Anaesthetic management of an asthmatic child for appendicectomy.
A 13-yr-old boy was scheduled for emergency appendicectomy because of abdominal pain. His preoperative medical history was complicated by a recent hospital admission for management of asthma. He had presented to hospital seven days earlier because of dyspnoea, tachypnoea and oxygen desaturation to 77% on room air. Following admission, he required intensive nonventilatory management of his asthma, including intravenous salbutamol, methylprednisolone, and aminophylline, as well as use of an ipratroprium bromide inhaler and 100% oxygen by mask. He was discharged to the ward, and continued on prednisone (delta-cortisone), beclomethasone inhaler, ipratroprium inhaler, and salbutamol inhaler. During his ICU stay, he complained of nonspecific abdominal pain, interpreted as gastro-oesophageal reflux. After four days, he was discharged to the ward. On his sixth hospital day, he began to experience right-sided lower abdominal pain and right shoulder pain. A surgeon was consulted, and the patient was found to have a very tender right lower quadrant with guarding and rebound pain. He was therefore scheduled for appendicectomy; antibiotic therapy with ampicillin, gentamicin, and metronidazole was initiated.
Kuwahara
B
B
Department of Anaesthesia, Alberta Children's Hospital, University of Calgary, Canada.
Goresky
G V
GV
D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D001062:Appendectomy / Q000379:methods; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use
D009020:Morphine; D008012:Lidocaine; D001507:Beclomethasone; D000420:Albuterol; D005283:Fentanyl; D011241:Prednisone; D008775:Methylprednisolone; D002045:Bupivacaine