ABSTRACT
A 12-year-old boy with mental retardation and cerebral palsy developed hyperthermia during dental treatment performed while he was conscious. During the treatment, he was highly excited, and shortly after completion of the procedure, general muscular spasms occurred. His axillary temperature was 41.6 degrees C then. He was transferred to another general hospital and there he was judged to have become afebrile and was discharged. His condition deteriorated during the night, and he was readmitted to the same hospital the following morning. The patient did not respond to the therapy and died from multiple organ failure on the 13th day. It was thought that hyperthermia had led to rhabdomyolysis and DIC. The cause of death is discussed. Hyperthermia in a handicapped patient is not always transient or benign, and can be life threatening.
Subject(s)
Anesthesia, Dental/adverse effects , Anesthesia, Local/adverse effects , Dental Care for Disabled/adverse effects , Malignant Hyperthermia/etiology , Cerebral Palsy , Child , Disseminated Intravascular Coagulation/etiology , Fatal Outcome , Humans , Intellectual Disability , Male , Malignant Hyperthermia/complications , Multiple Organ Failure/etiology , Rhabdomyolysis/etiologyABSTRACT
BACKGROUND: The purpose of this study was to determine whether oral midazolam 1.5 mg x kg(-1) is a safe and effective alternative to standard-dose midazolam (0.5-1.0 mg x kg(-1)) premedication for infants and children with congenital heart disease. METHODS: A total of 193 infants and children (4 months to 2 years) undergoing cardiovascular surgery were studied. Each patient received 0.5, 1.0, or 1.5 mg x kg(-1) of oral midazolam. The level of sedation was assessed with a 5-point scale and vital signs were measured including blood pressure (BP), heart rate (HR) and oxyhaemoglobin saturation (SpO2) before and after the medication. RESULTS: Infants and children premedicated with oral midazolam 1.5 mg x kg(-1) were better sedated than those with standard-dose midazolam: 4% of infants and children given 1.5 mg x kg(-1) of midazolam became agitated compared with 14% given 1.0 mg x kg(-1) and 26% in those given 0.5 mg x kg(-1). Ninety percentage of infants and children given 1.5 mg x kg(-1) of midazolam achieved satisfactory sedation (calm, drowsy, or asleep) in 30 min, whereas 68% in those given 1.0 mg x kg(-1) and 35% in those given 0.5 mg x kg(-1). Midazolam 1.5 mg x kg(-1) did not cause any statistically significant decrease in BP, HR, or SpO2, although eight infants and children showed > or =20% drop in systolic BP and six infants and children showed >5% drop in SpO2. No 'spelling attacks', seizure-like activity, apnoea, nor laryngospasm were observed in any infants and children during and after the medication. CONCLUSIONS: Oral midazolam 1.5 mg x kg(-1) is excellent for preanaesthetic medication for infants and children undergoing cardiovascular surgery.
