Hypertensive response to dinoprost under anesthesia.
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Biomedical subjects
Publications and source records attributed to J F Mayhew.
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A two-year-old female child status post-bilateral nephrectomies sustained a cardiac arrest following the central intravenous administration of vancomycin chloride. This report reviews the literature concerning the problems associated with the use of vancomycin chloride in the perioperative period.
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The case history is given of a 6-month-old girl who survived an attack of malignant hyperthermia that occurred during the repair of a cleft lip. We believe that this is the youngest such patient reported to date. The current concepts of the mechanisms of excessive heat production and muscular rigidity are presented. The need for constant awareness, early recognition, and prompt and proper treatment on the part of both the operating surgeon and the anesthesiologist are stressed to avoid a fatal outcome. Unfortunately, as yet there is no conclusive, consistent screening test available to identify those who will experience such an episode. Because a patient has once undergone general anesthesia uneventfully does not mean that malignant hyperthermia will not occur during a subsequent procedure or even during use of some amide local anesthetics.
A comprehensive plan for intraoperative fluid and electrolyte maintenance in the pediatric surgical patient should be made before the start of anesthesia and carried out carefully but aggressively by the surgeon and anesthesiologist. There must be careful assessment of intraoperative blood loss, accurate calculation of the volume of clear fluids given, and frequent measurement of electrolyte levels, blood gas levels, and hematocrit values, particularly during long operative procedures. Tabulated are maintenance fluid requirements, suggested fluid replacement schedules, and formulas for determining blood volume and allowable blood loss, plus a regimen for blood replacement.
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