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Broder MS, Chen E, Yan JT, Chang E, Tarbox MH, Larkin AA, White KK. National burden of achondroplasia: an analysis of the National Inpatient and Nationwide Ambulatory Surgery Samples. J Comp Eff Res 2022; 11:1135-1146. [PMID: 36039778 DOI: 10.2217/cer-2021-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: To estimate the cost of US hospital admissions and outpatient surgeries associated with achondroplasia. Materials & methods: Using 2017 data from nationally representative databases, this study identifies hospital admissions and outpatient encounters with an achondroplasia diagnosis. Descriptive measures are reported. Results: There were 1985 achondroplasia admissions nationwide. The most frequent admissions were neonatal care (33.7%) in children and musculoskeletal (22.7%) in adults. Average hospital length of stay was 6.8 days, 2.2 days longer than the US mean. Total mean inpatient costs were US$19,959, $7789 greater than the US mean. In the outpatient setting, children 5-14 years accounted for 56.9% of procedures. Conclusion: Achondroplasia is a serious condition with a wide range of lifelong complications frequently requiring hospitalization and surgical intervention.
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Affiliation(s)
- Michael S Broder
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
| | - Er Chen
- BioMarin Pharmaceutical Inc., San Rafael, CA 94901, USA
| | - Jessie T Yan
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
| | - Marian H Tarbox
- PHAR (Partnership for Health Analytic Research) Beverly Hills, CA 90212, USA
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Savarirayan R, Ireland P, Irving M, Thompson D, Alves I, Baratela WAR, Betts J, Bober MB, Boero S, Briddell J, Campbell J, Campeau PM, Carl-Innig P, Cheung MS, Cobourne M, Cormier-Daire V, Deladure-Molla M, Del Pino M, Elphick H, Fano V, Fauroux B, Gibbins J, Groves ML, Hagenäs L, Hannon T, Hoover-Fong J, Kaisermann M, Leiva-Gea A, Llerena J, Mackenzie W, Martin K, Mazzoleni F, McDonnell S, Meazzini MC, Milerad J, Mohnike K, Mortier GR, Offiah A, Ozono K, Phillips JA, Powell S, Prasad Y, Raggio C, Rosselli P, Rossiter J, Selicorni A, Sessa M, Theroux M, Thomas M, Trespedi L, Tunkel D, Wallis C, Wright M, Yasui N, Fredwall SO. International Consensus Statement on the diagnosis, multidisciplinary management and lifelong care of individuals with achondroplasia. Nat Rev Endocrinol 2022; 18:173-189. [PMID: 34837063 DOI: 10.1038/s41574-021-00595-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/31/2022]
Abstract
Achondroplasia, the most common skeletal dysplasia, is characterized by a variety of medical, functional and psychosocial challenges across the lifespan. The condition is caused by a common, recurring, gain-of-function mutation in FGFR3, the gene that encodes fibroblast growth factor receptor 3. This mutation leads to impaired endochondral ossification of the human skeleton. The clinical and radiographic hallmarks of achondroplasia make accurate diagnosis possible in most patients. However, marked variability exists in the clinical care pathways and protocols practised by clinicians who manage children and adults with this condition. A group of 55 international experts from 16 countries and 5 continents have developed consensus statements and recommendations that aim to capture the key challenges and optimal management of achondroplasia across each major life stage and sub-specialty area, using a modified Delphi process. The primary purpose of this first International Consensus Statement is to facilitate the improvement and standardization of care for children and adults with achondroplasia worldwide in order to optimize their clinical outcomes and quality of life.
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Affiliation(s)
- Ravi Savarirayan
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.
| | - Penny Ireland
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Melita Irving
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Dominic Thompson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Inês Alves
- ANDO Portugal / ERN BOND, Évora, Portugal
| | | | - James Betts
- Centre for Nutrition, Exercise & Metabolism, Department for Health, University of Bath, Bath, UK
| | - Michael B Bober
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Jenna Briddell
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jeffrey Campbell
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | | | - Moira S Cheung
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Martyn Cobourne
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | | | | | | | | | - Virginia Fano
- Paediatric Hospital Garrahan, Buenos Aires, Argentina
| | | | - Jonathan Gibbins
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Mari L Groves
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Therese Hannon
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julie Hoover-Fong
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Greenberg Center for Skeletal Dysplasias, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Juan Llerena
- National Institute Fernandes Figueira, Rio de Janeiro, Brazil
| | | | | | | | - Sharon McDonnell
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Klaus Mohnike
- Universitätskinderklinik, Otto-von-Guericke Universität, Magdeburg, Germany
| | - Geert R Mortier
- Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Amaka Offiah
- Sheffield Children's Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Keiichi Ozono
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Steven Powell
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yosha Prasad
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | | | - Pablo Rosselli
- Fundación Cardio infantil Facultad de Medicina, Bogota, Colombia
| | - Judith Rossiter
- University of Maryland St. Joseph Medical Center, Towson, MD, USA
| | | | | | - Mary Theroux
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Matthew Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - David Tunkel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Colin Wallis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Wright
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Svein Otto Fredwall
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Sukhavasi A, O'Malley TJ, Maynes EJ, Choi JH, Gordon JS, Phan K, Tchantchaleishvili V. Cardiac interventions in patients with achondroplasia: a systematic review. J Thorac Dis 2020; 12:998-1006. [PMID: 32274169 PMCID: PMC7139002 DOI: 10.21037/jtd.2020.02.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with achondroplasia and other causes of dwarfism suffer from increased rates of cardiovascular disease relative to the remainder of the population. Few studies have examined these patients when undergoing cardiac surgery or percutaneous intervention. This systematic review examines the literature to determine outcomes following cardiac intervention in this unique population. An electronic search was performed in the English literature to identify all reports of achondroplasia, dwarfism, and cardiac intervention. Of the 5,274 articles identified, 14 articles with 14 cases met inclusion criteria. Patient-level data was extracted and analyzed. Median patient age was 55.5 [interquartile ranges (IQR), 43.8, 59.8] years, median height 102.0 [98.8, 112.5] cm, median BMI 32.1 [27.0, 45.9], and 57.1% (8/14) were male. Of these 14 patients, nine had the following documented skeletal abnormalities: 66.7% (6/9) had scoliosis, 66.7% (6/9) had kyphosis, 11.1% (1/9) had lordosis, 11.1% (1/9) pectus carinatum and 11.1% (1/9) spinal stenosis. Coronary artery disease was present in 53.8% (7/13), and 30.8% (4/13) patients previously suffered a myocardial infarction. Of the eight patients who underwent cardiac surgery, 37.5% (3/8) underwent multivessel coronary artery bypass grafting, 37.5% (3/8) underwent aortic valve replacement, 25.0% (2/8) underwent type A aortic dissection repair, and the remaining 12.5% (1/8) underwent pulmonary thromboendarterectomy. Six patients underwent percutaneous intervention. Median cardiopulmonary bypass time was 136.5 [110.0, 178.8] minutes. Median arterial cannula size was 20.0 [20.0, 24.0] Fr. Bicaval cannulation was performed in all cases describing cannulation strategy (5/5). Median superior vena cava cannula size was 28.0 [28.0, 28.0] Fr, and inferior vena cava cannula size was 28.0 [28.0, 28.0] Fr. No mortality was reported with a median follow up time of 6.0 [6.0, 10.5] months. In conclusion, Common cardiac procedures can be performed with reasonable safety in this patient population. Operative adjustments may need to be made with respect to equipment to accommodate patient-specific needs.
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Affiliation(s)
- Amrita Sukhavasi
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas J O'Malley
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Elizabeth J Maynes
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jae Hwan Choi
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Gordon
- Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin Phan
- Southwest Sydney Clinical School, University of New South Wales (UNSW), Liverpool Hospital, Sydney, Australia
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Shah LM, Bisson EF. Susceptibility of Cervical Spinal Stenosis to Hypoxic-Ischemic Cord Injury. World Neurosurg 2020; 133:314-317. [DOI: 10.1016/j.wneu.2019.10.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
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5
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Touil LL, Saggar AK, Taghizadeh R. Autologous breast reconstruction in patients with achondroplasia: Reconstructive and anaesthetic challenges. J Plast Reconstr Aesthet Surg 2019; 72:1219-1243. [PMID: 30981635 DOI: 10.1016/j.bjps.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- L L Touil
- Department of Plastic and Reconstructive Surgery, Knowsley and St Helens NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, Merseyside, United Kingdom.
