Search

This case report describes a mycobacterial infection in an adult Whippet cross dog. The dog was diagnosed with Mycolicibacterium sediminis infection, a species of mycobacteria that is yet to be reported as a causative agent of infection in humans or domestic animals. The dog was presented for specialist opinion of a 6-month history of severe facial lymphadenopathy that was nonresponsive to antibiotic and immunosuppressive therapy. A necrotic lesion developed on her right antebrachium approximately 10-14 days before presentation. The dog was anaesthetised for computed tomography and nodule and skin biopsies including fresh tissue for mycobacterial polymerase chain reaction (PCR). The nodules contained pyogranulomatous inflammation and perivascular necrosis that are typically found in mycobacterial infections. The mycobacterial PCR isolated Mycolicibacterium sediminis. The dog was prescribed triple antibiotic therapy and tapered off corticosteroids, with noticeable improvement within 4 weeks and resolution of granulomas within 3 months of therapy. Presence of chronic dermal pyogranulomatous inflammation should raise suspicions for mycobacterial disease, and fresh tissue should be submitted for PCR to aid in diagnosis., (© 2024 Australian Veterinary Association.)

Background: Midface advancements in children with syndromic craniosynostosis present challenges for anesthesiologists and intensive care teams., Aims: This study reviewed the perioperative airway management protocol for immediate tracheal extubation after midface surgery at our tertiary center over the past 10 years., Methods: A retrospective cohort study was performed to obtain information on respiratory disorders, surgical and anesthetic management, airway support, and respiratory complications following le Fort III (LF3) and monobloc (MB) with distraction. Patients with a tracheostomy were excluded., Results: Thirty-two patients (12 LF3, 20 MB) were included. All were immediately extubated with a median of 25 min after surgery. Immediate extubation was performed in young patients (n = 8/32, < 5 years old), in patients with severe OSA (n = 6/32, median oAHI 23/h), with difficult airways (n = 5/32, Cormack-Lehane airway grade ≥ 3), with significant intraoperative blood loss (n = 32, median 46 mL/kg), and with long operative times (n = 32, median 223 min). The majority of patients received no or only oxygen support in the first hours after extubation (n = 29/32) and could be discharged from the pediatric intensive care unit to the surgical ward after 1 day (n = 30/32). A 5-month-old patient with MB required intermittent oxygen and Guedel airway throughout his hospitalization due to airway obstruction at the tongue base combined with supine positioning to allow external traction., Conclusions: Despite the pre-existing airway disorder, the extent of the procedure and the effect of anesthesia on airway tone, all patients were extubated immediately after midface advancement, with only one young patient needing prolonged postoperative support. Immediate extubation is feasible following midface advancement in patients with syndromic craniosynostosis. Further prospective randomized trials are needed to demonstrate superiority to delayed extubation., (© 2025 The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.)

Study Objective: During rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO 2 ) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO 2 (tcPCO 2 ) monitoring during rigid bronchoscopies or MLS., Design: Prospective observational study., Setting: Operating theatre of a tertiary pediatric hospital, from January 2019 to March 2021., Patients: Children with an age < 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO 2 monitoring were excluded., Interventions: TcPCO 2 monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO 2 group)., Measurements: The total tcPCO 2 load outside of the normal range (35-48 mm Hg) was calculated as the area under the curve (AUC) and compared between the groups. Anesthesiologists in the tcPCO 2 group received a questionnaire after each procedure., Main Results: A total of 120 patients were included. No significant differences were found between the two groups in the AUC during the procedure (19,202 (7,863-44,944) vs 17,737 (9,800-47,566) mm Hg · s, P = 0.84) or between different ventilation strategies. The maximal tcPCO 2 level was 69.2 (62.1-81.2) mm Hg in the control group and 71.1 (62.8-80.8) mm Hg, (P = 0.85) in the tcPCO 2 group. Spontaneous breathing was associated with lower tcPCO 2 levels. The general satisfaction score of tcPCO 2 monitoring rated by the anesthesiologist was 8.19 (0.96)., Conclusions: TcPCO 2 levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO 2 monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO 2 monitoring provides valuable insight in CO 2 load and applied ventilation strategies., Competing Interests: Declaration of competing interest The authors have declared no conflict of interest. This study was funded by the Erasmus MC Sophia Foundation (grant number: B1603B)., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)