Cases reported "Apnea"

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11/18. Esophageal spasm associated with apnea and bradycardia in an infant.

    A newborn infant was found to have diffuse esophageal spasm in association with apnea and bradycardia. This association has not been physiologically documented before. The infant's condition improved after the administration of glycopyrrolate, an anticholinergic agent. It is speculated that the association of esophageal spasm and bradycardia may be mediated by the vagus.
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12/18. Massive clonidine ingestion with hypertension in a 9-month-old infant.

    The antihypertensive drug clonidine has a double and antagonistic effect on arterial blood pressure. As a result of activation of peripheral alpha-adrenergic receptors, it causes a transient increase in blood pressure; by a central action it decreases sympathetic tone which results in sustained bradycardia and hypotension. Both central and peripheral effects are experimentally blocked by tolazoline, an alpha-adrenergic blocking agent. The toxic symptoms seen in clonidine poisoning are usually produced by the central effect. A case of severe clonidine poisoning in a 9-month-old infant is reported. The clinical picture included coma, miosis, apneic spells, bradycardia, and hypertension. Rapid and complete recovery was obtained with supportive treatment that included assisted ventilation. No adrenergic blockers or antihypertensive drugs were given. Use of tolazoline in cases of clonidine overdose in children remains controversial. Supportive measures alone may be adequate for even the most severe cases.
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13/18. Prolonged succinylcholine-induced apnea caused by atypical cholinesterase: report of case.

    A case of prolonged apnea after administration of succinylcholine in a patient homozygous for the dibucain variant cholinesterase (genotype E1aE1a) has been presented. knowledge of the patient's medical history, preoperative laboratory tests, and the length of apnea enabled the surgical team to eliminate liver disease, carcinoma, and malnutrition from the differential diagnosis. This, in addition to the patient's failure to respond to an anticholinesterase agent, led to the belief that the patient had an atypical cholinesterase response to succinylcholine and not one secondary to a decreased production of cholinesterase enzyme from an impaired liver or prolonged paralysis for the nondepolarizing agent, pancuronium. Treatment consisted of maintaining adequate pulmonary ventilation nitrous oxide sedation to diminish anxiety until the patient regained spontaneous respiration. Anticholinesterase agents were used after the patient had progressed to a phase II depolarization block. After a cholinesterase assay of the family's serum, all members having the atypical allele were instructed to obtain medical alert identification.
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14/18. asthma death induced by ibuprofen.

    We describe the case of a 40 year old woman, who had suffered from asthma since infancy, with a negative case history of asthma induced by aspirin or nonsteroidal anti-inflammatory (NSAID) agents, who died after ingesting 400 mg of ibuprofen. The autopsy specimens collected 3 months after death had all the characteristic pathological features of fatal asthma. The medical records showed that the patient was not informed of the potential fatal outcome of an asthma attack, and that she was not properly treated.
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15/18. apnea and factitious illness (Munchausen syndrome) by proxy.

    OBJECTIVE. munchausen syndrome by proxy (MSP) is recognized in the differential diagnosis of apparent life-threatening events, but the early signs and the full spectrum of this presentation are not well recognized. We aim to describe MSP presenting with apnea to illustrate this spectrum and the evolution in our management over a period of 10 years. patients AND RESULTS. Eleven children in five families seen in one institution and assessed by one team are described in detail. The children had apnea and/or pallor, but with a wider age range than usually seen with apparent life-threatening events, sometimes associated with other injuries, and a large percentage of parents were health care providers. In no case was apnea witnessed by health care professionals other than the parents. There were frequent disagreements in management between professionals and, consequently, delays in considering the diagnosis at first. There were two deaths. A team developed, allowing the diagnosis of MSP to be considered sooner and the cases to be assessed and managed consistently. CONCLUSION. MSP is part of child abuse, and it needs to be recognized by all physicians. family assessment is required and the development of a team interested in MSP facilitates assessment and management.
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16/18. munchausen syndrome by proxy: otolaryngologists beware!

    munchausen syndrome by proxy (MSBP) is a rare condition in which a parent or guardian fabricates an illness in a child either by inducing physical signs or prevaricating. A case presenting as recurrent episodes of infant apnoea is reported. A high index of suspicion is required for the diagnosis and, therefore, the otolaryngologist must be familiar with the condition if the life of the infant is to be protected and potentially harmful unnecessary investigations are to be avoided.
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17/18. Anaesthetic management of children with Joubert syndrome.

    We report the anaesthetic management of two children with Joubert syndrome. Children with this syndrome have abnormalities of respiratory control due to changes in the brainstem and cerebellum. They are extremely sensitive to the respiratory depressant effects of anaesthetic agents, including nitrous oxide. Anaesthesia using inhalational induction, controlled ventilation, avoidance of opioids, and close postoperative monitoring is recommended.
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18/18. apnea following spinal anaesthesia in two former pre-term infants.

    PURPOSE: To report the occurrence of apnea and bradycardia in two former pre-term infants who received spinal anaesthesia without inhalational or intravenous anaesthetic agents during inguinal herniorrhaphy. CLINICAL FEATURES: Two former pre-term infants who had no recent history of apnea or bradycardia and who had been discharged from the hospital presented for anaesthetic care during inguinal herniorrhaphy. Spinal anaesthesia using 1 mg.kg-1 tetracaine in dextrose 10% was performed. A sensory level of T4-6 was obtained in both infants. Neither infant received intravenous, oral, or inhalational agents for sedation. Five to ten minutes after placement of the spinal block, the two infants had frequent episodes of apnea and bradycardia. No change in the sensory level of spinal anaesthesia was noted. The apnea and bradycardia continued for a variable time into the postoperative period. caffeine benzoate 10 mg.kg-1 was administered to one infant. Other than the apnea and bradycardia, both infants had uncomplicated postoperative courses. CONCLUSION: apnea can occur when spinal anaesthesia is used as the sole anaesthetic technique in the former pre-term infant. Appropriate monitoring for such problems based on the infant's post-conceptual age is suggested.
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