Dexmedetomidine was used to facilitate opioid and benzodiazepine withdrawal in an 8-mo-old infant. A processed electroencephalogram (Bispectral Index) was used to guide the titration of dexmedetomidine in this neurologically impaired infant. This is the first report of dexmedetomidine use in an infant to manage chemical dependence withdrawal.
This report describes the intraoperative course of a pediatric patient with neuromuscular scoliosis who died of massive fat and marrow emboli during posterior instrumentation for scoliosis surgery. In addition, the report describes the incidence and consequences of embolic events during spine surgery as well as the most common clinical sequelae. This patient's unique presentation is highlighted.
<p class="abstract"><strong>Background:</strong> 30 patients with nasal septal perforation after surgical correction of septal deviation undergoing trials of septal closure were divided into 2 groups to compare between results of free inferior turbinate graft with bacterial cellulose and results of free inferior turbinate graft only in closure of nasal septal perforation. To compare between results of free inferior turbinate graft with bacterial cellulose and results of free inferior turbinate graft only in closure of nasal septal perforation.</p><p class="abstract"><strong>Methods:</strong> Prospective randomized study in which 30 patients with nasal septal perforation after surgical correction of septal deviation undergoing trials of septal closure were divided into 2 groups; group I (15 patients) in which free inferior turbinate graft with bacterial cellulose would be used in closure of nasal septal perforation; group II (15 patients) in which free inferior turbinate graft only would be used in closure of nasal septal perforation. </p><p class="abstract"><strong>Results:</strong> Septal perforation healing (closure) would be in 10 patients in group I while in 6 patients in group II. Improvement in nasal obstruction, crustion, epistaxis and breathing sound in group I would be better than in group II.</p><p class="abstract"><strong>Conclusions:</strong> Use of free inferior turbinate graft with bacterial cellulose would be an effective method than use of free inferior turbinate graft only in closure of nasal septal perforation.</p>
Gestational trophoblastic disease can lead to excess thyroid hormone release and rarely, thyroid storm. We present a case of complete molar pregnancy with hyperthyroidism that was not identified or treated before surgical evacuation of uterine contents. Untreated hyperthyroidism preoperatively led to unanticipated thyroid storm immediately after emergence from anesthesia. It is important for anesthesia providers to recognize the link between gestational trophoblastic disease and thyrotoxicosis, and appreciate the severe consequences than can occur if left untreated. Anesthesia providers should strongly consider preoperative consultation and treatment. Being prepared to treat intraoperative symptoms and thyroid storm is paramount. (A&A Practice. 2021;15:e01495.) GLOSSARY β-hCG = beta subunit of human chorionic gonadotropin; bpm = beats per minute; CARE = CAse REports; FT3 = free triiodothyronine; FT4 = free thyroxine; HR = heart rate; ICU = intensive care unit; IV = intravenous; POD = postoperative day; PRBCs = packed red blood cells; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid stimulating hormone
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