RESUMO
Infants with hypoplastic left heart are at increased risk of adverse events including mortality when they undergo procedures with general anesthesia in the inter-stage period after stage I Norwood. This is primarily caused by an imbalance between pulmonary and systemic blood flows augmented by decreased function of the single ventricle. These factors can be aggravated by general anesthesia, hence the increased risk. Many of these infants experience feeding dysfunction and require a gastrostomy to optimize nutrition. We report a case of open gastrostomy in an infant with Norwood physiology under spinal anesthesia with an excellent outcome.
Assuntos
Raquianestesia , Síndrome do Coração Esquerdo Hipoplásico , Gastrostomia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Cuidados Paliativos/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This is a case report of a 12-year-old female with idiopathic scoliosis undergoing posterior scoliosis reconstruction that developed an acute onset of central diabetes insipidus (CDI) during surgery. The diagnosis was made as a result of an intraoperative increase in urine output to 6.82 ml/kg/hour (550 ml), a serum sodium increase from 139 to 147 mmol/L, a serum osmolality of 299 mOsmol/kg, a rapid response to vasopressin administration and a low vasopressin level of < 0.5 picograms/ml (normal, 1-5 picograms/ml). This is the first reported case of CDI with a documented low vasopressin level that has occurred in a pediatric scoliosis surgical patient.
Assuntos
Diabetes Insípido Neurogênico , Diabetes Mellitus , Hipernatremia , Cifose , Escoliose , Adolescente , Criança , Feminino , Humanos , Escoliose/cirurgiaAssuntos
Anfetaminas/efeitos adversos , Anestesia/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Cannabis/efeitos adversos , Hipotensão/induzido quimicamente , Paroxetina/efeitos adversos , Adolescente , Anfetaminas/urina , Anestesia/métodos , Anestésicos Inalatórios/administração & dosagem , Depressão/tratamento farmacológico , Interações Medicamentosas , Feminino , Humanos , Fumar Maconha/efeitos adversos , Fumar Maconha/urina , Dor Pós-Operatória/prevenção & controle , Paroxetina/administração & dosagem , Fusão Vertebral/efeitos adversos , Detecção do Abuso de SubstânciasRESUMO
Pain serves as a useful warning function of potential tissue damage. The systemic response to pain is characterized by activation of the sympathetic nervous system. The ensuing neuroendocrine response results in a myriad of adverse effects on the various organ systems, which can adversely affect surgical outcomes. When effective neuraxial anesthesia and analgesic techniques are employed, the surgical patient may benefit from decreases in morbidity, mortality, and prevention of subsequent development of chronic pain. The use of intrathecal and epidural techniques in the pediatric population is well established and allows these patients to benefit from superior pain relief and improved surgical outcomes.
