RESUMO
First described in 1956 subsequent to a reaction reported to the newly introduced antipsychotic drug chlorpromazine, neuroleptic malignant syndrome (NMS) is a rare, potentially life-threatening reaction to antipsychotic drugs characterized by high fever, muscle rigidity, altered mental status, and autonomic instability. All neuroleptics, including newer antipsychotics, have been linked to this condition. Due to similar symptoms, it is debatable if individuals with NMS can be susceptible to malignant hyperthermia (MH). This case report presents the anesthetic care of a 30-year-old male undergoing general anesthesia in the office-based dental environment. The rationale behind the selected total intravenous anesthesia technique without NMS or MH triggering agents is outlined as well as other agents that may still be questionable regarding their trigger effect for NMS.
Assuntos
Anestésicos , Antipsicóticos , Síndrome Maligna Neuroléptica , Masculino , Humanos , Adulto , Síndrome Maligna Neuroléptica/diagnóstico , Síndrome Maligna Neuroléptica/etiologia , Síndrome Maligna Neuroléptica/terapia , Antipsicóticos/efeitos adversos , Anestésicos/uso terapêutico , Anestesia Geral/efeitos adversosRESUMO
The Bispectral Index System is a useful guide for timing of adequate intubation conditions in office-based pediatric general anesthesia without neuromuscular blockade. As the number of cases in the office-based setting increase, many clinicians opt to intubate patients without neuromuscular blockade to avoid airway complications associated with skeletal muscle relaxation. Conventionally, this technique is conducted using the traditional monitoring criteria of vital signs, end-tidal inhalation agents, as well as anesthesiologist timing and knowledge of the pharmacodynamics of the anesthetic agent to help determine the proper depth of anesthesia for adequate intubating conditions. This study retrospectively assesses the use of the Bispectral Index System (BIS) as a guide for timing of nonparalytic tracheal intubation in pediatric office-based general anesthesia. Anesthetic records for 168 children, American Society of Anesthesiology physical status I and II, and ranging in age from 18 months to 17 years were retrospectively analyzed. Intubation outcomes were based on 6 preset criteria to reflect the adequacy of the technique. The mean BIS value during the time of intubation was 34.7. There were no complications encountered. A BIS mean value of 34.7 provided adequate intubation conditions without muscle relaxation in office-based pediatric anesthesia without complications.
Assuntos
Anestesia Dentária , Anestesia Geral , Consultórios Odontológicos , Eletroencefalografia/métodos , Intubação Intratraqueal , Administração Oral , Adolescente , Assistência Ambulatorial , Anestésicos Dissociativos/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Criança , Pré-Escolar , Assistência Odontológica , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Lactente , Injeções Intramusculares , Ketamina/administração & dosagem , Masculino , Éteres Metílicos/administração & dosagem , Midazolam/administração & dosagem , Monitorização Fisiológica , Bloqueio Neuromuscular , Medicação Pré-Anestésica , Estudos Retrospectivos , Sevoflurano , Fatores de Tempo , Sinais VitaisRESUMO
Möbius syndrome is a rare congenital disorder with the primary diagnostic criteria of congenital facial and abducent nerve palsy. Orofacial anomalies and limb malformations may be associated with the disorder. Involvement of other cranial nerves also is common. Occasionally, the V, X, XI, and XII cranial nerves are involved, resulting in difficulty of chewing, swallowing, and coughing, which often leads to respiratory complications. Mental retardation and autism have been reported in some cases. An 18-year-old Hispanic male came to the General Practice Residency clinic at the University of Illinois at Chicago for dental treatment. The patient had a history of Möbius syndrome, mental retardation, and behavioral problems. Because of acute situational anxiety and violent behavior, we arranged for the patient to have general anesthesia while we provided complete oral rehabilitation. This article discusses the treatment of a patient, including special considerations taken during anesthesia and dental management. A review of the special challenges concerning patients with such a condition are reviewed.