Anaesthesia and familial dysautonomia with congenital insensitivity to pain

Synopsis of the patient: A six year old boy presented for cosmetic surgery to his nose, which had been fractured some months previously. The trauma had resulted in some deviation of the nasal septum and ugly scarring on the bridge of his nose. Mother explained that he was accident prone and very emotionally labile. Significantly he had developed a compartment syndrome following a tibial fracture at 4 years of age. The fracture went unnoticed initially because he continued to run around unperturbed. His mother was somewhat aggressive and distrustful of the medical fraternity as she had been suspected of child abuse in the past

Anaesthesia for Cleft Lip and Palate Surgery

No Abstrac

Paediatric regional anaesthesia: new developments and improving accuracy

Regional anaesthesia can provide absolute pain relief without the risks of opiate-induced respiratory depression. The purpose of this paper is to (i) provide insight into some new techniques that may improve the success and accuracy of peripheral nerve blocks, with particular reference to the role of nerve mapping, nerve stimulators and portable ultrasound; (ii) introduce methods to reduce the risk of intraneural injection; (iii) suggest methods to prolong the analgesia provided by peripheral nerve blocks, i.e. continuous peripheral nerve catheters appropriate for use in children; and (iv) propose methods to manage local anaesthetic toxicity, with particular reference to the use of intralipid solutions

The child with a runny nose! Upper respiratory tract infection in children: impact on anaesthesia

Some children have on average of six upper respiratory tract infections (URTI) per annum. There are strongly held opinions about the management of these children when they may present for surgery. Anaesthesia practice varies widely and is often based on anecdotal experience. This brief review offers guidelines to address this problem based on some of the recent literature

Anaesthesia and Wolf-Hirschhorn Syndrome

A 4-year-old female, weighing 12kg, presented for ENT and dental examination under anaesthesia. Nasal intubation was requested to facilitate the dental examination. On examination she had the distinctive facial features of Wolf-Hirschhorn syndrome that included hyperteleorism, prominent glabella, short “beaked” nose, short philtrum, mild micrognathia and microsomia, but she had no cleft lip or palate, nor iris coloboma. She had generalised hypotonia. She initially failed to thrive because of feeding difficulty, recurrent infections and aspiration pneumonia, requiring numerous hospital admissions. She is developmentally delayed and has a history of convulsions that are controlled with levetiracetam 750mg and lamotrigine 25mg. The PDA noted at birth had closed by 3 months and there was no other cardiac abnormality. She had intra-uterine growth retardation (IUGR) and was delivered prematurely at 34 weeks by emergency Caesarean section to a 34-year old primigravida. At 8 months she underwent an anti-reflux procedure for recurrent aspiration. A feeding gastrostomy was placed at the same time, in view of her difficulty with swallowing and refusal to eat. The Nissen fundoplication was made difficult by a small diaphragmatic hernia. Intubation at that time was noted to be difficult, but not impossible, using a Miller 1 laryngoscope blade. Anaesthesia was uneventful and consisted of a sevoflurane induction, maintenance with isoflurane and a thoracic epidural for peri-operative pain management. There was no suggestion of malignant hyperthermia. On this occasion she required no sedative premedication. On arrival in theatre, she was asleep in her father’s arms and a “steal induction” using sevoflurane was performed. After ascertaining that the larynx could be visualised, albeit with some difficulty, a nasal RAE endotracheal tube was softened in hot water to facilitate passage through the more patent left nostril. A smaller ET tube (4mm) than expected for her age (5mm) was placed atraumatically without muscle relaxants. A throat pack was inserted to prevent potential soiling of the airway. Anaesthesia, lasting 2 hours, was uneventful and she remained normothermic. A paracetamol suppository (250mg), placed prior to surgery, provided adequate postoperative analgesia.

Anaesthesia and Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth disease is named after three neurologists. Charcot and Marie first described this unusual slowly progressive hereditary motor and sensory neuropathy in France in 18861 . The muscle atrophy was characterized by weakness and wasting of the feet and leg muscles, followed by involvement of the hands. Tooth, in England, also described this peroneal type of progressive muscular atrophy with essentially the same clinical features in the same year. Tooth correctly postulated correctly that the disease was due to a neuropathy and not a myelopathy as was proposed by Charcot and Marie

Körnvergröberung in Gegenwart von flüssigen Filmen an den Korngrenzen

Der signigkante Einfluss der Umschmelzmechanismen beim Konzentrationsausgleich zur Einstellung der Gleichgewichtskonzentration im Temperaturgradienten wird mit den in dieser Arbeit durchgeführten Konzentrationsmessungen und quantitativen Gefügebetrachtungen nachgewiesen

Aerosol Data Sources and Their Roles within PARAGON

We briefly but systematically review major sources of aerosol data, emphasizing suites of measurements that seem most likely to contribute to assessments of global aerosol climate forcing. The strengths and limitations of existing satellite, surface, and aircraft remote sensing systems are described, along with those of direct sampling networks and ship-based stations. It is evident that an enormous number of aerosol-related observations have been made, on a wide range of spatial and temporal sampling scales, and that many of the key gaps in this collection of data could be filled by technologies that either exist or are expected to be available in the near future. Emphasis must be given to combining remote sensing and in situ active and passive observations and integrating them with aerosol chemical transport models, in order to create a more complete environmental picture, having sufficient detail to address current climate forcing questions. The Progressive Aerosol Retrieval and Assimilation Global Observing Network (PARAGON) initiative would provide an organizational framework to meet this goal