Positional Change Used to Manage Postextubation Respiratory Failure in a Child With Cerebral Palsy.

Dental treatment for patients with cerebral palsy (CP) is often performed under general anesthesia due to involuntary movements that can render dental treatment difficult. Since CP is often accompanied by spasticity, care must be taken when positioning patients during general anesthesia. We report the management of a 14-year-old girl with CP and epilepsy undergoing general anesthesia for dental treatment who experienced respiratory failure due to acute thoracoabdominal muscle hypertonia after extubation. She had a history of cardiac arrest due to respiratory failure caused by acute muscle hypertonia and successful resuscitation. General anesthesia was induced after careful positioning of the patient to prevent spastic muscle stretching, and the dental treatment was completed without complications. However, upon awakening after extubation, the patient developed respiratory failure due to acute muscle hypertonia. The patient was resedated and repositioned from a supine to a sitting position, and her symptoms improved. There was no recurrence of muscle hypertonia, and she recovered fully without complications. In this case, respiratory failure associated with acute muscle hypertonia was successfully managed by position change after initial treatment with positive-pressure ventilation and propofol. It is important to be prepared for the possibility of respiratory failure associated with acute muscle hypertonia and its countermeasures when providing general anesthesia for patients with CP.

Spratelloides atrofasciatus Schultz, 1943, a valid species of round herring (Clupeiformes: Clupeidae).

The western Pacific marine clupeoid fish, Spratelloides atrofasciatus Schultz, 1943, previously regarded as a synonym of S. gracilis (Temminck and Schlegel, 1846), is redescribed here as a valid species on the basis of the holotype and 115 non-type specimens collected from the Ryukyu Islands. Both S. atrofasciatus and S. gracilis are similar chiefly in having a midlateral band that does not fade anteriorly. S. atrofasciatus differs from Spratelloides gracilis in having fewer anal fin rays, pectoral fin rays, vertebrae and gillrakers. Spratelloides atrofasciatus also has a shorter head length, a shorter upper jaw length, a shorter snout length, a wider lateral band equal to the eye diameter; numerous black pigment spots on the inner side of the gill opening that are visible from the outside in preserved specimens (vs not visible in S. gracilis). The two species are sympatrically distributed in the Ryukyu Islands. Spratelloides atrofasciatus matures from 32 mm SL and grows to a known maximum size of 45mm SL, while S. gracilis matures from about 50 mm SL and grows to over 100 mm SL.