Osteogenesis imperfecta (OI), which is a rare autosomal dominant disorder involving connective tissue, is manifested by skeletal fragility. In addition to its rarity, OI is associated with various risks, such as a difficult airway and malignant hyperthermia (1). Thus, it requires careful anesthesia management. We describe a case of OI in which surgical intervention was planned for a left inguinal hernia. The 2-month-old male patient weighed 3.2 kg on admission. In the operating room, the patient underwent a continuous electrocardiogram, pulse oximetry, noninvasive blood pressure, and temperature monitoring. Readings were recorded every 5 minutes. The patient's baseline heart rate (HR) was 135 beats/min -1 , his blood pressure (BP) was 110/62 mmHg, his SpO 2 was 98%, and his skin temperature was 33.2°C. Hydration was started with a mixed pediatric solution (Biofleks, Osel, Turkey), which was administered intravenously at a rate of 10 mL/kg/h. Due to the extreme fragility of the patient's bones, excessive neck extension may have led to a fracture, and overly vigorous laryngoscopy may have caused cervical teeth and mandibular injury (2). Spinal anesthesia administration was decided upon because of the short duration of the operation, the probability of difficult intubation, and the risk of mandibular bone fracture associated with intubation. Given the risk of malignant hyperthermia in patients with OI (3) and the fact that succinylcholine can induce fasciculation, resulting in fractures and dislocation, 2.5 mg/kg of propofol was administered without sevoflurane induction, and mask ventilation was carried out. The patient was carefully positioned in the left lateral knee-chest position. Then, 1 mg/kg of 0.5% bupivacaine (Marcaine, Eczacibasi, Turkey) was administered intrathecally using a 26 G Quincke (Atraucan, Braun, Germany) spinal needle at the level of L4 -L5 at a rate of 0.1 mL/sec. The needle was withdrawn after maintaining it in this position for 10 seconds (Figure 1). The surgery was initiated after it was confirmed by pinprick that the patient did not feel pain in the inguinal area. During the operation, spontaneous breathing was maintained with supplementary oxygen through a facemask. Paracetamol (Parol, Atabay, Turkey; 10 per 1 cc) 20 mg/kg was infused during the first 20 minutes of the surgery for postoperative analgesia. The surgery lasted for 45 minutes, and perioperative complications were not observed during the surgery. Postsurgery, the patient's intraoperative BP, HR, and SpO 2 values were as follows: 125 -140 beats.min -1 , 103/60 -108/65 mmHg, and 98% -99%, respectively. The patient was awakened by tactile stimulation and monitored in the recovery unit. He was transferred to the clinic after the motor block was discontinued.Patients with OI may have anatomical abnormalities and bleeding diathesis, giving rise to difficulties during the administration of regional anesthesia. Bleeding diathesis and hemorrhage may result from the poor support of blood vessels due to a lack of normal adult collagen,...
Aim: Hypothermia is a rare complication of antipsychotic drugs but serious outcomes including death may result. In this study, we aimed to investigate body temperature alterations in acute phase of chlorpromazine treatment, the relationship of inflammatory indicators and risk factors for hypothermic effect in intensive care unit (ICU) patients. Materials and methods: 63 intensive care patients who needed sedative treatment due to agitation were divided into two groups as Group 1 (n = 30) with temperatures ≤ 38°C, and Group 2 (n = 33) with temperatures > 38°C according to baseline body temperatures. Also, recurrent measurements for 12 hours were made at specific intervals following 25 mg intravenous chlorpromazine. Results: In Group 1, decrease in body temperatures was significant from 4th to 12th hours (p < 0.01), while in Group 2, significant decreases in body temperatures at all measurement hours were observed (p < 0.01). Temperature changes (delta temperature) observed at specific measurement intervals were significantly higher in Group 2 compared to Group 1. That difference was statistically significant at all intervals except for ΔTemperature B-6 (p < 0.05). The odds of hypothermic effects by chlorpromazine were 16%, 46%, 3%, and 18% for Acute Physiology and Chronic Health Evaluation II, procalcitonin, C-reactive protein, and white blood cells, respectively. Conclusion: Chlorpromazine treatment applied for agitation in ICU patients was associated with acute hypothermic effect. Severity of disease and comorbidities might increase risk of hypothermia, and inflammatory biomarkers might be predictors of adverse drug reaction.
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