Anesthetic Management of a Child with Family History of Malignant Hyperthermia: Case Report
Tiago Freire da Fonte,
Lucas Gianni Menegaz,
Marcos Lopes de Miranda,
Rodrigo Montebello de Araújo,
Carlos Darcy Alves Bersot
Issue:
Volume 1, Issue 3, November 2013
Pages:
21-23
Received:
27 August 2013
Published:
10 November 2013
DOI:
10.11648/j.ja.20130103.11
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Abstract: Malignant hyperthermia (MH) is a rare and autosomal dominant myopathy triggered by volatile anesthetics and depolarizing neuromuscular blocking agents such as succinylcholine and is characterized by an acute hypermetabolic clinical state. This report presents the importance of preoperative preparation and perioperative management of patients with a family history of MH, in which there is no possibility of a diagnostic confirmation. Attention must be directed to the preparation of the anesthetic machine because modern workstations need longer cleansing times than their predecessors.Case Report: A two-year-old male child, weighing 16 kg, with a family history of MH, confirmed by muscular biopsy, underwent an elective umbilical and unilateral inguinal hernioplasty, and postectomy under intravenous general anesthesia associated with a caudal block. The preanesthetic care involves the preparation of the surgical environment and assessment of possible perioperative events. The patient's exhaled CO2 fraction and body temperature were continuously monitored throughout the surgery and immediate postoperative period. The patient recovered without further events and was discharged from the hospital after two days.In a patient with family history of MH the administration of intravenous general anesthesia with the adequate preparation of the surgical environment allowed safe anesthetic management for the proposed surgical procedure.
Abstract: Malignant hyperthermia (MH) is a rare and autosomal dominant myopathy triggered by volatile anesthetics and depolarizing neuromuscular blocking agents such as succinylcholine and is characterized by an acute hypermetabolic clinical state. This report presents the importance of preoperative preparation and perioperative management of patients with a...
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Congenital Deficiency in Factor VII of the Coagulation and the Anesthesia
Hicham Bakkali,
Salahedine Massou,
Fayçal Labrini,
Khalil Mounir,
Mustapha Bensghir,
Hicham Azendour,
Hicham Balkhi,
Charqui Haimeur
Issue:
Volume 1, Issue 3, November 2013
Pages:
24-26
Received:
27 October 2013
Published:
20 November 2013
DOI:
10.11648/j.ja.20130103.12
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Abstract: The constitutional deficiency in factor VII (FVII) of the coagulation is a rare autosomal recessive disease, responsible for a hemorrhagic syndrome of variable intensity poorly correlated with plasma levels of FVII. This deficit is suspected in front of an isolated reduction in the rate of prothrombine and confirmed by the dosage of this factor. We report a case of congenital FVII deficiency in a patient aged 22 years, who underwent surgical treatment of nephrolithiasis. FVII deficiency was 22%, no replacement therapy was introduced to the patient, and no bleeding complications were observed in intraoperative or postoperative. In conclusion, the perioperative transfusion with fresh frozen plasma (FFP) or the contribution of FVII in a patient with a moderate deficit in FVII is not systematic, and it cannot be considered if there is a risk of bleeding or in case of deficiency of FVII.
Abstract: The constitutional deficiency in factor VII (FVII) of the coagulation is a rare autosomal recessive disease, responsible for a hemorrhagic syndrome of variable intensity poorly correlated with plasma levels of FVII. This deficit is suspected in front of an isolated reduction in the rate of prothrombine and confirmed by the dosage of this factor. We...
