ABSTRACT
La polineuropatía amiloidótica familiar (PAF) por transtiretina es una enfermedad dominante autosómica rara que provoca depósitos sistémicos de amiloides. Afecta al sistema nervioso y se caracteriza por neuropatía progresiva de tipo sensorial, motora y autonómica. Los pacientes con PAF requieren a menudo cirugía y cuidados anestésicos para transplante hepático e implantación de cardioversores-desfibriladores/marcapasos. La neuropatía periférica es un hallazgo común, aunque no existen casos reportados sobre su interferencia en la monitorización de la transmisión neuromuscular de la anestesia. Reportamos el caso de un paciente con PAF en el que la falta de concienciación y los factores de distracción condujeron a la malinterpretación de la monitorización neuromuscular y originaron sedación y ventilación innecesarias en la unidad de cuidados post-anestésicos. PAF puede interferir con la monitorización neuromuscular habitual del nervio cubital. Los anestesiólogos deben estar al tanto del compromiso neuromuscular potencial para encontrar la mejor localización de la monitorización en cada paciente. En este caso sugammadex fue seguro y fiable para el antagonismo del bloqueo neuromuscular del rocuronio, a pesar de la falta de monitorización cuantitativa adecuada.(AU)
Transthyretin familial amyloid polyneuropathy (FAP) is a rare autosomal dominant disease that provokes systemic deposition of amyloid. It affects the nervous system and it is characterized by progressive sensory, motor, and autonomic neuropathy. Patients with FAP often require surgery and anesthetic care for hepatic transplantation and cardioverter-defibrillator/pacemaker implantation. Peripheric neuropathy is a common finding, but there are no reported cases of its interference with anesthetic neuromuscular transmission monitoring. We report a case of a FAP patient where lack of awareness and distracting factors led to misinterpretation of neuromuscular monitoring and unnecessary sedation and ventilation in the post anesthetic care unit. FAP may interfere with the usual cubital nerve neuromuscular monitoring. Anesthesiologists should be aware of potential neuromuscular compromise to find the best monitoring location for each patient. Sugammadex was safe and reliable in the antagonism of rocuronium neuromuscular blockade in this case, despite the lack of adequate quantitative monitoring.(AU)
Subject(s)
Humans , Male , Aged , Risk Management , Health Status Indicators , Amyloid Neuropathies, Familial , Peripheral Nervous System Diseases , Neuromuscular Monitoring , Postoperative Complications , Patient Safety , Inpatients , Physical Examination , Symptom Assessment , Cardiopulmonary Resuscitation , Anesthesiology , SpainABSTRACT
Transthyretin familial amyloid polyneuropathy (FAP) is a rare autosomal dominant disease that provokes systemic deposition of amyloid. It affects the nervous system and it is characterized by progressive sensory, motor, and autonomic neuropathy. Patients with FAP often require surgery and anesthetic care for hepatic transplantation and cardioverter-defibrillator/pacemaker implantation. Peripheric neuropathy is a common finding, but there are no reported cases of its interference with anesthetic neuromuscular transmission monitoring. We report a case of a FAP patient where lack of awareness and distracting factors led to misinterpretation of neuromuscular monitoring and unnecessary sedation and ventilation in the post anesthetic care unit. FAP may interfere with the usual cubital nerve neuromuscular monitoring. Anesthesiologists should be aware of potential neuromuscular compromise to find the best monitoring location for each patient. Sugammadex was safe and reliable in the antagonism of rocuronium neuromuscular blockade in this case, despite the lack of adequate quantitative monitoring.
Subject(s)
Amyloid Neuropathies, Familial , Liver Transplantation , Humans , Neuromuscular Monitoring , ForearmABSTRACT
Transthyretin familial amyloid polyneuropathy (FAP) is a rare autosomal dominant disease that provokes systemic deposition of amyloid. It affects the nervous system and it is characterized by progressive sensory, motor, and autonomic neuropathy. Patients with FAP often require surgery and anesthetic care for hepatic transplantation and cardioverter-defibrillator/pacemaker implantation. Peripheric neuropathy is a common finding, but there are no reported cases of its interference with anesthetic neuromuscular transmission monitoring. We report a case of a FAP patient where lack of awareness and distracting factors led to misinterpretation of neuromuscular monitoring and unnecessary sedation and ventilation in the post anesthetic care unit. FAP may interfere with the usual cubital nerve neuromuscular monitoring. Anesthesiologists should be aware of potential neuromuscular compromise to find the best monitoring location for each patient. Sugammadex was safe and reliable in the antagonism of rocuronium neuromuscular blockade in this case, despite the lack of adequate quantitative monitoring.
ABSTRACT
AIM: This in vitro study analyzed the antierosive potential of a high-fluoride dentifrice on enamel adjacent to restorations. METHODS AND MATERIALS: Enamel blocks (6 × 6 × 3 mm) from bovine incisor teeth were restored with three different restorative materials (resin, conventional glass ionomer cement, and resin-modified glass ionomer cement) and treated with dentifrices containing 0, 1100, or 5000 ppm F. After restorative procedures, initial surface Vickers hardness of the blocks were obtained. The specimens were submitted to pH cycles (4 × 90 seconds in soft drink) and treatments for five days. Between the challenges and overnight, the blocks remained in artificial saliva. At the end of the experiment, the final hardness was assessed and the percentage of surface mineral loss (%SML) was calculated. A 3 × 3 factorial design was used to conduct statistical analysis. Data were analyzed by analysis of variance and t-test, with significance level fixed at 5%. RESULTS: High-fluoride dentifrice decreased demineralization caused by erosive challenge regardless of the restorative material used (p<0.001). Likewise, the blocks restored with conventional glass ionomer cement showed lower values of SML irrespective of dentifrice used (p<0.001). CONCLUSION: Use of a high-fluoride dentifrice on teeth restored with conventional glass ionomer cement offers additional protection against enamel erosion.
