Journal of clinical anesthesia
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Review Case Reports
Anesthetic care for the child with congenital central alveolar hypoventilation syndrome (Ondine's curse).
Idiopathic congenital central alveolar hypoventilation syndrome, otherwise known as Ondine's curse, is a rare neuropathologic syndrome characterized by an inadequate respiratory drive with hypoventilation and periods of prolonged apnea resulting in hypercarbia and hypoxemia. Although no definite pathologic abnormality has been identified to account for the disorder, it is thought to represent a primary defect related to altered function of central chemoreceptors resulting in defective control of minute ventilation. Associated problems related to neural crest cell migration, including neuroblastoma formation and Hirschsprung's disease, suggest that the primary defect is defective neural crest cell migration and function. ⋯ Cardiovascular issues include the possible presence of cor pulmonale and autonomic nervous system dysfunction. Central nervous system issues include the frequent occurrence of seizures and mental retardation. The preoperative work-up, premedication, and the intraoperative/postoperative care and monitoring of these patients is reviewed.
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Randomized Controlled Trial Clinical Trial
Changes in respiratory pattern and arterial blood gases during sedation with propofol or midazolam in spinal anesthesia.
To investigate changes in respiratory pattern and arterial blood gases during sedation with propofol or midazolam in spinal anesthesia. ⋯ Significant decreases in %RC and pO2 during propofol sedation seem to depend on paradoxical respiration due, in part, to upper airway obstruction; therefore, attention should be directed to the respiratory pattern during sedation, especially with propofol.
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To determine the influences of age and gender on the dose response and the time course of effect of atracurium. ⋯ Age and gender have significant effects on the dose response and time course of effect of atracurium. Older patients and women are more sensitive to atracurium-induced neuromuscular block than are young patients and men.