rocuronium and Scoliosis

The danger of anaphylaxis, a rare but life threatening complication of general anesthesia (GA) can be summarized in two: 1. General Anesthesia masks the typical early signs of allergy which can be seen in an awake patient. 2. Anaphylaxis during GA manifests mostly as circulatory/ventilatory failures which can be interpreted as adverse effects of anesthetics or surgery and this can lead to critical delay of effective therapy. A 19-year-old female admitted for posterior spinal fusion and instrumentation (the 5th surgery in patient's life) desaturated seconds after intubation. Cardiopulmonary resuscitation (CPR) was started and the absence of cutaneous signs along with a loud holosystolic murmur were questioned. The patient was promptly resuscitated and allergy to rocuronium was confirmed by intradermal tests 6weeks later. Factors influencing decision making and potential etiology of the newly heard holosystolic murmur during anaphylaxis are discussed.

Topics: Adult; Anaphylaxis; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Cardiopulmonary Resuscitation; Clinical Decision-Making; Drug Hypersensitivity; Female; Fentanyl; Humans; Hypotension; Intradermal Tests; Neuromuscular Nondepolarizing Agents; Propofol; Rocuronium; Scoliosis; Shock; Spinal Fusion; Systolic Murmurs; Vasoconstrictor Agents; Young Adult

Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care.

Topics: Achondroplasia; Androstanols; Anesthesia, General; Anesthesia, Obstetrical; Anesthetics, Intravenous; Cesarean Section; Female; Humans; Infant, Newborn; Neuromuscular Nondepolarizing Agents; Patient Care Team; Piperidines; Pregnancy; Remifentanil; Rocuronium; Scoliosis; Young Adult

Friedreich's ataxia is a rare hereditary neurodegenerative disease caused by a defect in the gene that encodes a mitochondrial protein called frataxin. We report the use of rocuronium 0.6 mg kg(-1) in two adolescent girls with Friedreich's ataxia undergoing propofol-sufentanil-oxygen-air anaesthesia for spinal surgery. Neuromuscular transmission was monitored using acceleromyography, and onset and recovery times were recorded. The clinical duration of rocuronium was comparable to that of children without neuromuscular disease (25% recovery T(1)=44 and 24 min for patients 1 and 2 respectively).

Topics: Adolescent; Androstanols; Anesthesia Recovery Period; Anesthesia, Intravenous; Child; Female; Friedreich Ataxia; Humans; Kyphosis; Muscle Relaxation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium; Scoliosis; Time Factors

Advances in the treatment of congenital heart disease have led to a new group of adolescents or adults patients with cardiac anomalies. The anaesthetic management of these patients can be challenging especially when they are scheduled for major noncardiac surgery inducing haemodynamic instability. We report the case of a 14-year-old boy scheduled for posterior spinal fusion for idiopathic scoliosis who underwent a Fontan operation in infancy for pulmonary atresia with right ventricle hypoplasia. The preoperative investigations and the anaesthetic management are described.

Topics: Adolescent; Androstanols; Anesthesia, Intravenous; Anesthetics, Combined; Fentanyl; Fontan Procedure; Heart Defects, Congenital; Heart Ventricles; Humans; Male; Midazolam; Pulmonary Atresia; Rocuronium; Scoliosis; Spinal Fusion; Thiopental