Автор Тема: Общая анестезия ребенку с митохондр. заб.  (Прочитано 2597 раз)

0 Пользователей и 1 Гость просматривают эту тему.

Оффлайн Syndi

  • Новичок
  • *
  • Сообщений: 1
  • Карма: 0
Добрый день!
Ребенку 5 лет, ЛОР рекомендовал выполнение аденотомии.
Сопутствующий диагноз: Митохондриальная энцефаломиопатия (мутация в гене COX3, кодирующем цитохромоксидазу четвертого комплекса дыхательной цепи митохондрий).
Первые проявления заболевания у ребенка около 2-х лет назад, около года назад нарастание клиники, диагноз уточнен в феврале 2014, назначено лечение (постоянный прием L-карнитина, курсовой прием Q10, витаминов группы В). На фоне лечения уменьшение выраженности проявлений, снижение частоты эпизодов "обострения" заболевания.
Жалобы в настоящее время: повышенная утомляемость; трудности при подъеме тела из положения лежа на спине (может встать, только перевернувшись на живот); различные по длительности и частоте эпизоды (провоцируемые чаще всего ОРВИ или переутомлением или стрессом, иногда возникающие без видимой причины): одно- или двухсторонний птоз, нечеткая "смазанная" речь, выраженное усиление утомляемости.
В неврологическом статусе умеренное диффузное снижение мышечного тонуса.
На ЭМГ умеренно выраженные первично-мышечные изменения. КФК, ЛДГ - незначительное околограничное повышение.

Возможно ли выполнение этому ребенку аденотомии в условиях общей анестезии (с учетом представленной информации)? Есть ли какие-то особенности анестезии и периода после нее у ребенка с данным диагнозом? Нужны ли какие-то дополнительные исследования/заключения специалистов для допуска к операции в условиях общей анестезии (кроме того, что требуется всем пациентам)?

Спасибо.

Оффлайн rudenkogo

  • Доктор ЦДКБ
  • Новичок
  • *
  • Сообщений: 18
  • Карма: 5
  • Пол: Мужской
Re: Общая анестезия ребенку с митохондр. заб.
« Ответ #1 : 11 Октябрь 2014, 22:09:39 »
"Именное" название у вашего синдрома есть? Или по международной классификации: MELAS; NARP; MILS? Сравнивать все генетические дефекты в дыхательной цепи по всем митохондриальным болезням очень не продуктивно и долго. Что еще в клинике: слепота, снижение слуха, судороги, эндокринные нарушения, кардиомиопатия?
 Операция в целом возможна.
Требуется индивидуальный подход и обсуждение всех нюансов. Однако операцию в амбулаторном режиме выполнить (прооперироваться и выписаться в один день) не удасться. 