| | - A K Saggar
- Department of Anaesthesiology, Knowsley and St Helens NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, Merseyside, United Kingdom
| | - R Taghizadeh
- Department of Plastic and Reconstructive Surgery, Knowsley and St Helens NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, Merseyside, United Kingdom
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6
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Moriyama S, Hara M, Kaneko Y. Acute type A aortic dissection repair in an octogenarian with achondroplasia: a case report. Surg Case Rep 2018; 4:53. [PMID: 29884976 PMCID: PMC5993690 DOI: 10.1186/s40792-018-0461-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/31/2018] [Indexed: 11/14/2022] Open
Abstract
Background Achondroplasia is an inherited disorder and the most common type of short-limbed dwarfism in human beings, affecting more than 250,000 individuals worldwide. To the best of our knowledge, no study has reported a correlation between achondroplasia and aortic dissection. Here, we report a rare case of acute type A aortic dissection repair in a patient with achondroplasia. Case presentation An 82-year-old Japanese female with achondroplasia was admitted to our hospital because of acute-onset severe chest pain migration to her back accompanied by numbness and pain in the right lower limb. A computed tomography scan revealed acute type A aortic dissection with right leg ischemia because of an occlusion of the right common iliac artery. We successfully performed hemiarch repair. Conclusions This report presents the first case of a patient at such an advanced age with dwarfism and cardiac surgery and the second case to illustrate successful acute aortic dissection repair in achondroplasia. Of note, all procedures were performed without specialized equipment. Overall, this report adds to the experience of successful cardiac surgery in this unique patient population.
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Affiliation(s)
- Shuji Moriyama
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara, Yatsushiro, Kumamoto, 866-8533, Japan.
| | - Masahiko Hara
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yasushi Kaneko
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara, Yatsushiro, Kumamoto, 866-8533, Japan
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7
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Huecker M, Harris Z, Yazel E. Occult Spinal Cord Injury after Blunt Force Trauma in a Patient with Achondroplasia: A Case Report and Review of Trauma Management Strategy. J Emerg Med 2017; 53:558-562. [DOI: 10.1016/j.jemermed.2017.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/14/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022]
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8
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Lange EMS, Toledo P, Stariha J, Nixon HC. Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism. Can J Anaesth 2016; 63:945-51. [PMID: 27174298 DOI: 10.1007/s12630-016-0671-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/27/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The literature on the anesthetic management of parturients with dwarfism is sparse and limited to isolated case reports. Pregnancy complications associated with dwarfism include an increased risk of respiratory compromise, an increased risk of Cesarean delivery, and an unpredictable degree of anesthesia with neuraxial techniques. Therefore, we conducted this retrospective review to evaluate the anesthetic management of parturients with a diagnosis of dwarfism. METHODS We used a query of billing data to identify short statured women who underwent a Cesarean delivery during May 1, 2008 to May 1, 2013. We then hand searched the electronic medical record for qualifying patients with heights < 148 cm and a diagnosis of dwarfism. The extracted data included patient demographics and obstetric and anesthetic information. RESULTS We identified 13 women with dwarfism who had 15 Cesarean deliveries in total. Twelve of the women had disproportionate dwarfism, and ten of the 15 Cesarean deliveries were due to cephalopelvic disproportion. Neuraxial anesthesia was attempted in 93% of deliveries. The dose chosen for initiation of neuraxial anesthesia was lower than the typical doses used in parturients of normal stature. Neuraxial anesthetic complications included difficult neuraxial placement (64%), high spinal (7%), inadequate surgical level (13%), and unrecognized intrathecal catheter (7%). CONCLUSIONS The data collected suggest that females with a diagnosis of dwarfism may have difficult neuraxial placement and potentially require lower dosages of local anesthetic for both spinal and epidural anesthesia to achieve adequate surgical blockade.
