Hypoalbuminemia-Related Prolonged Sedation After General Anesthesia: A Case Report

Saad, Mary; Clec'h, Bénédicte Le; Dhonneur, Gilles

doi:10.1213/xaa.0000000000001180

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…First of all, Saad et al (2020) strongly highlighted the importance of preoperative malnutrition screening and management for the risk of anesthetic overdose. In our case, the girl has hypoalbuminemia with underlying protein-losing enteropathy.…”

Section: Discussionmentioning

confidence: 99%

Case report: The art of anesthesiology—Approaching a minor procedure in a child with MPI-CDG

Chang

Tsai

et al. 2022

Front. Pharmacol.

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Background: Protein glycosylation plays an important role in post-translational modification, which defines a broad spectrum of protein functions. Accordingly, infants with a congenital disorder of glycosylation (CDG) can have N-glycosylation, O-glycosylation, or combined N- and O-glycosylation defects, resulting in similar but different multisystem involvement. CDGs can present notable gastrointestinal and neurologic symptoms. Both protein-losing enteropathy and hypotonia affect the decision of using anesthetics. We reported a case of MPI-CDG with protein-losing enteropathy and muscular hypotonia that underwent different anesthesia approach strategies of vascular access. Here, we highlight why intubation with sevoflurane anesthesia and sparing use of muscle relaxants is the optimal strategy for such a condition.Case presentation: A 25-month-old girl, weighing 6.6 kg and 64 cm tall, suffered chronic diarrhea, hypoalbuminemia, and hypotonia since birth. Protein-losing enteropathy due to MPI-CDG was documented by whole-exome sequencing. She underwent three sedated surgical procedures in our hospital. The sedation was administered twice by pediatricians with oral chloral hydrate, intravenous midazolam, and ketamine, to which the patient showed moderate to late recovery from sedation and irritability the following night. The most recent one was administered by an anesthesiologist, where endotracheal intubation was performed with sevoflurane as the main anesthetic. The patient regained consciousness immediately after the operation. She had no complications after all three sedation/anesthesia interventions and was discharged 7 days later, uneventful after the third general anesthesia procedure.Conclusion: We performed safe anesthetic management in a 25-month-old girl with MPI-CDG using sevoflurane under controlled ventilation. She awoke immediately after the procedure. Due to the disease entity, we suggested bypassing the intravenous route to avoid excess volume for drug administration and that muscle relaxant may not be necessary for endotracheal intubation and patient immobilization when performing procedures under general anesthesia in CDG patients.

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Section: Discussionmentioning

confidence: 99%

Case report: The art of anesthesiology—Approaching a minor procedure in a child with MPI-CDG

Chang

Tsai

et al. 2022

Front. Pharmacol.

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“…Some agitated and aggressive patients require benzodiazepine therapy such as diazepam or lorazepam. If tachycardia, hallucinations, and hypertension do not improve within 2-3 hours with the above treatment, they should be treated accordingly [143,144]. There is no specific treatment for patients who abuse ketamine.…”

Section: Ketamine Abusementioning

confidence: 99%

Ketamine, an Old–New Drug: Uses and Abuses

Savić Vujović,

Jotić,

Medić

et al. 2023

Preprint

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Ketamine as an old - new drug has variety of clinical implications. In the last 30 years, ketamine has become popular for acute use in humans. Ketamine at standard doses is principally utilized for the induction and maintenance in surgical procedures. Beside its use in anesthesia and analgesia, recently studies had shown that ketamine find the place in the treatment of asthma, epilepsy, depression, bipolar affective disorders, alcohol and heroin addiction. Its mechanism of action is complex, but it mostly acts as a noncompetitive antagonist at the N-methyl-D-aspartate (NMDA) receptor. Ketamine is generally considered relatively secure and does not result in serious adverse effects when used at low doses and for short periods- Also, ketamine is known as a powerful psychostimulant. During the past decade, ketamine has been one of the commonly abused drug.

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“…Some agitated and aggressive patients require benzodiazepine therapy such as diazepam or lorazepam. If tachycardia, hallucinations, and hypertension do not improve within 2–3 h with the above treatment, they should be treated accordingly [ 153 , 154 ]. Patients engaging in ketamine abuse do not have a specific treatment.…”

Section: Ketamine Abusementioning

confidence: 99%

Ketamine, an Old–New Drug: Uses and Abuses

Savić Vujović,

Jotić,

Medić

et al. 2023

Pharmaceuticals

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Ketamine as an old–new drug has a variety of clinical implications. In the last 30 years, ketamine has become popular for acute use in humans. Ketamine in standard doses is principally utilized for the induction and maintenance of surgical procedures. Besides its use in anesthesia and analgesia, recent studies have shown that ketamine has found a place in the treatment of asthma, epilepsy, depression, bipolar affective disorders, alcohol and heroin addiction. Ketamine primarily functions as a noncompetitive antagonist targeting the N-methyl-D-aspartate (NMDA) receptor, but its mechanism of action is complex. It is generally regarded as safe, with low doses and short-term use typically not leading to significant adverse effects. Also, ketamine is known as a powerful psychostimulant. During the past decade, ketamine has been one of the commonly abused drugs.

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Hypoalbuminemia-Related Prolonged Sedation After General Anesthesia: A Case Report

Cited by 4 publications

References 9 publications

Case report: The art of anesthesiology—Approaching a minor procedure in a child with MPI-CDG

Case report: The art of anesthesiology—Approaching a minor procedure in a child with MPI-CDG

Ketamine, an Old–New Drug: Uses and Abuses

Ketamine, an Old–New Drug: Uses and Abuses

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