Achondroplasia is associated with craniofacial abnormality, musculoskeletal deformations, and respiratory, cardiovascular abnormalities. So, anesthetic management is one of clinical challenges. Herein, we report and discuss a case of achondroplastic patient underwent osteosynthesis for femur fracture, which was chosen on the base of patient’s anatomical and physiological characteristics. The patient had thoracolumbar kyphosis (21.8°), previous spine surgery, short neck, obstructive sleep apnea, and mild cervical limitation. Intubation was conducted with smaller cuffed endotracheal tube under videolaryngoscope guidance. Mechanical ventilation was applied with volume control mode, using a tidal volume of 8-10 ml/kg without positive end-expiratory pressure. The patient was supine after placing support under shoulders and head during intubation and surgery. Intraoperative body temperature was maintained using air-forced waring blanket. Complete and careful preoperative evaluation is absolutely important to select the appropriate anesthetic method. Ideal anesthetic management in each case should be based on an individualized decision-making.
Brugada syndrome is associated with high risk for sudden death without structural cardiac defects due to ventricular arrhythmias. A 47-years-old man with Brugada syndrome has admitted because of right patella fracture. General anesthesia with sevoflurane and remifentanil was carefully maintained according to the BIS for the maintenance of adequate anesthetic depth and to avoid tachycardia during the surgery. Blood pressure and heart rate of the patient were maintained less than 150/90 mmHg and 100 beat/min perioperatively. There were no adverse events, and the patient was discharged home after ten days.
The optimum concentrations of clove oil as an anesthetic for olive flounder (Paralichthys olivaceus) and the stress response of the fish to clove oil anesthesia were determined over a range of water temperatures, and investigated in a simulated transport experiment using analysis of various water and physiological parameters. While the time for induction of anesthesia decreased significantly as both the concentration of clove oil and water temperature increased, the recovery time increased significantly (P<0.05). The plasma cortisol concentration in fish at each temperature increased significantly up to 12 h following exposure (P<0.05), then decreased to 48 h (P<0.05). The DO dissolved oxygen concentrations, pH values, and the fish respiratory frequencies decreased over 6 h following exposure to clove oil in all experimental groups (P<0.05), whereas the NH4 + and CO2concentrations in all experimental groups increased up to 6 h (P<0.05). The pH values and DO concentrations increased with increasing clove oil concentration (P<0.05) in the 6 h following exposure, and the CO2 and NH4 + concentrations and the respiratory frequencies decreased with increasing clove oil concentration (P<0.05). The results of this experiment suggest that clove oil reduced the metabolic activity of olive flounder, thus reducing NH4 + excretion and O2 consumption. In conclusion, clove oil appears to be a cost-effective and efficient anesthetic that is safe for use and non-toxic to the fish and users. Its use provides the potential for improved transportation of olive flounder.
Wolff-Parkinson-White syndrome (WPW) is a common disorder of the conduction system of the heart. Patients with such disorder may be asymptomatic or present with cardiac symptoms like palpitation and dyspnea. The anesthetic management of these patients is challenging as they are known to develop life threatening tachyarrhythmia. We report a hemodynamic management of a 53-year-old male with WPW syndrome scheduled for laparoscopic cholecystectomy under general anesthesia. We performed total intravenous anesthesia with propofol and remifentanil, and we placed the laryngeal mask airway behind the endotracheal tube using Bailey's Maneuver before extubation of endotracheal tube.
We experienced an 18-month-old patient with congenital lobar emphysema who underwent one-lung ventilation. With con-sideration that positive pressure ventilation could induce cardiopulmonary distress, induction was performed with spontane-ous breathing using sevoflurane without neuromuscular blocking agent. Bronchospasm occurred after intubation and posi-tion change, twice. He was relieved by administration of neuromuscular blocking agents. We discussed induction methods with minimal positive-pressure ventilation and the treatments for bronchospasm.