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Affiliation(s)
- Elizabeth M S Lange
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL, 60611, USA.
| | - Paloma Toledo
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL, 60611, USA.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jillian Stariha
- Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA
| | - Heather C Nixon
- Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA
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9
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McCaffer CJ, Douglas C, Wickham MH, Picozzi GL. Acute upper airway obstruction and emergency front of neck access in an achondroplastic patient. BMJ Case Rep 2015; 2015:bcr-2015-209614. [PMID: 25827920 DOI: 10.1136/bcr-2015-209614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dwarfism is defined as a failure to attain a height of 148 cm in adulthood. Achondroplasia is the most common form of short-limbed dwarfism. Although this condition is relatively rare, with an incidence of 0.5-1.5 per 10,000 live births, most medical professionals will come across the achondroplastic dwarf (AD) during their career. Faulty endochondral ossification produces the characteristic short stature phenotype, as well as severe craniofacial, central nervous system, spinal, respiratory and cardiac anomalies. These unusual characteristics may present airway management difficulties in elective as well as emergency situations. Within the literature there is very little information regarding the emergency insertion of a surgical airway in an adult AD. We present our experience of this situation in the form of a case report and a review of the relevant literature.
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Affiliation(s)
- Craig James McCaffer
- Department of Otolaryngology and Head and Neck Surgery, NHS Lanarkshire, Airdrie, Lanarkshire, UK
| | - Catriona Douglas
- Department of Ear Nose and Throat, Monklands District General Hospital, Lanarkshire, UK
| | - Matthew H Wickham
- Department of Ear Nose and Throat, Monklands District General Hospital, Lanarkshire, UK
| | - Gerard L Picozzi
- Department of Ear Nose and Throat, Monklands District General Hospital, Lanarkshire, UK
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Al-Jughiman M, Yanagawa B, Rondi K, Dalamagas C, Peterson MD, Bonneau D. Acute Type A Dissection Repair in an Achondroplastic Dwarf: Anesthetic, Perfusion, and Surgical Concerns. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:143-6. [PMID: 26798732 DOI: 10.12945/j.aorta.2014.14-020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/08/2014] [Indexed: 11/18/2022]
Abstract
In this report we present a 43-year-old male with achondroplastic dwarfism who presented with acute Type A aortic dissection with aortic insufficiency. The patient underwent successful Bentall and hemiarch repair. Anesthetic, perfusion-related, and surgical planning and execution are presented.
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Affiliation(s)
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
| | - Kevin Rondi
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
| | - Constantine Dalamagas
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
| | - Mark D Peterson
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
| | - Daniel Bonneau
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and
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11
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Dubiel L, Scott GA, Agaram R, McGrady E, Duncan A, Litchfield KN. Achondroplasia: anaesthetic challenges for caesarean section. Int J Obstet Anesth 2014; 23:274-8. [PMID: 24768304 DOI: 10.1016/j.ijoa.2014.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 01/07/2023]
Abstract
Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care.
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Affiliation(s)
- L Dubiel
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK.
| | - G A Scott
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - R Agaram
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - E McGrady
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - A Duncan
- Department of Obstetrics and Gynaecology, Princess Royal Maternity Hospital, Glasgow, UK
| | - K N Litchfield
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
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12
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Anesthesia for cesarean section in a patient with achondroplasia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rcae.2012.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Osorio Rudas W, Socha García NI, Upegui A, Ríos Medina Á, Moran A, Aguirre Ospina O, Rivera C. Anestesia para cesárea en paciente con acondroplasia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rca.2012.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Anesthesia for cesarean section in a patient with achondroplasia☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240040-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Bakhshi RG, Jagtap SR. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery. Clin Pract 2011; 1:e120. [PMID: 24765361 PMCID: PMC3981419 DOI: 10.4081/cp.2011.e120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 10/29/2011] [Accepted: 11/03/2011] [Indexed: 11/23/2022] Open
Abstract
Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000-40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.
