PubMed · 14913348
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V O SARUKHANLAN, V A MALKHASIAN. 1952. [Paridural anesthesia].. https://pubmed.ncbi.nlm.nih.gov/14913348/
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Otolaryngologic or ear, nose, and throat (ENT) problems are common in children with Down Syndrome (DS). This includes problems with chronic ear infections and chronic middle ear effusions with associated hearing loss, airway obstruction, and sleep apnea, as well as problems with chronic rhinitis and sinusitis. In addition, many of these ENT problems require surgical interventions, and there are special anesthesia considerations that need to be addressed in children with DS. These include subglottic stenosis, post-operative airway obstruction, and cervical spine concerns. As the care of children with DS has become more consistent and proactive, outcomes from the treatment of these ENT manifestations have improved. Aggressive interventions, both medical and surgical, have led to a decreased incidence of hearing loss, good control of the chronic rhinitis, and a better awareness of the incidence of sleep apnea and sleep-disordered breathing in individuals with DS. These common otolaryngologic manifestations of DS are reviewed with recommendations for ongoing care and monitoring.
Plasma catecholamines were measured following surgery under anaesthesia and after exposing hagfish to 90 and 110% sea water (SW). Plasma noradrenaline (NA) concentration increased from a resting value of 7 to 818 nM l(-1) on anaesthesia. Plasma adrenaline (AD) did not change. NA concentrations also increased during volume depletion (110% SW), but to much lower values (26 nM l(-1 )at 100 min). AD concentrations were increased at 20 min, then fell. During volume loading (90% SW) NA fell, and AD increased to a maximum concentration of 511 nM l(-1) at 40 min (resting concentration 24 nM l(-1)). The data are consistent with a vasoconstrictory role for NA on central veins when venous pressures fall and a vasodilatory role for AD on volume expansion.
BACKGROUND: Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands with or without light tactile stimulation. Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non-anaesthesiologists. AIM: To describe drug regimens that can be successfully and safely targeted to moderate sedation for endoscopy by non-anaesthesiologists. RESULTS: Moderate sedation can be achieved using narcotics and benzodiazepines. There is interest in some countries in propofol for endoscopy, which is often viewed as an agent for deep sedation. Indeed, propofol cannot be targeted to moderate sedation for endoscopy as a single agent because of coughing during upper endoscopy and pain withdrawal responses during colonoscopy. Pre-treatment with low doses of narcotic and/or benzodiazepine blocks these effects, allowing propofol to be targeted to moderate sedation. Fospropofol, a prodrug of propofol in clinical development, can also be targeted to moderate sedation if co-administered with narcotic. CONCLUSION: Moderate sedation provides a safety margin when compared with deep sedation and general anaesthesia. Development of protocols that target agents such as propofol to moderate sedation will expand the sedation agents available to non-anaesthesiologists and help ensure that this expansion occurs safely.