Hyperglycemia and hyperosmolar hyperglycemic syndrome (HHS) are the rare adverse effects of diazoxide. Furosemide has been reported to worsen glucose tolerance and cause HHS. A 5-yr-old girl presented to the emergency department with complaints of tachycardia, polyuria, and lethargy for 1 wk prior to hospitalization. She was treated with two diuretics for aortic valve reflux disease and diazoxide for congenital hyperinsulinemia. She was diagnosed with HHS based on her serum glucose level of 529 mg/dL and serum osmotic pressure of 357 mOsm/kg. There were no findings suggestive of new-onset diabetes mellitus. She had fever on admission and, was diagnosed with a urinary tract infection. The blood diazoxide level at the time of hospitalization was 25 µg/dL. Diazoxide use, even in patients with low diazoxide levels, may cause hyperglycemia. Patients on diuretics and diazoxide must be carefully monitored, considering the risk of developing HHS.
BackgroundThe tongue flap is an accepted treatment method for cleft palate repair. Orotracheal or nasotracheal intubation using a fiberoptic scope is preferred for the division of the tongue flap. We report two cases of tongue flap division in which the patients received adequate sedation and analgesia without tracheal intubation.Case presentationTwelve- and 13-year-old male patients were treated at our hospital for tongue flap division, performed as part of a cleft palate repair. We planned to divide the tongue flap under sedation with remifentanil (1 μg/kg/min continuous infusion) and local anesthesia, followed by induction of general anesthesia, and orotracheal intubation after the tongue flap was divided. During the procedure, patients were breathing spontaneously and were cooperative. Patients were able to follow the surgeons’ verbal cues to thrust out the tongue during the procedure, so that the surgeons could easily insert the sutures.ConclusionsDuring the division of the tongue flap in two children, excellent sedative and analgesic effects were achieved using continuous remifentanil infusion.
A patient who complained of severe nausea after general anesthesia was treated with droperidol, resulting in respiratory depression.When general anesthesia was introduced, there was no problem with mask ventilation and tracheal intubation, but after respiratory arrest, mask ventilation and tracheal intubation were difficult, and SpO₂ decreased to 17% . Tracheal intubation was possible using McGRATH. There were no neurological sequelae.Postoperative nausea and vomiting (PONV) is a very unpleasant complication for patients and its prevention is important. Droperidol is a drug that can be used in Japan and is useful for both prevention and treatment of PONV. From this experience, however, we realized that significant respiratory depression may occur after administration of droperidol.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.