1/9. Oculostapedial synkinesis following Bell's palsy.A case of oculostapedial synkinesis occurring after Bell's palsy is described. This rare phenomenon has not previously been reported following Bell's palsy. The authors discuss the method of objectively proving the diagnosis, which can be difficult. The patient was successfully treated by stapedius tendon section under local anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. King syndrome: a genetically heterogenous phenotype due to congenital myopathies.We report on a patient with myopathy, kyphoscoliosis, joint contractures, and a facial appearance consistent with King syndrome. Unlike other reported cases, our patient had hyperextensible joints, normal stature, and pectus excavatum. The cardiac ventricles, aorta, and pulmonary artery were dilated. malignant hyperthermia did not occur under anaesthesia although there was a transient increase in CK levels. Muscle bulk and tone were significantly decreased but collagen and elastin fibres were normal. The variable clinical presentation of King syndrome suggests that the manifestations are caused by different congenital myopathies and in all cases there is probably an increased risk of malignant hyperthermia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/9. Pompe's disease and anaesthesia.A case report of a child with Pompe's disease (glycogen storage disease Cori type II), who underwent two general anaesthetics, is presented. The progressive infiltration of heart and skeletal muscle with glycogen results in a severe form of cardiomyopathy and respiratory muscle weakness. Consequently, there are significant problems in the anaesthetic management of these patients. Although there are theoretical attractions for some anaesthetic drugs, the key factors in a successful outcome are attention to anaesthetic technique and close monitoring.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
4/9. Spinal block, after dantrolene pretreatment, for resection of a thigh muscle herniation in a young malignant hyperthermia susceptible man.We describe a young man who experienced malignant hyperpyrexia, probably triggered by suxamethonium and/or enflurane during his second operation for an epigastric hernia. His malignant hyperthermia susceptibility was later verified using the caffeine/halothane contracture test in vitro. Subsequently, a tumorous mass, consisting of herniated and hypertrophied muscle grew in his thigh, and was resected under spinal anaesthesia. Whereas dantrolene (2.5 mg/kg i.v.) pretreatment produced impaired swallowing, the subsequent high spinal block, in addition, resulted in laboured breathing. It is stressed that respiratory power should be monitored when patients pretreated with dantrolene are given spinal anaesthesia. The muscular symptoms and test results in the patient's relatives are also discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/9. strabismus as a possible sign of subclinical muscular dystrophy predisposing to rhabdomyolysis and myoglobinuria: a study of an affected family.Administration of succinylcholine to normal individuals results in alterations in muscle membrane integrity expressed as a slight increase in the concentrations of creatine phosphokinase (CK) in serum and appearance of small amounts of myoglobin in the urine, but without clinical symptoms. Subjects with strabismus due to congenital muscular dystrophy may develop more significant rhabdomyolysis expressed as muscle stiffness and weakness, massive myoglobinuria, marked elevation of serum CK and other enzymes, metabolic acidosis, tachycardia and moderate elevation of body temperature. In some cases grave malignant hyperthermia with significant hypoxia, metabolic acidosis, tachycardia and marked abnormalities in serum electrolyte concentrations may cause irreversible damage to the central nervous system and other vital organs and death. A case of difficult anaesthesia for a six year old boy belonging to family affected with muscular dystrophy is presented. More attention must be given to preoperative examination (anamnesis, serum enzymes) or ophthalmological patients and more careful monitoring during anaesthesia and in the early postoperative period must be instituted to prevent and treat complications induced by succinylcholine and volatile anaesthetic agents.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/9. Suxamethonium-induced jaw stiffness and myalgia associated with atypical cholinesterase: case report.An 11-year-old boy was given halothane, nitrous oxide and oxygen, pancuronium 0.4 mg and suxamethonium 100 mg for induction of anaesthesia. In response to this a marked jaw stiffness occurred which lasted for two minutes and the anaesthesia were terminated. Four hours of apnoea ensued and he suffered generalized severe myalgia lasting for one week. He was found to have atypical plasma cholinesterase with a dibucaine number of 12, indicating homozygocity. This was verified by study of the family. The case shows that prolonged jaw rigidity and myalgia may occur after suxamethonium in patients with atypical cholinesterase despite pretreatment with pancuronium.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
7/9. 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 = 3keywords = anaesthesia (Clic here for more details about this article) |
8/9. Upper limb compartment syndromes: a complication of malignant hyperthermia in a patient with ill-defined myopathy.We report a case of compartment syndrome complicating malignant hyperthermia (MH) in a 12-yr-old girl with a history of myopathy and multiple skeletal deformities; she underwent bilateral achilles tendon surgery. Marked oedema of both forearms became evident in the immediate postoperative period and resolved after conservative treatment. Compartment syndrome is a rare complication of MH. Early recognition and therapy may prevent the onset of muscle ischaemia and distal neurovascular deficit. The need for urgent surgery and repeated anaesthesia in the early phase of recovery from an acute episode of MH may thus be reduced.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/9. Lumbosacral plexopathy from iliopsoas haematoma after combined general-epidural anaesthesia for abdominal aneurysmectomy.PURPOSE: To report a case of iliopsoas haematoma after resection of an abdominal aortic aneurysm which resulted in a lumbosacral plexopathy. CLINICAL FEATURES: An 81-yr-old man presented with an abdominal aortic aneurysm for aneurysmectomy and tube grafting. An epidural catheter was placed at the L1-2 spinal level and combined epidural-general anaesthesia was provided for surgery. The surgery was complex and a suprarenal clamp was necessary to obtain proximal control. A continuous infusion of demerol through the epidural catheter was prescribed for postoperative analgesia. On the first postoperative day, examination revealed a paretic, pulseless right leg and he was returned to the operating room for femoral-femoral bypass. By the following day, the motor and sensory impairment had progressed to complete paralysis with loss of all deep tendon reflexes and absent sensation below L1, despite palpable pulses in the leg. A CT of the abdomen demonstrated a right iliopsoas haematoma. There was no evidence of either disc herniation or an epidural haematoma. A diagnosis of lumbosacral plexopathy secondary to a iliopsoas haematoma was made. CONCLUSION: Iliopsoas haematoma is a rare cause of postoperative neurological deficit following aortic vascular surgery. The haematoma results in compression of the lumbosacral neural elements and typically presents as a femoral neuropathy. The diagnosis is clinical and can be readily validated with computed tomography.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |