Pain on injection of rocuronium in pediatric patients can be alleviated by pretreatment with i.v. lidocaine.

No abstract

Treacher Collins syndrome (TCS) is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. The mechanism of inheritance is autosomal dominant with variable expressivity. Because of this variability in expression, some affected individuals exhibit virtually no overt clinical manifestations. However, most children with TCS present with the following classic facial features: down-sloping palpebral fissures, colobomata of the lower eyelid, scanty lower eyelashes, malar hypoplasia, and micro- or retrognathia. Cleft palate is present in up to 35% of patients and an additional 30-40% have congenital palatopharyngeal incompetence. Abnormalities of the ear are very common and vary from minor malformations to severe microtia and hearing loss. Hearing loss may be due to atresia of the auditory canals or ossicular malformation of the middle ear. Despite these many development abnormalities, TCS patients are usually of normal intelligence. We report the case of a 3 1/2-yr-old patient with TCS undergoing cleft palate repair and discuss fiberoptic intubation through a laryngeal mask airway using two endotracheal (ETT) tubes secured via an ETT connector.

Purpose: Living organ donation is being performed with increasing frequency to overcome the shortage of organs for transplantation. Our experience in the anesthetic management of donors with relevant issues is discussed and complications encountered are recorded. Methods: Data were collected retrospectively and analyzed on all 22 left lateral hepatectomies performed at our institution between 1993 to 1997 for transplantation. ]~lts Major ethical concern was the risk to the donors and anesthetic issues were those of a major abdominal procedure. All except four donors were parents (mother/father). Average blood loss was 805 _+ 479 ml and only two donors required blood transfusion. Mean operative time was 8.2 -+ 1.5 hr. Thoracic epidural analgesia was the most commonly adopted mode of pain relief. Average time to return of bowel sound postoperatively was 3. I ___ 1.0 days and was not influenced by the postoperative analgesic technique used. Total duration of hospital stay was 8.4 _ I. I days. Three donors developed minor postoperative complications atrial fibrillation and retained JP drain; left lower lobe pneumonia; and incisional hernia. All patients recovered uneventfully. Concision: Living organ donors contribute towards decreasing the shortage of organs for transplantation. Minimizing the discomfort associated with the surgical intervention and providing a complication-free perioperative course will positively influence the continued availability of such donations. On review of the first 22 left lateral hapatectomies performed, we observed only minor complications. Postoperative pain was a serious problem and thoracic epidural provided satisfactory analgesia.Objectis Le don d'organe vivant se fait de plus en plus souvent en raison du manque d'organes pour la transplantation. Notre exp&ience de I'anesth&ie des donneurs ainsi que les questions qui y sont pertinentes sont examin6es et les complications qui surviennent sont pr&ent~es. M(:thode : Une collecte r&rospective suivie d'une analyse des donn~es des 22 h6patectomies lat&ales gauches r~alisEes pour la transplantation entre 1993 et 1997 ~ notre institution. ~ltats :Notre principale souci &hique a EtE celui du risque encouru par les donneurs, etnos choix anesth&iques, ceux d'une intervention abdominale majeure. Les donneurs, sauf quatre, &aient des parents (m&e/p&e). La perte sanguine moyenne a &6 de 805 -479 ml, et deux donneurs ont eu besoin de transfusion. Le temps moyen de I'op&ation a ~t~ de 8,2 -1,5 h. I'analg&ie ~pidurale thoracique a &6 privil6gi& comme traitement de la douleur. Le temps moyen n6cessaire au retour des bruits intestinaux postop6ratoires a EtE de 3, I _ 1,0 jours peu importe la technique analg6sique postop6ratoire utilis~e. La dur& totale du s~jour hospitalier a &~ de 8,4 -+ I, I jours. Trois donneurs ont d~velopp6 des complications postop&atoires mineures de fibrillation auriculaire et de r&ention du drain de Jackson-Pratt, de pneumonie du lobe inf&ieur gauche et de hernie au site de I'incision. Tous les patients se sont r&ablis sans i...