Patients with Treacher Collins Syndrome (TCS) present unique airway management problems for anesthesiologists due to mandibular micrognathia, the small oral aperture, and temporomandibular joint anomalies. We describe...Patients with Treacher Collins Syndrome (TCS) present unique airway management problems for anesthesiologists due to mandibular micrognathia, the small oral aperture, and temporomandibular joint anomalies. We describe the case of a pediatric TCS patient with limited mouth opening who experienced severe airway obstruction during deep inhalation anesthesia (sevoflurane following i.v. midazolam) for routine dental work. When difficult airway management is expected, intubation of conscious patients is a well-recognized technique in adults;however, it is rarely appropriate for pediatric patients who usually do not cooperate. According to general anesthesia algorithms for pediatric patients with difficult airways, in most pediatric patients, tracheal intubation is performed after the induction of general anesthesia and some authors have reported the usefulness of LMA for maintaining airway patency in patients with TCS. However, in our case LMA could not be used because of severe limitation of mouth opening. In addition, the LMA is so bulky that it is impossible to insert a LMA into patients with narrow airway anatomy. We initially planned to carry out fiber-optic intubation while awake and under sedation if the airway patency could not be secured after the induction of anesthesia. The patient was sedated properly with midazolam and sevoflurane, and awake fiberoptic intubation was performed uneventfully. Our experience in this case highlighted that careful planning of backup contingencies is important in achieving fiberoptic intubation and maintaining airway patency in pediatric TCS patients with limited mouth opening, and that awake intubation can be successful even in pediatric patients.展开更多
Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused...Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate.Increases in systolic blood pressure（SBP） and heart rate（HR） were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg？kg 21 ？h 21.This response was associated with an increase in the low-frequency band of SBP variability（SBP-LF）.As the infusion rate increased to 10 mg？kg 21 ？h 21 or more,decreases in SBP and HR were observed.This response was associated with the reduction of SBP-LF.In conclusion,lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects,depending on the depth of pentobarbital anesthesia.The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.展开更多
文摘Patients with Treacher Collins Syndrome (TCS) present unique airway management problems for anesthesiologists due to mandibular micrognathia, the small oral aperture, and temporomandibular joint anomalies. We describe the case of a pediatric TCS patient with limited mouth opening who experienced severe airway obstruction during deep inhalation anesthesia (sevoflurane following i.v. midazolam) for routine dental work. When difficult airway management is expected, intubation of conscious patients is a well-recognized technique in adults;however, it is rarely appropriate for pediatric patients who usually do not cooperate. According to general anesthesia algorithms for pediatric patients with difficult airways, in most pediatric patients, tracheal intubation is performed after the induction of general anesthesia and some authors have reported the usefulness of LMA for maintaining airway patency in patients with TCS. However, in our case LMA could not be used because of severe limitation of mouth opening. In addition, the LMA is so bulky that it is impossible to insert a LMA into patients with narrow airway anatomy. We initially planned to carry out fiber-optic intubation while awake and under sedation if the airway patency could not be secured after the induction of anesthesia. The patient was sedated properly with midazolam and sevoflurane, and awake fiberoptic intubation was performed uneventfully. Our experience in this case highlighted that careful planning of backup contingencies is important in achieving fiberoptic intubation and maintaining airway patency in pediatric TCS patients with limited mouth opening, and that awake intubation can be successful even in pediatric patients.
基金financially supported by our department (Department of DentalAnesthesiology,Osaka University Graduate School of Dentistry)
文摘Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses;however,the effects of anesthesia with pentobarbital sodium on these responses are unclear.Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate.Increases in systolic blood pressure（SBP） and heart rate（HR） were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg？kg 21 ？h 21.This response was associated with an increase in the low-frequency band of SBP variability（SBP-LF）.As the infusion rate increased to 10 mg？kg 21 ？h 21 or more,decreases in SBP and HR were observed.This response was associated with the reduction of SBP-LF.In conclusion,lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects,depending on the depth of pentobarbital anesthesia.The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.
