Trisomy 15 is a rare genetic disorder presenting unique anesthetic challenges. This is a case of a patient with Trisomy 15 and unrepaired ventriculo-septal defect presented for emergent removal of a subglottic trachea...Trisomy 15 is a rare genetic disorder presenting unique anesthetic challenges. This is a case of a patient with Trisomy 15 and unrepaired ventriculo-septal defect presented for emergent removal of a subglottic tracheal granuloma. Developed anesthetic plan allowed the patient to breathe spontaneously with a combination of inhalational and intravenous anesthetics. Our technique offered optimal operating conditions and adequate depth of anesthesia. The important points of the case include an understanding of the physical characteristics of a patient with Trisomy 15 and unrepaired ventriculo-septal defect and an anesthetic plan for emergent removal of an obstructing subglottic granuloma via rigid bronchoscopy.展开更多
Although considered a safe modality for monitoring spinal cord function, motor evoked potentials (MEP) may cause tongue laceration in rare cases. Bite blocks are essential in order to prevent tongue and mucosal injury...Although considered a safe modality for monitoring spinal cord function, motor evoked potentials (MEP) may cause tongue laceration in rare cases. Bite blocks are essential in order to prevent tongue and mucosal injury during monitoring with MEP, but there is no consensus on the ideal bite block to use for this purpose. Potential concerns include tongue necrosis from prolonged use of an oral airway as a hard bite block, and TMJ dysfunction caused by occlusal interference when blocks interrupt the normal occlusal surface. We had a case of tongue laceration during MEPs. Bite blocks should be placed prior to the start of monitoring to prevent teeth occlusion. Because rigid bite blocks may cause pressure injury to oropharyngeal structures soft bite blocks are recommended. The bite block needs to be placed in a way to prevent occlusion by both front teeth and molars and to keep the tongue in the middle of the mouth. Ongoing vigilance to bite block placement is strongly recommended.展开更多
文摘Trisomy 15 is a rare genetic disorder presenting unique anesthetic challenges. This is a case of a patient with Trisomy 15 and unrepaired ventriculo-septal defect presented for emergent removal of a subglottic tracheal granuloma. Developed anesthetic plan allowed the patient to breathe spontaneously with a combination of inhalational and intravenous anesthetics. Our technique offered optimal operating conditions and adequate depth of anesthesia. The important points of the case include an understanding of the physical characteristics of a patient with Trisomy 15 and unrepaired ventriculo-septal defect and an anesthetic plan for emergent removal of an obstructing subglottic granuloma via rigid bronchoscopy.
文摘Although considered a safe modality for monitoring spinal cord function, motor evoked potentials (MEP) may cause tongue laceration in rare cases. Bite blocks are essential in order to prevent tongue and mucosal injury during monitoring with MEP, but there is no consensus on the ideal bite block to use for this purpose. Potential concerns include tongue necrosis from prolonged use of an oral airway as a hard bite block, and TMJ dysfunction caused by occlusal interference when blocks interrupt the normal occlusal surface. We had a case of tongue laceration during MEPs. Bite blocks should be placed prior to the start of monitoring to prevent teeth occlusion. Because rigid bite blocks may cause pressure injury to oropharyngeal structures soft bite blocks are recommended. The bite block needs to be placed in a way to prevent occlusion by both front teeth and molars and to keep the tongue in the middle of the mouth. Ongoing vigilance to bite block placement is strongly recommended.
