Assuntos
Abscesso/diagnóstico , Celulite (Flegmão)/diagnóstico , Pálpebras , Sinusite Frontal/complicações , Doenças Orbitárias/diagnóstico , Abscesso/etiologia , Abscesso/terapia , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/etiologia , Drenagem/métodos , Medicina de Emergência/métodos , Sinusite Frontal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/etiologia , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
Cantrell's pentalogy (CP) is a rare congenital syndrome combining a defect of the supraumbilical abdominal wall, the agenesis of the lower part of the sternum and of the anterior portion of the diaphragm, the absence of the diaphragmatic part of the pericardium, and a cardiac malformation. It was first described by Cantrell in 1958 (1,2). We report the case of a prematurely born infant with CP and Wolff-Parkinson-White (WPW) syndrome who required surgery first for bilateral inguinal hernia repair and later for Blalock-Taussig shunt. During these two procedures, our anaesthetic plan was to preserve the fragile equilibrium of both the pulmonary and the cardiovascular systems.
Assuntos
Anormalidades Múltiplas , Anestesia/métodos , Procedimentos Cirúrgicos Operatórios , Cardiopatias Congênitas/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Lactente , Masculino , Síndrome , Síndrome de Wolff-Parkinson-WhiteRESUMO
We have studied the effects of mivacurium after induction of anesthesia with fentanyl-propofol in healthy adult women. Anesthesia was maintained with nitrous oxide in oxygen and continuous infusion of propofol (6-10 mg/kg/hr.). A myorelaxograph (Datex NMT 100) measuring the responses of the adductor pollicis to Train of Four (TOF) stimulations of the ulnar nerve was installed after induction. Three bolus dosages of mivacurium were administered just after induction: 0.15 mg/kg (group A), 0.17 mg/kg (group B) and 0.19 mg/kg (group C). Intubation was attempted at 75% TI-suppression. The conditions of intubation were good to excellent in the three groups except for one patient in group A (0.15 mg/kg). Successful intubation was performed faster in group C(p = 0.017). The curarization time was significantly longer in group C(0.19 mg/kg) vs the other groups (p = 0.002). As soon as the first signs of recovery (TI increment) appeared, a continuous infusion of mivacurium (10 micrograms/kg/min) was started to maintain a complete neuromuscular block. After stopping the continuous infusion, there were no differences in spontaneous recovery between groups A and B but patients from group C showed a lenghtening of the recovery time. There is no effect of the different bolus dosages on vital signs. We conclude that a bolus dosage of 0.19 mg/kg after induction of anesthesia with fentanyl-propofol offers the best choice when a rapid sequence of induction is required. Mivacurium could be an interesting muscle relaxant in one-day surgery even if a risk of prolonged curarization exists due to its degradation by plasma cholinesterases.