ABSTRACT
The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.
Subject(s)
Humans , Anesthesia, General , Autonomic Nervous System , Bradycardia , Dilatation , Hypotension , Reflex , Syncope , Urinary Bladder , Urinary Bladder Neoplasms , Urinary Catheterization , Urinary Catheters , UrinationABSTRACT
Neurogenic pulmonary edema is known in patients after head injuries or other cerebral lesions. Typically, this form of pulmonary edema occurs minutes to hours after central nervous system injury and may manifest during the perioperative period. It is always a life-threatening symptom after increased intracranial pressure (ICP), where immediate therapeutic interventions are imperative. Rapid initiation of strategies aimed at ameliorating hypoxia including support of oxygenation and ICP reduction is paramount. We report a case that responded dramatically to inhaled nitric oxide (NO). This therapy, to our experience, seems to provide a way not to reduce pulmonary hypertension, but to improve ventilation-perfusion mismatch for the treatment of refractory hypoxemia in neurogenic pulmonary edema patient.
Subject(s)
Humans , Hypoxia , Central Nervous System , Craniocerebral Trauma , Hypertension, Pulmonary , Intracranial Pressure , Nitric Oxide , Oxygen , Perioperative Period , Pulmonary EdemaABSTRACT
PURPOSE: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. METHODS: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. RESULTS: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. CONCLUSION: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.
Subject(s)
Humans , Advance Directives , Hospice Care , Hospices , Internal Medicine , Linear Energy Transfer , Living WillsABSTRACT
No abstract available.