Anesthetic Management of Cervical Disc Herniation in a Patient with Churg-Strauss Syndrome: A Case Report

Churg-Strauss syndrome (CSS) or allergic granulomatosis is a necrotizing vasculitis with different presentations. In this case highlights the anesthetic management of a known case of CSS who underwent posterior spinal fixation surgery. Our patient fulfilled the ACR diagnosis criteria because of  showing asthma, paranasal sinusitis, positive skin biopsy and eosinophilia.Before anesthesia induction, laryngeal nerves block by lidocaine was conducted. Fiber-optic bronchoscopy was preceded by inserting a No. 7.5 spiral cuffed endotracheal tube

Avicenna, Al-Ghazali, Zakariya Al-Razi and Omar Khayyam: The Predecessors of Modern Medicine and Metaphysics

No Abstrac

Anesthesia Management of Bullous Emphysema in Patient Candidate for Craniotomy

Introduction: Manypatients withemphysemawill develop cystic air spaces in the lung parenchymaknownas bullae. Positive pressureventilation increases the pressure in a bulla and increases the risk of rupture and tension pneumothorax. Therefore, anesthesiamanagement, for surgeries other than lung volume reduction surgery (LVRS), is challenging in these patients.Case Presentation: A 62-year-old male patient was brought to the emergency department due to a fall resulting in head trauma anda leak of CSF from a previous surgical site of a CP (cerebellopontine) angle tumor. The chest CT scan depicted bilateral bullae in thelungs. Anesthesia was induced and maintained with an inhalational method using Sevoflurane and spontaneous mask ventilation.Conclusions: Patients with bilateral bullae could be managed with spontaneous ventilation; one of the safe choices is inhalationalinduction and maintenance with Sevoflurane

Anesthetic Management of a Patient with Achondroplasia Undergoing Adenotonsillectomy: A Case Report

Background: There are several situations that can create a challenge to every anesthesiologist; one of them is genetic disorders such as achondroplastic dwarfism. Achondroplastic dwarfism is the most common form of skeletal dysplasia, affecting about one in 20,000 newborns. It is an autosomal disorder caused by a mutation of the fibroblastic growth factor receptor-3 gene.Case Presentation: A 7‐year‐old boy diagnosed with achondroplasia was admitted for adenotonsillectomy. He had several classical symptoms and signs of upper airway and cardiac involvement. In this case report, we describe the anesthetic management of this patient, while reviewing the difficulties encountered by the anesthesia team perioperatively.Conclusions: Difficulties with airway management and physiology of this disease can create significant challenges to the anesthesiologist. So, we should keep in mind that achondroplasia can be a complicated situation and were should be prepared to manage it

Anesthetic consideration of Niemann-Pick Disease type C

Nieman-Pick disease type C is a rare, autosomal recessive, neurometabolic disorder associated with the accumulation of unesterified cholesterol in lysosomes and late endosomes. Because of multiple organ involvement and wide range of clinical manifestations, these patients will demand multiple diagnostic and therapeutic procedures requiring anesthesia. Sincepathogenesis of this disease is still unknown, further investigations on cellular and molecular basis of NPC is needed. In this report we present a known case of NPC1 requiring anesthesia for Percutaneous Endoscopic Gastrostomy and a brief review about molecular basis and recent advances in this field. 

Crouzon Syndrome: a fibroblast growth factor receptor 2 gene mutation

Crouzon syndrome is a rare autosomal dominant premature cranyosynostosis, caused by fibroblast growth factor receptor 2 gene mutation on chromosome 10. The predominant skull and facial malformations with potential compromise airway make the crouzon syndrome a demanding issue for anesthesiologists and surgeons, required dynamic team work. In this report we describe a child, a known case of Crouzon syndrome who was a candidate for optic nerve decompression through endoscopic surgery. The anesthetic considerations and management are presented.Key words: Crouzon Syndrome, FGFR2 gene, Difficult Intubation, Anesthesi

Could molecular studies save Hydroxyethyl starch from total disappearance?

Up until now, hydroxyethyl starch (HES) solutions have mainly been indicated as "volume expanders". Recent unfavorable reports of these solutions such as probability of kidney injury or inducing coagulopathy have relatively ejected these solutions in many centers, particularly in European countries. Despite several confirming studies, multiple anecdotal letters or reviews has challenged total disappearance of these colloids from medicine practice. Also, some novel observations emphasized the distinguished ability of HES to preserve the microvascular integrity even at the presence of an inflammatory process. Despite extreme statements has been published demanding immediate suspension of these fluids from the market, it seems logical to revise the most recent studies which may declare new pathways to approach HES family of solutions.

