Massive inhalation of desflurane due to vaporizer dysfunction

Centre Hospitalier Privé Saint-Grégoire, Sant-Gregor, Brittany, France
Anesthesiology (Impact Factor: 5.88). 12/2005; 103(5):1096-8. DOI: 10.1097/00000542-200511000-00026
Source: PubMed
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    ABSTRACT: This chapter discusses general anesthetics and therapeutic gases. The effect of intravenous fentanyl given before thiopental induction on airway irritation caused by a stepwise increase in desflurane was studied in 80 children aged 2–8 years in a double-blind, randomized, placebo-controlled study. Fentanyl reduced the incidence of airway irritation (cough 2.5% versus 43%; secretions 28% versus 83%; excitation 10% versus 83%; apnea 20% versus 65%). The mean expired desflurane concentration at which the first airway irritation symptom occurred was greater with fentanyl. In two studies the value of combining antiemetic agents in treating postoperative nausea and vomiting was demonstrated. Intravenous dexamethasone and tropisetron reduced the incidence of postoperative nausea and vomiting by about 35% in a double-blind, randomized, placebo-controlled study in 320 patients after anesthesia with benzodiazepine premedication, propofol, rocuronium, desflurane in air/O2, and fentanyl or sufentanil, followed by a continuous infusion of remifentanil. The two drugs had additive effects, although even in the combination group the incidence of nausea and vomiting was still unacceptably high.
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    ABSTRACT: The patients were infant male twins born by cesarean delivery following a healthy pregnancy at 36 weeks' gestation to unrelated parents. At 4 months of age, twin 2 presented with hepatomegaly and a right suprarenal mass. Resection of an adrenal tumor and a liver tumor biopsy were performed. Twin 1 had no symptoms at 4 months of age. Screening by abdominal ultrasonography showed multiple masses in the liver but no adrenal mass. Metaiodobenzylguanidine scintigraphy showed positive findings in multiple liver masses. A laparoscopic biopsy for a liver tumor was performed. All primary tumor and liver tumor specimens from twin 2 and the liver tumor of twin 1 had the same histologic classification of neuroblastoma and nearly identical genetic aberrations, including a chromosome gain or loss using array-comparative genomic hybridization. From these clinical and pathologic findings and genetic analyses, we strongly demonstrate the transplacental metastatic spread from twin 2 to twin 1. In the literature, 9 pairs of concordant twin neuroblastomas, including the current twin, have been presented; and the clinical findings of 5 twin pairs may represent placental metastases from one twin with congenital neuroblastoma to the other twin. This study is the first report presenting the possibility of twin-to-twin metastasis in monozygotic twins with neuroblastoma based on an analysis of the clinical features and genetic aberrations.
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