Outcome of anesthetic management for children with craniofacial deformities.

BACKGROUND: The challenge for anesthetic management for children with craniofacial deformities is to develop comprehensive anesthetic care. The purposes of this study were to review the authors' experience with airway management and ventilator support and evaluate outcome during the perioperative period among these patients at the Tawanchai Center, Srinagarind Hospital. METHODS: A retrospective (2005-2009), descriptive study was conducted to analyze the anesthetic management and perioperative outcomes among children with craniofacial deformities at the Tawanchai Center. Techniques for airway management included direct laryngoscope (DL), DL with stylet, fiber-optic bronchoscope (FOB), laryngeal mask airway, retrograde intubation, a combination of these techniques and more than one anesthesiologist. RESULTS: Forty-five children with craniofacial deformities were classified as having the following: craniosynostosis; craniofacial microsomia; Treacher-Collins syndrome (TCS); coloboma of the eye, heart defects, atresia choanae, retarded growth and/or development, genital and/or urinary abnormalities, ear abnormalities and deafness (CHARGE) syndrome; frontoethmoidal encephalomeningocele; Pierre Robin sequence; and craniofacial cleft. Most of the patients underwent induction of anesthesia by inhalation of an anesthetic agent. The children with TCS were the most difficult group with regard to airway management with DL view (13%), and multiple airway accessories and intubation techniques were needed. The two most common methods for management of difficult airway obstructions were the use of stylet and FOB. No complications occurred during intubation and minor complications were observed during the perioperative period. CONCLUSION: A successful outcome depended on the provision of interdisciplinary craniofacial team management, comprehensive anesthetic evaluation and management, well-informed and cooperative children and supportive family members.

Single injection fascia iliaca block for pain control after arthroscopic anterior cruciate ligament reconstruction: a randomized, controlled trial.

BACKGROUND: Arthroscopic anterior cruciate ligament reconstruction (AACLR) is one of the orthopedic surgeries associated with moderate to severe post-operative pain. The fascia iliaca block (FIB), a block of the femoral nerve and lateralfemoral cutaneous nerve of the thigh, is relatively simple, safe, and provides effective analgesia post-operatively OBJECTIVE: To investigate the effectiveness of using fascia iliaca block for post-operative pain relief after AACLR. MATERIAL AND METHOD: After approval by the Ethics Committee for Khon Kaen University (HE510817), the patients were randomly allocated into two groups using a computer-generated random number and concealed by sealed opaque envelopes. FIB was delivered via a 16-gauge Tuohy needle at the PACU. The patients received either 0.2 % bupivacaine with adrenaline or 0.9% NSS 40 mL. Morphine consumption, time to first rescue analgesia, Numerical Rating Scale (NRS), side effects, and complication within 24 hours were recorded RESULTS: Forty-seven patients were enrolled. There was a statistically significant difference in the 24 hours morphine consumption between the bupivacaine and NSS groups (22.1 +/- 7.2 and 31.8 +/- 9.3 mg, respectively; p < 0.001). Time to first rescue analgesia was significantly longer in the bupivacaine group (4.60 +/- 2.2 vs. 2.83 +/- 1.6 hour p 0.003). The difference of resting and on movement pain score were also significant (2.1 (95% CI 1.3-2.8), p < 0.001 and 1.8 (95% CI 1.2-2.4), p < 0.001 respectively. Neither serious side effect nor neurological sequel was found. CONCLUSION: The fascia iliaca block is effective for providing pain control for at least 24 hours after anterior cruciate ligament reconstruction. This technique is quite easy, safe, and inexpensive to use.

An experience with intubating laryngeal mask airway for difficult airway management: report on 38 cases.

A retrospective study was performed on 38 patients (23 males and 15 females) in whom the intubating laryngeal mask airway (ILMA) was used for airway management at Srinagarind and Siriraj Hospital in 2003. The patients 'age and weight ranged between 12 and 75 years and 40 and 94 kg, respectively. Difficult tracheal intubation was suspected before starting general anesthesia in 17 patients, whereas it was found difficult after induction of general anesthesia in 21. The ILMA was successfully placed in all patients with airway patency classified as 'good' and 'acceptable' in 36 patients (94.7%), and 'poor' in two. Oxygen saturation during intubation was maintained above 95 percent in all patients. Tracheal intubation through the ILMA was successful in 34 patients (89.5%), which was described as 'easy' in 27 of 34 patients (79.4%). In the remaining 7, 2-5 attempts were required for successful tracheal intubation. The types of endotracheal tubes used were: 1) the pre-formed silicone tube in 55.9 percent, 2) the pre-formed flexible tube in 41.2 percent; and, 3) the standard polyvinyl tube in 2.9 percent. In the four patients with failed tracheal intubation through the ILMA, three were successfully intubated with conventional laryngoscopy and one with gum elastic bougie. There were no serious complications following the use of the ILMA in these patients. The ILMA proved a safe, very useful and easy to use device with a high success rate for difficult airway management.

Oral manifestations and dental management of a child with Zellweger syndrome.

Zellweger syndrome (ZS) is a rare autosomal recessive disorder, resulting from an impairment in peroxisome function. It is characterized by craniofacial dysmorphism and neurological abnormalities, and involves several systems, which may complicate dental and anesthesia management. The case of a 7-year-old girl diagnosed with ZS is described with emphasis on oral manifestations, oral rehabilitation under general anesthesia (GA), and home oral care. Apart from the unique features of ZS, she presented with clinodactyly, distinctive palatal vault, Class III malocclusion, missing teeth, microdontia, and delayed dental formation. Dental treatment under GA was conducted with concerns of risk of respiratory insufficiency. Oral home care by the parent and regular recall visits were essential to maintain good oral health. Children with ZS may survive into late childhood. They, however, present multiple health problems that are of special concern for not only the pediatric dentist but also the anesthesiologist. Collaboration with the medical team is essential for optimal care of these patients.