ABSTRACT
BACKGROUND: Atelectasis because of anesthesia is a recognized problem but may be affected by the anesthetic technique. We compared magnetic resonance images of atelectasis in children undergoing two types of anesthesia. METHODS: Children requiring anesthesia for magnetic resonance imaging (MRI) had additional lung imaging sequences at the beginning and the end of anesthesia. Children had either i.v. propofol infusion (PI) without an artificial airway (n = 26) or positive pressure ventilation (PPV) via a tracheal tube (n = 20); the technique was chosen for clinical reasons. The extent of atelectasis was scored by two independent radiologists. RESULTS: The median ages (range) for PI and PPV groups were 45 months (1-77 months) and 18 months (2-74 months), respectively. The proportion of children with atelectasis was different in the first lung scan (42% vs 80%), but in the second scan atelectasis was seen frequently in both groups (82% vs 94%) with a greater extent in the PPV group. The atelectasis score was higher in young children, but all children had normal oxygen requirements and saturations. CONCLUSIONS: Many factors may influence the development of atelectasis but this study found less extensive atelectasis with PI than PPV. PI allows for sufficient motionlessness, required for high diagnostic image quality in pediatric MRI.
Subject(s)
Anesthesia, General/adverse effects , Anesthetics, Intravenous/adverse effects , Magnetic Resonance Imaging/methods , Positive-Pressure Respiration/adverse effects , Propofol/adverse effects , Pulmonary Atelectasis/chemically induced , Alfentanil/administration & dosage , Alfentanil/adverse effects , Anesthesia, General/methods , Anesthetics, Intravenous/administration & dosage , Child , Child, Preschool , Female , Humans , Infant , Infusions, Intravenous/methods , Intubation, Intratracheal/methods , Isoquinolines/administration & dosage , Isoquinolines/adverse effects , Lung/pathology , Male , Mivacurium , Neuromuscular Nondepolarizing Agents/administration & dosage , Neuromuscular Nondepolarizing Agents/adverse effects , Observer Variation , Positive-Pressure Respiration/methods , Propofol/administration & dosage , Prospective StudiesABSTRACT
OBJECTIVE: To present the rare case of a displaced odontoid fracture after manipulative treatment. CLINICAL FEATURES: A 37-year-old, 15-week pregnant patient was referred with acute neck pain and a diffuse paravertebral swelling that started after cervical manipulation performed by her general medical practitioner 5 days before. Because of pregnancy, a cervical spine radiographic series was not obtained before treatment. Magnetic resonance imaging revealed a displaced odontoid fracture associated with a pathological process in the vertebral body of C2 and a paravertebral hematoma on the left side from C2 to C4. INTERVENTION AND OUTCOME: After initial halo vest immobilization, an anterior-posterior fusion of C1-C2 was performed. The histological analysis showed features of an aneurysmal bone cyst. The patient was discharged and had an undisturbed pregnancy and was without any neurological complications. CONCLUSIONS: Because of the weakening lesion in C2, the spinal manipulation most likely caused the displaced odontoid fracture. Special imaging should be performed, preferably with magnetic resonance imaging, when a patient experiences significant new symptoms after cervical manipulation.