Anesthetic management of patients with Klippel-Feil syndrome, a case series

Introduction: Klippel feil syndrome (KFS) is a rare entity which is characterized by failure of normal segmentation of cervical vertebrae resulting in short neck with restricted movement and cervical instability. This anomaly increases the risk of neurological damage during airway instrumentation like laryngoscopy and positioning for surgery.Case Rports: We report three patients, a 42 year old male patient with KFS who scheduled for craniocervical fusion under general anesthesia and a 6 year old girl candidate for cleft palate repair and a 26 year old woman candidate for craniocervical fusion.Conclusion: All the cases were successfully managed using fiberoptic bronchoscope in first two cases and gum elastic bougie (GEB) in the last case. All things together, Awake fiberoptic intubation could be the safest technique for airway management

Anesthetic considerations of Palmoplantar Keratoderma (PPK), a case report.

Palmoplantar keratoderma(PPK) refers to a group of heterogeneous disorders defined by thickening of skin on the palms and soles. Due to diversity of symptoms and involved organs, the term PPK does not describe each individual patient precisely. The syndrome is quite rare and unknown to the anesthesiologists, while serious associations such as difficult airway or cardiac disease are significant challenges during perioperative management. The literature lacks enough data on anesthetic considerations in these patients, implicating case reports as the only available sources. We revised the accessible information through description of our patient

A Series of Awake Craniotomy Procedures Performed in Iran

“Awake craniotomy” is a technique used in neurosurgical procedures, commonly performed to remove a tumor or an epileptogenicfocus while the patient is awake. There has been an increasing trend towards performing this type of procedure because of its advantages;above all, the ability to map the eloquent cortex to reduce post-surgical neurological sequel. The aim of this article is tointroduce 8 cases of awake craniotomies, performed in Loghman-e-Hakim hospital in Tehran, Iran. Patients were selected accordingto our specific criteria. Oral clonidine (4 g/kg), dexamethason (8 mg/IV), midazolam (0.03 mg/kg/IV), and sufentanil (3 g/kg/IV)were used as premedication. Patients underwent cerebral state monitoring and other monitoring modalities during the procedure.A laryngeal mask was used during the asleep phase of the anesthesia. General anesthesia was induced using propofol and lidocaine.Local anesthesia was provided with bupivacaine in the incision and pin insertion sites. Anesthesia was maintained using propofoland remifentanil infusion. A total of 8 patients underwent the procedure. No significant complications, including hemodynamicinstability, depressed respiration, the need to put the patient to sleep before mapping or tumor resection, intraoperative seizures,aspiration, and brain edema were observed in any of our patients. In conclusion, we believe that a modified asleep-awake-awaketechnique instead of the asleep-awake-asleep technique may provide less complications and less need to manage the patients’ airway.“Awake craniotomy” is a technique used in neurosurgical procedures, commonly performed to remove a tumor or an epileptogenicfocus while the patient is awake. There has been an increasing trend towards performing this type of procedure because of its advantages;above all, the ability to map the eloquent cortex to reduce post-surgical neurological sequel. The aim of this article is tointroduce 8 cases of awake craniotomies, performed in Loghman-e-Hakim hospital in Tehran, Iran. Patients were selected accordingto our specific criteria. Oral clonidine (4 g/kg), dexamethason (8 mg/IV), midazolam (0.03 mg/kg/IV), and sufentanil (3 g/kg/IV)were used as premedication. Patients underwent cerebral state monitoring and other monitoring modalities during the procedure.A laryngeal mask was used during the asleep phase of the anesthesia. General anesthesia was induced using propofol and lidocaine.Local anesthesia was provided with bupivacaine in the incision and pin insertion sites. Anesthesia was maintained using propofoland remifentanil infusion. A total of 8 patients underwent the procedure. No significant complications, including hemodynamicinstability, depressed respiration, the need to put the patient to sleep before mapping or tumor resection, intraoperative seizures,aspiration, and brain edema were observed in any of our patients. In conclusion, we believe that a modified asleep-awake-awaketechnique instead of the asleep-awake-asleep technique may provide less complications and less need to manage the patients’ airway