Inadvertent administration of drug residue causing respiratory arrest: case series

Objective To review the presentation and treatment of children diagnosed with bacterial tracheitis at our institution and to review the available literature focusing on key presenting symptoms and clinical outcomes of children diagnosed with bacterial tracheitis. Study Design Case series with literature review. Setting Tertiary children’s hospital and available literature. Subjects and Methods Case series of children with bacterial tracheitis retrospectively reviewed at a tertiary children’s hospital. Those with a tracheostomy or those who developed bacterial tracheitis as a complication of prolonged intubation were excluded. Results Thirty-six children were identified (mean ± SD age, 6.7 ± 4.5 years). The most common presenting symptom was cough (85%), followed by stridor (77%) and voice changes/hoarseness (67%). A concurrent viral illness was found for 55%, and the most common bacteria cultured was methicillin-sensitive Staphylococcus aureus. Pediatric intensive care admission occurred for 69%, and 43% required intubation. No patient required tracheostomy. One patient (2.7%) died secondary to airway obstruction and subsequent respiratory arrest. Four patients had recurrence of bacterial tracheitis 4 to 12 months following their initial presentation. Conclusion Bacterial tracheitis is an uncommon condition with an atypical presentation and variable clinical course but serious consequences if left unrecognized. Staphylococcus is the most common bacteria identified, and many patients will have a prodromal viral illness. Changes in patient epidemiology and presentation may have occurred over time.

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Case Report: Ictal Central Apnea as First and Overlooked Symptom in Temporal Lobe Seizures

Frontiers in Neurology ◽

10.3389/fneur.2021.753860 ◽

2021 ◽

Vol 12 ◽

Author(s):

Elisa Micalizzi ◽

Anna Elisabetta Vaudano ◽

Giada Giovannini ◽

Giulia Turchi ◽

Leandra Giunta ◽

...

Keyword(s):

Oxygen Saturation ◽

Temporal Lobe ◽

Age At Onset ◽

Case Series ◽

Respiratory Arrest ◽

Respiratory Pattern ◽

Epileptogenic Zone ◽

Central Apnea ◽

Focal Seizures ◽

Neurophysiological Studies

Ictal respiratory changes have been mainly described following generalized tonic-clonic seizures and recently considered to be a biomarker to assess the risk of sudden unexplained death in epilepsy (SUDEP). Nonetheless, modification of respiratory pattern can be related also to focal seizures, especially arising from the temporal lobe. Changes in cardiac function such as tachycardia or bradycardia could be often associated. We report a short case series of four patients with temporal lobe epilepsy admitted to our Epilepsy Monitoring Unit (EMU) presenting with an ictal central apnea as the first clinical manifestation of their seizures. None of these patients was aware of the occurrence of respiratory arrest. Age at onset ranged from 15 to 29 years. One patient had seizures with prolonged central apnea accompanied by a significant decrease in oxygen saturation. Neuroimaging in two patients showed alterations of mesial temporal lobe structures, including the amygdala. Recent neurophysiological studies supported the existence of a cortical network involving the limbic system that modulates downstream brainstem respiratory centers. Monitoring for respiratory changes and oxygen saturation in focal seizures is warranted for their potential value in identifying the epileptogenic zone and for a better understanding of ictal respiratory changes that could potentially define a subgroup of patients with high risk of seizure-related autonomic changes.

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Respiratory arrest in patients undergoing arteriovenous graft placement with supraclavicular brachial plexus block: a case series

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2012.11.009 ◽

2013 ◽

Vol 25 (4) ◽

pp. 321-323 ◽

Cited By ~ 4

Author(s):

Anoushka Afonso ◽

Yaakov Beilin

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Case Series ◽

Respiratory Arrest ◽

Arteriovenous Graft ◽

Graft Placement ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

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Identification of a novel GRIN2D variant in a neonate with intractable epileptic encephalopathy-a case report

BMC Pediatrics ◽

10.1186/s12887-020-02462-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiancheng Jiao ◽

Li Li ◽

Min Sun ◽

Junchen Fang ◽

Lingzhi Meng ◽

...