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Affiliation(s)
- Rochana Girish Bakhshi
- Department of Anaesthesia, Padmashree Dr D.Y. Patil Medical College & Hospital, Nerul, Navi Mumbai, Maharashtra, India
| | - Sheetal R Jagtap
- Department of Anaesthesia, Padmashree Dr D.Y. Patil Medical College & Hospital, Nerul, Navi Mumbai, Maharashtra, India
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16
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Jain A, Jain K, Makkar JK, Mangal K. Case study: Anaesthetic management of an achondroplastic dwarf undergoing radical nephrectomy. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abrão MA, da Silveira VG, de Almeida Barcellos CFLV, Cosenza RCM, Carneiro JRI. Anesthesia for bariatric surgery in an achondroplastic dwarf with morbid obesity. Rev Bras Anestesiol 2009; 59:79-86. [PMID: 19374219 DOI: 10.1590/s0034-70942009000100011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Achondroplasia is the most common form among the different types of osteochondrodysplasia that cause dwarfism. Dwarves develop obesity quite frequently and surgical treatment has shown greater efficacy, both for effective weight loss and long term maintenance. The objective of this report was to present the case of bariatric surgery with Y-en-Roux gastric bypass in an achondroplastic dwarf with morbid obesity. The different difficulties in the anesthetic management of this patient and the way they were dealt with were discussed in order to decrease intraoperative morbidity and mortality. CASE REPORT This is a 29 years old female dwarf with achondroplasia and morbid obesity since childhood. She was 123 cm tall and weighed 144 kg at the time of admission to the Bariatric Surgery service. With a body mass index (BMI) of 95.18 kg.m2, she had several associated diseases especially of the respiratory system and osteoarticular system. After a long follow-up with diet, exercises, and psychological support, her clinical condition improved and she was referred for surgery: Y-en-Roux gastroplasty using the technique of Capella-Fobi. Intubation of the awake patient under direct laryngoscopy was difficult and a bronchofibroscope had to be used. Surgery was uneventful and the patient was maintained under total intravenous anesthesia with continuous infusion of remifentanil and propofol. She was extubated at the end of the surgery still in the operating room. CONCLUSIONS The simultaneous comorbidities of achondroplasia and morbid obesity can hinder the anesthetic management, especially regarding the airways. A thorough pre-anesthetic evaluation is necessary to anticipate the conducts and minimize risks, therefore optimizing the evolution of anesthesia.
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Affiliation(s)
- Maria Angélica Abrão
- CET/SBA Prof. Bento Gonçalves do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), RJ.
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Neema PK, Sethuraman M, Vijayakumar A, Rathod RC. Sinus venosus atrial septal defect closure in an achondroplastic dwarf: anesthetic and cardiopulmonary bypass management issues. Paediatr Anaesth 2008; 18:998-1000. [PMID: 18811848 DOI: 10.1111/j.1460-9592.2008.02669.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Nance JR, Golomb MR. Ischemic spinal cord infarction in children without vertebral fracture. Pediatr Neurol 2007; 36:209-16. [PMID: 17437902 PMCID: PMC2001276 DOI: 10.1016/j.pediatrneurol.2007.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 01/08/2007] [Indexed: 11/22/2022]
Abstract
Spinal cord infarction in children is a rare condition that is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treatment, and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular injury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children, the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult, due to the small transverse area of the cord, cerebrospinal fluid artifact, and inadequate resolution of magnetic resonance imaging. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature that highlight the difficulties and controversies in the management of this condition.
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Affiliation(s)
- Jessica R Nance
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Platis CM, Wasersprung D, Kachko L, Tsunzer I, Katz J. Anesthesia management for the child with Sanjad-Sakati syndrome. Paediatr Anaesth 2006; 16:1189-92. [PMID: 17040310 DOI: 10.1111/j.1460-9592.2006.01981.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sanjad-Sakati syndrome (SSS) is a rare genetic disorder characterized by congenital hypoparathyroidism, hypocalcemia and hyperphosphatemia, seizures, severe intrauterine and postnatal growth failure, dwarfism, mental retardation, dysmorphic features including retromicrognathia and abnormal dentition and increased susceptibility to infection. It is mainly confined to children in the Middle-East countries. We report the anesthesia management of a 12-year-old boy with SSS for dental treatment, and discuss the anesthesia implications of this disorder.
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Affiliation(s)
- Cari M Platis
- Department of Anesthesia, Schneider Children's Medical Center of Israel, Tel Aviv, Israel.
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21
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Ansari MH, Abraham A. Anaesthetic management of unexpected subglottic stenosis in an achondroplasic dwarf. Acta Anaesthesiol Scand 2004; 48:928-9. [PMID: 15242447 DOI: 10.1111/j.0001-5172.2004.00433.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
There appears to be an absence of uniform guidelines for management of labor analgesia in pregnant patients with uncommon medical conditions such as Marfan's syndrome, Ehlers-Danlos syndrome, achondroplastic dwarfism, previous back surgery, and kyphoscoliosis. A Medline search for articles highlighting considerations for obstetric anesthesia in parturients with these disorders was performed. Because of the multiorgan involvement and varied presentations of these disorders, no uniform or routine obstetric anesthetic recommendations can be made. In the absence of uniform obstetric anesthesia guidelines for pregnant patients with Marfan's syndrome, Ehlers-Danlos syndrome, achondroplastic dwarfism, previous back surgery, and kyphoscoliosis, the decision whether to administer regional anesthesia (epidural labor analgesia) should be based on an individual risk-to-benefit ratio on a case-by-case basis.
