Saturday, January 14, 2012
Wednesday, January 11, 2012
Anaesthetic management in a patient with multiple sclerosis
Anaesthetic management in a patient with multiple sclerosis
Lata M Kulkarni, CS Sanikop, HL Shilpa, Anupama Vinayan
Department of Anaesthesiology, KLE University's, Jawaharlal Nehru Medical College & KLES Dr. Prabhakar Kore Hospital, Nehru Nagar, Belgaum, India
Multiple sclerosis (MS) is an autoimmune demyelinating disorder of the central nervous system (CNS) with genetic predisposition characterized by a wide variety of neurological impairment and symptoms due to multi-focal areas of inflammation and demyelination in brain and spinal cord. [1],[2] The treatment is symptomatic and with immunosuppressant drugs as there is no cure for MS.
Prevalence, increases with latitude, is rare in Asian countries, highest in north Scotland, northern Europe, and northern United States and in Canada. [1]
Exact prevalence in India is not available, but occasionally an anaesthesiologist may encounter a case of MS.
A boy of sixteen years who was a known case of MS for past eight years presented with fracture shaft of femur following a sudden fall while on treatment of MS following a relapse and was scheduled to undergo open reduction, internal fixation. He had history of limb weakness, relapsing--remitting type with movement-induced muscle spasms, gradually progressing in all the four limbs. During past two months there was diminution of vision in both the eyes and he was restricted to bed. Bowel and bladder function was normal. There was no history of seizures, difficulty in speech, swallowing and breathing. On examination he was moderate in built, weighed 38 kg with normal pulse, blood-pressure, respiration and temperature.
CNS examination revealed a conscious patient with normal higher functions, but mentally depressed. Speech was normal. There was loss of power in all the four limbs, 2/5 in both upper limbs and 2/5 in right lower limb (left lower limb with fracture) as per Medical Research Council (MRC) rating. Co-ordination was impaired in upper and lower limbs with marked movement-induced spasticity, hyper responsive deep reflexes and up-going Babinski. He also had optic neuritis. Gait could not be tested. His sensory system, other cranial nerves, brain-stem function appeared normal. Heart-rate response to deep breathing was normal. His other systems were normal.
Laboratory investigations (routine haematological, liver and kidney function, serum electrolytes), chest X-ray and electrocardiogram (ECG) were normal.
Magnetic resonance imaging (MRI) scan showed patchy bright signals within the cord on T 2 -weighed images from C 1 to T 10 vertebral levels suggesting demyelination. No focal lesion of brain parenchyma was seen.
He was receiving oral methotrexate and folic acid, oral baclofen and methylcobalamin for last six years. Recently, he was treated with intravenous (I.V.) methyl prednisolone during an acute attack followed by tapering dose of oral prednisolone, during last 6-8 weeks.
Lata M Kulkarni, CS Sanikop, HL Shilpa, Anupama Vinayan
Department of Anaesthesiology, KLE University's, Jawaharlal Nehru Medical College & KLES Dr. Prabhakar Kore Hospital, Nehru Nagar, Belgaum, India
 Introduction |  |
Multiple sclerosis (MS) is an autoimmune demyelinating disorder of the central nervous system (CNS) with genetic predisposition characterized by a wide variety of neurological impairment and symptoms due to multi-focal areas of inflammation and demyelination in brain and spinal cord. [1],[2] The treatment is symptomatic and with immunosuppressant drugs as there is no cure for MS.
Prevalence, increases with latitude, is rare in Asian countries, highest in north Scotland, northern Europe, and northern United States and in Canada. [1]
Exact prevalence in India is not available, but occasionally an anaesthesiologist may encounter a case of MS.
| Case Report | |
A boy of sixteen years who was a known case of MS for past eight years presented with fracture shaft of femur following a sudden fall while on treatment of MS following a relapse and was scheduled to undergo open reduction, internal fixation. He had history of limb weakness, relapsing--remitting type with movement-induced muscle spasms, gradually progressing in all the four limbs. During past two months there was diminution of vision in both the eyes and he was restricted to bed. Bowel and bladder function was normal. There was no history of seizures, difficulty in speech, swallowing and breathing. On examination he was moderate in built, weighed 38 kg with normal pulse, blood-pressure, respiration and temperature.
CNS examination revealed a conscious patient with normal higher functions, but mentally depressed. Speech was normal. There was loss of power in all the four limbs, 2/5 in both upper limbs and 2/5 in right lower limb (left lower limb with fracture) as per Medical Research Council (MRC) rating. Co-ordination was impaired in upper and lower limbs with marked movement-induced spasticity, hyper responsive deep reflexes and up-going Babinski. He also had optic neuritis. Gait could not be tested. His sensory system, other cranial nerves, brain-stem function appeared normal. Heart-rate response to deep breathing was normal. His other systems were normal.
Laboratory investigations (routine haematological, liver and kidney function, serum electrolytes), chest X-ray and electrocardiogram (ECG) were normal.
Magnetic resonance imaging (MRI) scan showed patchy bright signals within the cord on T 2 -weighed images from C 1 to T 10 vertebral levels suggesting demyelination. No focal lesion of brain parenchyma was seen.
He was receiving oral methotrexate and folic acid, oral baclofen and methylcobalamin for last six years. Recently, he was treated with intravenous (I.V.) methyl prednisolone during an acute attack followed by tapering dose of oral prednisolone, during last 6-8 weeks.
Monday, January 9, 2012
Propofol induced refractory status epilepticus
Study affiliation: Doctor Soliman Fakeeh Hospital, Jeddah Saudi Arabia.
Curr Pediatr Res 2010; 14 (1): 43-45
Successful treatment of Propofol induced refractory status epilepticus with calcium gluconate
Rafat Mosalli
Department of Pediatrics, Omm Al-Qura University, Mecca, Saudi Arabia
Abstract
Propofol-induced seizure-like phenomena (SLP) is well described following anesthesia or sedation with this drug. The episode is usually benign and responds well to standards anti-convulsant therapy. The occurrence of status epilepticus refractory to conventional treat-ment and successful treatment with intravenous Calcium has been rarely reported. We de-scribe a patient who developed status epilepticus refractory to standard treatment during recovery from Propofol anesthesia and successfully treated with intravenous calcium. The report highlights a potentially harmful complication of the Propofol and suggests that intra-venous calcium may be effective as an anticonvulsant treatment for Propofol-induced status epilepticus.
Key words: Propofol, seizure, calcium , status epilepticus.
Tuesday, January 3, 2012
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