1/4. Combination of balanced and regional anaesthesia for minimally invasive surgery in a patient with myasthenia gravis.A 45-year-old man with cryptorchism, who was known to suffer from generalized myasthenia gravis, was admitted to hospital for surgical treatment using laparoscopy. Such minimally invasive surgery requires good muscle relaxation. However, the use of neuromuscular blocking agents in patients with myasthenia gravis may lead to prolonged apnoea after operation, thus necessitating mechanical ventilation of the lungs. We used a combination of general anaesthesia (with desflurane), and epidural anaesthesia (with the amide local anaesthetic ropivacaine) to obtain excellent abdominal relaxation during surgery. Tracheal extubation was possible immediately after the operation and no adverse effects were observed. The patient was discharged from hospital on the second day after operation. The combination of regional and general anaesthesia for minimally invasive surgery in this patient permitted safe anaesthetic management.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. Respiratory arrest after a caudal injection of bupivacaine.A 3.5-year-old child with Cornelia de lange syndrome presenting for orchidopexy and herniotomy received general anaesthesia which was supplemented by a caudal injection of bupivacaine. Shortly after this he had a respiratory arrest with fixed dilated pupils. No cardiovascular system instability was observed. Approximately one hour later the child made a rapid and complete recovery. The possible causes of these events are discussed with particular reference to the potential effects of caudal injections on intracranial pressure.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
3/4. Anaesthesia for a child with centronuclear myopathy.Centronuclear myopathy (CNM) is an inherited condition involving most muscle fibres in all the body mass, first described in 1966, which has a varying spectrum of presentations. Until recently it had not been associated with an increased risk of malignant hyperpyrexia. A seven-year-old male with CNM was admitted to our hospital for elective surgery. High dose propofol anaesthesia was used, supplemented with N2O/O2 from a new anaesthesia machine. The operation was successful with uncomplicated anaesthesia and recovery.- - - - - - - - - - ranking = 0.42857142857143keywords = anaesthesia (Clic here for more details about this article) |
4/4. Anaesthetic management of a child with Bartter's syndrome.We report the anaesthetic management of an eight-year-old asthmatic boy with Bartter's syndrome who had bilateral orchidopexy with caudal epidural analgesia. Bartter's syndrome is a rare congenital disorder characterized by hypokalaemic hypochloraemic metabolic alkalosis, hyperaldosteronism, hyperreninaemia and hyperplasia of the juxtaglomerular apparatus of the kidneys. Characteristically, although these patients are normotensive they may be hypovolaemic. They may have unstable baroreceptor responses and show marked resistance to vasopressors. Hence, fluid, acid-base and electrolyte imbalances along with haemodynamic instability pose particular problems in their anaesthetic management. Previous case reports have described the management of these patients with general anaesthesia, our patient had his orchidopexy with caudal epidural analgesia using plain bupivacaine 0.5%. The patient was haemodynamically stable throughout surgery and was comfortable with caudal analgesia as the sole anaesthetic. Hypovalaemia, acid-base status and electrolyte imbalance were treated before instituting caudal epidural analgesia. We present this case report which describes the anaesthetic considerations in the light of the pathophysiology of Bartter's syndrome.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |