Paediatric anaesthesia
-
Paediatric anaesthesia · Feb 2006
Case ReportsThe postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne's muscular dystrophy.
Anesthesia may be administered to patients with Duchenne's muscular dystrophy, but cases are reported in which apparently healthy children suffer hyperkalemic cardiac arrest. We present the case of a 5-year-old boy whose muscular dystrophy was discovered following a fatal, perioperative cardiac arrest in the postanesthesia care unit.
-
Paediatric anaesthesia · Feb 2006
Comparative StudyPostoperative morphine consumption in children with sickle-cell disease.
Effective pain control is a primary goal in the perioperative management of patients with sickle-cell disease. To understand analgesic requirements better, the authors compared postoperative morphine consumption and pain scores in sickle and non-sickle children who had undergone laparoscopic cholecystectomy. ⋯ Sickle children self-administered more than double the amount of morphine, reported more intense pain, and remained hospitalized for more than twice as long as nonsickle children undergoing the same surgical procedure. These findings probably have a multifactorial origin, and might be attributable in part to alterations in pain perception, opioid pharmacokinetics, opioid tolerance, and psychosocial variables.
-
We describe a case of a 2-year-old boy who ingested 35 mg.kg(-1) of amitriptyline. He developed central nervous system toxicity, as demonstrated by coma and seizures and cardiac toxicity (cardiac arrest) within 1 h of ingestion. The cardiac toxicity was refractory to standard therapy. ⋯ An echocardiogram and MRI brain were subsequently performed and were normal. The patient was discharged 2 weeks later with normal cognitive, behavioral and motor function. We discuss the benefit of prolonged and effective cardiopulmonary resuscitation in the management of this potentially fatal poisoning.
-
Paediatric anaesthesia · Feb 2006
Case ReportsCaudal block complication in a patient with trisomy 13.
In this report we describe a complication of a caudal block in a 4-year-old child with trisomy 13. The patient's history was remarkable for microcephaly, developmental delay, seizures, apnea, and prolonged emergence times. Induction of anesthesia and tracheal intubation were uneventful. ⋯ A radiogram suggestive of spinal dysraphism, found on subsequent review, was confirmed by a magnetic resonance imaging scan consistent with tethered cord and dural ectasia. Congenital abnormalities associated with trisomy 13 and cutaneous signs suggestive of spinal abnormalities are reviewed. Avoidance of neuraxial regional anesthesia in these patients is recommended.