Keyword(s):

Nmda Receptors ◽

Case Series ◽

Respiratory Arrest ◽

Epileptic Encephalopathy ◽

Partial Control ◽

Case Presentation ◽

Whole Exome ◽

Novel Variant ◽

The Central Nervous System ◽

Spike Wave

Abstract Background N-methyl-D-aspartate (NMDA) receptors are ligand-gated ion channels that mediate excitatory synaptic transmission in the central nervous system. The functional NMDA receptors are heterotetramers consisting mainly of two GluN1 and two GluN2 subunits. GluN2 is encoded by the GRIN2D gene. A few case series have shown that GRIN2D variants are linked to developmental and epileptic encephalopathy. In this article, we report a novel GRIN2D variant, namely c.2021C > A (p.T674K) in a neonate with intractable epileptic encephalopathy. Case presentation A 12-day-old boy who had stiffness of the lower and upper extremities since birth was transferred from a local hospital to our department. On admission, the patient presented with head tilting backwards, staring, apnea and hypertonia of limbs. Video electroencephalogram showed continuous, generalized or multi-focal spike-wave and spike-and-slow wave discharges and hypsarrhythmia. A treatment regimen composed of phenobarbital, midazolam, levetiracetam and clonazepam was administered, which however led to only partial control of the seizure. Whole-exome sequencing identified c.2021C > A (p.T674K) in GRIN2D in the patient while such a mutation was not detected in the parents. The patient was hospitalized for 1 month and died of sudden cardio-respiratory arrest 2 weeks after discharge. Conclusions A novel variant of GRIN2D was identified in a neonate with epileptic encephalopathy. Epilepsy associated with this GRIN2D mutation is refractory to conventional anti-epileptic medications.

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Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis - A retrospective case series analysis

Annals of Cardiac Anaesthesia ◽

10.4103/0971-9784.69076 ◽

2010 ◽

Vol 13 (3) ◽

pp. 236 ◽

Cited By ~ 7

Author(s):

SampaDutta Gupta ◽

Soumi Das ◽

Tapas Ghose ◽

Achyut Sarkar ◽

Anupam Goswami ◽

...

Keyword(s):

Aortic Stenosis ◽

Right Ventricular ◽

Pediatric Patients ◽

Case Series ◽

Respiratory Arrest ◽

Balloon Valvuloplasty ◽

Ventricular Pacing ◽

Retrospective Case ◽

Congenital Aortic Stenosis ◽

Right Ventricular Pacing

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Postoperative Respiratory Depression Associated with Pregabalin: A Case Series and a Preoperative Decision Algorithm

Pain Research and Management ◽

10.1155/2011/561604 ◽

2011 ◽

Vol 16 (5) ◽

pp. 353-356 ◽

Cited By ~ 27

Author(s):

Naveen Eipe ◽

John Penning

Keyword(s):

Respiratory Depression ◽

Postoperative Period ◽

Present Report ◽

Case Series ◽

Perioperative Period ◽

Respiratory Arrest ◽

Postanesthesia Care Unit ◽

Decision Algorithm ◽

Healthy Elderly ◽

Obstructive Sleep

Pregabalin is gaining popularity in the perioperative period for its usefulness in treating neuropathic pain and its apparent opioid-sparing effect. The present report describes the perioperative course of three patients who received pregabalin and experienced significant respiratory depression in the postoperative period. All three patients consented to the report and publication of the present case series. The first patient was elderly with borderline renal dysfunction. She experienced respiratory arrest in the immediate postoperative period following a craniotomy for tumour excision. The second patient presented with severe respiratory depression 12 h after receiving a spinal anesthetic for joint replacement, and was later found to have clinically significant obstructive sleep apnea. The third patient, who was an otherwise healthy elderly individual on benzodiazepines for anxiety, experienced respiratory arrest in the postanesthesia care unit after an uneventful anesthesia for lumbar spine decompression. All of these patients were treated successfully with standard resuscitation measures. Although other causes of respiratory depression in these patients were considered, there appears to be an association between pregabalin and this complication. The present article briefly reviews the evidence regarding the perioperative use of pregabalin. Based on the authors’ experience and the available evidence, they believe that pregabalin may be useful in the management of acute pain in carefully selected patients undergoing certain surgeries. A clinical algorithm has been developed to guide the perioperative use of pregabalin. This algorithm may be helpful in increasing the safety of perioperative pregabalin use.

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