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Uludag Yanaral T, Karaaslan P, Uzunoglu E, Atalay YO, Tobias JD. Liver Transplantation in a Child with Kartagener Syndrome: A Case Report. Int Med Case Rep J 2021; 14:295-299. [PMID: 34007221 PMCID: PMC8123947 DOI: 10.2147/imcrj.s311843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Kartagener syndrome (KS) is a rare genetic disorder consisting of the triad of situs inversus, chronic sinusitis, and bronchiectasis. Although there are previous reports regarding the anaesthetic considerations in KS, none have included liver transplantation. Case Presentation An 11-year-old boy with a diagnosis of KS underwent liver transplantation due to extrahepatic biliary atresia. Previous diagnostic imaging confirmed situs inversus and the absence of an inferior vena cava. The patient's peak airway pressure intermittently increased intraoperatively from 15 to 30 cm H2O due to increased pulmonary secretions, which required frequent suctioning of the endotracheal tube. Intraoperative volume resuscitation included 200 mL of 5% albumin, 5 units of erythrocyte suspension and 3 units of fresh frozen plasma. Intermittently, a norepinephrine infusion was required to maintain the MAP. Coagulation function was monitoring using the thromboelastogram to guide the use of blood products including fresh frozen plasma. At the end of the surgery, the patient was transferred to the intensive care unit. He was discharged from the intensive care unit on postoperative day 5, and from the hospital on postoperative day 28. He continues to do well with normal liver function 23 months after surgery. Conclusion Despite the risk of pulmonary related to airway secretions and exacerbation of hemodynamic instability related to anatomical variations in the inferior vena cava anatomy, KS patients can be safely anesthetized with careful planning and attention of the disease process, even for complex surgical procedures such as liver transplantation.
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Affiliation(s)
- Tumay Uludag Yanaral
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Pelin Karaaslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Emine Uzunoglu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Yunus Oktay Atalay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Joseph Drew Tobias
- Departments of Anesthesiology & Pain Medicine, Nationwide Children's Hospital & The Ohio State University, Columbus, OH, USA
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2
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Boufettal R, Erguibi D, Hajri A, Idrissi A, Jai SR, Chehab F. [Laparoscopic cholecystectomy in a patient with situs inversus]. Pan Afr Med J 2019; 31:183. [PMID: 31065323 PMCID: PMC6488259 DOI: 10.11604/pamj.2018.31.183.14061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 10/30/2018] [Indexed: 11/22/2022] Open
Abstract
La coeliochirurgie est la technique de référence pour le traitement de la lithiase vésiculaire symptomatique. Jusqu’à ce jour, seuls 42 cas de cholécystectomie laparoscopique chez des patients présentant un situs inversus ont été publiés. Ainsi, nous rapportons un nouveau cas d'un patient, suivi pour cardiopathie congénitale complexe à type de ventricule unique sur situs inversus et dextrocardie. C’est un patient qui était hospitalisé pour prise en charge chirurgicale de lithiase vésiculaire symptomatique. Une cholécystectomie laparoscopique était réalisée. La disposition des trocarts et l’abord chirurgical étaient complètement inverses et symétriques par rapport à l’abord laparoscopique normal.
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Affiliation(s)
- Rachid Boufettal
- Service de Chirurgie Générale III, CHU Ibn Rochd, Casablanca, Maroc.,Faculté de Médecine et de Pharmacie Casablanca, Université Hassan II, Casablanca, Maroc
| | - Driss Erguibi
- Service de Chirurgie Générale III, CHU Ibn Rochd, Casablanca, Maroc.,Faculté de Médecine et de Pharmacie Casablanca, Université Hassan II, Casablanca, Maroc
| | - Amal Hajri
- Service de Chirurgie Générale III, CHU Ibn Rochd, Casablanca, Maroc.,Faculté de Médecine et de Pharmacie Casablanca, Université Hassan II, Casablanca, Maroc
| | - Anass Idrissi
- Service de Chirurgie Générale III, CHU Ibn Rochd, Casablanca, Maroc.,Faculté de Médecine et de Pharmacie Casablanca, Université Hassan II, Casablanca, Maroc
| | - Saad Rifki Jai
- Service de Chirurgie Générale III, CHU Ibn Rochd, Casablanca, Maroc.,Faculté de Médecine et de Pharmacie Casablanca, Université Hassan II, Casablanca, Maroc
| | - Farid Chehab
- Service de Chirurgie Générale III, CHU Ibn Rochd, Casablanca, Maroc.,Faculté de Médecine et de Pharmacie Casablanca, Université Hassan II, Casablanca, Maroc
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3
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Abstract
At December 2014, this review has been withdrawn from the Cochrane Library. This review is out of date, although it is correct at the date of publication. The review may be misleading as new studies could alter the original conclusions. All previous versions of the review can be found in the ‘Other versions’ tab. We are seeking additional authors to support the updating of this review. For further information, please contact PaPaS Managing Editor, Anna Hobson [Contact Person]. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Joseph F Standing
- Pharmaceutical Biosciences, Uppsala Universitet, Division of Pharmacokinetics and Drug Therapy, Uppsala Universistet BMC Box 591, Uppsala, Sweden, 75124
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Abraham B, Shivanna S, Tejesh CA. Dextrocardia and ventricular septal defect with situs inversus: Anesthetic implications and management. Anesth Essays Res 2015; 6:207-9. [PMID: 25885619 PMCID: PMC4173458 DOI: 10.4103/0259-1162.108333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The patients with complicated congenital heart diseases are reaching adulthood with advances in corrective surgeries and medical management. Impact of anesthetic agents on complex cardiac and extra cardiac anomalies and presence of previous palliative procedures can be a challenge for the anesthesiologist perioperatively, while these patients present for cardiac/noncardiac surgeries. We report the perioperative management of a patient with ventricular septal defect, dextrocardia, pulmonary hypertension, and situs inversus who underwent a successful hernioplasty and hydrocelectomy with a combined spinal epidural anesthesia. This discussion relates to the anesthetic management in such conditions with a special reference to Kartagener's syndrome.