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Abstract
A 12-year-old girl diagnosed with achondroplasia was admitted for bilateral ear surgery and adenotonsillectomy. She had classical symptoms and signs of upper airway obstruction, which is often seen in patients with achondroplasia. We describe the anaesthetic management of this patient, emphasizing the airway difficulties encountered and their anaesthetic implications.
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Affiliation(s)
- B S Krishnan
- Department of Anaesthesia, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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24
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Doyle DJ, Arellano R. Upper airway diseases and airway management: a synopsis. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2002; 20:767-87, vi. [PMID: 12512262 DOI: 10.1016/s0889-8537(02)00019-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article summarizes some of the more important upper airway conditions likely to affect airway management. A number of upper airway conditions may present difficult challenges to the anesthesiologist. For instance, infected airway structures may lead to partial airway obstruction, stridor, or even complete airway obstruction. Partial airway obstruction may be mild, as in snoring or nasal congestion, or may be more severe, perhaps requiring the use of airway adjuncts, such as a nasopharyngeal airway. Complete airway obstruction is usually managed by prompt intubation, but surgical airways are sometimes needed as a last resort.
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Affiliation(s)
- D John Doyle
- Department of General Anesthesiology E31, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Kuhnert SM, Faust RJ, Berge KH, Piepgras DG. Postoperative macroglossia: report of a case with rapid resolution after extubation of the trachea. Anesth Analg 1999; 88:220-3. [PMID: 9895096 DOI: 10.1097/00000539-199901000-00041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S M Kuhnert
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Monedero P, Garcia-Pedrajas F, Coca I, Fernandez-Liesa JI, Panadero A, de los Rios J. Is management of anesthesia in achondroplastic dwarfs really a challenge? J Clin Anesth 1997; 9:208-12. [PMID: 9172028 DOI: 10.1016/s0952-8180(97)00033-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To review our eight-year anesthetic experience with achondroplastic patients. DESIGN Retrospective study. SETTING University hospital. PATIENTS 15 achondroplastic patients who underwent 53 surgical procedures of orthopedic surgery between 1987 and 1994. INTERVENTIONS Anesthetic technique, drugs, number of incidents, and complications in the intraoperative and postoperative period were recorded. MEASUREMENTS AND MAIN RESULTS Adequate premedication before the transfer to the operating room was very useful to reduce anxiety and increase cooperation. Inhalation induction was well tolerated and allowed easy peripheral venous cannulation. Only one patient presented difficulties during intubation (on two occasions). In the other patients, we found small difficulties only during ventilation with a face mask, which was easily corrected by modifying the position of the patient and/or inserting an oropharyngeal airway. No adverse effect was identified for any particular anesthetic drug or technique used. CONCLUSIONS Although the characteristic deformities of achondroplastic patients can impede the management of anesthesia, in our study we found no special difficulties. Airway complications did not occur. Thus, no specific optimal anesthetic regimen can be recommended.
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Affiliation(s)
- P Monedero
- Department of Anesthesiology and Critical Care, School of Medicine, University of Navarra, Pamplona, Spain
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Denton R. Anaesthetic problems in the Nance Insley syndrome. Anaesthesia 1996; 51:100-1. [PMID: 8669555 DOI: 10.1111/j.1365-2044.1996.tb07688.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Six patients with achondroplasia and symptoms suggestive of cervicomedullary junction compression are reviewed; these included three females and three males, with an average age of 8 years (range 7 months to 30 years). The mean duration of symptoms prior to intervention was 1.9 years. Symptoms included occipitocervical pain, ataxia, incontinence, apnea, and respiratory arrest. Radiological investigations consisted of plain films with flexion and extension views, pluridirectional tomography, thin-section computerized tomography, and magnetic resonance imaging. Typical findings included marked foramen magnum stenosis, ventrolateral cervicomedullary junction compression secondary to central and paramesial basilar invagination, and dorsal cervicomedullary junction compression secondary to ligamentous hypertrophy and invagination of the posterior atlantal arch. All patients underwent posterior fossa decompression and atlantal laminectomy. Surgery consistently revealed marked dorsal and paramesial overgrowth of the rim of the rim of the foramen magnum, with thickening and invagination of the atlantal posterior arch and a dense fibrotic epidural band resulting in dorsal cervicomedullary compression. Intraoperative ultrasonography was used to determine the extent of decompression required. Three patients required duraplasty. Three patients had concurrent hydrocephalus, two of whom had undergone ventriculoperitoneal shunting prior to surgical decompression of the posterior fossa. One patient developed a pseudomeningocele postoperatively, requiring serial lumbar punctures before it resolved. No patient developed craniovertebral instability following decompression. Improvement or resolution of symptoms was noted in all patients, with an average follow-up period of 4.8 years. Thus, cervicomedullary compression in patients with achondroplasia can be successfully treated with dorsal decompression of the craniovertebral junction. Dense epidural fibrotic bands are frequently noted in these cases and must be aggressively released to ensure satisfactory decompression.
