ABSTRACT
Arrhythmias occurring during surgery are mostly benign and improve without special treatment, but sometimes life threatening and poor vital signs may require immediate antiarrhythmic or electrotherapy. In some cases, permanent arrhythmias may require continued treatment after surgery. A cardiac event occurred to a 28-year-old man who underwent Bile duct resection/Roux-en-Y hepaticojejunostomy due to cholelithiasis with cholecystitis and choledocholithiasis. He diagnosed mental retardation level 2. Pre-operation laboratory test is normal except liver function test (AST 64, ALT 141). Electrocardiography shows 57 bpm heart rate, sinus rhythm, first degree AV block and long corrected QT interval that was checked 462ms and echocardiography shows LVEF 67%, normal echocardiogram. When we prepared extubation after finishing operation, Sugammadex 200mg was injected. Suddenly, patient’s oxygen saturation was low at 85%. We started manual ventilation for oxygenation and saturation was increased at 100%. When we extubated endotracheal tube, his ECG changed NSR to idiopathic VT. Firstly we considered that is PSVT and infused adenosine 6mg twice and 12mg once. But arrhythmia was continuous and vital sign changed unstable. We performed reintubation and defibrillated at 200J. After defibrillation, arrhythmia converted sinus rhythm. We transferred the patient to the ICU and evaluated further to see if the patient had heart problems. During admission in ICU, attending surgeon tried to extubate endotracheal tube 2 more times. But, Idiopathic VT occurred whenever try to extubate. Finally, in the fourth attempt, extubation without occurrence of VT succeeded with continuous IV esmolol and dexmedetomidine.
ABSTRACT
Background@# A high hematocrit level in patients with erythrocytosis is linked with increased blood viscosity and increased risk of thromboembolism. Therefore, it is necessary to adequately lower the hematocrit level before performing a high-risk surgery. Case: A 67-year-old man was scheduled for aortic valve replacement due to severe aortic stenosis. The preoperative hematocrit level of this patient was very high due to secondary polycythemia by hypoxia. We decided to perform acute normovolemic hemodilution after anesthetic induction to reduce the risk of thromboembolism in the patient. The patient was discharged after a successful surgery and a post-operative period without any side effects. @*Conclusions@#We estimate that patients with secondary polycythemia may benefit from acute normovolemic hemodilution to reduce their hematocrit levels while undergoing cardiac surgery using cardiopulmonary bypass. However, it is necessary to control the hematocrit level, since a significant decrease can cause side effects.
ABSTRACT
Arrhythmias occurring during surgery are mostly benign and improve without special treatment, but sometimes life threatening and poor vital signs may require immediate antiarrhythmic or electrotherapy. In some cases, permanent arrhythmias may require continued treatment after surgery. A cardiac event occurred to a 28-year-old man who underwent Bile duct resection/Roux-en-Y hepaticojejunostomy due to cholelithiasis with cholecystitis and choledocholithiasis. He diagnosed mental retardation level 2. Pre-operation laboratory test is normal except liver function test (AST 64, ALT 141). Electrocardiography shows 57 bpm heart rate, sinus rhythm, first degree AV block and long corrected QT interval that was checked 462ms and echocardiography shows LVEF 67%, normal echocardiogram. When we prepared extubation after finishing operation, Sugammadex 200mg was injected. Suddenly, patient’s oxygen saturation was low at 85%. We started manual ventilation for oxygenation and saturation was increased at 100%. When we extubated endotracheal tube, his ECG changed NSR to idiopathic VT. Firstly we considered that is PSVT and infused adenosine 6mg twice and 12mg once. But arrhythmia was continuous and vital sign changed unstable. We performed reintubation and defibrillated at 200J. After defibrillation, arrhythmia converted sinus rhythm. We transferred the patient to the ICU and evaluated further to see if the patient had heart problems. During admission in ICU, attending surgeon tried to extubate endotracheal tube 2 more times. But, Idiopathic VT occurred whenever try to extubate. Finally, in the fourth attempt, extubation without occurrence of VT succeeded with continuous IV esmolol and dexmedetomidine.
ABSTRACT
Injuries of the larynx are common in patients with a history of inhalation burns. When anesthesia is performed in such patients, the possibility of tracheal intubation should be thoroughly checked in advance, and preparation should be made in case of possible failure. 73-year-old woman who underwent laser cordotomy due to posterior glottic stenosis due to inhalation burn. Her height and weight were 140 cm and 58.9 kg. We proceeded anesthesia, because preoperative fiberoptic laryngoscopy and otolaryngology consultation showed that tracheal intubation was possible. However, the intubation failed and the manual ventilation was not performed afterwards, so the cricothyroidotomy was performed as an emergency. Anesthesia in patients with posterior glottic stenosis due to inhalation burns requires a great deal of attention and, above all, thorough evaluation in order to confirm the possibility of tracheal intubation. If this is not possible, you should look for alternatives and be prepared, and even if you think it's possible, try anesthesia with thorough preparation for the possible failure.
Subject(s)
Aged , Female , Humans , Anesthesia , Burns, Inhalation , Constriction, Pathologic , Cordotomy , Emergencies , Inhalation , Intubation , Laryngoscopy , Larynx , Otolaryngology , VentilationABSTRACT
Injuries of the larynx are common in patients with a history of inhalation burns. When anesthesia is performed in such patients, the possibility of tracheal intubation should be thoroughly checked in advance, and preparation should be made in case of possible failure. 73-year-old woman who underwent laser cordotomy due to posterior glottic stenosis due to inhalation burn. Her height and weight were 140 cm and 58.9 kg. We proceeded anesthesia, because preoperative fiberoptic laryngoscopy and otolaryngology consultation showed that tracheal intubation was possible. However, the intubation failed and the manual ventilation was not performed afterwards, so the cricothyroidotomy was performed as an emergency. Anesthesia in patients with posterior glottic stenosis due to inhalation burns requires a great deal of attention and, above all, thorough evaluation in order to confirm the possibility of tracheal intubation. If this is not possible, you should look for alternatives and be prepared, and even if you think it's possible, try anesthesia with thorough preparation for the possible failure.
ABSTRACT
Injuries of the larynx are common in patients with a history of inhalation burns. When anesthesia is performed in such patients, the possibility of tracheal intubation should be thoroughly checked in advance, and preparation should be made in case of possible failure. 73-year-old woman who underwent laser cordotomy due to posterior glottic stenosis due to inhalation burn. Her height and weight were 140 cm and 58.9 kg. We proceeded anesthesia, because preoperative fiberoptic laryngoscopy and otolaryngology consultation showed that tracheal intubation was possible. However, the intubation failed and the manual ventilation was not performed afterwards, so the cricothyroidotomy was performed as an emergency. Anesthesia in patients with posterior glottic stenosis due to inhalation burns requires a great deal of attention and, above all, thorough evaluation in order to confirm the possibility of tracheal intubation. If this is not possible, you should look for alternatives and be prepared, and even if you think it's possible, try anesthesia with thorough preparation for the possible failure.