1/8. heart block following propofol in a child.We present the case of a nine-year-old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/8. Suxamethonium-induced rhabdomyolysis in a healthy middle-aged man.A 43-year-old man developed rhabdomyolysis after uvulo- palatopharyngoplasty. After induction with thiopentone and suxamethonium the anesthesia was maintained with halothane. The patient responded to treatment and made an uneventful recovery. In earlier reports of rhabdomyolysis after general anaesthesia with halothane and suxamethonium almost all the patients had malignant hyperthermia (MH) or muscular dystrophy. About 50% of malignant hyperthermia patients carry a mutation in the RYR1 gene. Our patient did not have mutations in the four MH-associated genes tested, but the total amount of different mutations is by now about twenty. Therefore, despite these negative tests rhabdomyolysis may be a sign of subclinical malignant hyperthermia which cannot be ruled out by our investigations. This rare case of rhabdomyolysis in a healthy man suggests careful monitoring of the patient when-ever suxamethonium is used.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/8. The use of the laryngeal mask airway in post-tonsillectomy haemorrhage--a case report.INTRODUCTION: The use of the laryngeal mask airway in elective adenotonsillectomy has been well described. However, there is no literature to support its use in post-tonsillectomy haemorrhage. CLINICAL PICTURE: We report a case of a patient who presented with primary post-tonsillectomy haemorrhage, which required general anaesthesia for haemostasis after undergoing bilateral functional endoscopic sinus surgery, uvulopalatopharyngoplasty and tonsillectomy. TREATMENT AND OUTCOME: The laryngeal mask airway was used successfully after an initial attempt at endotracheal intubation had failed. There were no complications. CONCLUSIONS: The laryngeal mask airway can be used to secure the airway for haemostasis for post-tonsillectomy haemorrhage if intubation is not possible.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
4/8. Obstructive sleep apnoea causing severe pulmonary hypertension reversed by emergency tonsillectomy.A three-year-old boy is reported with severe upper respiratory tract obstruction and sleep apnoea that was associated with reversible pulmonary hypertension and cardiac enlargement, and relieved by emergency tonsillectomy. The importance of intermittent cyanosis and difficulty in arousal during the day are stressed, together with the risk of death from anaesthesia in such patients without full pre-operative assessment. Despite this risk, and the current climate of increasing reluctance to subject children to tonsillectomy, the operation is absolutely essential and potentially lifesaving in certain children such as the boy described.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/8. Obstructive sleep apnoea.A patient with obstructive sleep apnoea is described, who required admission to an intensive care unit on two separate occasions within 2 months. The first admission was after anaesthesia for operation on the upper airway. The second occurred after a relative overdose of an opioid analgesic was administered. The diagnosis, treatment and anaesthetic management of patients with this syndrome are discussed.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
6/8. A polygraphic study of one case of primary alveolar hypoventilation (Ondine's curse).We report here on a case of primary alveolar hypoventilation in a 9 yr old child. From the age of 8 years, the patient has suffered from episodes of bronchopneumonia associated with severe respiratory insufficiency and lethargy. After recovery, cyanosis developed during the night and, later on, during the day. On two occasions, serious respiratory depression followed ketamine sedation for cardiac catheterization and total anaesthesia for cerebral angiography. Pulmonary function tests showed normal volumes and normal mechanics of breathing; blood gas analysis revealed a slight hypercapnic acidosis and hypoxia. The ventilatory response to CO2 was virtually absent, whereas voluntary hyperventilation normalized blood gas values. A polygraphic recording during sleep showed a marked worsening of hypoventilation, which occurred soon after falling asleep and continued throughout all sleep stages; sporadic central apnoeas, at times prolonged, were recorded only during light sleep. The patient, now 14 yr old, is maintained in satisfactory condition with low flow nocturnal oxygen administration combined with the use of a body respirator during sleep twice a week.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
7/8. Sleep apnoea syndrome and anaesthesia.The sleep apnoea syndrome is reviewed, defined, and classified. Particular emphasis is placed on the identification of a patient population that is prone to sleep apnoea and the diseases and syndromes that are associated with it. For anaesthetists, direct enquiry into daytime and nighttime sleep abnormalities and careful examination of the upper airway are important for preoperative detection of these patients and especially patients with obstructive sleep apnoea who might present for anaesthesia and operation. A typical case is reported and details of the preoperative, peroperative and postoperative management are discussed.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
8/8. Abductor vocal fold palsy in the shy-drager syndrome presenting with snoring and sleep apnoea.The case of an elderly male with shy-drager syndrome is presented. His presentation to the Sleep Clinic for assessment of snoring illustrates bilateral abductor vocal fold palsy as a rare presentation of the syndrome. This case emphasizes the need for thorough investigation of all patients with sleep-related breathing disorders with video and sound recordings prior to anaesthesia and surgery.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |