Midazolam-Fentanyl Intravenous Sedation in Children: Case Report of Respiratory Arrest

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 463-467
Author(s):  
Myron Yaster ◽  
David G. Nichols ◽  
Jayant K. Deshpande ◽  
Randall C. Wetzel
Keyword(s):  
Case Report ◽  
Physical Restraint ◽  
Respiratory Arrest ◽  
Route Of Administration ◽  
Intravenous Sedation ◽  
Parental Anxiety ◽  
Safety And Efficacy ◽  
Therapeutic Procedures ◽  
Sedation And Analgesia ◽  
Separation From Parents

Children undergoing diagnostic or therapeutic procedures are often frightened and uncooperative. This fear may be exacerbated by parental anxiety, by separation from parents, and by pain or the anticipation of pain from the procedure itself. To achieve satisfactory sedation and analgesia, various drugs administered alone and in combination have been recommended using either an oral,1 intramuscular,2-5 intravenous,6-8 or a rectal9,10 route of administration. Although each has some purported advantage, none of the drugs or techniques that are currently available are absolutely safe or completely reliable.11-14 Because of this concern for safety and efficacy, many children experiencing procedure-related pain are often inadequately treated with analgesics and are immobilized primarily by physical restraint.

Therapeutic Orphans

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 688-689
Author(s):  
STEVEN J. WEISMAN ◽  
NEIL L. SCHECHTER
Keyword(s):  
Case Report ◽  
Respiratory Arrest ◽  
Intravenous Sedation ◽  
Safe Technique ◽  
Sedation And Analgesia

To the Editor.— The report by Yaster et al, “Midazolam-Fentanyl Intravenous Sedation in Children: Case Report of Respiratory Arrest,”1 is the first we are aware of in the pediatric literature which reviews and promotes the use of this method of sedation and analgesia for children. Unfortunately,the title of the article and some of its emphasis may have the unfortunate consequence of delaying acceptance of this generally safe technique which is clearly not the intent

scholarly journals Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report

2015 ◽  
Vol 62 (1) ◽  
pp. 25-30
Author(s):  
Bill W. S. Kim ◽  
Robert M. Peskin
Keyword(s):  
Case Report ◽  
Dental Treatment ◽  
Deep Sedation ◽  
Single Agent ◽  
Intravenous Sedation ◽  
Oral Rehabilitation ◽  
Anesthetic Agents ◽  
History Of ◽  
Sedation And Analgesia ◽  
Outpatient Settings

Abstract Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.

Surgical treatment of alveolar echinococcosis: a single centre experience and systematic review of the literature

2019 ◽  
Vol 98 (4) ◽  
pp. 167-173
Keyword(s):  
Case Report ◽  
Echinococcus Multilocularis ◽  
Alveolar Echinococcosis ◽  
Lymphatic System ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Safety Margin ◽  
Surgical Removal ◽  
Single Centre Experience ◽  
Therapeutic Procedures

Introduction: Alveolar echinococcosis (AE) is a zoonosis caused by Echinococcus multilocularis. AE is primarily localised in the liver. Echinococcus multilocularis imitates tumour-like behaviour. It can metastasise through blood or lymphatic system to distant organs. Echinococcosis often remains asymptomatic due to its long incubation period and indistinct symptoms. Clinical symptoms are determined by the parasite’s location. Diagnosis of echinococcosis is based on medical history, clinical symptoms, laboratory tests, serology results, imaging methods and final histology findings. Surgical removal of the cyst with a safety margin, followed by chemotherapy is the therapeutic method of choice. Case report: We present a case report of alveolar echinococcosis in a thirty-year-old female patient in whom we surgically removed multiple liver foci of alveolar echinococcosis. The disease recurred after two years and required another surgical intervention. Conclusions: Alveolar echinococcosis is a disease with a high potential for a complete cure provided that it is diagnosed early and that the recommended therapeutic procedures are strictly adhered to.

scholarly journals Neonatal Birthmarks at the 4 Central Hospitals in Vientiane Capital, Lao PDR

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199090
Author(s):  
Vilounna Sanaphay ◽  
Sourideth Sengchanh ◽  
Alongkone Phengsavanh ◽  
Anousavanh Sanaphay ◽  
Leelawadee Techasatian
Keyword(s):  
Sebaceous Gland ◽  
Neonatal Period ◽  
Lao Pdr ◽  
Skin Lesions ◽  
Medical Advice ◽  
Point Of View ◽  
Parental Anxiety ◽  
Skin Disorders ◽  
Clinical Point ◽  
Therapeutic Procedures

Newborn skin disorders are quite common and happen to occur during the neonatal period. Most of the birthmarks are transient; however, worried parents often seek medical advice from their child’s physician regarding skin lesions. Thus, it is important to differentiate the skin lesions from pathologic ones to avoid unnecessary diagnostic or therapeutic procedures. This is the first published study in Lao neonates that carried out the data from 4 central hospitals in Vientiane Capital, Lao PDR from September 2019 to February 2020. Among 500 neonates, Sebaceous gland hyperplasia (53%), Mongolian patches (46.6%), and Erythema toxicum neonatorum (30%) were the 3 most common cutaneous conditions found in the Lao newborns. From a clinical point of view, these findings are often a source of parental anxiety and medical concern for inexperienced clinicians.

Cardiac and Respiratory Arrest in a 12-Year-Old Girl with Acute Permethrin Toxicity: A Case Report

2021 ◽  
Author(s):  
Hesam Adin Atashi ◽  
Hamid Zaferani Arani ◽  
Seyyed Mojtaba Ghorani ◽  
Mahya Sadat Teimouri Khorasani ◽  
Masoumeh Moalem
Keyword(s):  
Case Report ◽  
Brain Damage ◽  
Respiratory Arrest ◽  
Spontaneous Circulation ◽  
Type I ◽  
Medical Problems ◽  
Present Case Report ◽  
Case Presentation ◽  
Hypoxic Brain Damage ◽  
Hypoxic Brain

Abstract Background: Permethrin (PER) is widely employed as the most frequently used type I synthetic pyrethroid insecticide. Despite its worldwide application, reports of pediatric toxicity following permethrin administration are scarce.Case presentation: The present case report involves a 12-year-old Afghan girl, with no previous medical problems, who drank an unknown insecticide covertly at home. Two hours after ingestion, she was taken to the emergency room with neither breathing signs nor a heartbeat. She was immediately transferred to the cardiopulmonary resuscitation (CPR) room, and her spontaneous circulation was returned after a few minutes of CPR. She was then intubated, volume resuscitated with intravenous normal saline, and connected to the mechanical ventilator after being transferred to the ICU ward. The patient remained comatose without spontaneous breathing, her pupils became bilateral mydriasis, and central diabetes insipidus became evident after three days due to apnea and hypoxic brain damage following insecticide ingestion. The chemical analysis of the insecticide bottle showed 10% permethrin without organophosphates, as initially expected. Unfortunately, after seven days, the patient passed away due to resistant hypotension and severe brain damage.Conclusion: Permethrin is widely used globally as an insecticide. However, there are many unmet needs in permethrin toxicity treatment, and the treatment is mainly supportive. Depending on the amount and dose of permethrin, the most common symptoms can vary from headache, dyspnea, and vomiting to metabolic acidosis and cardiac and respiratory arrest, which can lead to hypoxic brain damage and death, as was the outcome in our case.

Abstract 1122‐000097: Recurrent Carotid Cavernous Fistula Requiring Complex Repair of Ruptured Cavernous Carotid Aneurysm: A Case Report

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Rami Z. Morsi ◽  
Faten El Ammar ◽  
Sonam Thind ◽  
Scott J. Mendelson ◽  
Cedric McKoy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Large Scale ◽  
Mechanical Valve ◽  
Covered Stent ◽  
Stent Grafts ◽  
Cerebral Angiogram ◽  
Safety And Efficacy ◽  
Third Nerve Palsy ◽  
History Of

Introduction : There are no studies investigating the safety and efficacy of covered stent grafts, particularly the newly developed stents such as the PK Papyrus stent, for endovascular treatment of direct carotid cavernous fistulas (CCFs). Methods : We present a case of a 75‐year‐old female who presented to the hospital with a three‐week history of worsening left eye vision, chemosis, proptosis, and partial third nerve palsy. Patient was found to have left direct Type A CCF secondary to ruptured cavernous segment carotid aneurysm. Results : The CCF was treated with coil embolization and pipeline Shield stent embolization devices with immediate stagnation and improvement of symptoms. Patient had history of an aortic mechanical valve and thus was started on warfarin and ASA. After achieving INR level of 2.5‐3.5, patient started to have recurrent swelling of the left eye associated and decreased visual acuity. Repeated diagnostic cerebral angiogram revealed residual CCF. Onyx liquid embolization and a Surpass Evolve Flow Diverter were attempted to slow the fistulization with no success. Multiple attempts for direct percutaneous superior ophthalmic vein cannulation were also unsuccessful. At this point, two coronary graft‐covered PK Papyrus stents were implanted across the fistula pouch, which resulted in immediate resolution of the CCF with evidence of persistent normal flow within left ophthalmic artery. Patient’s visual acuity and left eye movement improved. Conclusions : This case report highlights the effectiveness and safety of covered stent grafts, particularly more flexible stents such as the PK Papyrus stent, in navigating the carotid vasculature and closing direct CCFs and may be used as a first‐line technique. More large‐scale studies are warranted to investigate the safety and efficacy of using such stent grafts to treat direct CCFs in the setting of antithrombotic agents and anticoagulation.

scholarly journals Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth

2014 ◽  
Vol 23 (3) ◽  
pp. 124-134 ◽  
Author(s):  
Barbara Harper
Keyword(s):  
Case Report ◽  
American Academy ◽  
Water Immersion ◽  
Protective Mechanisms ◽  
Safety And Efficacy ◽  
American Academy Of Pediatrics ◽  
Growing Body ◽  
Water Birth

The 2014 objection to birth in water voiced by both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) in ACOG Bulletin #594 on immersion in water during labor and birth is nothing new. The Committee on Fetus and Newborn published the very same opinion in 2005, based on a case report that was published in 2002 in the journal Pediatrics. What has changed since 2002 is a growing body of evidence that reports on the safety and efficacy of labor and birth in water. This article reviews the retrospective literature on water birth and explains newborn physiology and the protective mechanisms that prevent babies from breathing during a birth in water.

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