RESUMEN
Morquio syndrome is a subtype of mucopolysaccharidoses, wherein the accumulation of glycosaminoglycans (GAGs) in various organ systems lead to alteration of anatomy and physiology. Most prominent features are extensive bony abnormalities, which normally require surgical correction. This paper reports the case of a 7-year-old child with Morquio syndrome who successfully underwent correction of genu valgum under general endotracheal anesthesia via asleep induction and videolaryngoscopy, with supplemental peripheral nerve block. The precautions and anesthetic care done to ensure a safe procedure are discussed, especially with anticipation of a possible difficult airway.
RESUMEN
OBJECTIVES: We tested the hypothesis that calling emergency medical services ("15", French equivalent of 911 or 999 calls) and response by a mobile intensive care unit staffed by emergency physicians (MICU) reduces the time to treatment to within the 3-hour time window required for administration of recombinant tissue plasminogen activator. METHODS: This study compared the time from symptom onset to admission (prehospital time), from admission to treatment (imaging and treatment delays, hospital time), and total time from symptom onset to treatment in an observational cohort of 53 consecutive patients, according to how they reached the hospital (Group 1: MICU and group 2: standard emergency ambulance dispatched by EMS center [2a] or direct admission [2b]). RESULTS: The study included 52 patients (1 was excluded because hospitalized at the time of the stroke): 27 (51.9%) in group 1, 16 (30.8%) in group 2a, and 9 (17.3%) in group 2b. Calling "15" shortened total home-to-needle time by 24 minutes (p=0.034). The mean total time was not significantly shorter in group 1 (152 versus 162 min; p=0.27) but MICUs were used for patients farther away (mean distance 25 versus 11 km; p=0.02). The average prehospital time was thus higher in group 1 (86 versus 69 min; p=0.044), but was compensated by a reduction in the average hospital time (66 versus 93 min; p=0.0001), due mainly to shorter waits for imaging (22 versus 45 min; p=0.0001). CONCLUSION: Calling the emergency services number reduces mean total time. MICUs were associated with a longer prehospital time, mainly due to greater distances, but they facilitated in-hospital management.