• Dexmedetomidine as an Adjuvant for MRI Sedation in a Neurologically Impaired Child

      Qadeer, Ahsan; Yates, Laurie J.; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Emergence from anesthesia may be delayed in neurologically impaired children. The higher incidence of respiratory complications in these patients is due to the associated comorbidities such as gastroesophageal reflux and poor function of laryngeal and pharyngeal reflexes. Use of dexmedetomidine (DEX), a highly selective alpha-2 adrenergic receptor agonist, is becoming popular, as practitioners continue to discover its safety and efficacy as a sedative and anesthetic adjunct. The primary advantage DEX may have over other agents commonly used for pediatric sedation is a lack of significant respiratory events, such as changes in respiratory rate, end-tidal CO2 and oxyhemoglobin saturation. In this case report, DEX was effectively used to provide sedation for MRI in a child with severe neurological impairment.
    • Emergent Airway Management in an Infant with Congenital Laryngeal Cyst Causing Airway Obstruction

      Downard, Martina; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Congenital Laryngeal Cysts (CLC) is a rare but often life-threatening condition that affects approximately one in 150,000 live births. Clinical presentation of CLC includes respiratory distress, stridor, feeding intolerance, and failure to thrive. If the cyst is large enough to cause complete obstruction of the airway, asphyxia may rapidly cause death if left untreated in a neonate. Therefore, CLC must be included in the differential in an infant or newborn with stridor and respiratory distress refractory to medical treatment. This case report describes an infant with a history of worsening stridor who was found to have a large cystic mass obstructing the airway.
    • Improving cultural competency among anesthesiology residents via virtual interactions with Hispanic standardized patients

      Arthur, Mary E.; Albritton, Josephine; Florentino-Pineda, Ivan; Odo, Nadine; Head, C. Alvin; Palladino, Christie; Department of Anesthesiology and Perioperative Medicine (Association of American Medical Colleges, 2010-11)
      Hispanics/Latinos comprise about 15% of the US population and are the fastest growing minority in America. In Georgia, however, Hispanics represent only about 3% of the population, and health professionals training in the state may have few opportunities to interact with Hispanic patients. Language and cultural barriers, lack of health insurance, and so on, can lead to health disparities. Improved cultural competence among health care professionals can help to reverse such disparities. As such, the Medical College of Georgia at Georgia Health Sciences University (MCG) has made it a priority to improve the cultural competency of its allied health, dental, medical and nursing students through its Quality Enhancement Plan. Similarly, the anesthesiology department is planning a project in which residents will interview the standardized patient remotely via Skype and webcams, in a manner similar to the telemedicine model, then receive immediate feedback from the SP and faculty member.
    • Intranasal Septal Perforation in a 4-Year-Old by an Impacted Button Battery: A Case Report and Review of the Literature

      Mattingly, Diana; Crews, Lindsay K; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2010-03)
      While intranasal foreign bodies account for less than 1% of pediatric emergency room visits, proper diagnosis and management is critical to minimize significant morbidity and mortality. Intranasal button batteries in particular pose a significant threat to the pediatric population as nasal mucosal necrosis, septal perforation, facial cellulitis, and lateral nasal wall necrosis can occur within hours of insertion. The incidence of impacted button batteries has risen with the increased prevalence in common electronics like hearing aids, watches, and musical greeting cards. One study estimated that button batteries comprised 7% of intranasal foreign bodies removed from pediatric patients in a 6-month period. We report a case of intranasal button battery impaction in a 4-year-old male that resulted in significant tissue injury and required general anesthesia for extraction.
    • Severe Compartment Syndrome Following Extravasation of Fluids in a Critically Ill Neonate

      Martinez-Lu, Kianfa; Weatherred, Ted; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Intravenous therapy is generally a safe and effective way to administer different therapies to patients of all ages. Despite its ubiquitous use in modern medicine, it is not devoid of complications. Hematoma formation, phlebitis, infection, and tissue infiltration are some common complications of the use of peripheral IV catheters. Here we report a case in which peripheral IV fluid extravasation caused severe compartment syndrome in a critically ill preterm neonate undergoing exploratory laparotomy in the NICU.
    • Use of Dexmedetomidine as Adjuvant for the Anesthetic Management of Obese Children with Obstructive Sleep Apnea Undergoing Tonsillectomy and Adenoidectomy

      Mendiola, Raul A.; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Obstructive sleep apnea (OSA) in children is most commonly associated with tonsillar and adenoid hypertrophy. Use of opioids and residual amounts of inhaled agents can cause severe respiratory depression and thus represent an added risk to patients with OSA in the immediate postoperative period. Dexmedetomidine, a specific alpha 2-adrenergic receptor agonist, is known for its hypnotic, sedative, analgesic and sympatholytic properties. It potentiates analgesia with the advantages of minimal respiratory compromise, rapid onset and clearance. Because dexmedetomidine has been shown to be effective as an analgesic and sedative agent while minimizing respiratory compromise, it offers a safer alternative as an adjuvant for the anesthetic management of obese pediatric patients with OSA undergoing tonsillectomy and adenoidectomy.
    • The Use of Dexmedetomidine During Nasotracheal Intubation in a Patient with CHARGE Syndrome

      Crews, Lindsay K; Mattingly, Diana; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2010-03)
      CHARGE Syndrome (CS), also known as Hall-Hittner syndrome, is a congenital disorder comprised of multiple anomalies (coloboma, heart defect, atresia choanal, retarded growth and development, genital hypoplasia, ear anomalies/deafness). First described in 1979 by Hall and Hittner, it is caused by a mutation in the gene CHD7 on chromosome 8.1 Facial and upper airway features of CS, including midface hypoplasia, micrognathia, cleft lip, and palate, anterior larynx, and subglottic stenosis, make the airway management of these patients a challenge for the anesthesiologist. Because difficult airway management is a concern, spontaneous ventilation is recommended until the airway is secured. We report the use of dexmedetomidine (DEX) for deep sedation in a CS patient who required nasotracheal intubation using a fiberoptic bronchoscope (FB) while breathing spontaneously.