Induction Of Anesthesia For Surgery Research Articles

Parental Accompaniment in Operating Rooms Reduces Child Anxiety.

We believe that parental presence before the induction of anesthesia for surgery among children with a cleft palate/lip would be effective in mitigating their preoperative anxiety. We assessed the states of patients with a cleft palate/lip when their parents accompanied them into operating rooms and clarified their and their parents' cognition using a questionnaire. Data were collected via nursing observation when patients and their parents entered the operating room. Furthermore, an anonymous questionnaire was administered to patients and parents after the operation regarding their feelings about parental presence in the operating room. In total, nine patients cried when they entered the surgical room. Furthermore, six patients and three parents reported preoperative anxiety. In addition, eight patients agreed that they were satisfied with the presence of their parents before induction. Approximately half of the patients cried. However, the presence of parents before the induction of anesthesia was effective in reducing anxiety among most patients and their parents.

P166 “LONG QT SYNDROME:AN ENTIRE FAMILY WITH KCNQ1 MUTATION”

Abstract Introduction Congenital long QT syndrome (LQTS) is characterized by prolongation of the QT interval that can trigger life–threatening arrhythmias leading to syncope and sudden death. Mutations in genes encoding for ion channels have been identified in 75% of LQTS cases. Long QT syndrome type 1 (LQTS1) is one of three subtypes of LQTS identified based on genetic substrate. LQTS1 is linked to a “loss–of–function” mutation in the gene encoding the potassium channel KCNQ1, and arrhythmias tend to occur during childhood with prevalence in the male sex. Adrenergic triggers are the most important trigger for arrhythmic events. Clinical Case Extensive family with long QT syndrome with positive genetics for mutation in the KCNQ1 gene. The index case in the family appears to be a woman who at the age of approximately 30 years died suddenly after surgery. The first patient subjected to genetic analysis, with positive result, was the daughter of this woman who, at the age of about 25 years has experienced a ventricular arrhythmia during induction of anesthesia for surgery with baseline ECG finding of prolonged QTc. Set beta–blocker therapy, arrhythmias no longer occurred. Subsequently, a cardiological screening including electrocardiogram, transthoracic echocardiography and genetic analysis was undertaken in first–degree relatives and, in cases of positivity, this screening was progressively extended to second–, third– and fourth–degree relatives. All the women in the family analyzed, eight in total, including two girls aged 5 and 12 years, tested positive for genetic analysis, and one of the women had a syncopal episode at the age of 50 years. Of the men analyzed, four in total, only two (father and son) tested positive on genetic analysis. In all patients with positive genetics a QTc >480 msec was detected on ECG in clinostatism and/or orthostatism, for which a diagnosis of LQTS1 (mean Schwartz–score 4) was made and beta–blocker therapy was started. Conclusions This clinical case describes an entire family with LQTS with positive genetics for KCNQ1 with phenotypic manifestations different from those described in the literature, in particular with prevalence in the female sex and with onset of arrhythmias in adulthood.

Recurred pneumocephalus in a head trauma patient following positive pressure mask ventilation during induction of anesthesia -A case report-

Pneumocephalus is a condition which usually results from head trauma. It has been known that iatrogenic pneumocephalus can occur as a complication of positive pressure mask ventilation during induction of anesthesia or ventilatory care for head trauma patients. We report a case of mask ventilation during anesthesia induction in a 50-year-old male patient with head trauma. Initial pneumocephalus associated with cerebrospinal fluid leakage was diagnosed immediate following head injury involving facial sinuses. He was managed with emergent lumbar drainage and supportive care. Pneumocephalus recurred following positive pressure mask ventilation (PPMV) during anesthesia induction for surgery on the right arm. Recurred pneumocephalus was managed with high flow oxygen and supportive care. Anesthesiologists should be aware of pneumocephalus as a potential complication of PPMV in head trauma patients, even after resolution of previous pneumocephalus.

Anaesthesia Induction in Children: A Psychological Evaluation of the Efficiency of Parents' Presence

Journal of Craniofacial Surgery: May 2005 - Volume 16 - Issue 3 - p 512 doi: 10.1097/01.scs.0000171972.21808.0a

Intravenous verapamil therapy in imminent myocardial infarction.