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Affiliation(s)
- T C Ryken
- Division of Neurosurgery, University of Iowa Hospitals and College of Medicine, Iowa City
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Dvorak DM, Rusnak RA, Morcos JJ. Multiple trauma in the achondroplastic dwarf: an emergency medicine physician perspective case report and literature review. Am J Emerg Med 1993; 11:390-5. [PMID: 8216523 DOI: 10.1016/0735-6757(93)90174-a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Although uncommon, the achondroplastic dwarf (AD) may become the victim of multiple trauma, presenting special challenges for the emergency department (ED) physician. Traditional management of airway, breathing, circulation, and neurological disability is altered by the unique anatomic features of achondroplasia. Despite facial abnormalities observed in the AD, orotracheal and nasotracheal intubation are usually accomplished without particular difficulty; however, abnormalities of the base of the skull and cervical spine make hyperextension of the neck especially hazardous in these patients. The lungs are functionally normal, although vital capacity is decreased and thoracic case abnormalities and abdominal obesity impair lung expansion. Vascular access in the AD is difficult. Peripheral access is difficult because of excessive subcutaneous fat, whereas central venous access is complicated by neck, chest wall, and spinal abnormalities that obscure commonly used anatomic landmarks. Major neurological syndromes observed in ADs are hydrocephalus, cervical medullary compression, and thoracolumbar stenosis. The ED physician should recognize these syndromes, their potential to produce neurological disability, and their unique implications for trauma.
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Affiliation(s)
- D M Dvorak
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415
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Beilin Y, Leibowitz AB. Anesthesia for an achondroplastic dwarf presenting for urgent cesarean section. Int J Obstet Anesth 1993; 2:96-7. [PMID: 15636859 DOI: 10.1016/0959-289x(93)90087-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Achondroplasia is a physeal dysplasia which leads to dwarfism secondary to a decrease in the proliferation of cartilage in the growth plate. This, coupled with normal persistent bone formation, leads to the development of short tubular bones. Achondroplastic dwarfism is among the more common types of dwarfism and is inherited as an autosomal dominant trait. Its incidence is reported as 1 in 26,000 live births. Most achondroplastic dwarfs have a normal life span. The selection and management of anesthesia for the achondroplastic dwarf must take into account a variety of anatomic deformities. The physiologic and hormonal changes of pregnancy further complicate anesthetic administration. We report the safe use of a continuous lumbar epidural anesthetic in an achondroplastic dwarf who presented for urgent cesarean section.
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Affiliation(s)
- Y Beilin
- The Mount Sinai Medical Center, Department of Anesthesiology, One Gustave L. Levy Place, Box 1010, New York, NY 10029, USA
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Carstoniu J, Yee I, Halpern S. Epidural anaesthesia for caesarean section in an achondroplastic dwarf. Can J Anaesth 1992; 39:708-11. [PMID: 1394760 DOI: 10.1007/bf03008234] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This report describes the anaesthetic management of an 18-yr-old achondroplastic dwarf who presented for elective Caesarean section. Epidural anaesthesia was performed without technical difficulty using 8 ml carbonated lidocaine 2% with epinephrine 1:200,000. Although the skeletal abnormalities of achondroplasia have been cited as contraindications to the use of epidural anaesthesia, clinical experience does not support this contention. Previous reports have described technical difficulties in these patients, such as dural puncture and inability to advance the catheter into the epidural space, but no serious complications resulted and epidural anaesthesia was successful on subsequent attempts. The existing literature on the anaesthetic management of achondroplasia for Caesarean section is reviewed and considerations are presented concerning the choice of local anaesthetic, the epidural test dose, and dose titration.