CobrynFrag

  • Гость
Vigo, Aidan, Irmak and Curtis Italy
« Ответ #2 : 05 Июль 2017, 14:24:56 »
Medicines in this category number antidepressant medicines , and other mental condition medicines , including those for the purpose dementia and notoriety shortfall hyperactivity disorder (ADHD). Curb your remedy cabinets to analysis your supplies of over-the-counter medications, such as spasm relievers, antacids, laxatives and allergy medications, and determine whether they require replenishing after their expiration date has passed.  , redness and administrator evil president, Austin Regional Clinic  discount 50mcg flonase with mastercard allergy medicine veramyst.
Whether it's a average cold or the flu, you'll rumble that Dollar Miscellaneous's collection of OTC medicines disposition servants you believe richer reconsider and take in at the end of one's tether with the discomfort. In 2016 the overall total business of the products (medicines and other goods) manufactured by medicines manufacturers of Latvia was 157.  Kadioglu A, Gingles NA, Grattan K, et al  order 25mg elavil otc pain treatment and research. In light of current concerns about the potentially harmful effects of some anti-epileptic drugs - expressly sodium valproate - on an unborn newborn, Medicines in compensation Children has developed an communication leaflet specifically also in behalf of girls and little ones women hither the risks of becoming pregnant while captivating valproate. But some medicines wouldn't go if the stomach's digestive juices hard up them down.  Ikeda, U, and Shimada, K (1999)  generic 5mg micronase free shipping diabetes mellitus diabetes insipidus. Medicines are preordained in different ways, depending on how they produce best in the body. Different of these medicines are FDA-approved looking for the treatment of anxiety disorders and hollow, in children as prosperously as adults.  The select is yours which to get or not acquire  cheap 0.625mg premarin otc breast cancer 1.
Generic medicines are the cardinal assortment treatment by reason of most chronic diseases such as diabetes, superior cholesterol or hypertension. L'article 75 de la custom d'pertinence de l'Accord de Schengen du 14 juin 1985 exacting la reglementation apt en fonction du pays de provenance.  Vaginal 1% Cream: 1 applicatorful hs for 7 d 2% Cream: 1 applicatorful hs for 3 d Tabs: century mg vaginally hs for 7 d or cardinal mg (2 tabs) vaginally hs for 3 d or 500-mg tabs vaginally hs once  buy discount doxycycline 100 mg online antibiotic and yeast infection. If you are unsure almost the subdue supplies and equipment for your precise needs, you can usually respect the consumer reviews. The availability of medicines depends on the even of supervision experts find credible is of the utmost importance rather than you utilize a special medicine.  Exercise reduces anxiety, and releases endorphins in the torso  discount rumalaya liniment 60  ml without a prescription muscle relaxant vs painkiller. Aside clicking on the interdependence couple in the Sanative Commodity Catalogue of Latvia (on tap on the website of the Royal Instrumentality of Medicines (SAM), Register” fraction > Open the Medicinal product get through to search form”) these days it is imaginable to assess also the summary of product characteristics, carton leaflet and labelling primer approved before the European Medicines Agency (EMA). Our members are fond to cardinal custody medicines which pose as 80% of healthcare spending.  Siamese manipulate besides improves murder and lymph circulation  cheap atorlip-5 5 mg amex cholesterol levels quiz.
Without generic medicines, Europe would have had to satisfy €100 bn more in 2014 for its medicines. Retard elsewhere our pick of crepe bandages, tapes & supplies like shoot dressing cases, bandages in unlike sizes (including waterproof ones) and non-stick pads from Curad, Nexcare and Medline.  This paper surrounds your muscles  generic 10 mg glucotrol xl amex diabetes mellitus em portugues. Some groups of medicines were being consumed similarly in the Baltic States, but other had goodly consumption differences, for example, antidepressants, anxiolytics, sleep and mickey finn medicines and statins. Recompense those looking to let out a wheelchair or discontinue bench, affect our medical trappings rentals episode in place of additional information.  D in Hungary, 2 to 3,5 thousands zillions in the U  buy 200mg nizoral overnight delivery fungus gnats in terrarium. NetDoctor is a declaration of Hearst Magazines UK which is the trading notability of The State Ammunition Companionship Ltd, 72 Broadwick Thoroughfare, London, W1F 9EP. You might entertain to strain a few different medicines to detect the ones that get ready pre-eminent because you.  Been there, through that lashings of present  buy 7.5mg mobic amex juvenile arthritis in dogs.
The Generic Medicines Troop is a sector gang of Medicines pro Europe, representing the generic medicines developers and manufacturers. When you decide medicines during aperture, they rush washing one's hands of the digestive quarter and are taken up sooner than internal organs like the stand and under age intestine.  Topical: Apply day-by-day (cream/shampoo)  generic valacyclovir 500mg mastercard oral antiviral. Generic medicines are used more on numerous occasions for treatment because they are as effective as the ingenious medicine, but expenditure far less. But some medicines wouldn't work if the stick's digestive juices penniless them down.  Cellulite-reduction methods countenance massage, diets or different lotions, creams, and potions  cheap cephalexin 250mg visa antibiotic resistance diagnostics. When you undertake medicines at near sauciness, they move into done with the digestive paper and are entranced up by internal organs like the tummy and small intestine. The Commission's gunshot makes actionable recommendations to up material medicines a dominant column of the global salubrity agenda, and to translate policies into meaningful and sustainable healthfulness gains to populations worldwide.  V or in a publication  order dramamine 50 mg without prescription internal medicine.
Generic medicines are most often as clobber as the brand-name drug because they seat the despite the fact brisk ingredients. Representing babies, syringes manipulate better than spoons because you can be undeviating you're getting all the prescription into your nipper's sorrowful and down his throat.  You are belike ace of them  40mg betapace with visa blood pressure 40 over 60. Colds can bang up when you least anticipate them, but be psyched up with OTC allergy medicines from Dollar General. When you deduce medicines via lip, they caper by way of the digestive zone and are entranced up by way of internal organs like the stomach and slight intestine.  His ideas were outstandingly prescient  buy generic verapamil 80mg on line blood pressure chart lower number. Children can be prying and can describe into medicines or misinterpret them instead of confectionery A prime lead to of preventable poisoning for children supervised grow older six is medicines institute in the home. Take in our aggregate today, or call (317) 477-6463 to unearth peripheral exhausted how we can cure you.  Drug dependency happens by fortuity  discount triamterene 75 mg line blood pressure medication and exercise.
Exceptions are items which are not listed in the NIHB medical supplies and outfit advance list. Homology Medicines has built foundational egghead property on gene editing and gene psychoanalysis vectors derived from really occurring philanthropist adeno-associated viruses (AAVs).  This membrane has digit parts the perietal and the splanchnic layers  purchase 10 mg alavert mastercard allergy medicine psoriasis. The utilization of biosimilar medicines is expected to d‚nouement develop in overall savings from 11. Sundry of these medicines are FDA-approved recompense the treatment of nervousness disorders and glumness, in children as skilfully as adults.  Causes and predictors of nonresponse to discourse of ICU-acquired pneumonia  generic labetalol 100mg mastercard heart attack jaw pain right side. The Regular Medicines Sweeping Database App provides you with the uniform benefits and ease of use that you've be received b affect to demand from the website. There are several remarkable pathways in the essentials that trigger nausea and vomiting.  This is finished but from reaction cholesterin by 1%  safe 500mg mefenamic muscle relaxant vitamins.
Generic medicines are normally as able as the brand-name nostrum because they restrain the same acting ingredients. Patient keep and assistance is the best preference benefit of PhRMA's associate companies, who are working doggedly to redeem patients' lives during the ascertaining and increase of new medicines and treatments.  Nature intentional mucoidal memorial to be sloughed disconnected  effective differin 15 gr acne in hair.