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Affiliation(s)
- Betsy Abraham
- Department of Anesthesiology, Critical Care and Pain, M S Ramaiah Medical College and Hospitals, Bangalore, India
| | - Shivakumar Shivanna
- Department of Anesthesiology, Critical Care and Pain, M S Ramaiah Medical College and Hospitals, Bangalore, India
| | - C A Tejesh
- Department of Anesthesiology, Critical Care and Pain, M S Ramaiah Medical College and Hospitals, Bangalore, India
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5
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Kendigelen P, Tütüncü AÇ, Erbabacan ŞE, Kaya G, Altındaş F. Anaesthetic Management of a Patient with Synchronous Kartagener Syndrome and Biliary Atresia. Turk J Anaesthesiol Reanim 2015; 43:205-8. [PMID: 27366497 DOI: 10.5152/tjar.2015.94546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 09/24/2014] [Indexed: 11/22/2022] Open
Abstract
Kartagener syndrome is an autosomal recessive disorder characterized by primary ciliary dyskinesia accompanied by sinusitis, bronchiectasis, and situs inversus. Synchronous extrahepatic biliary atresia and Kartagener syndrome are very rare. During the preoperative preparation of patients with Kartagener syndrome, special attention is required for the respiratory and cardiovascular system. It is important to provide suitable anaesthetic management to avoid problems because of ciliary dysfunction in the perioperative period. Further, maintaining an effective pain control with regional anaesthetic methods reduces the risk of pulmonary complications. Infants with biliary atresia operated earlier have a higher chance of survival. Hepatic dysfunction and decrease in plasma proteins are important for the kinetics of drugs. In this presentation, the anaesthetic management of patients with synchronous Kartagener syndrome and biliary atresia, both of which are rare diseases, is evaluated.
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Affiliation(s)
- Pınar Kendigelen
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayşe Çiğdem Tütüncü
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Şafak Emre Erbabacan
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Güner Kaya
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Fatiş Altındaş
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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Abstract
We present 21 studies of cases of lung cancer in patients with situs inversus totalis (SIT) published worldwide. The first case was described in 1952. Thirteen patients were from Japan, 4 from Eastern Europe, including 2 Polish cases from the authors` center (Department of Thoracic Surgery, Pomeranian Medical University in Szczecin, Poland), 2 from Western Asia, 1 from the U.S. and 1 from Australia. Male patients (20/21) as well as left-sided lung cancer cases (14/21) and squamous cell carcinoma cases (8/21) dominated in the entire group. Thirteen patients underwent surgical treatment. There were 10 left-sided and 3 right-sided surgical interventions with uneventful intra- and postoperative course. Explorative thoracotomy was performed in one case only on the right side. Upper lobectomy was performed in 5 cases, pneumonectomy in 3 cases, lower bilobectomy and middle lobectomy in one case and lower lobectomy in two cases. Surgery was performed through thoracotomy in 10 cases, VATS-assisted approach in two cases and sternotomy in one case. Descriptions of the surgical anatomy confirmed mirror image of the anatomy in all cases and were consistent with the preoperative CT images. Preoperative diagnosis was discussed including the role of 3-D reconstruction of CT for improving perioperative safety in this group of patients. In conclusion, lung cancer/SIT cases despite inversed but regular anatomy can be operated on radically as cases with normal anatomy with preservation of intraoperative security level.
