In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized.
Blood Transfusion ; Cardiopulmonary Bypass ; Erythropoietin ; Heart ; Hemoglobins ; Humans ; Infant ; Infant, Newborn ; Iron ; Jehovah's Witnesses ; Oxygen ; Parents ; Thoracic Surgery ; Ultrafiltration ; Wit and Humor as Topic

BACKGROUND: Although Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation. METHODS: Fifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects. RESULTS: There was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008). CONCLUSIONS: In a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.
Airway Management ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Transillumination

No abstract available.
Humans ; Laryngectomy ; One-Lung Ventilation ; Tracheostomy

No abstract available.
Humans ; Spine

Sacroiliac joint block can be performed for the diagnosis and treatment of sacroiliac joint dysfunction. Although sacroiliac joint block is a common procedure, complications have not been reported in detail. We report a case of iliacus pyomyositis and sacroiliac joint infection following a sacroiliac joint block. A 70-year-old female patient received sacroiliac joint blocks to relieve pelvic pain. The patient was admitted to the emergency room two days after the final sacroiliac joint block (SIJB) with the chief complaints of left pelvic pain corresponding to a visual analogue scale (VAS) score of 9 and fever. A pelvic MRI indicated a diagnosis of myositis. After 1 month of continuous antibiotic therapy, the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level remained elevated. A 67Ga SPECT/CT was done. Abnormal uptake was seen at the left sacroiliac joint (SIJ), and septic sacroiliitis was suspected. The CRP normalized to 0.29 mg/dl and the ESR decreased to 60 mm/hr, and the patient had no fever after 57 days of antibiotic therapy. She was directed for follow up at an outpatient clinic.
Ambulatory Care Facilities ; Blood Sedimentation ; C-Reactive Protein ; Emergencies ; Female ; Fever ; Follow-Up Studies ; Humans ; Muscles ; Myositis ; Pelvic Pain ; Pyomyositis ; Sacroiliac Joint ; Sacroiliitis

OBJECTIVE: Children are sedated before undergoing diagnostic imaging tests in emergency medicine or pediatric sedation anesthesia units. The aim of this study was to identify variables potentially affecting the dose of ketamine required for induction of sedation in pediatric patients undergoing diagnostic imaging.METHODS: This retrospective study included children aged 0 to 18 years who underwent sedation with ketamine for computed tomography or magnetic resonance imaging in the pediatric sedation anesthesia unit of a tertiary medical center between January 2011 and August 2016. The children’s hemodynamic status and depth of sedation were monitored during the examination. We recorded data on demographics, categories of imaging tests, ketamine doses administered, adverse events, respiratory interventions, and duration of sedation. Data for patients who experienced adverse events were excluded.RESULTS: Sixty-six patients were included in the final analysis. Univariate linear regression analysis revealed that patient age, height, and body surface area (BSA) affected the sedative dose of ketamine administered. These three variables showed multicollinearity in multivariate linear regression analysis and were analyzed in three separate models. The model with the highest adjusted R-squared value suggested the following equation for determination of the dose of ketamine required to induce sedation: ketamine dose (mg)=-1.62+0.7×age (months)+36.36×BSA (m²).CONCLUSION: Variables such as age and BSA should be considered when estimating the dose of ketamine required for induction of sedation in pediatric patients.
Anesthesia ; Body Surface Area ; Child ; Demography ; Diagnostic Imaging ; Emergency Medicine ; Hemodynamics ; Humans ; Ketamine ; Linear Models ; Magnetic Resonance Imaging ; Patient Care ; Retrospective Studies

Despite of various neurophysiologic monitoring methods under general anesthesia, functional mapping at awake state during brain surgery is helpful for conservation of speech and motor function. But, awake craniotomy in children or adolescents is worrisome considering their emotional friabilities. We present our experience on anesthetic management for awake craniotomy in an adolescent patient. The patient was 16 years old male who would undergo awake craniotomy for removal of brain tumor. Scalp nerve block was done with local anesthetics and we infused propofol and remifentanil with target controlled infusion. The patient endured well and was cooperative before scalp suture, but when surgeon sutured scalp, he complained of pain and was suddenly agitated. We decided change to general anesthesia. Neurosurgeon did full neurologic examinations and there was no neurologic deficit except facial palsy of right side. Facial palsy had improved with time.
Adolescent ; Anesthesia, General ; Anesthetics, Local ; Brain ; Brain Neoplasms ; Child ; Craniotomy ; Dihydroergotamine ; Facial Paralysis ; Humans ; Male ; Nerve Block ; Neurologic Examination ; Neurologic Manifestations ; Piperidines ; Propofol ; Scalp ; Sutures

Tension pneumothorax during ventilating bronchoscopy for foreign body removal is a rare but life-threatening complication. The authors present a case of cardiac arrest caused by tension pneumothorax in a 9-month-old girl who underwent ventilating bronchoscopy for foreign body (peanut) removal. Tension pneumothorax was due to tracheobronchial lacerations caused by a bronchoscope. The patient was successfully resuscitated by cardiopulmonary resuscitation and chest tube insertion. The airway injury was effectively repaired by thoracotomy under extracorporeal membrane oxygenation.
Bronchoscopes ; Bronchoscopy ; Cardiopulmonary Resuscitation ; Chest Tubes ; Extracorporeal Membrane Oxygenation ; Foreign Bodies ; Heart Arrest ; Humans ; Infant ; Lacerations ; Pneumothorax ; Thoracotomy

Transfusion-induced hyperkalemia can lead to cardiac arrest, especially when the patient rapidly receives a large amount of red blood cells (RBCs), previously stored for a long period of time, irradiated or both. We report on a case of application of the Continuous AutoTransfusion System (CATS) to wash RBCs, in order to lower the high potassium (K+) level in the packed RBCs unit, during massive transfusion following transfusion-induced hyperkalemic cardiac arrest. After the washing process using CATS, there was no more electrocardiographic abnormality or cardiac arrest due to hyperkalemia. This case emphasizes the potential risk to develop transfusion-related hyperkalemic cardiac arrest, during massive transfusion of irradiated, pre-stored RBCs. CATS can be effectively used to lower the K+ concentration in the packed RBCs unit, especially when the risk of transfusion-induced hyperkalemia is high.
Animals ; Blood Transfusion ; Blood Transfusion, Autologous ; Cats ; Electrocardiography ; Erythrocytes ; Heart Arrest ; Humans ; Hyperkalemia ; Potassium

BACKGROUND: Patients showed a different response following intravenous midazolam injection. Some children showed irritability or were not sedated by midazolam. We hypothesized that there may be genetic variations of the MDR1 gene, based on the response to midazolam. METHODS: One hundred and ninety-three pediatric patients were recruited in this study. Midazolam (0.1 mg/kg) was injected intravenously before surgery. Anxiety score (activity, vocalizations, emotional expressivity, state of apparent arousal) was checked before and 5 minutes after midazolam injection. In addition, other manifestations after midazolam injection were recorded. After anesthesia, 2 ml of blood was sampled. Children were genotyped MDR1. Haplotype was analyzed using the software package PHASE, version 2.0. RESULTS: The observed frequencies of MDR1 haplotype of TTT, TGC, CAC, CGC were 0.334, 0.205, 0.182 and 0.225, respectively. There was no significant correlation between the response of midazolam and the MDR1 haplotype of TTT, TGC, CAC or CGC (P = 0.98). CONCLUSIONS: Genotyping of MDR1 may not be related to the response of midazolam in children.
Anesthesia ; Anxiety ; Child ; DNA ; Genetic Variation ; Haplotypes ; Humans ; Midazolam ; Polymorphism, Genetic