Anesthetic implications of two genetic translocation (6p21; 6p13) in a patient with history of congenital varicella syndrome: a case report.

The coexistence of multiple chromosomal abnormalities and Congenital Varicella Syndrome (CVS) in one patient is a rare event in which anesthetic implications should be considered. This case report describes a 9-year-old female with CVS and a karyotype analysis of 6p21; 16p13 genetic translocations. We conducted a detailed investigation of the consequences of such findings and the potential outcomes in anesthesia of this uncommon incident including thorough research on the characteristics present in each condition. We concluded that: (1) coexistence of two genetic translocations (6p21; 16p13) in one patient, and simultaneously with CVS is undoubtedly an extremely rare event; (2) difficult airway management, potential cardiac dysfunction, risk of pulmonary aspiration, fluid disturbances, and a hard to access peripheral vascularity are among the most important anesthetic implications as a consequence of having all these disorders; (3) ketamine was a safety and efficacious option for sedation during fiber optic bronchoscopy.

Continuous spinal anesthesia for hip replacement in an elderly patient with an anterior mediastinal mass: a case report.

Incremental dosing of intrathecal local anesthetic for an indefinite duration performed during continuous spinal anesthesia (CSA) allows for better control of adverse effects caused by sympathetic nerve blockade. This case report describes a 91-year-old female with a left intertrochanteric fracture and a large thyroid mass causing contralateral anterior displacement of the trachea and the great vessels. We conducted a detailed investigation of the different techniques that can be used in such circumstances and the consequences each may have on a patient. We concluded that: better control of sympathetic nerve blockade and less adverse effects can be achieved with CSA, optimal management of thrombocytopenia should be done in a patient prior to regional anesthesia, and CSA is an anesthetic alternative to consider on elderly patients with an anterior mediastinal mass undergoing hip fracture surgery.

Diabetes alters cardiovascular responses to anaesthetic induction agents in STZ-diabetic rats.

BACKGROUND: People with diabetes are at increased risk of cardiovascular (CV) morbidity and mortality during surgery. The most appropriate anaesthetic induction agent for these patients is unknown. METHODS AND RESULTS: We assessed the CV effects of propofol, etomidate and ketamine in streptozotocin (65 mg/kg, IP) diabetic rats. In non-diabetic rats, none of these anaesthetics significantly modified cardiac output, heart rate or stroke volume, but ketamine increased systolic blood pressure (SBP) compared to etomidate and propofol (89.6 ± 2.4 mmHg, vs. 72.7 ± 3.0 and 75.4 ± 1.9; p < 0.05). In diabetic rats, by contrast, cardiac output was lower with ketamine (82.6 ± 14 ml/min) and etomidate (78.2 ± 15.8 ml/min) than with propofol (146 ± 21 ml/min, N = 8, p < 0.01). SBP, however, was higher in the propofol-treated group (93.3 ± 3.4 mmHg, p < 0.05). CONCLUSION: These results suggest that hyperglycaemia modifies CV responses to induction anaesthetics.

Anesthetic management of a patient undergoing surgery for bilateral pheochromocytoma: a case report.

Pheochromocytomas are rare neuroendocrine tumors. Patients with pheochromocytoma may develop potentially lethal cardiovascular and other complications, especially in the setting of diagnostic or interventional procedures (e.g. upon induction of anesthesia or during surgery). Perioperative management of patients with pheochromocytoma requires detailed knowledge on the pathophysiology and potential complications. This is a case of a 38 year-old, male, with history of bilateral pheochromocyto-, ma, and hypertension secondary to pheochromocytoma, that was scheduled for open bilateral cortical-sparing adrenalectomy under general anesthesia combined with thoracic epidural anesthesia. Although resection of bilateral pheochromocytomas continues being a challenging situation for the anesthetic management, morbidity and mortality can be significantly decreased with preoperative alpha-antagonists treatment, as well as volume restoration, vasoactive drugs, and closely monitoring intra- and postoperatively.

Alpha-2B adrenergic receptor mediated hemodynamic profile of etomidate.

Etomidate has been used since 1972 as an inductor and in maintaining anesthesia. There are multiple mechanisms that account for the biologic effects of etomidate. One of the most prominent features of this drug is that it provides anesthesia without gross changes in hemodynamic parameters. This feature allows using etomidate in patients with considerable cardiopulmonary compromise avoiding the characteristic hypotension produced by other anesthetics. The mechanism that provides the basis for its cardiovascular stability is the capacity to bind and stimulate peripheral alpha-2B adrenergic receptors with a subsequent vasoconstriction. Alterations in the function or number of these receptors may account for abnormal responses during etomidate induction.