Brief Atonia Associated with Electroencephalographic Paroxysm in an Infant with Infantile Spasms
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Summary: The loss of muscular tone or muscular inhibition associated with sharp waves observed during abnormal tonic posture in a patient with infantile spasms of early onset is described. The latency between the beginning of a sharp wave and the muscular inhibition varied from 30 to 700 msec, and the duration of the inhibition ranged from 100 to 400 msec. These brief muscular inhibitions may sometimes precede tonic seizures, and these phenomena might be noticeable only in the state of steady tonic muscular contraction. RÉSUMÉ Les auteurs décrivent une perte du tonus musculaire ou une inhibition musculaire qui accompagne des paroxysmes EEG de pointes lentes chez des enfants qui présentent des spasmes infantiles très précoces. La latence entre le début de la pointe lente et l'inhibi‐tion musculaire varie de 30 à 700 msec, et la durée de I'inhibition se situe entre 100 et 400 msec. Ces brèves inhibitions musculaires peuvent précéder une composante tonique et elles peuvent n'être appréciables que lorsque le sujet est en état de contraction musculaire tonique. RESUMEN En un enfermo con espasmos infantiles de comienzo precoz se describe la pérdida de tono muscular o de inhibición muscular asociadas a ondas agudas que se observan durante la postura tónica anormal. La latencia entre el comienzo de la onda aguda y la inhibición muscular varió de 30 a 700 milisegundos y la duración de la inhibición osciló entre 100 y 400 milisegundos. Esta breve inhibición muscular puede preceder ataques tónicos y estos fenómenos pueden apreciarse solamente en el estado de contracción muscular tónica permanente. ZUSAMMENFASSUNG Beschreibung eines Patienten, bei dem BNS‐Krämpfe frühzeitig aufgetrétén sind. Er zeigte während einer abnormen tonischen Haltung den Verlust des Muskeltonus (muskulare Inhibition), die von sharp waves begleitet wurde. Die Latenz zwischen dem Beginn der sharp waves und der muskulären Inhibition variierte zwischen 30 und 700 ms, ihre Dauer zwischen 100 und 400 ms. Diese kurze muskuläre Inhibition kann gelegentlich tonischen Anfällen vorhergehen und diese Phänomene könnten nur zu bemerken sein im Stadium der stetigen muskulären tonischen Kontraktion.Keywords:
Tonic (physiology)
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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ABSTRACT Airway management is particularly difficult in children with severe congenital anomalies. Such patients are extre- mely sensitive to the respiratory depressant effects of anaesthetic agents. We describe the successful and safe app- lication of caudal anaesthesia for inguinal hernia repair in three cases with severe congenital anomalies (Joubert syndrome, I-cell syndrome). The three patients concerned had congenital anomalies including serious facial defor- mity, respiratory failure and cardiovascular defects. They were administered a single dose of caudal epidural anaest- hesia for inguinal hernia surgery in order to avoid complications associated with general anaesthesia. Caudal block was performed and 1 mL/kg levobupivacaine 0.25% administered. We conclude that caudal epidural anaesthesia can be an effective, suitable and safe anaesthetic technique for inguinal herniotomy without the need for general anaesthesia or endotracheal intubation in children with severe congenital anomalies. Key Words: Caudal anaesthesia, children, congenital anomaly OZET Havayolu yonetimi, ciddi konjenital anomalileri olan cocuklarda ozellikle zordur. Bu tur hastalar anestezik ilaclarin solunum depresan etkilerine karsi asiri derecede duyarlidir. Kaudal anestezinin inguinal herni onarimindaki basarili ve guvenli uygulamasi konjenital anomalileri (Joubert sendromu, I-cell hastaligi) olan uc olguda gosterilmistir. Ilgili uc cocuk hastada, ciddi yuz deformitesi, solunum yetmezligi ve kardiyovaskuler bozukluk dahil konjenital bozuk- luklar vardi. Genel anesteziyle iliskili komplikasyonlari onlemek icin inguinal herni cerrahisinde tek doz kaudal epi- dural anestezi uygulandi. Kaudal anestezide %0.25 levobupivakain 1 mL/kg kullanildi. Kaudal epidural anestezinin, ciddi konjenital bozukluklari olan cocuklarda inguinal herni onarimi acisindan genel anesteziye veya endotrakeal entubasyona gerek duyulmadan etkili, uygun ve guvenli bir alternatif anestezi teknigi olabilecegi sonucuna varildi. A na h ta r Sozcukler: Kaudal anestezi, cocuk, konjenital bozukluk
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Budd–Chiari syndrome
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