RESUMO
Stickler's syndrome is an autosomal multisystem disorder accompanying characteristic midface hypoplasia, retromicrognathia, and cleft palate. Mandibular hypoplasia causes difficulties in mask ventilation and endotracheal intubation, especially in infants. A 7-month-old girl diagnosed as Stickler's syndrome was scheduled for the laparoscopic inguinal hernia repair. However, during the direct laryngoscopy for endotracheal intubation, neither the vocal cords nor the epiglottis were visualized. At fifth intubation attempts, the part of the vocal cords was barely visualized, and the tracheal intubation was finaly successful. Anesthesia was maintained with sevoflurane and remifentanil. The patient had an uneventful recovery and was discharged on the second postoperative day without any complications. Sevoflurane and remifentanil allow faster recovery from anesthesia and both have been recommended for patients with difficult tracheal intubation in a patient such as with Stickler's syndrome.
Assuntos
Anestesia , Fissura Palatina , Face/anormalidades , Hérnia Inguinal/cirurgia , Intubação Intratraqueal/métodos , Anormalidades da Boca , Feminino , Humanos , Lactente , Laparoscopia , Laringoscopia , Éteres Metílicos , Piperidinas , Remifentanil , Sevoflurano , SíndromeRESUMO
We successfully treated a 61-year-old woman with a pheochromocytoma and angina. We administered doxizosin mesilate for a month to achieve a good control of blood pressure and CABG was followed without any problems. After 3 months, pheochromocytoma was resected. There were no cardiac ischemia during both operations. We believe that it is very important to control blood pressure and to determine which operation, CABG or the pheochromocytoma resection, should be performed first, in these cases.
Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia Epidural , Anestesia por Inalação , Anestesia Intravenosa , Angina Pectoris/complicações , Angina Pectoris/cirurgia , Ponte de Artéria Coronária sem Circulação Extracorpórea , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Antagonistas Adrenérgicos alfa/uso terapêutico , Doxazossina/uso terapêutico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
In this case report, we describe recurrent spasms of the right coronary artery with no apparent preexisting abnormal angiogram that caused second-degree atrioventricular (AV) block and inferior wall hypokinesis. These hemodynamic changes were induced by mechanical compression of the right coronary artery by a pericardium drain tube. From our experience, we should be aware that mechanical compression may trigger an exaggerated vasomotor response, leading to severe coronary artery spasms.