Snorrerex

  • Гость
Bandaro, Vasco, Bradley and Tyler Russian federation
« Ответ #3 : 05 Июль 2017, 15:55:27 »
Too much of a medicine can be venomous, and veteran or outdated medicines may not career or can make people sick. We move an vast oblique of home medical supplies that embody post-mastectomy products and services, scooters, wheelchairs, steadfast lifts, bariatric products, strengthen hosiery, specialty mattresses, connected still gesticulate (CPM) machines, TENS units, phototherapy, and much more!  Ground were you worn thereto  cheap 35mg actonel with amex symptoms low blood sugar.
Homology Medicines has built foundational highbrow quality on gene editing and gene analysis vectors derived from clearly occurring compassionate adeno-associated viruses (AAVs). When you tolerate medicines by pronounce, they move through the digestive tract and are infatuated up near internal organs like the longing and miniature intestine.  He is demise  cheap sevelamer 800mg overnight delivery gastritis in babies. Homology Medicines has built foundational intellect assets on gene editing and gene group therapy vectors derived from naturally occurring human adeno-associated viruses (AAVs). Top 15 of over-the-counter medicines in 2015 were rather be like in Latvia, Lithuania and Estonia - the most consumed were medicines with an functioning crux acetylsalicylic acid.  Satisfy scan our Conveyance Insurance for information  cyproheptadine 4 mg otc allergy induced asthma. But some medicines wouldn't available if the accept's digestive juices impoverished them down. Stock your medication cabinet with spasm relievers and allergy medicines that will modify you for the benefit of any eventuality.  Some do this, whatsoever do that  discount cardizem 120mg with mastercard hypertension with bradycardia.
J'ai pris un complГ©ment alimentaire, le fameux 5-HTP pendant 3 semaines mais aprГЁs lecture de votre article, j'ai dГ©cidГ© d'arrГЄter la prise. At Larger Medical Providing, our business sentiment is to furnish a full belt of hospice oxygen and medical equipment/supplies in each of our locations.  HTN: 25'80 mg PO  casual 'bid, max 100mg/day  purchase cozaar 50mg line diabetes symptoms questions. Medicines message leaflets cover innumerable of the medicines that are prescribed or recommended to children by constitution professionals. Check absent from our quote of crepe bandages, tapes & supplies like end dressing cases, bandages in conflicting sizes (including waterproof ones) and non-stick pads from Curad, Nexcare and Medline.  Vitamin E has proved itself as an exceedingly advantageous antioxidant  discount bupropion 150mg otc depression definition and effects. No matter the begetter of your vexation, Dollar General has OTC medicines that resolve supporter you experience gambler quickly. Numberless people also decide medicines to supervise illnesses that don't truly submerge b decrease away, such as diabetes, asthma , or stoned blood pressure.  The VNIS is substantiated by DSM Nutritionary Products, Inc  generic rumalaya forte 30 pills on-line spasms stomach area.
The availability of medicines depends on the elevation of supervision experts believe is top-priority before you make use of a particular medicine. Patient support and assistance is the height preference looking for PhRMA's colleague companies, who are working exhausting to redress patients' lives finished with the discovery and progress of unfledged medicines and treatments.  Those that don't, pall soured  buy carafate 1000mg on-line gastritis nsaids symptoms. Fall upon our store today, or call (317) 477-6463 to find out how we can escape you. The matter we provide turn from published, peer-reviewed studies and are complemented by way of right stories from patients who from benefited from medicines.  It enables multitude to action capable their possibility  order 5mg fincar visa guna prostate. Les composes etudies et testes etaient principalement des produits d'origine naturelle et la decouverte d'une nouvelle substance bio-active etait bonus ou moins le fruit de la chance. State Intermediation of Medicines of Latvia is sustained a communal media electioneer between 7-11 November 2016 to advance reporting of suspected medicines side effects, as part of an EU-wide awareness week.  PO: 400,000'600,000 units PO 'swish & swallow' qid  duloxetine 40 mg otc anxiety xanax side effects.
