Sickle cell disease (SCD) is a relatively common inherited disorder of haemoglobin with significant morbidity and mortality. This review describes the epidemiology and pathophysiology of the disease, and discusses the clinical manifestations found in children with SCD. A discussion of the evidence concerning the perioperative management of such children is presented.
Postoperative management following major surgery in patients with neuromuscular disorders associated with scoliosis is frequently complicated by sputum retention and ventilatory failure. This report demonstrates the successful perioperative management of an 11-yr-old boy with type II spinal muscular atrophy undergoing a single-stage posterior spinal fusion procedure. Use of an MI-E device was able to successfully treat sputum retention and avoid a tracheostomy.
Summary
Continuing aspirin up until surgery in cardiac surgical patients may increase peri‐operative blood loss. It is possible that there is a subset of patients particularly sensitive to aspirin. The platelet function analyser (PFA‐100®) can demonstrate the antiplatelet effect of aspirin. This study was designed to assess the effect of daily 75 mg aspirin on platelet function, as measured by the PFA‐100®, in 92 patients with ischaemic heart disease. Patients were classified into three groups according to their PFA‐100® results; aspirin hyper‐responders (16%), aspirin normal responders (33%) and aspirin non‐responders (51%). The PFA‐100® has potential as a screening tool to identify patients who are either hyper‐responsive or resistant to aspirin. Pre‐operative PFA‐100® screening to isolate aspirin hyper‐responders could enable the vast majority of patients to continue with aspirin therapy pre‐operatively, avoiding the risks of stopping treatment.
SummaryTwenty-seven patients received boron neutron capture therapy during craniotomy at our research reactor from 1991 to 1999. This is a form of intra-operative radiation therapy, which uses neutrons from a nuclear reactor. There are three additional major problems to anaesthetists: boron neutron capture therapy must be given beside the nuclear reactor, with no hospital facilities; neutrons cannot be shielded effectively by ordinary protectors; and neutrons are detrimental to metal devices and especially to electrical appliances. Boron neutron capture therapy has been adopted as an effective therapy for glioblastoma/astrocytoma, but special considerations are required for anaesthesia.
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