Anaesthetic considerations in a child with fibrodysplasia ossificans progressiva

Kleyenstuber, Thomas

doi:10.1080/22201181.2018.1517918

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…В розвинених країнах ПГПТ займає 3 місце за поширеністю серед ендокринних хвороб після цукрового діабету та захворювань щитоподібної залози [6]. Враховуючи сукупність факторів, які включають прояв та перебіг ПГПТ, лікар стикається з складністю тактики лікування та ведення таких пацієнтів, з високим ризиком ускладнень (частіше, інтрата післяопераційних) [7,8]. Важливо врахувати призначення медикаментів у пацієнтів з ПГПТ.…”

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Primary Hyperparathyroidism: Optimization of Anaesthesia

Tarasenko¹,

Дубров²,

Palamarchuk³

et al. 2021

Pain Anaesth Int Care

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Background and Aims. The majority of cases of primary hyperparathyreosis (PHPT) due to solitary adenoma and require the target surgery. Research of new anesthesia/analgesia methods, which afford to have an opioid-sparing effect, is going. Methods. 127 patients with PHPT were divided into 3 groups: the group STI-BCSPB (n=26) was used combined general anesthesia (GA) with sevoflurane (SEV), the tracheal intubation (TI) with the myorelaxant introduction and bilateral cervical superficial plexus blockade (BCSPB); the group STI (n=82) was used SEV anaesthesia with IT and no BCSPB; the group PLM-BCSPB (n=19) was provided propofol (P) GA with protection air-ways by laryngeal mask (LM) and BCSPB. In both groups (STI-BCSPB and PLM-BCSPB) were used co-analgesics, such as dexamethasone (DXM) 8 mg IV, 2% lidocaine (L) 1,0-1,5 mg/kg IV, metamizole (M) or paracetamol (P) 1 g IV, dexketoprofen (DKTP) 50 mg IV as pre-emptive analgesia 30 min before surgery. Ketamine 25 mg IV was used for induction anaesthesia in these groups. In STI group only opioid with P were used for induction of GA. Duration of surgery (DoS), anaesthesia (DoA), opioid consumption, time from the operation ending until the eyes opening (EyOp), desaturation was measured. All data M±m Results. DoS for STI-BCSPB, STI and PLM-BCSPB was respectively 38.7±2.7, 37.8±1.3 and 35.6±1.7 min (NS), DoA was respectively 63.8±3.1, 59.4±1.4 m and 53,8±2.7 min (p= 0.028 STI vs PLM-BCSPB, p= 0.024 STI-BCSPB vs PLM-BCSPB, the difference is significant (DS). EyOp was 15.4±1.1, 15.6±1.2 and 11.6±0.9 min respectively for STI-BCSPB, STI and PLM-BCSPB (p=0.022 STI vs PLM-BCSPB (DS) and p=0.025 STI-BCSPB vs PLM-BCSPB (DS). Desaturation (SpO2 below 92%) due to residual sedation and the effect of muscles relaxants was observed in 39 (47.6%) and 11 (42,3%) patients in STI and STI-BCSPB during the first 30 min postop compared to 2 cases (10.5%) in PLM-BCSPB (both STI groups were DS vs PLM-BCSPB, chi-square test). The dose of intra-op fentanyl was 334.3±17.1, 256.5±16.9 197.3±15.3 mcg in STI, STI-BCSPB and PLM-BCSPB respectively, (DS for PLM-BCSPB vs other groups, DS between STI groups). Conclusions. Combine methods GA with BCSPB have some benefits over mono GA. Co-analgesics afford to achieve an opioidsparing effect. Under ectomy of single parathyroid adenoma, the use of propofol and BSCPB with the laryngeal mask without muscles relaxants seems more preferable compared to sevoflurane anesthesia with BBSCP and tracheal intubation due to the shorter anesthesia duration, time to eye-opening after surgery, lower desaturation frequency.

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Primary Hyperparathyroidism: Optimization of Anaesthesia

Tarasenko¹,

Дубров²,

Palamarchuk³

et al. 2021

Pain Anaesth Int Care

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Tracheostomy for the pediatric patient with fibrodysplasia ossificans progressiva: a case report

Kobayashi,

Hirai,

Suzuki

et al. 2024

surg case rep

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Background Fibrodysplasia ossificans progressiva (FOP) is an extremely rare connective tissue disease characterized by subsequent ossification of skeletal muscles, tendons, ligaments, and other fibrous tissues. The ossification of these tissues progresses during childhood and leads to limb and trunk deformities. Since any surgery may trigger subsequent ossification, it is relatively contraindicated for patients with FOP. In this report, we describe our experience in performing tracheostomy in a pediatric patient with FOP who developed a restrictive respiratory disorder due to progressive deformity of the trunk. Case presentation A 12-year-old boy, diagnosed with FOP at the age of one, was referred for a tracheotomy after requiring 2 months of oral intubation and mechanical ventilation due to severe deformity-induced dyspnea. After changing from oral intubation to nasal intubation, we carefully considered the indications and benefits of tracheostomy in patients with FOP. Eventually, tracheostomy was successfully performed using our surgical design: creating a skin incision at the level of the cricoid cartilage that can always be identified, creating inverted U-shaped incision on the anterior tracheal wall to make a flap, and suturing the entire circumference of the tracheotomy and skin. One month after the surgery, he regained normal breathing and pronunciation and returned to school. The patient showed no unfavorable postoperative outcomes over a 4-year follow-up period. Conclusions Tracheostomy in our pediatric case of FOP required careful perioperative management. However, it could effectively improve the patient’s quality of life.

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Anaesthetic considerations in a child with fibrodysplasia ossificans progressiva

Cited by 2 publications

References 32 publications

Primary Hyperparathyroidism: Optimization of Anaesthesia

Primary Hyperparathyroidism: Optimization of Anaesthesia

Tracheostomy for the pediatric patient with fibrodysplasia ossificans progressiva: a case report

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