ABSTRACT
This case involved a pulmonary thromboembolism, which originated from the lower extremity. A 68-year-old female, with a femur neck fracture, underwent spinal anesthesia with 0.5% heavy bupivacaine 11 mg for total hip arthroplasty. Ten minutes after the induction of spinal anesthesia, dyspnea, tachycardia and hypotension appeared. Under the impression of a pulmonary embolism, intubation was done and dopamine and epinephrine were infused. The operation stopped and she was sent to the intensive care unit. On the spiral CT chest angiogram, a pulmonary embolism was found. Deep venous thrombosis was detected in the left lower extremity on the venogram. Heparin therapy was started at a rate of 800 U/hour with a bolus of 5000 U. A consultative operation for the removal of deep vein thrombosis was performed by a chest surgeon, and total hip arthroplasty was performed successfully under spinal anesthesia.
Subject(s)
Aged , Female , Humans , Anesthesia, Spinal , Arthroplasty, Replacement, Hip , Bupivacaine , Dopamine , Dyspnea , Epinephrine , Femoral Neck Fractures , Femur Neck , Femur , Heparin , Hypotension , Intensive Care Units , Intubation , Lower Extremity , Pulmonary Embolism , Tachycardia , Thorax , Tomography, Spiral Computed , Venous ThrombosisABSTRACT
BACKGROUND: Intravenous alfentanil is one of the effective methods to minimize the hemodynamic responses to laryngoscopy and endotracheal intubation. The purpose of this study is to get effective dose (ED50, ED95) of alfentanil to minimize the hemodynamic responses to laryngoscopy and endotracheal intubation. METHODS: Sixty patients were divided into four groups. Each group received intravenous normal saline 5 ml (Control group), alfentanil 10microgram/kg (Al10), alfentanil 20microgram/kg (Al20) and alfentanil 30microgram/kg (Al30), respectively. Mean arterial pressure (MAP) and heart rate (HR) were measured before and after intubation. We considered the doses of alfentanil effective when the increase in MAP and HR after intubation did not exceed 10% of those before intubation. RESULTS: The ED50 of alfentanil was 12.7 (8.6-16.4)microgram/kg for MAP, 20.1 (15.7-25.6)microgram/kg for HR, respectively. The ED95 of alfentanil was 26.4 (21.7-36.2)microgram/kg for MAP, 38.6 (31.2-56.7)microgram/kg for HR, respectively. CONCLUSIONS: Alfentanil was effective to minimize the hemodynamic responses to laryngoscopy and endotracheal intubation with its ED50 and ED95 as mentioned earlier.