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Our Experience With Regional Anesthesia in a Case of Pierre Robin Syndrome.

Onal O, Zora ME, Saltali A, Bozdogan S, Bengi Celik J - Anesth Pain Med (2016)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Reanimation, Selcuk University Medical Faculty, Konya, Turkey.

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Pierre-Robin Syndrome (PRS) is characterized by micrognathia, glossoptosis, and a “u-shaped” cleft palate... Neonates with PRS present with respiratory obstruction varying from mild to severe directly after birth or during the first week of life... A sufficiently severe obstruction can result in obstructive apnea, hypoxia, failure to thrive, and death... We report a case of a patient with PRS who could not be intubated previously and who had a history of tracheostomy; this patient was scheduled to undergo an operation for hip dysplasia... An 8-year-old boy weighing 18 kg and diagnosed with PRS underwent preoperative evaluation that revealed restricted mouth opening, micrognathia, short extremities, mild airway obstruction, and respiratory distress (Figure 1)... His Mallampati score was 3, his head-neck extension was comfortable, and his thyromental distance was within the normal range... Preoperative laboratory and imaging tests yielded normal results... Airway obstruction is caused by the presence of glossoptosis, in addition to cleft palate and micrognathia with retrognati... No problems were encountered with mask use in our case, so an I-gel was placed under propofol anesthesia without using any muscle relaxants, and a spinal block was carried out for postoperative analgesia... The intubation and extubation of PRS cases requires special care, and preoperative monitoring is warranted... For operations under the umbilicus, regional anesthesia can be a good alternative in children who are at high risk from general anesthesia... In fact, previous studies have demonstrated that regional anesthesia is a safe alternative in neonates.

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Image of the Patient After Extubation
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fig27453: Image of the Patient After Extubation

Mentions: His Mallampati score was 3, his head-neck extension was comfortable, and his thyromental distance was within the normal range. Preoperative laboratory and imaging tests yielded normal results. This patient had a history of difficult intubation, and tracheostomy preparations were made to allow for a difficult intubation. The patient had no other known diseases and conditions that contraindicated spinal anesthesia (SA). Preoxygenation was performed under routine monitoring. The patient’s baseline heart rate was 131 beats min-1, his blood pressure was 112/64 mmHg, and his SpO2 was 94%. Premedication and amnesia treatment consisted of administration of 10 mg midazolam (Dormicum, Roche, Istanbul, Turkey) intranasal 10 minutes prior to the procedure. The patient was then administered 2 mg/kg propofol, 25 µg fentanyl (Talinat, Vem Ilac, Istanbul, Turkey), and 40 mg methylprednisolone (Prednol-l, Mustafa Nevzat, Istanbul, Turkey) intravenously. A no. 2.0 I-gel was placed while the patient was in the supine position, and the patient was then placed in a lateral decubitus position. The skin was prepared with antiseptic and a spinal block was carried out by administering 0.4 mg/kg hyperbaric bupivacaine to the L4-5 vertebral space, as described previously (4) (Figures 2 and 3).


Our Experience With Regional Anesthesia in a Case of Pierre Robin Syndrome.

Onal O, Zora ME, Saltali A, Bozdogan S, Bengi Celik J - Anesth Pain Med (2016)

Image of the Patient After Extubation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834743&req=5

fig27453: Image of the Patient After Extubation
Mentions: His Mallampati score was 3, his head-neck extension was comfortable, and his thyromental distance was within the normal range. Preoperative laboratory and imaging tests yielded normal results. This patient had a history of difficult intubation, and tracheostomy preparations were made to allow for a difficult intubation. The patient had no other known diseases and conditions that contraindicated spinal anesthesia (SA). Preoxygenation was performed under routine monitoring. The patient’s baseline heart rate was 131 beats min-1, his blood pressure was 112/64 mmHg, and his SpO2 was 94%. Premedication and amnesia treatment consisted of administration of 10 mg midazolam (Dormicum, Roche, Istanbul, Turkey) intranasal 10 minutes prior to the procedure. The patient was then administered 2 mg/kg propofol, 25 µg fentanyl (Talinat, Vem Ilac, Istanbul, Turkey), and 40 mg methylprednisolone (Prednol-l, Mustafa Nevzat, Istanbul, Turkey) intravenously. A no. 2.0 I-gel was placed while the patient was in the supine position, and the patient was then placed in a lateral decubitus position. The skin was prepared with antiseptic and a spinal block was carried out by administering 0.4 mg/kg hyperbaric bupivacaine to the L4-5 vertebral space, as described previously (4) (Figures 2 and 3).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Reanimation, Selcuk University Medical Faculty, Konya, Turkey.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Pierre-Robin Syndrome (PRS) is characterized by micrognathia, glossoptosis, and a “u-shaped” cleft palate... Neonates with PRS present with respiratory obstruction varying from mild to severe directly after birth or during the first week of life... A sufficiently severe obstruction can result in obstructive apnea, hypoxia, failure to thrive, and death... We report a case of a patient with PRS who could not be intubated previously and who had a history of tracheostomy; this patient was scheduled to undergo an operation for hip dysplasia... An 8-year-old boy weighing 18 kg and diagnosed with PRS underwent preoperative evaluation that revealed restricted mouth opening, micrognathia, short extremities, mild airway obstruction, and respiratory distress (Figure 1)... His Mallampati score was 3, his head-neck extension was comfortable, and his thyromental distance was within the normal range... Preoperative laboratory and imaging tests yielded normal results... Airway obstruction is caused by the presence of glossoptosis, in addition to cleft palate and micrognathia with retrognati... No problems were encountered with mask use in our case, so an I-gel was placed under propofol anesthesia without using any muscle relaxants, and a spinal block was carried out for postoperative analgesia... The intubation and extubation of PRS cases requires special care, and preoperative monitoring is warranted... For operations under the umbilicus, regional anesthesia can be a good alternative in children who are at high risk from general anesthesia... In fact, previous studies have demonstrated that regional anesthesia is a safe alternative in neonates.

No MeSH data available.