Subject(s)
Glucose Metabolism Disorders/metabolism , Glucose Metabolism Disorders/physiopathology , Glycation End Products, Advanced/metabolism , Lung/physiology , Skin/metabolism , Aged , Asymptomatic Diseases , Case-Control Studies , Diabetes Mellitus, Type 2/metabolism , Diabetes Mellitus, Type 2/physiopathology , Early Diagnosis , Female , Glucose Metabolism Disorders/complications , Glycation End Products, Advanced/analysis , Humans , Kidney Diseases/diagnosis , Kidney Diseases/metabolism , Male , Middle Aged , Optical Imaging , Prediabetic State/metabolism , Prediabetic State/physiopathology , Respiratory Function Tests , Skin/diagnostic imaging , Spain , Vascular Diseases/diagnosis , Vascular Diseases/metabolismABSTRACT
Prader-Willi syndrome (PWS) is a genetic disease caused by a loss of paternal genes located in chromosome 15. Children affected by this syndrome often have preterm delivery; during childhood the hallmarks are: severe infantile hypotonia and feeding problems. Afterward, neurologic manifestations, endocrine signs and dysmetabolic abnormalities are usually seen together with craniofacial manifestations and musculoskeletal abnormalities. Obesity causes sleep abnormalities including sleep apnea. The case we present is of a 5 year old child (CA) scheduled for strabismus surgery. The child has a lot of typical (PWS) signs. A number of anaesthesiologic problems are associated with (PWS). Some of them relate to obesity, others to facial dysmorphism. Moreover, the syndrome may give a prolonged and exaggerated response to every sedative drug. P.W.S. is also characterized by thermoregulatory disorders. Sleep apnea occurs often. Considering all these problems, we planned a monopharmacologic anaesthesiologic procedure using sevoflurane.
Subject(s)
Anesthesia, Inhalation , Anesthetics, Inhalation , Methyl Ethers , Prader-Willi Syndrome , Strabismus/surgery , Anesthetics, Inhalation/pharmacokinetics , Body Temperature Regulation , Child, Preschool , Face/abnormalities , Female , Humans , Hypoglycemia/etiology , Intraoperative Complications/prevention & control , Methyl Ethers/pharmacokinetics , Muscle Hypotonia/etiology , Obesity/etiology , Prader-Willi Syndrome/complications , Prader-Willi Syndrome/psychology , Respiration Disorders/etiology , Sevoflurane , Strabismus/complicationsABSTRACT
BACKGROUND: The aim of this study was to evaluate the discharge rate of children undergoing ophthalmic surgery of medium length (69-120') in a day-hospital regime under general anesthesia with orotracheal intubation and using Sevoflurane as the only anesthetic agent. EXPERIMENTAL PROTOCOL: prospective study. SETTING: the study was carried out in the operating theatre of the Ophthalmic Clinic at Florence University. PATIENTS: 58 pediatric patients aged 2-10 years, ASA I-II, 13-34 kg. OPERATIONS: correction of strabismus, cataract, glaucoma, palpebral ptosis and intubation of lacrimal tracts. Parameters measure: Any signs of reactivity in the airways to Sevoflurane on induction or reawakening (cough, bronchospasm, laryngospasm and psychomotor agitation), hemodynamic variables (heart rate and NIBP); reawakening time (from turning off the vaporiser to extubation), discharge time from recovery room (SatO2 > or = 97% in ambient atmosphere), discharge time from hospital (stable vital signs, response to simple and complex commands). RESULTS: The mean reawakening time was 7 min, discharge time from the recovery room was 20 min, discharge time from the hospital 80% after four hours, 100% after six hours. No respiratory and/or cardiovascular complications were reported nor psychomotor agitation. CONCLUSIONS: General anesthesia with Sevoflurane and Atracurium was found to be a realistic and reliable technique in pediatric ophthalmic surgery of medium length performed in day hospital.
Subject(s)
Ambulatory Surgical Procedures , Anesthetics, Inhalation , Methyl Ethers , Ophthalmologic Surgical Procedures , Child , Child, Preschool , Female , Humans , Intubation, Intratracheal , Male , Prospective Studies , SevofluraneABSTRACT
Latex allergy has become a real problem among both surgical staff (paramedics and physicians) and patients especially pediatric patients with urogenital malformations and spina bifida. Latex allergy is produced from both natural molecules which compose the substance produced from Hevea brasiliensis (rubber tree) and industrial additives contents in latex devices. Diagnosis of latex allergy may be carried out through a preoperative Prik-test. A characteristic of latex allergy reaction is the starting of symptoms (more than 15 minutes after allergen contact). Pathophysiology of latex allergy is the same of all allergic reactions; it is an antigen-antibody reaction and type I or II reaction may occur. There are a lot of devices that surgeons and anesthesists use in the operative theatre and that should not be used in presence of a patient with latex allergy. Guaranteed latex-free devices should always be present in store.