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Affiliation(s)
- J Carstoniu
- Department of Anaesthesia, Women's College Hospital, Toronto, Ontario
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McArthur RD. Obstetric anaesthesia in an achondroplasic dwarf at a regional hospital. Anaesth Intensive Care 1992; 20:376-8. [PMID: 1524185 DOI: 10.1177/0310057x9202000322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- R D McArthur
- Lyell McEwin Health Service, Elizabeth Vale, South Australia
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Abstract
A patient with achondroplasia presented for elective Caesarean section under epidural anaesthesia. A block from C5 to S4 developed over 20 minutes after 12 ml plain bupivacaine 0.5%. This case serves to highlight the difficulties of regional anaesthesia in the gravid achondroplastic dwarf.
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Affiliation(s)
- J R Brimacombe
- Department of Anaesthetics, Northern General Hospital, Sheffield
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Abstract
Anaesthetists are responsible for the management of the airway in patients with unstable cervical spines. Unfortunately, the anaesthetic literature does not contain a recent, critical analysis of the current medical literature to aid anaesthetists attending such patients. This review is intended to serve such a purpose. Using the Index Medicus as a guide, 30 years of medical literature were reviewed, with emphasis on the last ten years. Key words employed for this review are cited in the manuscript. Relevant papers were selected from anaesthetic, orthopaedic, rheumatologic, emergency medicine and trauma journals and reviewed. Relevant findings included the high prevalence of cervical spinal instability in such disorders such as Trisomy 21 and rheumatoid arthritis and the relatively low incidence after trauma. There are deficiencies in the minimalist approaches to assessing the cervical spine, such as a simple cross table lateral radiograph after trauma, as they are neither sensitive nor specific. Finally, recognizing the potential for instability and intubating with care, while avoiding spinal movement, appears to be more important than any particular mode of intubation in preserving neurological function.
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Affiliation(s)
- E T Crosby
- Department of Anaesthesia, Women's College Hospital, Toronto, Ontario
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Stokes DC, Pyeritz RE, Wise RA, Fairclough D, Murphy EA. Spirometry and chest wall dimensions in achondroplasia. Chest 1988; 93:364-9. [PMID: 3338305 DOI: 10.1378/chest.93.2.364] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Standard values for pulmonary function in short-limbed dwarfism are not available. Therefore, chest diameters and expiratory spirograms were measured in 58 female and 44 male subjects between 7 and 60 years of age with achondroplasia, the most common form of dwarfism. Standing height in adults was 49.6 +/- 3.2 (SD) inches with a sitting/standing height ratio of 0.66 (normal 0.52-0.53). Despite extremely short stature, only AP chest diameters in males were smaller than control subjects of similar age. The following equations were derived for forced vital capacity (FVC): males (under 25 years), FVC(L) = -3.56 + 0.162 X sitting height (in) + 0.067 X age (yrs); males (over 25 years), FVC(L) = -0.73 + 0.162 X sitting height (in) -0.047 X age (yrs); females (under 20 years), FVC(L) = -3.56 + 0.150 X sitting height (in) + 0.067 X age (yrs); females (over 20 years), FVC(L) = -1.92 + 0.150 X sitting height (in) -0.016 X age (years). Similar prediction equations were derived for FEV1 and FEF25-75%: FEV1/FVC % was 84.2 (+/- 6.5) for females and 88.0 (+/- 6.5) for males. We also compared the observed FVC measurements to values calculated using standing heights derived from the subject's sitting height, assuming a normal body proportion. The observed vital capacity in achondroplasia was only 67.6 (+/- 19.2) percent of that predicted for normally proportioned females and 72.4 (+/- 13.6) percent for males, suggesting reduced vital capacity in achondroplasia, due to reduced chest wall compliance or abnormal lung growth.
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Affiliation(s)
- D C Stokes
- Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD
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Abstract
We have presented the salient points of managing achondroplastic dwarfs in the operating room. In presenting our experience in dealing with this group of patients we hope that we will make the tasks of those who care for these patients easier and help focus their attention on those problems that are more likely to occur.
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