Liver Transplantation in a Child with Kartagener Syndrome: A Case Report.

BACKGROUND: Kartagener syndrome (KS) is a rare genetic disorder consisting of the triad of situs inversus, chronic sinusitis, and bronchiectasis. Although there are previous reports regarding the anaesthetic considerations in KS, none have included liver transplantation. CASE PRESENTATION: An 11-year-old boy with a diagnosis of KS underwent liver transplantation due to extrahepatic biliary atresia. Previous diagnostic imaging confirmed situs inversus and the absence of an inferior vena cava. The patient's peak airway pressure intermittently increased intraoperatively from 15 to 30 cm H2O due to increased pulmonary secretions, which required frequent suctioning of the endotracheal tube. Intraoperative volume resuscitation included 200 mL of 5% albumin, 5 units of erythrocyte suspension and 3 units of fresh frozen plasma. Intermittently, a norepinephrine infusion was required to maintain the MAP. Coagulation function was monitoring using the thromboelastogram to guide the use of blood products including fresh frozen plasma. At the end of the surgery, the patient was transferred to the intensive care unit. He was discharged from the intensive care unit on postoperative day 5, and from the hospital on postoperative day 28. He continues to do well with normal liver function 23 months after surgery. CONCLUSION: Despite the risk of pulmonary related to airway secretions and exacerbation of hemodynamic instability related to anatomical variations in the inferior vena cava anatomy, KS patients can be safely anesthetized with careful planning and attention of the disease process, even for complex surgical procedures such as liver transplantation.

The peer review process.

The peer review process provides a foundation for the credibility of scientific findings in medicine. The following article discusses the history of peer review in scientific and medical journals, the process for the selection of peer reviewers, and how journal editors arrive at a decision on submitted manuscripts. To aid authors who are invited to revise their manuscripts for further consideration, we outline steps for considering reviewer comments and provide suggestions for organizing the author's response to reviewers. We also examine ethical issues in peer review and provide recommendations for authors interested in becoming peer reviewers themselves.

Bedside ultrasonography for the confirmation of gastric tube placement in the neonate.

BACKGROUND: Naso/Orogastric tube (NOGT) misplacement can lead to significant complications. Therefore, the assessment of tube position is essential to ensure patient safety. Although radiography is considered the gold standard for determining NOGT location, new methods may be helpful in reducing repetitive radiation exposure, especially for neonates. In this study, we sought to investigate if bedside ultrasonography (BUSG) can be used to verify NOGT placement in neonatal intensive care patients. MATERIALS AND METHODS: Infants requiring NOGT placement were enrolled. After insertion of the NOGT, the location was first identified using BUSG and then confirmed using abdominal radiography for comparison. RESULTS: The study cohort included 51 infants with an average gestational age of 34 ± 4.9 weeks. BUSG determined the NOGT location correctly with a sensitivity of 92.2%. The location of the NOGT could not be determined by BUSG in four neonates (7.8%). In one infant, the NOGT was positioned in the esophagus, as determined both by BUSG and radiography. CONCLUSION: BUSG is a promising diagnostic tool for determining NOGT location in neonates, thereby eliminating the need for abdominal radiography.

Efficacy and safety of intravenous thiopental for sedation during magnetic resonance imaging in pediatric patients: A retrospective analysis.

INTRODUCTION: Although the administration of rectal thiopental for sedation during magnetic resonance imaging (MRI) has been well described, there are limited data regarding its intravenous (IV) use in this clinical scenario. The aim of this study was to investigate the efficiency of IV thiopental for sedation during MRI in the pediatric population. METHODS: A retrospective review was conducted over a 12-month period of pediatric patients who received IV thiopental for sedation during MRI. Data collected included the procedure length, the induction dose, the time to sedation, recovery time, total sedation time, and adverse events. The parents were telephoned and questioned regarding any adverse effect after discharge and their satisfaction (yes = satisfied; no = not satisfied) regarding the sedation process. RESULTS: A total of 300 (American Society of Anesthesiology I-II status) pediatric patients received IV thiopental for sedation during MRI. The average age of the patients was 4.7 ± 3 years. Thiopental was administered as an initial IV bolus dose of 3 mg/kg, followed by additional bolus doses of thiopental (1 mg/kg) as needed to achieve a Ramsay sedation score of 4. The average procedure length was 20.7 ± 11.9 min. The average total dose of thiopental during the procedure was 5.6 ± 0.9 mg/kg. Patients recovered in an average time of 11 ± 5.6 min after a total sedation time of 31.7 ± 14.2 min. None of the patients had oxygen desaturation, adverse effects before or after discharge, and no patient required unplanned hospital admission. All parents were satisfied with the sedation process. CONCLUSION: IV thiopental is an effective, safe, and inexpensive medication for the sedation of children undergoing MRI.

Sugammadex to reverse neuromuscular blockade and provide optimal conditions for motor-evoked potential monitoring.

Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade (NMB) via a mechanism that differs completely from acetylcholinesterase inhibitors. By encapsulating rocuronium, sugammadex can provide recovery of neuromuscular function even when there is a profound degree of NMB. We report anecdotal experience with the use of sugammadex to reverse NMB to facilitate intraoperative neurophysiological monitoring (motor evoked potentials) in an adolescent with scoliosis during posterior spinal fusion. Its potential application in this unique clinical scenario is discussed, and potential dosing schemes are reviewed.

A simple technique to achieve vascular access for continuous venous-venous ultrafiltration in a toddler.

Acute renal failure is associated with increased mortality in the Pediatric Intensive Care Unit. When anuric or oliguric renal failure occurs, the associated fluid overload may compromise respiratory function and has been shown to be associated with worse outcomes. Renal replacement therapy using continuous venous-venous hemofiltration (CVVH) allows for fluid, solute, and nitrogenous waste removal. However, large bore vascular access with placement of a double-lumen dialysis catheter is necessary to ensure effective flow rates to allow for CVVH. We present a technique to facilitate exchange of a 4 Fr double-lumen central venous catheter to an 8 Fr double-lumen dialysis catheter for CVVH in a 2-year-old toddler who developed acute renal failure following surgery for congenital heart disease. This technique may be particularly valuable in patients with associated conditions including fluid overload and coagulation disturbances which may increase the morbidity of vascular access techniques.