Conversion of Hemiblock to Complete Heart Block by Intraoperative Motor-Evoked Potential Monitoring
We present a case in which intraoperative monitoring with motor-evoked potentials resulted in complete heart block in a patient with a history of hemiblock. Neuromonitoring has been associated with arrhythmias in patients with ostensibly normal conduction systems, and we propose that monitoring personnel, anesthesiologists, and surgeons need to be aware of this risk and exercise caution when monitoring motor-evoked potentials in patients with known conduction deficits.
COBALT IS an essential trace element involved in vitamin B12 and myocardial metabolism. Although biologically necessary for normal physiologic function, cobalt can cause serious adverse health effects at high exposure levels.1 Several case reports of patients with metal-on-metal implants or occupational exposure have suggested that elevated serum cobalt levels may lead to a variety of different systemic symptoms or complications including neurologic (auditory and visual impairment, cognitive decline, peripheral neuropathy); cardiovascular (cardiomyopathy and arrhythmias); and endocrine (hypothyroidism) abnormalities.
We report on an 63-year-old man who presented for repair of an ascending aortic dissection. After cardiopulmonary bypass separation assisted with high-dose epinephrine, ES developed requiring over 40 defibrillatory shocks. The epinephrine infusion was held and within 5 min, the ES self-terminated. ES in the context of cardiovascular surgery with the use of epinephrine for hemodynamic support has not be previously reported. Clinicians need to be cognizant of the seemingly paradoxical effect of epinephrine to induce ES. Initial ES treatment involves acute stabilization (treating or removing exacerbating factors (i.e., excess catecholamines)).
We report the efficacy and safety interscalene brachial plexus block combined with general anesthesia in a patient with BrS. Awake and double-guided interscalene block was performed. After performing the block, general anesthesia was induced with fentanyl, propofol and rocuronium and maintained with oxygen-air/sevoflurane mixture. Sugammadex was administered for neuromuscular reversal. During perioperative period, the patient remained hemodynamically stable with anormal sinus rhythm and no ST segment changes. Hospital discharged occurred 36h after surgery without complications. General recommendations include avoidance of ...
PATIENTS UNDERGOING cardiac surgery are at risk for cardiovascular collapse from a variety of pathologies including, but not limited to, hemorrhage, tamponade, myocardial infarction, arrhythmias, or cardiogenic shock. Tension pneumothorax is a rare complication after cardiac surgery and requires prompt recognition and treatment. The subsequent case report describes an occurrence of tension pneumothorax and hemodynamic instability after the use of an airway exchange catheter (AEC) to extubate and reintubate a patient with a difficult airway following cardiac surgery.
CONCLUSION Continuous administration of phenylephrine increased fluid responsiveness during liver resection, suggesting complex effects of continuous vasopressor infusion involving changes in cardiac preload and afterload. TRIAL REGISTRATION UMIN000011024.
CONGENITAL LONG QT syndrome (LQTS) is the most common of genetic arrhythmia syndromes associated with lethal ventricular arrhythmias and sudden cardiac death in an otherwise healthy young population.1 Hundreds of mutations in genes linked to LQTS have been identified. Although at least 17 genotypes of congenital LQTS have been reported to date, types 1, 2, and 3 LQTS (LQT1, LQT2, and LQT3, respectively) amount to approximately 90% of all genotype-confirmed cases.2,3 LQT1 is caused by loss-of-function mutations in KCNQ1 gene encoding α-subunit of cardiac slowly activating delayed rectifier K+ channel (IKs channel).
Condition: Evaluation of Cardiac Arrhythmias in Hand Surgery Using Local Anesthesia With Adrenaline Interventions: Procedure: Local anesthesia with lidocaine and adrenalin.; Drug: lidocaine and adrenalin; Drug: lidocaine and arterial blockage Sponsor: Uri farkash Recruiting
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Abstract Tyrosine kinase inhibitors are known to clinically induce various types of cardiovascular adverse events; however, it is still difficult to predict them at preclinical stage. In order to explore how to better predict such drug-induced cardiovascular adverse events, we tried to develop a new protocol by assessing acute electrophysiological, cardiohemodynamic, and cytotoxic effects of dasatinib in vivo and in vitro. Dasatinib at 0.03 and 0.3 mg/kg was intravenously administered to the halothane-anesthetized dogs for 10 min with an interval of 20 min between the dosing (n = 4). M...
Karel Pacak Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PP...