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Can Sodium Channel Blocker Lidocaine Attenuate Haemodynamic Responses to Endotracheal Intubation in Patients with Coronary Artery Disease Effectively
S. Singh,
Kulsum,
H. Shroff,
A. Singh,
A. Annamalai,
D. E. Mahrous
Issue:
Volume 1, Issue 3, November 2013
Pages:
27-35
Received:
16 September 2013
Published:
20 December 2013
DOI:
10.11648/j.ja.20130103.13
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Abstract: Background: Tachycardia and hypertension are well documented sequels of laryngoscopy and endotracheal intubation; they are transient, highly variable and are generally well tolerated in healthy patients. In hypertensive patients with coronary artery disease (CAD) these cardiovascular responses to laryngoscopy and intubation is exaggerated. The aim of this study was to evaluate the efficacy of lidocaine in attenuating cardiovascular response to laryngoscopy and endotracheal intubation in patients posted for elective off pump coronary artery bypass grafting (OPCABG) as these patients are on a low dose of ß-blockers. Materials and Methods: After obtaining institutional ethical approval, 60 patients aged 40 to 70 years from either sex of the American Society of Anaesthesiologists (ASA) physical status III with coronary artery disease (CAD) undergoing elective coronary artery bypass grafting (CABG) surgery under general anaesthesia were selected for the study. Participants were randomly allocated into two groups comprising 30 subjects each. Group I received lidocaine 1.5 mg/kg and group II (control) received a placebo (normal saline) 3 minutes prior to laryngoscopy. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and rate pressure product (RPP) were measured before induction as baseline, after intubation, at minute 1, 3, 5 and 7 minutes respectively after tracheal intubation while they were also observed for any complications. Results: There was a significant increase in HR, SBP, DBP, MAP and RPP in the control (placebo) group as compared to the lidocaine group (P < 0.05) at 1 minute with onward decreases at 3, 5, and 7 minutes respectively after intubation. Conclusions: Prophylactic therapy with lidocaine was found to be safe and effective in attenuating cardiovascular responses to laryngoscopy and tracheal intubation in patients posted for elective OPCABG on a low dose of ß-blockers.
Abstract: Background: Tachycardia and hypertension are well documented sequels of laryngoscopy and endotracheal intubation; they are transient, highly variable and are generally well tolerated in healthy patients. In hypertensive patients with coronary artery disease (CAD) these cardiovascular responses to laryngoscopy and intubation is exaggerated. The aim ...
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Prospective Study of Priming Versus Non-Priming of Wik-Wire Extension Set during Continuous Spinal Anaesthesia for Repeat Caesarean Section: A Pilot Study
Sotonye Fyneface-Ogan,
Otokwala Job Gogo
Issue:
Volume 1, Issue 3, November 2013
Pages:
36-40
Received:
4 January 2014
Published:
30 January 2014
DOI:
10.11648/j.ja.20130103.14
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Abstract: Background: Continuous spinal anaesthesia during Caesarean delivery has been found to offer considerable advantages over "single-shot" spinal. Aim: This study aimed to find the difference between priming and non-priming of the Wik-Wire extension set with local anaesthetic on the induction-incision interval. Methods: Thirty ASA I and II parturients aged between 21 and 38 years scheduled for elective repeat Caesarean section were randomly allocated into one of two groups of 15 patients each. Patients in Group A had the Wik-Wire extension set primed with 1 ml of isobaric bupivacaine and threaded through flexible cannula. On connection with the hub of the cannula, back flow of cerebrospinal fluid (CSF) was confirmed by a drop hanging at the hub of the set. Group 2 patients had the un-primed Wik-Wire extension set connected to the flexible cannula. On connection with the hub of the cannula, back flow of CSF was evidenced by lowering the extension set to fill the tubing until the proximal cap of extension set was fully primed with passive flow of CSF. Isobaric 0.5% bupivacaine 10 mg was then administered intrathecally as the parturients returned supine while ensuring 15o left uterine displacement. Induction to delivery interval (I-D), defined as time from institution of induction of regional anaesthesia to delivery was studied. Results: All patients had satisfactory anaesthesia. The mean induction to incision (I-I) interval in group A 3.8 ± 1.5 mins while this was 7.2 ± 2.2 mins in group B, p=0.001. One patient in group B required a single dose of 5 mg ephedrine; while none required vasopressor support in group B. Conclusions: The study concludes that a primed Wik-Wire extension set can significantly reduce the induction of continuous spinal anaesthesia to delivery interval provides a fast and effective anaesthesia for caesarean section.
Abstract: Background: Continuous spinal anaesthesia during Caesarean delivery has been found to offer considerable advantages over "single-shot" spinal. Aim: This study aimed to find the difference between priming and non-priming of the Wik-Wire extension set with local anaesthetic on the induction-incision interval. Methods: Thirty ASA I and II parturients ...
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