We studied 16 patients with small myocardial infarction who had further episodes of chest pain with ST-segment elevation, a sign of transmural myocardial ischemia and imminent infarction extension. Coronary angiography in 14 showed a critical lesion in 13. Intravenous verapamil abolished chest pain and ST-segment elevation. It caused a fall in right atrial and left ventricular end-diastolic pressures (LVEDP) and cardiac output, reflex systemic vasoconstriction, and a rise in systemic vascular resistance. There was no reflex tachycardia. Volume expansion raised LVEDP and restored a normal cardiac output. Accelerated junctional rhythm with isorhythmic A-V dissociation occurred in 5 patients. Two patients sustained a transmural infarction, 10 underwent coronary artery bypass grafting, and 4 are symptom-free with oral treatment. Intravenous treatment was an effective method of treating acute episodes of transmural myocardial ischemia and preventing their recurrence in patients with critical coronary artery narrowing. Continuous verapamil infusion stabilized the patients' condition and enabled smooth coronary angiography and induction of anesthesia for surgery.

Surgically remediable complications of myocardial infarction

S HOCK and ventricular failure after acute myocardial infarction generally are related to the degree of loss of contractile muscle and therefore complicate large infarctions or repeated infarction of previously damaged hearts.’ Less frequent but often more dramatic complications of acute infarction follow disruption of strategic structures, such as the interventricular septum or papillary muscles, producing shock and acute or chronic ventricular failure. Infarction of the free wall may be followed by acute rupture or by the development of chronic and sometimes disabling aneurysms. Surgical correction of septal and papillary muscle rupture and of chronic aneurysms antedated coronary artery bypass grafting, and the indications for surgery have become more clearly defined. The management of patients with these complications in the critical period preceding operation has also evolved considerably in recent years. Catheterization of the right heart at the bedside now permits rapid diagnosis of acute septal or papillary muscle rupture and allows continuous monitoring of the effects of treatment with vasodilators, intraaortic balloon counterpulsation, and inotropic or systemic pressor agents.‘.3 Such monitoring helps to predict the need for emergent surgery. Radionuclide imaging methods are of increasing help in estimating ventricular function and assessing wall motion4.’ Definitive cardiac catheterization, with ventriculography and coronary angiography, has proved safe even after recent infarction.h Induction of anesthesia for surgery has been improved by monitoring of right heart pressures and by the use of vasodilators and intraaortic balloon counterpulsation when needed. Early physiologic and pathologic changes in the infarcted heart determine the proper timing of surgical therapy and are therefore reviewed briefly here.

Radiologic and clinical evaluation of pheochromocytoma in children: report of 6 cases.

Pheochromocytomas arise from the chromaffin tissue of the adrenal medulla and paraspinal sympathetic ganglia. These tumors in rare instances occur in the brain (1) and neck (2) and, in a few cases, the bladder (3). Fewer than 5 per cent are found in the pediatric age group (4), and little has appeared in the radiologic literature about their manifestations in childhood. Approximately 100 cases of pheochromocytoma were reported in children by 1963 (5–7), the first case by Marchetti in 1904 (8). This paper describes 6 new cases in children and reviews briefly the clinical and roentgen features of childhood pheochromocytoma. Case Reports Case I: A n-year-old girl was admitted for evaluation of enuresis and high blood pressure of six months duration. Nose bleeds and headaches had been frequent since the age of five, and she had lost weight in recent months. Her father suffered from hypertension. Physical examination revealed a Grade III harsh systolic murmur to the left of the sternal border, as well as slight retinal arteriolar spasm. Her blood pressure was 140/110 with no difference between the arms and the legs. Fasting blood sugar was, on separate occasions, 120 mg per 100 cc and 94 mg per 100 cc, and the glucose tolerance test was abnormal. Urinary VMA (vanillyl mandelic acid) was elevated. Intravenous urography showed the right kidney to be slightly lower and 3 em shorter than the left, without a difference in rate of excretion of contrast material (Fig. 1). Aortography, using the Seldinger technic, demonstrated a mass in the right adrenal gland (Fig. 2). In the arterial phase, hypertrophied inferior suprarenal arteries supplied the pheochromocytoma. There was slight superior indentation of the distal half of the right renal artery, which was decreased in caliber by the adjacent tumor. In the late arterial phase, multiple irregularly arranged tumor vessels were seen. Still later an intense tumor blush outlined the lesion. During the induction of anesthesia for surgery, a hypertensive crisis and then shock developed. Blood transfusions were given, and pulmonary edema ensued. The patient recovered from these complications and was subjected to exploratory surgery ten days later after preoperative preparation with oral phentolamine (Regitine); a 3-cm pheochromocytoma was removed from the right suprarenal gland. The child's blood pressure fell postoperatively to 120/80, and her VMA excretion also became normal. Case II: This 9-year-old boy came to the Children's Clinic for repair of an inguinal hernia and an undescended testicle. He had been listless and tired for a few years, and his appetite was poor. He also complained of episodes of mild-to-moderate chest pain over the precordium, left anterior chest, and left scapula. These pains often occurred after vigorous activity. He was pale and seemed to have a rapid heart beat during these episodes.