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T P Beach

Publications and source records attributed to T P Beach.

13 recordsLinked to original sources
PubMed1997

Cardiac arrest on the day following surgery in children with unrecognized rhabdomyolysis.

We present tow male children who experienced cardiac arrest secondary to unrecognized rhabdomyolysis on the day following an uneventful general anesthetic and recovery room course for adenotonsillectomy. Neither child exhibited hypermetabolism typical of malignant hyperthermia or appeared to have a dystrophinophy, prompting the authors to search for other etiologies of childhood rhabdomyolysis infrequently associated with anesthesia. In this report, we review the heritable metabolic myopathies caused by enzyme deficiencies (enzymopathies) that can lead to life-threatening rhabdomyolysis following certain triggering conditions, and we offer suggestions for avoiding these triggers in the perianesthetic period. We also describe key symptoms an signs that postanesthetic caregivers should be aware of, and briefly comment on follow-up diagnostic studies.

Child↗
PubMed1995

Acquired QT interval changes and neck dissections.

STUDY OBJECTIVE: To determine if acquired long QT syndrome following right or left, radical or modified, neck dissections result in malignant arrhythmias or deaths. DESIGN: Prospective study. SETTING: Inpatient head and neck service of the Massachusetts Eye and Ear Infirmary. PATIENTS: 69 patients who underwent extensive neck surgery, without congenital long QT syndrome, medications known to prolong the QT interval, preoperative ventricular arrhythmias, or electrolyte abnormalities. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Preoperative and postoperative electrolytes were evaluated. Preoperative and postoperative electrocardiograms and QT intervals were evaluated. Continuous intraoperative and 10- to 12-hour postoperative monitoring of lead II or V5 were evaluated. Twenty-six patients (Group 1) underwent either right radical neck dissection or modified right radical neck dissection, 25 patients (Group 2) underwent either left radical neck dissection or modified left neck dissection, and 18 patients (Group 3) underwent extensive neck surgery without radical or modified neck dissection. Postoperatively, 38 patients (19 Group 1, 11 Group 2, and 8 Group 3 patients) developed a QT interval corrected for heart rate (QTc) of greater than 440 milliseconds. Repeated measures analysis of variance, comparing preoperative and postoperative QTc showed a statistically significant preoperative to postoperative change, but no significant difference among the three groups. No malignant arrhythmias or deaths were recorded in any of the three groups. CONCLUSIONS: Acquired long QT syndrome following radical neck dissection, without congenital, metabolic, or pharmacologic disturbance, is unlikely to trigger malignant arrhythmias, as previously reported for right radical neck dissection.

Analysis of Variance↗
PubMed1990

Negative pressure pulmonary oedema: a potential hazard of muscle relaxants in awake infants.

We report two cases of healthy infants who were given an IV intubating bolus of a nondepolarizing muscle relaxant (0.1 mg.kg-1 vecuronium) at the beginning of an inhalational induction of anaesthesia. Shortly after the introduction of low concentrations of gaseous agents, both infants exhibited airway obstruction although inspiratory muscle activity was still vigorous. The airway obstruction was due to approximation of the tongue to the posterior pharyngeal wall, and was easily corrected by insertion of an oral airway. The infants immediately exhibited fulminant pulmonary oedema, which responded to conventional therapy. It is postulated that paralysis of glossal muscles occurred prior to diaphragmatic paralysis, creating upper airway obstruction while preserving inspiratory muscle activity. This can rapidly lead to negative pressure pulmonary oedema in the small infant. Meticulous attention to the maintenance of an unobstructed upper airway is required if muscle relaxants are administered to the awake infant.

Airway Obstruction↗
PubMed1988

Negative pressure pulmonary oedema secondary to airway obstruction in an intubated infant.

We report the case of a healthy one-month-old male infant who underwent an uneventful endotracheal anaesthetic for hernia repair. During transport to the recovery room (a less than 30 second trip), the endotracheal tube in the spontaneously breathing infant became obstructed, possibly due to impaction of the tip in the right main bronchus. Restoration of the airway was followed by fulminant pulmonary oedema. Several days of vigorous respiratory and pharmacologic therapy were required for resolution of the infant's respiratory distress. We review other reported cases of acute airway obstruction associated with pulmonary oedema in children and briefly describe the proposed mechanisms. The difficulties of gauging proper endotracheal tube depth in the infant are noted. This case report demonstrates the importance of continuous monitoring during patient transport to the recovery room.

Airway Obstruction↗
PubMed1984

Halothane and children: the first quarter century.

For the past 25 years, halothane has been the primary anesthetic agent at Children's Hospital, Columbus, Ohio. To confirm our impression that adverse reactions to halothane are rarely a problem in children, we examined the records of 200,311 cases conducted with halothane from June 1, 1958, through May 31, 1983. Life-threatening complications due to side effects were identified in fifteen patients, and could be grouped into three areas: hepatitis (one), malignant hyperthermia (ten), and cardiac arrhythmias (four). No child died or sustained permanent sequelae. In eleven instances, other drugs (succinylcholine, atropine, cocaine, and epinephrine) possibly contributed to the adverse reactions.

Adolescent↗
PubMedDate not supplied

Assessment of intubation in croup and epiglottitis.

Nasotracheal intubation for the management of airway obstruction in acute epiglottitis has become a well-received practice. However, the same technique has not received widespread support in laryngotracheobronchitis. The purpose of this study was to update the series of nasotracheal intubations in croup and epiglottitis from Columbus Children's Hospital with the specific intent to evaluate its effectiveness. All patients were evaluated for any immediate and delayed complications. Delayed complications were evaluated using parent interviews and measuring expiratory flow rates. This study of 45 children intubated for epiglottitis and 83 intubations for croup reconfirms the earlier report from this institution about its safety in both conditions. However, it has identified a subset of the croup patients who are definitely at risk to develop complications of the technique. In those children under 1 year of age, a disturbingly high incidence of subglottic stenosis was identified and this appeared to be related to the patient's age, tube size, serial intubations (dilatations), and duration of intubation. Suggested guidelines for airway management in the light of the new information are presented.

Acute Disease↗