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Thread: Back from the ortho

  1. #16
    Join Date
    Mar 2004

    I've always thought they do MRI's to rule out neurological anomalies. I think with an MRI they are able to see the spinal cord. I think it's pretty standard with progressive infantile scoliosis and congenital scoliosis.


    I did a google search on MRI's and very briefly:

    MRI will help rule out the following: spinal tumor, dural ectasia, tethered cord, Arnold Chiari malformation, hydromyelia, hydrocephalus and syringomyelia

    Last edited by Celia; 02-23-2005 at 08:38 AM.

  2. #17
    Join Date
    Mar 2004

    I've got to get some work done !!! I won't be able to reply to you any more today. Tomorrow's another work day (hee hee)


  3. #18
    Join Date
    Mar 2004

    Anesthesia Risks


    As you know, life in not without risks. Anyone of us can walk out
    today and get hit by a car or else be involved in a fatal car

    My daughter has gone under general anesthesia, a total of eight times for cast changes and such. Three of those times she had something called a laryngospasm. One of those events was very severe and her sats went down to dangerously low levels, she had to be medicated, luckily it worked ! On another occasion, her sats went down to the low seventies. Not being a healthcare worker I didn't know what all of this meant, so I started doing some reading on anesthesia and laryngospasms in particular. I've been an advocate of casts for the treatment of infants and
    children with scoliosis - and I remain so. This is the treatment I
    have chosen for my own precious daughter. Unfortunately, these casts have to be applied while the child is under general anesthesia. Please be aware there are RISKS with anesthesia - especially with children six months of age and younger. I would never forgive myself if I encouraged you to subject your child to anesthesia and then something horrible happened. Knowledge is so important in making an informed decision - then again - too much knowledge can be a bad thing

    I thought I'd share with you some articles I've read:

    Cardiac arrest due to anesthesia. A study of incidence and causes.

    Keenan RL, Boyan CP.

    Cardiac arrests due solely to anesthesia were studied in a large
    university hospital over a 15-year period. There were 27 cardiac
    arrests among 163,240 anesthetics given, for a 15-year incidence of 1.7 per 10,000 anesthetics. Fourteen of these patients (0.9 per
    10,000) subsequently died. Detailed examination of the data from
    these 27 patients revealed that the pediatric age group had a
    threefold higher risk than adults, and that the risk for emergency
    patients was six times that for elective patients. Failure to provide
    adequate ventilation caused almost half of the anesthetic cardiac
    arrests, and one third resulted from absolute overdose of an
    inhalation agent. Hemodynamic instability in very ill patients was an association in 22%. Specific errors in anesthetic management could be identified in 75%. Progressive bradycardia preceding the arrest was observed in all but one case.

    Should you cancel the operation when a child has an upper respiratory
    tract infection?

    Cohen MM, Cameron CB.

    Department of Community Health Sciences and Anesthesia, University of
    Manitoba, Winnipeg, Canada.

    Cancelling an operation when a child has an upper respiratory tract infection (URI) is not always feasible or practical. Yet we know very little about the additional risk posed by a URI occurring in a child undergoing anesthesia and surgery. Using a large prospectively collected pediatric anesthesia database, we studied 1283 children with a preoperative URI and 20,876 children without a URI. We found that children with a URI were two to seven times more likely to experience respiratory-related adverse events during the intraoperative, recovery room, and postoperative phases of their operative experience. Although these children also experienced significant disruptions in temperature regulation, they were not at risk for any other deleterious events. The elevation in risk after URI as compared with children without a URI was not explained by differences in age, physical status scores, surgical site, and emergency or elective status. However, if a child had a URI and had
    endotracheal anesthesia, the risk of a respiratory complication
    increased 11-fold (95% confidence intervals 6.8, 18.1). We conclude that the administration of general anesthesia to children with a URI is not benign and that these children require more
    observation/management in all perioperative phases of their surgical procedure.

    [Emergency from anesthesia in small children. From laryngospasm to prolonged apnea]

    [Article in German]

    Gries A, Motsch J, Ulmer HE, Springer W.

    Klinik fur Anaesthesiologie der Universitat Heidelberg.

    Postoperative laryngospasm during emergence from anaesthesia
    represents a potentially life-threatening complication.Even if this
    is successfully overcome using drug therapy, new, serious problems may develop.We report the case of a 3 1/2 -year-old boy of African descent weighing 15 kg who developed a laryngospasm during emergence from anaesthesia.Because the airway obstruction could not be controlled by deepening the anaesthesia again and administering anti- obstructive drugs, the boy was given 15 mg succinylcholine.Thereafter prolonged apnea developed such that the patient had to be admitted to the pediatric intensive care unit.The child was extubated 6 h later
    and the further course was normal so that he could be released from the hospital the following day.Further diagnostic study revealed a dibucaine-sensitive, fluoride-resistant pseudocholinesterase in the plasma, which is a rare form of atypical pseudocholinesterase, explaining the prolonged arousal phase after the administration of succinylcholine.Three significant aspects of this case are discussed:

    1. risk factors and treatment of perioperative airway obstruction
    2. factors and treatment of prolonged apnea, and
    3. delayed arousal reactions and their management in an outpatient setting

    Early exposure to common anesthetic agents causes widespread
    neurodegeneration in the developing rat brain and persistent learningdeficits.

    Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, Olney JW, Wozniak DF.

    Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA. vj3w@v...

    Recently it was demonstrated that exposure of the developing brain during the period of synaptogenesis to drugs that block NMDA glutamate receptors or drugs that potentiate GABA(A) receptors can trigger widespread apoptotic neurodegeneration. All currently used general anesthetic agents have either NMDA receptor-blocking or GABA (A) receptor-enhancing properties. To induce or maintain a surgical plane of anesthesia, it is common practice in pediatric or obstetrical medicine to use agents from these two classes in combination. Therefore, the question arises whether this practice entails significant risk of inducing apoptotic neurodegeneration in the developing human brain. To begin to address this problem, we have administered to 7-d-old infant rats a combination of drugs commonly used in pediatric anesthesia (midazolam, nitrous oxide, and isoflurane) in doses sufficient to maintain a surgical plane of anesthesia for 6 hr, and have observed that this causes widespread apoptotic neurodegeneration in the developing brain, deficits in
    hippocampal synaptic function, and persistent memory/learning


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