Gasping infant for emergency neck exploration, anaesthesiologist’s nightmare!

Supriya R. Palsodkar, Anjali R. Bhure, Heena D. Pahuja, Neha K. Fuladi

Abstract


Children are not small adults. They have certain anatomical & physiological differences as compared to adults. Paediatric patients have limited body reserve and so they deteriorate very fast. Anaesthetising paediatric patient requires good clinical judgment and thorough knowledge of paediatric anatomy and physiology. Anaesthetising an infant who has respiratory distress preoperatively increases risk several folds. Also the cause of respiratory distress is vital and that can have an important anaesthetic implications. Here we report a case of a gasping infant operated for emergency neck exploration under anaesthesia, where the cause of respiratory distress was unknown, making the case further interesting and challenging.


Keywords


Gasping infant, Unknown cause, Emergency neck exploration, Anaesthesiologist’s challenges

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References


Charles J Cote. Pediatric Anesthesia in: Miller R. D. editor, Miller’s anaesthesia, seventh edition, chapter no. 82Paediatric anaesthesia, page no. 2560-2562, Churchill Livingstone.

Kirkpatrick SE, Pitlick PT, Naliboff J, Friedman WF:Frank-Starling relationship as an important determinant of fetal cardiac output. Am J Physiol1976; 231:495-500.

F Jewkes, M Woollard Assessment and management of paediatric primary survey negative patients Emerg Med J 2004;21(5):595-605.

Karambin. M. M. and Hashemian H. Causes of respiratory distress in children. Department of Pediatrics, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran. Acta medica Iranica. 2008; 46(5): 405-408.

Sagar S, Kumar N, Singhal M, Kumar S, Kumar A. A rare case of life-threatening penetrating oropharyngeal trauma caused by toothbrush in a child. J Indian Soc Pedod Prev Dent 2010;28:134-136.

Hellmann JR, Shott SR, Gootee MJ. Impalement injuries of the palate in children: review of 131 cases. Int J Pediatr Otorhinolaryngol. 1993;26(2): 157-163.

Bluestone CD, Rosenfield RM. Surgical atlas of paediatric otolaryngology. In: Decker BC, editor. London: Inc. Hamilton; 2002. pp. 482-6.

Pediatric Retropharyngeal Abscess, Author: Jason L Acevedo, MD; emedicine. medscape. com/article/ 995851-overview.

Sztajnbok J, Grassi MS, Katayama DM, Troster EJ. Descending suppurative mediastinitis: nonsurgical approach to this unusual complication of retropharyngeal abscesses in childhood. Pediatr Emerg Care. 1999 Oct;15(5):341-3.

Heilbronn YD, Tovi F, Hirsch M, Ronen J. Transverse cervical myelopathy: an unusual complication of retropharyngeal abscess. Head Neck Surg. 1984 Jul-Aug;6(6):1051-3.

Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections. Otolaryngol Head Neck Surg. 1997;116: 16-22. [PubMed].

Available from: http://www. Emedicine. com/ent/TOPIC669.htm. Last accessed on 2014 February 15].

Manjula Sudhakar Rao, YK Linga Raju, and PN Vishwanathan. Anaesthetic management of difficult airway due to retropharyngeal abscess Indian J Anaesth. 2010 May-Jun; 54(3): 246-248.

Masazumi Watanabe, Yoshiro Ohshika, Teruhiro Aoki, Keigo Takagi, Susumu Tanaka, Toshiro Ogata. Empyema and mediastinitiscomplicatingretropharyngeal abscessThorax 1994;49:1179-80.