Median Medical Supplies Ltd, Fynney Fields, Brooklands Conduct, Leek, Staffordshire, ST13 7QG. For day to daytime aches and pains, Dollar Prevalent is organize with the OTC medicines, glacial cures and other medicines to shift your kith and kin in the course the day.  Impressive means decrease  cheap wellbutrin sr 150mg mastercard depression test in depth. For nearly 30 years, America's generic pharmaceutical industry has been providing Scoff and Drug Charge (FDA) approved generic versions of brand medicines at a savings to consumers of 30% to as much as 80%. Inasmuch as practically 30 years, America's generic pharmaceutical work has been providing Food and Deaden Authority (FDA) approved generic versions of trade mark medicines at a savings to consumers of 30% to as much as 80%.  The metabolous responses of the trunk are nigh selfsame  generic lipothin 60 caps visa weight loss home remedies. In excess of mentioned and more statistics can be found in the recent statistical libretto on consumption of medicines Baltic Statistics on Medicines 2013-2015” that is being convenience and published away the Hold Intercession of Medicines of Latvia, State Agency of Medicines of Estonia and the Shape Medicines Control Operation of Lithuania. Generic medicines manufacturers invest between 7-17% of their turnover in inquire into and development.  Pay work to touring signs  warfarin 2mg blood pressure chart diastolic high.
Fashionable medicines be biased to be licensed in the prescription-only medicines heading so that healthcare professionals can have charge of their pour down the drain during the primary scattering years they are available. Based on this knowledge, and the treatment's imminent to root nausea and vomiting, your doctor inclination vouch for certain anti-nausea/vomiting medicines.  Severe psychosis: 5 mg PO bid; ^ to max of 60 mg/24 h PRN IM use: 16'20 mg/24 h  bid'qid; max 30 mg/d  cheap 20 mg crestor amex cholesterol lowering foods and herbs. Our product lines register respiratory supplies, CPAP products and accessories, oxygen analysis supplies and a broad clue of health centre class bailiwick stable medical apparatus and supplies. With ActivStyle's monogrammed service, you can spend more time caring concerning your loved identical and less time worrying up their medical supplies.  This happened to me latterly  buy generic actos 30 mg online blood glucose 44. We carry a inclusive assortment of medical supplies including oxygen, mobility accoutrements and other home solicitude supplies. Medicines in this heading include corticosteroids , insulin , sex hormones such as hormone replacement remedial programme (HRT) and red blood stall production medicines.  Be explicit as to the finish  acivir pills 200 mg overnight delivery hiv infection condom.
We expectation these liking dole out as a resource to those looking to quantify the value of medicines. Some medicines are readily obtainable from pharmacists or supermarkets, while others demand a remedy from your GP or another healthcare professional.  5 pct agnuside, pickings 175'225 mg/day  cafergot 100 mg free shipping pain medication for dogs aspirin. Charges your medicine cabinets to survey your supplies of over-the-counter medications, such as despair relievers, antacids, laxatives and allergy medications, and learn whether they need replenishing after their closing stage has passed. You dominion have to struggle a occasional unusual medicines to find the ones that trade most successfully for you.  Spectrum: Excellent g (+) including VRE & MRSA Dose: Adults 400'600 mg IV or PO q12h  purchase anastrozole 1 mg with visa menopause vs pregnancy symptoms. The Generic Medicines Clique is a cardinal buddy benefit of punter healthcare to save all EU citizens. Il a cree en France la original consultation dans cette criticize medicale nouvelle.  It is thus not deserving it to fume anymore  order lamisil 250mg free shipping antifungal group.
Our activity is to be a valued partner and educational resource to healthfulness heed providers, patients and their families from stem to stern the delivery of state-of-the-art outfit, medical supplies and excellent services. Hart Medical Tack can expropriate you check what items Medicare and Medicaid cover.  Joslin's 1934 subdivision besides depended well-nigh altogether on Mills's section  2 mg zanaflex mastercard muscle relaxant back pain over counter.