[A case of neonatal extracorporeal membrane oxygenation after heart surgery]. / Un caso di extracorporeal membrane oxygenation neonatale dopo intervento cardiochirurgico.

There is international experience of Extracorporeal Membrane Oxygenation (ECMO) in children suffering acute Respiratory failure (eg. meconium aspiration syndrome); on the contrary there is a lack of consistent experience in pediatric ECMO application in cardiac surgery as bridge to cardiac transplantation and as heart mechanical support after postcardiotomy failure. In fact there are good standardization criteria for selection, inclusion and exclusion in ECMO application for neonatal respiratory failure; differently pediatric ECMO timing (that is when to start and to stop this ventricular support) is not clear and standardized. We present one case of pediatric ECMO application in a neonate, who underwent cardiac operation for pulmonary valve aplasia and who was impossible to wean from cardiopulmonary bypass.

[A case of severe bronchospasm and laryngospasm after atracurium administration]. / Un caso di grave broncospasmo e laringospasmo dopo somministrazione di atracurium.

We present a case of severe intraoperative bronchospasm and laryngospasm, that happened after the administration of atracurium 0.5 mg/kg-1; this episode was very difficult to manage, in spite of a prompt bronchodilative treatment. This episode of bronchospasm happened again after extubation and it was so severe that it was necessary to intubate the patient quickly again. We administered bronchodilatative drugs again, and after half an hour it was possible to extubate the patient and to send him to the ward. He had no problems in the postoperative period. We carried on some investigations to evaluate the nature of this reaction: we measured the level of IgE, C3 and C4 complement factor during operation (one sample), in the first and second postoperative days. Moreover we did an intradermal test for all the drugs used during the operation. We concluded that it was an anaphylactoid reaction, sustained by atracurium.

[A case of double valve substitution in a female patient carrier of a factor X deficiency]. / Un caso di doppia sostituzione valvolare, in portatrice di deficit del fattore X.

We present the clinical case of a patient affected by mitral and aortic valvular disease submitted to double valvular replacement. This patient was also affected by congenital deficiency of factor X. We describe the normal problems encountered in cardiac surgery and the specific implications of this clinical case.

[Gorlin-Goltz syndrome. Observation of a case]. / Sindrome di Gorlin-Goltz. Osservazione di un caso.

A young girl (16 years old) came to our attention because she needed dental surgery for multiple cysts; she was affected by Gorlin-Goltz syndrome and by a partial deficit of clotting factor V. This syndrome is characterized by many alterations, some of which can interfere with a normal conduct of anesthesia, especially at intubation (prognathism, kyphoscoliosis, incomplete segmentation of cervical-thoracic vertebrae). Moreover this patient was heterozygote for factor V (it was reduced to 48%), so that she had some clotting alteration. We present therefore this case and the treatment undertaken.