Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report
Key Clinical Message The perioperative control of ammonia, reduction of stress, and administration of drugs tolerated in type 1 citrullinemia and Brugada pattern allowed the successful and uneventful management of general anesthesia in the study patient. Abstract The aim of this study was to report...
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Clinical Case Reports |
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| Online Access: | https://doi.org/10.1002/ccr3.7657 |
| _version_ | 1827861333448589312 |
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| author | Fabio Dell’Olio Pantaleo Lorusso Rosaria Arianna Siciliani Maria Massaro Giuseppe Barile Angela Tempesta Salvatore Grasso Gianfranco Favia Luisa Limongelli |
| author_facet | Fabio Dell’Olio Pantaleo Lorusso Rosaria Arianna Siciliani Maria Massaro Giuseppe Barile Angela Tempesta Salvatore Grasso Gianfranco Favia Luisa Limongelli |
| author_sort | Fabio Dell’Olio |
| collection | DOAJ |
| description | Key Clinical Message The perioperative control of ammonia, reduction of stress, and administration of drugs tolerated in type 1 citrullinemia and Brugada pattern allowed the successful and uneventful management of general anesthesia in the study patient. Abstract The aim of this study was to report the targeted perioperative management of general anesthesia (GA) adopted for dental extractions in a rare patient with type 1 citrullinemia and Brugada pattern. A male, Caucasian, adult type 1 citrullinemia patient needed dental extractions under GA. The medical history showed neurodevelopmental impairment, growth retardation, epilepsy, and a Type 2 Brugada electrocardiographic pattern in the second precordial lead. The authors focused the anesthesiologic protocol on the prevention of hyperammonemia and fatal arrhythmias. Changes in diet and 10% glucose solution administration prevented protein catabolism due to the fasting period (ammonia was 44 μmol/L preoperatively and 46 μmol/L postoperatively; glycemia was 120 g/dL preoperatively and 153 g/dL postoperatively). The patient received a continuous electrocardiogram, noninvasive blood pressure, pulse oximeter, entropy monitoring, train‐of‐four monitoring, and external biphasic defibrillator pads. Midazolam, remifentanil, and dexamethasone were administered for pre‐anesthesia; thiopental and rocuronium for induction; remifentanil and desflurane for maintenance; sugammadex for decurarization. After the intraligamentary injection of lidocaine 2% with epinephrine 1:100,000 for local anesthesia, the patient developed a transient Type 1 Brugada pattern that lasted a few minutes. The whole procedure lasted 30 min. The patient's discharge to ward occurred 3 h after the end of GA. The perioperative management of ammonia, reduction of stress, and administration of drugs tolerated in Type 1 citrullinemia and Brugada pattern allowed the successful and uneventful administration of GA in the study patient. |
| first_indexed | 2024-03-12T13:35:23Z |
| format | Article |
| id | doaj.art-5544008e64d849bb9d6a985b505a5906 |
| institution | Directory Open Access Journal |
| issn | 2050-0904 |
| language | English |
| last_indexed | 2024-03-12T13:35:23Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj.art-5544008e64d849bb9d6a985b505a59062023-08-24T05:00:36ZengWileyClinical Case Reports2050-09042023-08-01118n/an/a10.1002/ccr3.7657Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case reportFabio Dell’Olio0Pantaleo Lorusso1Rosaria Arianna Siciliani2Maria Massaro3Giuseppe Barile4Angela Tempesta5Salvatore Grasso6Gianfranco Favia7Luisa Limongelli8Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology Aldo Moro University Bari ItalyDepartment of Emergency and Organ Transplantation, Operating Unit of Anesthesiology Aldo Moro University Bari ItalyDepartment of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology Aldo Moro University Bari ItalyDepartment of Emergency and Organ Transplantation, Operating Unit of Anesthesiology Aldo Moro University Bari ItalyDepartment of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology Aldo Moro University Bari ItalyDepartment of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology Aldo Moro University Bari ItalyDepartment of Emergency and Organ Transplantation, Operating Unit of Anesthesiology Aldo Moro University Bari ItalyDepartment of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology Aldo Moro University Bari ItalyDepartment of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology Aldo Moro University Bari ItalyKey Clinical Message The perioperative control of ammonia, reduction of stress, and administration of drugs tolerated in type 1 citrullinemia and Brugada pattern allowed the successful and uneventful management of general anesthesia in the study patient. Abstract The aim of this study was to report the targeted perioperative management of general anesthesia (GA) adopted for dental extractions in a rare patient with type 1 citrullinemia and Brugada pattern. A male, Caucasian, adult type 1 citrullinemia patient needed dental extractions under GA. The medical history showed neurodevelopmental impairment, growth retardation, epilepsy, and a Type 2 Brugada electrocardiographic pattern in the second precordial lead. The authors focused the anesthesiologic protocol on the prevention of hyperammonemia and fatal arrhythmias. Changes in diet and 10% glucose solution administration prevented protein catabolism due to the fasting period (ammonia was 44 μmol/L preoperatively and 46 μmol/L postoperatively; glycemia was 120 g/dL preoperatively and 153 g/dL postoperatively). The patient received a continuous electrocardiogram, noninvasive blood pressure, pulse oximeter, entropy monitoring, train‐of‐four monitoring, and external biphasic defibrillator pads. Midazolam, remifentanil, and dexamethasone were administered for pre‐anesthesia; thiopental and rocuronium for induction; remifentanil and desflurane for maintenance; sugammadex for decurarization. After the intraligamentary injection of lidocaine 2% with epinephrine 1:100,000 for local anesthesia, the patient developed a transient Type 1 Brugada pattern that lasted a few minutes. The whole procedure lasted 30 min. The patient's discharge to ward occurred 3 h after the end of GA. The perioperative management of ammonia, reduction of stress, and administration of drugs tolerated in Type 1 citrullinemia and Brugada pattern allowed the successful and uneventful administration of GA in the study patient.https://doi.org/10.1002/ccr3.7657Brugada syndromecitrullinemiadental caregeneral anesthesialidocaine |
| spellingShingle | Fabio Dell’Olio Pantaleo Lorusso Rosaria Arianna Siciliani Maria Massaro Giuseppe Barile Angela Tempesta Salvatore Grasso Gianfranco Favia Luisa Limongelli Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report Clinical Case Reports Brugada syndrome citrullinemia dental care general anesthesia lidocaine |
| title | Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report |
| title_full | Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report |
| title_fullStr | Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report |
| title_full_unstemmed | Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report |
| title_short | Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report |
| title_sort | type 1 citrullinemia patient with brugada pattern undergoing general anesthesia for dental extractions a case report |
| topic | Brugada syndrome citrullinemia dental care general anesthesia lidocaine |
| url | https://doi.org/10.1002/ccr3.7657 |
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