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PubMed | Beppu Developmental Medicine & Rehabilitation Center
Type: Journal Article | Journal: Paediatric anaesthesia | Year: 2014

Reexpansion pulmonary edema (RPE) is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. This condition is recognized to occur more frequently in patients under the age of 40years, but there has been no detailed analysis of reported pediatric cases of RPE to date. For this review, PubMed literature searches were performed using the following terms: re(-)expansion pulmonary (o)edema AND (child OR children OR infant OR boy OR girl OR adolescent). The 22 pediatric cases of RPE identified were included in this review. RPE was reported in almost the entire pediatric age range, and as in adult cases, the severity ranged from subclinical to lethal. No specific treatment for RPE was identified, and treatment was administered according to the clinical features of each patient. Of the 22 reported cases, 10 occurred during the perioperative period, but were not related to any specific surgical procedures or anesthetic techniques, or to the duration of lung collapse. Pediatric anesthesiologists should be aware that pediatric RPE can occur after reexpansion of any collapsed lung and that some invasive therapies can be useful in severe cases.


PubMed | Beppu Developmental Medicine & Rehabilitation Center
Type: Case Reports | Journal: Masui. The Japanese journal of anesthesiology | Year: 2011

A 36-year-old woman weighing 31.7 kg with mental retardation was scheduled for dental treatment under general anesthesia. She had undergone anticonvulsant therapy (phenytoin, clonazepam, zonisamide) for years. Standard monitors and bispectral index (BIS) monitor were applied except for an accelomyography. Anesthesia was induced with propofol and vecuronium, and maintained with nitrous oxide in oxygen, with 1.5-2.0% end-tidal concentration of sevoflurane. Forty minutes after induction of anesthesia, spontaneous respiration (SR) started suddenly despite adequate depth of anesthesia (BIS value 35-40). Vecuronium 1 mg was administered and SR stopped immediately. After the event, however, SR started repeatedly and then additional vecuronium was administered every 30-40 minutes to stop SR until the end of the treatment. During the treatment, no factors (hypercapnia, hypoxemia, hyperthermia and so on) to shorten the muscle relaxation were observed. The treatment finished uneventfully She became awake rapidly and extubated. Post-extubation period was also uneventful. In this case, chronic phenytoin therapy induced resistance to vecuronium was highly suspected; however, since clonazepam and zonisamide have elevation effects on blood concentration of phenytoin, they might be also cofactors in resistance to vecuronium. Therefore, patients undergoing chronic anticonvulsant therapy should be paid more attention because they have resistance to neuromuscular blocking drugs.

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