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Standing JF, Savage I, Pritchard D, Waddington M. Cochrane Review: Diclofenac for acute pain in children. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/ebch.666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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8
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Abstract
BACKGROUND Diclofenac is commonly used for acute pain in children, but is not licensed for this indication in all age groups. OBJECTIVES 1) Assess the efficacy of diclofenac for acute pain in children. 2) Assess the safety of diclofenac for short-term use in children. 3) Identify gaps in the evidence to direct future research. SEARCH STRATEGY Seventeen databases indexing clinical trial reports were searched in February 2005 (with an update search as part of this first review in May 2008). A hand search of Paediatric Anaesthesia was undertaken and summaries obtained of adverse reaction reports from the UK Yellow Card Scheme and World Health Organization (WHO) Monitoring Centre. The reference lists of included studies were also searched. SELECTION CRITERIA Any published report, in any language, involving the administration of diclofenac to a patient aged 18 years or younger for acute pain and detailing either monitoring of efficacy or safety. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality and extracted the data. Authors were contacted where necessary. Review Manager version 5 was used for analysis. MAIN RESULTS 1) EFFICACY: randomised controlled trials (RCTs) comparing diclofenac with placebo/any other treatment by using pain scores (assessed or reported), or need for rescue analgesia.2) SAFETY: any type of study seeking adverse events (regardless of cause). An adverse event was defined as any reported adverse or untoward happening to a patient being treated with diclofenac for acute pain.Seven publications on diclofenac efficacy and 79 on safety (74 studies plus five case reports) were included in the final analysis. Compared with placebo/no treatment, diclofenac significantly reduced need for post-operative rescue analgesia (relative risk [RR] 0.6; number needed to treat to benefit [NNT] 3.6; 95% confidence interval [CI] 2.5 to 6.3).Compared with any other non-NSAID, patients receiving diclofenac suffered less nausea or vomiting, or both (RR 0.6; NNT 7.7 [5.3 to 14.3]). There appeared to be no increase in bleeding requiring surgical intervention in patients receiving diclofenac in the peri-operative period. Serious diclofenac adverse reactions occurred in fewer than 0.24% of children treated for acute pain. The types of serious adverse reactions were similar to those reported in adults. AUTHORS' CONCLUSIONS Diclofenac is an effective analgesic for perioperative acute pain in children. It causes similar types of serious adverse reactions in children as in adults, but these are rare. More research on optimum dosing and safety in asthmatic children is required.
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Affiliation(s)
- Joseph F Standing
- Pharmaceutical Biosciences, Uppsala Universitet, Division of Pharmacokinetics and Drug Therapy, Uppsala Universistet BMC Box 591, Uppsala, Sweden, 75124
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Ozkalkanli MY, Katircioglu K, Duzenli VE, Unal I, Savaci S. Brachial plexus block for the child with Kartagener's syndrome. Paediatr Anaesth 2008; 18:677-9. [PMID: 18331552 DOI: 10.1111/j.1460-9592.2008.02518.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Subotich D, Mandarich D, Katchar V, Bulajich B, Drndarski B. Lung resection for primary bronchial carcinoma in a patient with complete situs inversus. Clin Anat 2007; 19:358-62. [PMID: 16015631 DOI: 10.1002/ca.20125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Complete situs inversus is a rare syndrome with a frequency estimated at 1-2/10,000 births. Situs inversus may go unrecognized until discovery during emergency surgery or investigation of symptoms. We present a case of confirmed adenocarcinoma of the left lung, treated by upper lobectomy. The computed tomography (CT) scan of the thorax showed a mirror-image of the organs and vessels, confirmed by aortography and pneumoangiography. The heart was structurally normal. Abdominal CT scan showed a mirror-image of the abdominal organs. At thoracotomy, the gross appearance of the left lung and the arrangement of the pulmonary vessels and the bronchi corresponded to that normally found on the right side. Preoperative diagnosis of situs inversus in patients undergoing surgical treatment is important for operative technique and prevention of vessel injury. Preoperative angiographic examination is mandatory in patients with situs inversus undergoing lung resection.
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Affiliation(s)
- D Subotich
- Institute for Lung Diseases, Clinical Center of Serbia, 11 000 Belgrade, Serbia and Montenegro.
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11
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Bensaid A, El Harrar N, Miloudi Y, Essadi M, Roubal M, Kadiri F. [Anaesthesia for Kartagener's syndrome]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2006; 26:175-6. [PMID: 17182213 DOI: 10.1016/j.annfar.2006.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Abstract
We report a case of anesthesia in an adolescent with recurrent left pneumothorax, Kartagener's syndrome, and severe learning disability with behavioral difficulties. After induction of anesthesia, he rapidly developed severe desaturation as measured on pulse oximetry. Placement of an intercostal chest drain did not remedy the situation and he was found to have blocked the left main bronchus with viscous secretions. Subsequent suctioning relieved the obstruction. Despite successful postoperative thoracic epidural analgesia and minitracheostomy for bronchial toilet, he developed bronchopneumonia that resolved with antibiotics. We discuss anesthesia for patients with Kartagener's syndrome and for patients with pneumothorax.
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Affiliation(s)
- M Dylan Bould
- Department of Anesthesia, Royal Brompton Hospital, Sydney Street, London, UK.
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