ABSTRACT
Open heart surgery under cardiopulmonary bypass (CPB) in patients with liver cirrhosis is prone to the development of various complications associated with high mortality rates. According to recent studies, patients with advanced cirrhosis (Child-Pugh class B or C cirrhosis) have a significantly higher mortality rate (50-100%) after open heart surgery under CPB. We report the anesthetic management of cardiac surgery using CPB of 61-year-old man with aortic valve regurgitation, tricuspid regurgitation and ventricular septal defect (VSD) who had complicated by liver cirrhosis of Child-Pugh class B. The patient underwent successfully aortic valve replacement, tricuspid valvuloplasty and VSD closure. The use of tranexamic acid and transfusion of fresh whole blood appears to produce beneficial effects for outcome.
Subject(s)
Humans , Middle Aged , Aortic Valve , Cardiopulmonary Bypass , Fibrosis , Heart Septal Defects, Ventricular , Liver , Liver Cirrhosis , Thoracic Surgery , Tranexamic Acid , Tricuspid Valve InsufficiencyABSTRACT
The Brugada syndrome (BS) is characterized by ST segment elevation in the right precordial leads of electrocardiogram, with or without right bundle branch block in the absence of any obvious structural heart disease.Also, the BS has been identified as an important cause of sudden cardiac death.We have experienced anesthetic management of a patient with BS for one-lung ventilation by total intravenous anesthesia with propofol and remifentanil without untoward cardiovascular events.
Subject(s)
Humans , Anesthesia, Intravenous , Brugada Syndrome , Bundle-Branch Block , Death, Sudden, Cardiac , Electrocardiography , Heart , One-Lung Ventilation , Piperidines , PropofolABSTRACT
Heat-moisture exchanger (HME) is an inexpensive and effective device used to prevent respiratory complications that can be caused by endotracheal tube insertion during general anesthesia. But, HME can increase airway resistance and be occluded by the patient's secretions. Whether a HME could be occluded by clear fluids such as condensate in the airway circuit is not certain yet. In vitro, a case of HME occlusion by normal saline was reported. We report a case of HME obstruction by distilled water came from the heated wire circuit which was unintentionally connected to the HME.