[Emergency from anesthesia in small children. From laryngospasm to prolonged apnea].
Postoperative laryngospasm during emergence from anaesthesia represents a potentially life-threatening complication. Even if this is successfully overcome using drug therapy, new, serious problems may develop. We report the case of a 3 1/2 -year-old boy of African descent weighing 15 kg who developed a laryngospasm during emergence from anaesthesia. Because the airway obstruction could not be controlled by deepening the anaesthesia again and administering anti-obstructive drugs, the boy was given 15 mg succinylcholine. Thereafter prolonged apnea developed such that the patient had to be admitted to the pediatric intensive care unit. The child was extubated 6 h later and the further course was normal so that he could be released from the hospital the following day. Further diagnostic study revealed a dibucaine-sensitive, fluoride-resistant pseudocholinesterase in the plasma, which is a rare form of atypical pseudocholinesterase, explaining the prolonged arousal phase after the administration of succinylcholine. Three significant aspects of this case are discussed: 1. risk factors and treatment of perioperative airway obstruction 2. factors and treatment of prolonged apnea, and 3. delayed arousal reactions and their management in an outpatient setting.
Gries
A
A
Klinik für Anaesthesiologie der Universität Heidelberg. andre_gries@med.uni-heidelberg.de
Motsch
J
J
Ulmer
H E
HE
Springer
W
W
D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy; D000758:Anesthesia / Q000009:adverse effects*; D001049:Apnea / Q000201:enzymology / Q000209:etiology* / Q000628:therapy; D002091:Butyrylcholinesterase / Q000097:blood / Q000235:genetics; D002675:Child, Preschool; D004632:Emergency Medical Services; D006801:Humans; D007826:Laryngismus / Q000201:enzymology / Q000209:etiology* / Q000628:therapy; D008297:Male; D009467:Neuromuscular Depolarizing Agents; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D013390:Succinylcholine
D009467:Neuromuscular Depolarizing Agents; D002091:Butyrylcholinesterase; D013390:Succinylcholine