Anesthetic challenges and successful management of a child with Pelizaeus–Merzbacher disease using general and caudal anesthesia

Kapoor, Ravish; Zavala, Acsa M.; Meter, Antoinette Van; Williams, Uduak Ursula; Porche, Vivian H.; Owusu-Agyemang, Pascal

doi:10.4103/joacp.joacp_329_17

Cited by 2 publications

(6 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In pediatric anesthesia, sevoflurane is considered ideal for induction and maintenance of anesthesia due to rapid induction and postoperative awakening without respiratory depression, but the child is highly predisposed to agitation during the awakening period [ 5 ]. Dexmedetomidine provides effective cardiovascular effects, analgesia, and sedation and therefore has been increasingly used in clinical anesthesia in recent years [ 6 ]. Postoperative pain, agitation, and difficulty in cooperation after pediatric circumcision are disadvantageous to the rapid postoperative recovery and prolonged hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…The ultrasound visualization technique applied to nerve block improves the blocking effect and reduces the damage to neurovascular and surrounding tissues and organs. Studies have shown that ultrasound-guided dorsal penile nerve blocks are effective for analgesia with a low incidence of adverse effects [ 6 – 8 ]. Dexmedetomidine is a highly selective α 2 agonist ( α 2: α 1 = 1 620 : 1) with sedative, analgesic, and anxiolytic effects.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Yao

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

Objective. To assess the efficacy of dexmedetomidine anesthesia plus dorsal penile nerve block in pediatric circumcision. Methods. In this retrospective study, 80 children receiving circumcision in our hospital from February 2020 to February 2021 were recruited and assigned via different anesthesia methods at a ratio of 1 : 1 to receive dorsal penile nerve block plus dexmedetomidine anesthesia (combined anesthesia group) or only sevoflurane for total inhalational anesthesia (total anesthesia group). Traditional Chinese medicine (TCM) care was introduced to both groups of patients. Outcome measures included vital signs, operative indices, anesthesia effect, adverse reactions, parent satisfaction, and nursing satisfaction. Results. There were no significant differences in the heart rate, oxygen saturation, and mean arterial pressure between the two groups of children before anesthesia, after anesthesia, and during the awakening period ( P > 0.05 ). Patients receiving combined anesthesia showed a shorter time lapse before the disappearance of eyelash reflex, longer time lapse before postoperative analgesic use, faster awakening, and shorter operation time and hospital stay versus those receiving total inhalational anesthesia alone ( P > 0.05 ). The combined anesthesia resulted in a lower Induction Compliance Checklist (ICC) score, McGill score, and Richmond Agitation-Sedation Scale (RASS) score and a higher Ramsay score versus total anesthesia ( P > 0.05 ). Patients receiving combined anesthesia showed a significantly lower incidence of adverse events (5.00% (2/40)) versus total inhalational anesthesia (62.50% (25/40)) (X2 = 29.574, P > 0.05 ). The combined anesthesia group had a higher parent satisfaction (92.50% (37/40)) versus the total anesthesia group (75.00% (30/40)) (X2 = 4.501, P > 0.05 ). A total of 80 questionnaires were distributed, with a 100% return rate and a 100% validity rate, and all 80 questionnaires scored 90 points or above. The families of children in both groups were satisfied with the quality of TCM care. Conclusion. The efficacy of dorsal penile nerve block plus dexmedetomidine anesthesia in pediatric circumcision is better than total inhalational anesthesia with sevoflurane.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Yao

Wang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

show abstract

“…There are no restrictions on the use of anesthetic agents and analgesics in general anesthesia in patients with PMD [8]. However, suxamethonium can cause unpredictable reactions such as hyperkalemia and should be avoided in rapid induction [4][5][6][7][8]. Considerations in anesthesia should include efforts to prevent complications associated with abnormal muscle tone due to spasticity, airway complications due to decreased pharyngeal muscle strength, aspiration, and convulsions.…”

Section: Discussionmentioning

confidence: 99%

“…Because the incidence of PMD is extremely low, only a few case reports have been published regarding its anesthetic management [4][5][6][7][8]. In particular, epidural anesthesia has only been reported in one case of general anesthesia combined with caudal anesthesia [5]. In this report, we describe a case of general anesthesia combined with epidural anesthesia and postoperative continuous epidural analgesia in a pediatric patient with PMD.…”

Section: Introductionmentioning

confidence: 93%

“…The frequency in Europe and the United States is reported to be one in 200,000 to 500,000 live births and the number of patients in Japan is estimated to be about 200 [3]. Because the incidence of PMD is extremely low, only a few case reports have been published regarding its anesthetic management [4][5][6][7][8]. In particular, epidural anesthesia has only been reported in one case of general anesthesia combined with caudal anesthesia [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidural Anesthesia and Continuous Epidural Analgesia in a Pediatric Patient With Pelizaeus-Merzbacher Disease: A Case Report

Maruta¹,

Watanabe²,

Nagata³

et al. 2022

Cureus

View full text Add to dashboard Cite

Pelizaeus-Merzbacher disease (PMD) is a genetic leukodystrophy, which is a progressive and degenerative central nervous system abnormality caused by dysmyelination. Because the incidence of PMD is extremely low, only a few case reports have been published regarding its anesthetic management. In particular, epidural anesthesia has only been reported in one case of general anesthesia combined with caudal anesthesia. We performed general anesthesia combined with epidural anesthesia for the soft-tissue release surgery for bilateral hip subluxation in a six-year-old male patient diagnosed with PMD. General anesthesia was induced with sevoflurane in nitrous oxide and oxygen. Rocuronium was administered to facilitate tracheal intubation. After intubation, general anesthesia was maintained with sevoflurane in the air and oxygen. An epidural catheter was placed from L3/4. For epidural anesthesia and analgesia, 1% mepivacaine was used as needed, and 2 ml/h of 0.2% ropivacaine was started one hour before the end of surgery. During surgery, only epidural analgesia was provided as postoperative analgesia, and the patient did not complain of pain after extubation. Anesthesia lasted three hours and 55 minutes. No significant hemodynamic or respiratory changes occurred. Postoperatively, the patient received continuous epidural analgesia and regular oral acetaminophen, and pain control was good. The epidural catheter was removed on the second postoperative day. The postoperative course was good, and the patient was transferred to a pediatric rehabilitation hospital on the fifth postoperative day. No adverse events occurred and no neurological deficits were observed during hospitalization. In conclusion, anesthesiologists should pay attention to the possibility of perioperative aspiration, spasticity, and seizure, even with mild PMD. Proper preoperative evaluations, intraoperative monitoring, and anesthetic techniques will ensure safe anesthesia for PMD patients. Although regional anesthesia in patients with pre-existing neurologic deficits is controversial, we were able to safely perform epidural anesthesia and postoperative continuous epidural analgesia in a pediatric patient with PMD.

show abstract

Anesthetic challenges and successful management of a child with Pelizaeus–Merzbacher disease using general and caudal anesthesia

Cited by 2 publications

References 1 publication

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

Epidural Anesthesia and Continuous Epidural Analgesia in a Pediatric Patient With Pelizaeus-Merzbacher Disease: A Case Report

Contact Info

Product

Resources

About