Cases reported "Apnea"

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11/307. Convulsions and respiratory arrest in association with desmopressin administration for the treatment of a bleeding tonsil in a child with borderline haemophilia.

    Desmopressin (DDAVP) may be used to augment the action of factor viii in mild haemophilia. Its use has been associated with serious adverse effects. We report a case of a three-year-old child with a family history of haemophilia who suffered complications due to severe acute hyponatraemia following the administration of this drug for post-tonsillectomy bleeding. ( info)

12/307. Partial seizures manifesting as apnea only in an adult.

    PURPOSE: Although several cases of apneic seizures have been reported in neonates, epileptic seizures presenting as apnea only in adults are very rare. We present a case report of a 19-year-old man with viral encephalitis and frequent episodes of apneic seizures. methods: Prolonged electroencephalograms (EEGs), respiratory monitorings, and imaging including ictal-interictal subtraction single photon emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI) were performed. RESULTS: Ictal EEGs recorded during apneic episodes showed repetitive sharp waves or rhythmic theta activity arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea that showed ictal EEG discharges arising from the left posterior temporal area. Ictal-interictal subtraction SPECT coregistered with MRI revealed that the seizures originated from the left, posterior, midlateral temporal cortex. CONCLUSIONS: Previous studies with ictal EEG or brain stimulation suggest that apneic seizures might be mediated through the limbic and associated cortical systems. Our study reports on a very rare case of partial seizures with apnea only in an adult patient and is supported by ictal EEG and ictal-interictal subtraction SPECT coregistered with MRI. ( info)

13/307. Factors determining the onset and course of hypoxemia during apnea: an investigation using physiological modelling.

    We used the Nottingham physiology Simulator to examine the onset and course of hypoxemia during apnea after pulmonary denitrogenation. The following factors, as possible determinants of the hypoxemia profile, were varied to examine their effect: functional residual capacity, oxygen consumption, respiratory quotient, hemoglobin concentration, ventilatory minute volume, duration of denitrogenation, pulmonary venous admixture, and state of the airway (closed versus open). Airway obstruction significantly reduced the time to 50% oxyhemoglobin saturation (8 vs 11 min). Provision of 100% oxygen rather than air to the open, apneic patient model greatly prolonged time to 50% oxyhemoglobin saturation (66 vs 11 min). Hemoglobin concentration, venous admixture, and respiratory quotient had small, insignificant effects on the time to desaturation. Reduced functional residual capacity, short duration of denitrogenation, hypoventilation, and increased oxygen consumption significantly shortened the time to 50% oxyhemoglobin saturation during apnea. IMPLICATIONS: Reduction in oxygen levels during cessation of breathing is dangerous and common in anesthetic practice. We used validated, mathematical, physiological models to reveal the impact of physiological factors on the deterioration of oxygen levels. This study could not be performed on patients and reveals important information. ( info)

14/307. Can a dose of caudal clonidine cause respiratory depression in neonates?

    A case of multiple life-threatening postoperative apnoeas in a term neonate undergoing inguinal herniorrhaphy and orchidopexy who received light inhalation anaesthesia combined with caudal block with 1 ropivacaine 0.2% plus 2 clonidine is reported. The patient showed no apparent risk factors for postanaesthetic apnoea. Oxycardiorespirography five days after surgery only showed minor abnormalities. clonidine though administered caudally in the usual dose of 2 appeared to be the most likely cause for postanaesthetic apnoea in this neonate. ( info)

15/307. Apnoeic attacks as an isolated manifestation of epileptic seizures in infants.

    Apnoea as an isolated manifestation of seizures is well described in neonates but is only occasionally observed in infants. We present data from four infants, with apnoea as the sole manifestation of seizures, documented by polygraphic ictal electroencephalogram (EEGC) and video recording. The four infants, after normal pregnancy and delivery at term, showed the first apnoea at the age of 2-11 months. The interictal EEG was normal. The ictal EEG and video recording showed in all infants a focal rhythmic alpha or theta activity with or without generalization, which lasted 40-120 seconds. The apnoea appeared a few seconds after the beginning of rhythmic activity and the heart rate remained unchanged during the apnoea. At 2 years' follow-up, three children are seizure-free under anti-epileptic therapy with normal psychomotor development in two, and a slight delay in the third infant. The fourth child has partial seizures and is severely retarded. ( info)

16/307. Hypermagnesemia-induced cardiopulmonary arrest before induction of anesthesia for emergency cesarean section.

    We describe a 42-yr-old woman scheduled for emergency cesarean section who had sudden cardiopulmonary arrest just before induction of general anesthesia. Hypermagnesemia, caused by accidental overdose of magnesium sulfate during transportation to the operating room, was the primary cause of this life-threatening event. Anesthetic management after such events and a brief summary of the literature regarding iatrogenic hypermagnesemia in obsteric patients are provided. ( info)

17/307. Persistent mydriasis following intravenous atropine in a neonate.

    A neonate whose mother had recently taken amitriptyline developed fixed dilated pupils after a modest dose of intravenous atropine. Interaction of atropine with neonatal amitriptyline levels is suggested and evidence of neonatal effects from maternal antidepressant use is examined. There were no neurological sequelae, and the neonate's pupils became reactive again after 7 h. ( info)

18/307. Cardiac asystole in partial seizures.

    literature review shows many anecdotal case reports of cardiac asystole in ictal recordings of partial seizures. We have reviewed our data from the last five years, of patients who are being assessed for epilepsy surgery and found 2 out of more than 1,500 complex partial seizures, recorded in 589 consecutive patients, showing a significant period of asystole (13 and 15 seconds). Our previous studies of cardiac and respiratory parameters during partial seizures showed that a central apnoea occurred in 39%. It is probable that sudden death during seizures is due to the interaction of both cardiac and respiratory irregularities. Although rare (occurrence < 0.15%), the possibility of cardiac asystole occurring in an epilepsy monitoring unit highlights the need for resuscitation equipment to be readily available and for trained nursing staff. Furthermore, it is important to recognize that the semiology of seizures may be affected by the consequences of secondary cardiac asystole. ( info)

19/307. Morbid hypocalcemia associated with phosphate enema in a six-week-old infant.

    A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization. Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema. ( info)

20/307. Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst.

    The authors report the case of an infant with a lingual thyroglossal duct cyst who presented with breath-holding-like spells, which actually represented life-threatening ball-valve obstruction of the larynx, leading to hypoxemia and transient cerebral dysfunction. When evaluating apparent breath-holding spells in young infants, physicians should include dynamic, episodic upper airway obstruction in the differential diagnosis. ( info)
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