[Duchenne muscular dystrophy and anesthesia. A retrospective study]. / Duchennes muskeldystrofi og anaestesi.

This retrospective study comprising 37 patients with Duchenne's muscular dystrophy undergoing 56 general anaesthesias shows that 1) no atypical reactions occurred when suxamethonium was omitted, that 2) wherever atypical reactions were observed they were always preceded by the use of halothane and suxamethonium. Haemodynamic instability and intubation difficulties were the major complications encountered. Preoperative optimization and cautious anaesthetic practice avoiding suxamethonium and preferably also avoiding potent inhaled anaesthetics is recommended.

[BiPAP (Biphasic Positive Airway Pressure)--an apparatus for non-invasive respiratory support]. / BiPAP--et apparat til ikkeinvasiv respiratorisk støtte.

Ventilatory support to patients suffering from respiratory insufficiency using a non-invasive technique has gained increasing popularity during the last few years. BiPAP (biphasic positive airway pressure) (Respiconics) offers inspiratory support and expiratory resistance to this group of patients both in the hospital and, in particular, in the home. The apparatus has proven to be effective as for instance a long term support device for patients suffering from neuromuscular diseases, sleep apnoeas and during the postoperative period. It works without pressurized air and is portable.

[Congenital central hypoventilation--treated with nocturnal biphasic intermittent respiration via nasal mask]. / Medfødt central hypoventilation--behandlet med natlig bifasisk trykstøtte af respirationen via nasalmaske.

A case of congenital central hypoventilation syndrome (CCHS) was undiagnosed until the girl in question was eight years old. Her development was normal, although with symptoms and signs of nocturnal hypoventilation. At the age of eight, with an interval of eight months, she suffered two attacks of acute respiratory insufficiency necessitating intubation and respiratory treatment. The episodes were considered to be pneumonia/septicaemia, but were in retrospect proven to be lung congestion as a consequence of hypercapnia and hypoxaemia. After the last episode CCHS was confirmed. The difficulties in diagnosing CCHS are discussed. After extubation she has been successfully treated with nocturnal nasal intermittent positive pressure ventilation (NIPPV) with BiPAP (Respironic), and she has in this way avoided tracheostomy.

[Pregnancy and delivery in a woman with neuromuscular disease. Spinal muscular atrophy and severely reduced pulmonary function]. / Graviditet og fødsel hos en kvinde med neuromuskulaer sygdom. Atrophia musculorum spinalis og svaert nedsat lungefunktion.

Pregnancy and delivery are described in a 22-year-old woman suffering from spinal muscular atrophy. In spite of severe respiratory insufficiency with a vital capacity of 0.6 litre, pregnancy and planned caesarean section in general anaesthesia went without complications. Some explanations for this are presented. Teams involving respiratory centres specialized in the treatment of patients with neuromuscular diseases, obstetricians and neurologists are recommended. These teams may carry out individual counselling, frequent controls, respiratory support and planning of delivery.

[Obstruction of a naso-tracheal tube by an avulsed nasal concha]. / Nasotrakeal tube tilstoppet af afrevet concha nasalis.

Avulsion of a nasal concha by a nasotracheal tube obstructed the tube in a valvelike manner. The result was increased intrapulmonary pressure, hemodynamic instability, alveolar rupture, pneumomediastinum and pneumoperitoneum without pneumothorax. The case was successfully managed by removal of the nasotracheal tube and immediate oral reintubation.