Osteogenesis imperfecta is an inherited disorder of collagen with skeletal and extraskeletal manifestations that affect airway and anesthetic management of patients with the disease. This paper aimed to report a case of a patient with osteogenesis imperfecta for abdominal hysterectomy, discuss the anesthetic considerations of patients with the disease, describe balanced anesthesia using high dose dexmedetomidine as a primary agent and, use of ProSeal LMA for airway management. A 44- year old female with osteogenesis imperfecta is scheduled for abdominal hysterectomy for molar pregnancy. Airway management was achieved with a ProSeal LMA, and surgery was conducted using balanced anesthesia with high dose dexmedetomidine, midazolam, fentanyl, atracurium and O2- nitrous oxide. Dexmedetomidine was given at concentrations ranging from 0.7 mcg/kg/hr to 3mcg/kg/hr without untoward adverse effects. No complications were observed intraoperatively and in the immediate postoperative period. Dexmedetomidine is demonstrated to be safe and effective when used as part of a balanced anesthesia for patients with osteogenesis imperfecta. Likewise, the airway can be reliably managed with the use of a ProSeal LMA.
Human ; Female ; Adult ; OSTEOGENESIS IMPERFECTA ; DEXMEDETOMIDINE ; ANESTHESIA ; AIRWAY MANAGEMENT

INTRODUCTION: Intrathecal morphine, commonly administered at doses of 100 to 200 mcg, is a popular choice for post-cesarean analgesia; however, a trade-off between opioid analgesia and side effects exists. This study was conducted to determine the lowest dose of intrathecal morphine that will provide adequate analgesia with the least side effects among post-cesarean patients. METHODS: Sixty term parturients for cesarean delivery under spinal anesthesia were randomized into three treatment groups to receive 50, 100 or 150 mcg of intrathecal morphine with a standard multimodal pain regimen and intravenous tramadol as needed. Pain scores, demand for rescue analgesic, and incidence of adverse effects (nausea, vomiting, and pruritus) during the first 24 hours’ post-spinal anesthesia were recorded and compared between groups. RESULTS: Pain scores and demand for rescue doses of tramadol were higher for the 50-mcg group as compared to the other groups. There was no significant difference in pain scores between the 100 and 150-mcg groups. No rescue dose of tramadol was necessary in the 100 and 150-mcg groups. No significant difference was seen in the incidence and severity of nausea and vomiting across treatment groups. The incidence and severity of pruritus were significantly higher in the 150-mcg group. No significant difference was noted in the incidence and severity of pruritus between the 50 and 100-mcg groups. CONCLUSION A dose of 100 mcg of intrathecal morphine, in combination with a multimodal regimen, provides adequate analgesia with the least side effects.
pain management ; Pregnancy ; Female ; Cesarean Section ; Anesthesiology ; Analgesics, Opioid ; morphine

INTRODUCTION: Balanced general anesthesia technique is a popular choice for induction because it can minimize potential side effects from individual drugs when otherwise used alone. However, hypotension is still a common occurrence during induction. Perfusion Index (PI) has been used as a measure of systemic vascular resistance and has shown to predict hypotension after regional anesthesia and propofol induction. This study aimed to determine whether baseline PI can predict hypotension following balanced general anesthesia induction and determine a cut-off value where hypotension is expected to occur. METHODS: Thirty-five ASA I/II adults for elective surgery under general anesthesia were enrolled. Heart rate, blood pressure and PI were measured every minute from baseline to 5 minutes following induction and 10 minutes after endotracheal intubation. Hypotension was defined as fall in systolic BP (SBP) by >30% of baseline and/or mean arterial pressure (MAP) to <60 mmHg. Severe hypotension (MAP of <55 mm Hg) was treated. RESULTS: No hypotension was observed in the first 5 minutes. Within 10 minutes, hypotension occurred in 8.6% by SBP criterion and 2.6% by MAP criterion. Within 15 minutes, hypotension was seen in 5.7% by SBP and MAP criterion, respectively. PI showed very low (r < 0.2) to low (r = 0.2 to 0.39), negative to positive and insignificant correlation (p > 0.05) with hypotension whether using SBP or MAP criterion and whether observed at 10 or 15 minutes of anesthesia induction. The Area under the ROC curve is 0.397, 95% CI [0 .126, 0.667], p = 0.431. CONCLUSION This study lends inconclusive evidence on the usefulness of Innovo Deluxe Fingertip Pulse Oximeter with Plethysmograph and Perfusion Index to predict intraoperative hypotension following balanced general anesthesia induction for this sample of patients. However, there was a positive, moderate (r=0.538, 0.501 and 0.469) and significant (p<0.05) correlation between perfusion index and SBP, Diastolic BP and MAP, respectively.
oximetry ; hypotension ; Anesthesia, General ; arterial pressure ; blood pressure ; Perfusion index