Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Gonorrhea

Risk The prevalence of gonorrhea is decreasing, with 106.1:100,000 as of 2013. Most common in people ages 15–24 y, in large urban areas, and among people with low socioeconomic status and/or low levels of education. Incidence higher in men; prevalence higher in women. Overview Sexually transmitted disease. High incidence of coexisting chlamydial infection. Local infection: Purulent, profuse urethral discharge and possible epididymitis, prostatitis, or proctitis in…

Goldenhar Syndrome

Risk Incidence: 1:5500 live births. Second most common facial birth defect after cleft lip and palate. Extracraniofacial anomalies can range from one anomaly (13%) to multiple affected organ systems (42%). No gender or side predominance was detected. Central nervous system, cardiac, and skeletal anomalies each occurred in more than 10% of cases. Surgical correction usually takes place in severe cases. Cleft palate occurs in 25% of…

Glycogen Storage Diseases

Risk There are a total of 11 GSDs (0–7, 9, 11, and 12; there is no GSD 8 or 10); the most common are GSD I (Von-Gierke), GSD II (Pompe [3 types]) and GSD III (Cori or Forbe), which may each be as common as 1:50,000 individuals. The least common may occur as rarely as 1:1,000,000 or even less. GSDs I and III each account for…

Postoperative Nausea and Vomiting : Pediatric

Case Synopsis A 10-year-old girl with a history of motion sickness is scheduled for adenotonsillectomy. This will be her third surgery under general anesthesia. She had multiple episodes of postoperative nausea and vomiting (PONV) after the two previous procedures (dental rehabilitation and correction of strabismus), despite receiving antiemetic prophylaxis intraoperatively. After the strabismus surgery, she was hospitalized with dehydration caused by refractory postoperative emesis. Her mother…

Postoperative Apnea in Infants

Case Synopsis A 2.5-kg, 4-month-old male infant presents for a large, irreducible inguinal hernia repair. His history is significant for premature birth at 26 weeks of gestation, intraventricular hemorrhage, and immature lung disease requiring mechanical ventilation for 3 weeks. He was discharged home at 3 months. Combined spinal epidural (caudal) anesthesia is performed as the sole anesthetic technique for this procedure. After subarachnoid block in sitting…

Postobstruction Pulmonary Edema in Pediatric Patients

Case Synopsis A 5-year-old obese child with developmental delay, asthma, and obstructive sleep apnea presents for a tonsillectomy. Inhalation induction is begun. The airway is partially obstructed intermittently until nasopharyngeal and oral airways are inserted. On completion of surgery, pink, frothy fluid is noted in the endotracheal tube. A chest radiograph ( Fig. 201.1 ) is obtained, and the child is transferred to the intensive care…

Postintubation Croup

Case Synopsis A 4-year-old girl undergoes a general anesthetic for laparoscopic repair of an umbilical hernia. A few minutes after arriving in the postanesthesia care unit, she is noted to have inspiratory stridor. Problem Analysis You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Perioperative Aspiration Pneumonitis

Case Synopsis A 5-year-old boy with eosinophilic gastroenteritis, chronic dysphagia and vomiting, and radiographic evidence of delayed gastric emptying presents for repeat esophagogastroduodenoscopy to evaluate disease progression. Previous endoscopy studies have revealed the presence of stomach contents despite adherence to appropriate fasting guidelines. Acknowledgment The authors wish to thank Dr. Mark Meyer for his contribution to the previous edition of this chapter. Problem Analysis You’re Reading…

Pediatric Laryngospasm

Case Synopsis After extubation at the conclusion of adenotonsillectomy, a 5-year-old boy coughs and then develops high-pitched inspiratory stridor that progresses to silent rocking chest movements. Chest wall retractions are noted, and the breath sounds diminish until none are heard. Mask ventilation is attempted without success, and the patient desaturates rapidly. Problem Analysis Definition Among other functions, the larynx protects the upper airway and lungs from…

Pediatric Hyperthermia

Case Synopsis A healthy 12-year-old boy is undergoing a tympanomastoidectomy under general anesthesia with sevoflurane in oxygen and air, and supplemented with fentanyl. He has also received dexamethasone, ondansetron, and cefazolin. Approximately 2 hours into the case, he is noted to have an esophageal temperature of 38.1°C. His heart rate is 120 beats per minute, and his blood pressure is 122/78 mm Hg. Except for a…

