Heart block following propofol in a child

We present the case of a nine-year-old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. Propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. Heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.     

Successful resuscitation after ropivacaine and lidocaine-induced ventricular arrhythmia following posterior lumbar plexus block in a child

We report the case of a 13-yr-old girl scheduled for knee surgery under general anesthesia and posterior lumbar plexus block. A ventricular arrhythmia developed 15 min after local anesthetic injection. A 20% lipid emulsion was successful in converting the ventricular arrhythmia to a sinus rhythm. This is consistent with previous reports suggesting that lipid emulsion is an effective emergency treatment of local anesthetic toxicity. We recommend the immediate availability of lipid emulsion along with other emergency therapeutics in operating rooms where local anesthetics are used.     

Quadriplegia in a child following adenotonsillectomy

Neurological deterioration in a child following routine surgery, although rare, has potentially life threatening consequences. We report the case of a child who, following adentonsillectomy, developed quadriplegia and acute respiratory distress due to previously undetected atlanto‐axial instability. Patients with atlanto‐axial instability often have mild or non‐specific symptoms, despite severe cervical cord compression. Subtle manifestations may be ignored or attributed to other disease processes, which render patients with undiagnosed atlanto‐axial instability at risk of serious neurological injury during general anaesthesia, particularly at the time of laryngoscopy and tracheal intubation.     

Continuous infraclavicular brachial plexus block in a child

Continuous regional anesthesia for both intra- and postoperative use in adults is becoming more common. As with many new anesthesia techniques, however, there is often a lag time before the same techniques are utilized in children. Our patient was a 10-year-old child requiring reoperation on her fifth digit with planned 48-h admission for range of motion exercises. We wanted to have a continuous regional blockade to control the patient's pain during the postoperative manipulations of the digit. A search of the literature from the last 10 years did not show any reports of the placements of a continuous brachial plexus block in children. In this case report, we present the successful placement and use of a continuous infraclavicular catheter in a child undergoing upper extremity surgery.     

Sciatic nerve block in a child: a sonographic approach

Ultrasound technology can facilitate peripheral nerve blocks in clinical practice. In this case report, ultrasound imaging was used to identify the sciatic nerve and guide local anesthetic injection in the subgluteal region of a child undergoing Achilles tendon lengthening. Sonographic guidance may be especially useful for peripheral nerve blocks in children because the neural imaging is often excellent and reference landmarks are variable. IMPLICATIONS: In this case report, ultrasound was used to identify the sciatic nerve and guide local anesthetic injection in the subgluteal region of a child. Sonographic guidance may be especially useful for peripheral nerve blocks in children because the neural imaging is often excellent and reference landmarks are variable.