ABSTRACT
Suxamethonium is the only depolarising neuromuscular blocking agent, which is still being widely used during general anaesthesia. Some of its unique properties rank suxamethonium as an ideal neuromuscular blocking agent i.e. the fast onset of muscle paralysis and spontaneous neuromuscular block reversal. However, the agent may trigger malignant hyperthermia, hyperkaliaemia, severe bradycardia and other complications, which have to be considered. Due to differences in postsynaptic nicotine receptor structure and functional insufficiency of the neuromuscular junction, paediatric patients when compared to adults, are more sensitive to potential side effects when suxamethonium is administered. Malignant hyperthermia is an important risk factor. Ryanidine receptors located in the sarcoplasmic/endoplasmic reticulum membrane are responsible for the release of Ca2+ from intracellular stores and trigger this complication.The risk of hyprethermia increases in children when some neurologic and muscle diseases coexist. Nowadays, in rapid sequence induction of anaesthesia, suxamethonium may be replaced with rocuronium - a non-depolarising muscle relaxant which provides the intubating conditions similar to suxamethonium. The rocuronium-induced neuromuscular blockade, which lasts longer than blockade following suxamethonium, is reversed with sugammadex - a new selective relaxant binding agent. Despite new agents and methods, suxamethonium still remains the drug of choice for muscle relaxation for intubation in children.
Subject(s)
Anesthesia, General/adverse effects , Anesthetics, General/adverse effects , Neuromuscular Nondepolarizing Agents/adverse effects , Succinylcholine/adverse effects , Anesthetics, General/administration & dosage , Child , Child Welfare , Dose-Response Relationship, Drug , Hemodynamics , Humans , Muscle Relaxation/drug effects , Neuromuscular Nondepolarizing Agents/administration & dosage , Succinylcholine/administration & dosageABSTRACT
Regional cerebral oximetry (RCO), introduced to clinical practice 15 years ago, is a non-invasive method of measuring regional cerebral venous oxygen saturation using optical spectroscopy. Monitoring during anaesthesia is mainly directed at providing optimal oxygenation and avoiding desaturation incidents. RCO offers new and broader possibilities for measurement of cerebral and regional tissue oxygenation.This method has proven useful both in anaesthesia and in intensive care; The article shows the indications for which this method of monitoring may be useful during anaesthesia and in intensive care units, allowing the avoidance of more invasive methods, e.g., mixed venous saturation and venous bulbar saturation. It is also extremely useful in small children in whom cannulation of large vessels may be difficult or impossible. In the review, possible applications of the method are presented and discussed.
Subject(s)
Monitoring, Physiologic/methods , Oximetry/methods , Anesthesia/methods , Cerebrovascular Circulation , Child , Critical Care/methods , Humans , Monitoring, Intraoperative/methodsABSTRACT
BACKGROUND: Conjoined twins represent a rare case of embryonic failure. Siamese twins' final outcome is usually associated with poor prognosis due to complications, among which the inflammatory and septic disturbances are often present. CASE REPORT: The article describes Siamese twins of craniopagus type. One of the twins died of heart and aortic failure after 48 hours of life. The decision regarding surgical separation then became an emergency. At the same time laboratory results for the surviving twin I indicated steadily worsening coagulation functions and processes, which we believed were caused by the death of twin II, as well as by systemic inflammatory response syndrome (SIRS). CONCLUSIONS: Due to vascular conjunction between the twins' brains' circulatory systems the sequenced progress of coagulopathy was noticed in the surviving twin.
