RESUMO
Even though several studies have demonstrated the effectiveness of opioid free anesthesia (OFA) strategies in pediatric patients, OFA has not been studied in pediatric renal surgery. We, therefore, conducted a prospective observational pilot study on a total of 26 children to assess the feasibility and efficacy of using a single injection ultrasound-guided paravertebral block (PVB) at T10 level with 0.4 mL/kg bupivacaine 0.25% in combination with sevoflurane as an OFA technique in elective open renal surgery. A successful PVB (defined in terms of both hemodynamic change after the skin incision and the use of rescue analgesia) was observed in 25 children (96%). The interval between PVB and skin incision was 21 min [IQR (18-25)]. End tidal sevoflurane concentration was 2.1% [IQR (1.8-2.4)]. The median time between extubation and waking was 2.5 min [IQR (1-4)]. The median Face, Legs, Activity, cry, Consolability score in post-anesthesia care unit was 1.00 [IQR (0-2)]. Blood pressure falls were not significant at different measurement times. None of the patients had complications related to PVB, and only one patient had post-operative vomiting. PVB is an attractive method that can procure an effective OFA in combination with sevoflurane in pediatric renal surgery.
Assuntos
Analgésicos Opioides , Dor Pós-Operatória , Criança , Humanos , Dor Pós-Operatória/tratamento farmacológico , Projetos Piloto , Estudos Prospectivos , SevofluranoRESUMO
Asthma is a major cause of morbidity and mortality despite advances in outpatient treatment. Sometimes, children fail to respond to standard treatment and can potentially require mechanical ventilation. We describe a case of a 26-month-old girl with a severe asthma exacerbation successfully managed by ketamine administration via nebulization route that permitted to avoid mechanical ventilation. Nebulized ketamine might be a reasonable option to avoid mechanical ventilation in children who fail to respond to standard treatment of severe asthma exacerbation.
Assuntos
Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Ketamina/administração & dosagem , Nebulizadores e Vaporizadores , Pré-Escolar , Progressão da Doença , Serviço Hospitalar de Emergência , Feminino , Humanos , Respiração Artificial , Resultado do TratamentoRESUMO
BACKGROUND: Congenital cystic adenomatoid malformation is a rare pulmonary malformation, but is the most common lung malformation observed in children. In developing countries, such as Morocco, prenatal diagnosis is missing. Congenital cystic adenomatoid malformation may occur after birth in the presence of complications and needs a computed tomography scan for confirmation. However, our lack of awareness of this malformation has been responsible for a late and wrong diagnosis along with therapeutic errors. We report the first case in Morocco where diagnosis is confirmed by histology after death. CASE PRESENTATION: A 10-month-old Arab boy was prescribed various antibiotics (including anti-staphylococcal) and endured repeated chest drainages, leading to his death just after radiological diagnosis and instant surgery. CONCLUSIONS: The goal of this case report is to firmly express the need for both pediatricians and radiologists to enlarge diagnosis investigations, especially of congenital or constitutional entities in children, as soon as recurrence of respiratory distress and pulmonary infections are manifested. We also emphasize this important entity because of its frequency, to avoid the eventual therapeutic errors.
Assuntos
Antibacterianos/administração & dosagem , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Hipóxia/mortalidade , Pulmão/patologia , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Infecções Respiratórias/patologia , Tomografia Computadorizada por Raios X , Malformação Adenomatoide Cística Congênita do Pulmão/fisiopatologia , Malformação Adenomatoide Cística Congênita do Pulmão/terapia , Erros de Diagnóstico , Evolução Fatal , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/tratamento farmacológicoRESUMO
Factor VII is a new coagulation factor replacement therapy. It has permitted the practice of invasive procedures which were up until recently associated with a huge risk of bleeding in patients with hemophilia with inhibitors. Our case illustrates factor replacement therapy failure in a 13-year-old child operated on for hepatic cysts associated with a pelvic cyst. Major bleeding occurred postoperatively requiring several transfusions, an increase in dosage of factor VII, and administration of a heavy dose of factor VIII as a last resort. This case highlights the possibility of failure of factor replacement therapies constituting a life-threatening situation in which alternatives are few.
Assuntos
Equinococose/sangue , Fator VIII/uso terapêutico , Fator VIIa/uso terapêutico , Hemofilia A/sangue , Hemorragia/terapia , Adolescente , Transfusão de Sangue , Equinococose/complicações , Equinococose/parasitologia , Equinococose/cirurgia , Hemofilia A/complicações , Hemofilia A/parasitologia , Hemofilia A/cirurgia , Hemorragia/sangue , Hemorragia/etiologia , Humanos , Masculino , Complicações Pós-Operatórias , Proteínas Recombinantes/uso terapêuticoAssuntos
Acidentes Domésticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Acidentes Domésticos/mortalidade , Adolescente , Criança , Mortalidade da Criança , Pré-Escolar , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Marrocos/epidemiologia , Índices de Gravidade do TraumaRESUMO
Posttraumatic aneurysms of the axillary artery are extremely scarce. In pediatrics, no similar case has been described. Injuries of axillary artery are often associated with ischemic complications, whereas the bleeding risks are not well documented. We report the case of a 5-year-old boy who was admitted with a scapular pulsatile lump 2 weeks after a domestic accident. During his stay, he suddenly presented a hemorrhagic shock. The patient was immediately admitted to the operating room to undergo surgical hemostasis and was then transferred to intensive care unit to stabilize his vital functions. This case shows the possibility of spontaneous and life-threatening acute bleeding of posttraumatic aneurysms of the axillary artery.
Assuntos
Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Axila/irrigação sanguínea , Axila/lesões , Choque Hemorrágico/etiologia , Acidentes por Quedas , Anastomose Cirúrgica , Aneurisma Roto/diagnóstico , Transfusão de Sangue , Pré-Escolar , Diagnóstico por Imagem , Hemodinâmica , Humanos , Masculino , Ruptura EspontâneaRESUMO
Leech infestation occurs after swimming or ingestion of freshwater, especially in rural areas. Symptoms are different depending on the binding site of the leech. At the nasopharynx, it is mainly responsible for epistaxis. We report a case of an unknown pharyngeal location of a leech in a three year-old girl responsible for melena and leading to a severe anaemia.
Assuntos
Sanguessugas , Melena/parasitologia , Nasofaringe/parasitologia , Doenças Parasitárias/complicações , Anemia/parasitologia , Animais , Pré-Escolar , Epistaxe/parasitologia , Feminino , HumanosRESUMO
Actinomycosis is a rare bacterial infection. It has a pseudotumoral appearance when localized to the lungs or mediastinum. The diagnosis is often delayed because clinical presentation is nonspecific, bacteriologic diagnosis is difficult, and culture growth is slow. The diagnosis is mainly based upon histologic identification of actinomycotic sulfur granules. Actinomycosis is usually sensitive to penicillin G. Surgical treatment is reserved for failure of medical treatment and complications. We report a case of thoracic actinomycosis in a 13-year-old boy.