Ophthalmic Problems and Complications

Case Synopsis A 5-year-old girl with no prior ophthalmic history has a thyroglossal duct cyst excision under general anesthesia. On awakening, she complains that “something hurts in my eye.” Although there is no obvious foreign body in the eye, excessive tearing is noted. Her eyes had been taped closed after tracheal intubation. Corneal abrasion is suspected, and an ophthalmology consultation is obtained. Acknowledgment Special appreciation is…

Malignant Hyperthermia

Case Synopsis A healthy 12-year-old boy presents for reduction of a humerus fracture. Anesthesia is induced with sevoflurane. Fifteen minutes later, there is an abrupt increase in end-tidal carbon dioxide to greater than 70 mm Hg. He becomes tachycardic, with a heart rate of 150 beats per minute, and his temperature increases from 36.7°C to 39.4°C. Acknowledgment The author wishes to thank Dr. Karen M. Van…

Latex Allergy

Case Synopsis A 25-year-old woman with spina bifida was undergoing flexible cystoscopy through a suprapubic catheter. She underwent several genitourinary procedures in the past and has been self-catheterizing for 10 years. Twenty minutes after an uneventful anesthetic induction and endotracheal intubation, her oxygen saturation started to drop. Rash was observed all over her torso. Her blood pressure was maintained initially within the preinduction range. Problem Analysis…

Intraoperative Cardiac Arrest : Pediatric

Case Synopsis A 9-month-old boy, American Society of Anesthesiologists (ASA) class II, is undergoing craniosynostosis repair with general anesthesia consisting of 2.5% sevoflurane with oxygen and fentanyl. He has an endotracheal tube in place and is positioned prone on a gel roll. During craniectomy, tachycardia is appreciated on electrocardiogram (ECG) waveform, and the arterial line tracing demonstrates new hypotension. The pulse oximetry and end-tidal carbon dioxide…

Hypoxemia in the Pediatric Patient

Case Synopsis An otherwise healthy 5-year-old girl with adenotonsillar hypertrophy secondary to recurrent infections underwent an uneventful tonsillectomy and adenoidectomy with general anesthesia, was extubated, and was sent to recovery. The recovery nurse notifies you that the patient is stridulous with retractions. Cyanosis, tachycardia, and percutaneous arterial oxygen saturation (Sp o 2 ) less than 60% are noted. Problem Analysis Definition Hypoxemia is defined as an…

Hypothermia in the Pediatric Patient

Case Synopsis A 3-month-old girl, born at 32 weeks of gestation, presents to the magnetic resonance imaging (MRI) scanner for sedation for MRI of the brain. Her weight is 4.2 kg, and she is on nothing-by-mouth status for 6 hours. She is currently on no medications. She receives a general anesthetic, and the MRI is completed in 1 hour. After the MRI she is taken to…

Hypoglycemia and Hyperglycemia

Case Synopsis An otherwise healthy 4-year-old boy is scheduled for inguinal hernia repair. He has dinner at 5 pm the evening before surgery, as well as milk and cookies before going to bed at 9 pm . He is offered apple juice at 5:30 am (2 hours before his scheduled surgery), which he refuses. Owing to a surgical emergency, the boy’s surgery is delayed 4 hours.…

Emergence Agitation and Emergence Delirium

Case Synopsis An otherwise healthy 4-year-old boy undergoes general anesthesia for circumcision. The surgery proceeds without incident. When the child arrives in the postanesthesia care unit (PACU), he is noted to be restless, irritable, crying, and not responsive to routine calming measures. His agitated behavior escalates to incoherent screaming, thrashing of his extremities, and intermittent combativeness. Problem Analysis Definition Emergence agitation (EA) in young children is…

Difficult Pediatric Airway

Case Synopsis A 3-year-old child is scheduled for tonsillectomy and adenoidectomy. His past medical history is significant for Treacher Collins syndrome ( Fig. 188.1 ), and thus a difficult airway is anticipated. After inhalation induction with spontaneous respirations, successful intubation is performed with the use of a fiberoptic bronchoscope via a supraglottic device placement. Acknowledgment The author wishes to thank Dr. Hernando De Soto for his…

Delayed Emergence in Pediatric Patients

Case Synopsis A 2-year-old 14-kg girl with trisomy 21 remains unresponsive and intubated in the operating room 35 minutes after anesthetic agents were discontinued following adenotonsillectomy for obstructive sleep apnea. Intraoperatively she received propofol 2 mg/kg -1 , morphine 0.1 mg/kg -1 , and cisatracurium 0.2 mg/kg -1 . General anesthesia was maintained with sevoflurane 2.5% in a mixture of oxygen and air (Fi o 2…