia. The anaesthetic management of these cases with and without epidural anaesthesia is described and discussed.
Subject(s)
Anesthesia, Epidural/methods , Dysautonomia, Familial , Child, Preschool , Female , Fundoplication , Humans , Male , ReoperationABSTRACT
Down's syndrome is a common congenital abnormality associated with characteristic morphological features, impaired intellectual development and disorders of many organ systems with a broad spectrum of severity. Many of these, including defects in cosmetic appearance, are amenable to surgical correction. The risks of anaesthesia are increased in these children. In this article the anaesthetic implications of the syndrome are reviewed and the principles of perioperative management discussed.
