Assuntos
Anormalidades Múltiplas , Anestesia Geral/métodos , Face/anormalidades , Artropatias/congênito , Luxações Articulares/congênito , Éteres Metílicos/uso terapêutico , Anestésicos Inalatórios/uso terapêutico , Pré-Escolar , Feminino , Valvas Cardíacas/anormalidades , Hérnia Inguinal/cirurgia , Humanos , Laringoscopia , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Óxido Nitroso/uso terapêutico , Osteotomia , Oxigênio/uso terapêutico , Sevoflurano , Síndrome , Brometo de Vecurônio/uso terapêuticoRESUMO
Spinal muscular atrophy (SMA) type I is a relatively common inherited neuromuscular disease of hypotonic newborns, but is not associated with craniofacial abnormalities. There is nothing in the literature about difficult intubation in patients affected by this disease. We report a case of 34-month-old girl with SMA type I who was scheduled for emergency endoscopic laser treatment of tracheal stenosis caused by granulations. Tracheostomy was performed at 17 months of age and before this, the orotracheal tube was changed periodically without difficulty. For this laser treatment, orotracheal intubation was required. Preoperative physical examination revealed micrognathia and class II malocclusion. Opening her mouth was not difficult. Although difficult orotracheal intubation was predictable, we attempted to intubate her trachea as usual, but could not visualize the epiglottis. We decided to proceed with retrograde intubation, one of the standard techniques employed in a child with a difficult airway, via the tracheostome. A feeding nasogastric catheter was used as a guide catheter, and our strategy was successful. In this study we report a case of difficult airway in a child with SMA type I. The relationship between SMA type I with a tracheostome and difficult airway are discussed.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Intubação Intratraqueal/instrumentação , Atrofias Musculares Espinais da Infância/complicações , Pré-Escolar , Feminino , HumanosRESUMO
IMPLICATIONS: Airway compression from insertion of a transesophageal echocardiography (TEE) probe has been mostly limited to pediatric patients. We present a case of TEE-associated airway obstruction in an adult patient undergoing surgery for repair of a giant ascending aortic pseudoaneurysm.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Falso Aneurisma/complicações , Ecocardiografia Transesofagiana/efeitos adversos , Obstrução das Vias Respiratórias/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
IMPLICATIONS: Nicardipine-induced bradycardia has been reported in experimental animals but not in clinical patients. We report a clinical case of unexpected bradycardia caused by nicardipine. The mechanism of this bradycardia was not clear, and depression of sympathetic tone by epidural anesthesia, hypothermia, and paroxysmal atrial fibrillation might have been contributory.
