Abstract Missing
Over the past three years, 36 anaesthetics were administered to 27 patients with achondroplastic dwarfism. Twenty-four patients underwent craniectomy for foramen magnum stenosis. Sixteen of the operations were undertaken in the sitting position with nine incidents of venous air embolism (VAE), all of which occurred in patients under 12 years of age.
Six major complications occurred: two C-1 level spinal cord infarctions, two brachial plexus palsies, one severe macroglossia, and one accidental extubation.
Intravenous access in the small child with achondroplastic dwarfism is made difficult because of the excess, lax skin and subcutaneous tissue.
Airway management and laryngoscopy were not difficult and we found that endotracheal tube size was best predicted by the patient's weight and not age.
Blood loss was 38±9 mg·kg−1 in the prone position (n = 8) and 18±4 mg·kg−1 in the sitting position (n = 16), and was related to the surgical procedure rather than to dwarfism.
Our data indicate that complications are more likely to occur in the sitting position, and that these complications are of a serious nature, and every precaution should be taken to avoid their occurrence.
Résumé
Au cours de trois dernières années, 36 anesthésies ont été administrées à 27 patients atteint nanisme achondro-plasique. Vingt quatre patients ont subi une crdniectomie pour sténose du foramen occipital. Seize de ces opérations ont été accomplies dans une position assise avec neuf incidents d’embolies gazeuse, tous survenant chez des patients dgés de moins de 12 ans.
Six complications majeures sont survenues: deux infarcisment de la moelle épinière au niveau de C-1, deux plexus brachial, une macroglossie sévère, et une extuba-tion accidentelle.
L’accès intraveineux du patient avec un nanisme achondroplasique est difficile é cause de I’excès de peau et de tissus sous-cutané.
La conduite de maintien des voies aériennes et la laryngoscopie riétaient pas difficile et on a trouvé que la grosseur du tube endotrachéal est mieux prédite par le poids du patient plûtot que son ôge. Les pertes sanguines ont été de 38 ± 9ml.kg-1 en position couchie (n = 8) et 18 ±4 ml.kg-1 en position assise (n = 16), et était en relation avec la position chirurgicale plutôt qu’au nanisme. Nos données indiquent que les complications surviennent plus fréquemment en position assise celles ci sont dangeureuses et toutes les précautions doivent étre prises afin d’éviter leur survenue.
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Mayhew, J.F., Katz, J., Miner, M. et al. Anaesthesia for the achondroplastic dwarf. Can Anaesth Soc J 33, 216–221 (1986). https://doi.org/10.1007/BF03010834
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DOI: https://doi.org/10.1007/BF03010834