ABSTRACT
Torsade de pointes (TdP) is an uncommon and specific form of polymorphic ventricular tachycardia, associated with a prolonged QT interval. Prolongation of the QT interval is the most widely recognized electrophysiological abnormality in patients with liver cirrhosis. We observed a case of TdP leading to cardiopulmonary resuscitation after the induction of general anesthesia, in a patient with liver cirrhosis scheduled for emergency cadaveric donor liver transplantation. The patient had mild QT prolongation on preoperative electrocardiography with a corrected QT (QTc) interval of 455 ms. Drugs used in the preoperative period can elongate cardiac repolarization. Sevoflurane and 5-hydroxytryptamine type 3 receptor antagonists such as palonsetron, used during general anesthesia may have triggered further QT prolongation, producing a fatal condition such as TdP. More caution and consideration in selecting drugs for anesthetic management are necessary for liver cirrhosis patients, especially in patients with preoperative QT prolongation.
Subject(s)
Humans , Anesthesia, General , Cadaver , Cardiopulmonary Resuscitation , Electrocardiography , Emergencies , Heart Arrest , Liver Cirrhosis , Liver Transplantation , Liver , Long QT Syndrome , Preoperative Period , Serotonin , Tachycardia, Ventricular , Tissue Donors , Torsades de PointesABSTRACT
Spontaneous retropharyngeal hematoma is rare and difficult to diagnosis early. A 23-year-old male spontaneously developed acute onset of neck pain, limitation of neck motion, and mild dysphagia. Magnetic resonance imaging demonstrated blood products in prevertebral space from C2 to C4, suggesting a diagnosis of retropharyngeal hematoma. We report a rare case of spontaneous retropharyngeal hematoma causing neck pain.
Subject(s)
Humans , Male , Young Adult , Deglutition Disorders , Hematoma , Magnetic Resonance Imaging , Neck , Neck PainABSTRACT
Treatment for thoracic postherpetic neuralgia can cause penetrating atherosclerotic ulcerations Postherpetic neuralgia is a frequent complication of herpes zoster.It is more common in the elderly population.If the pattern of pain changes especially in the older patients, differential diagnosis is important because the symptoms of some diseases which may be life threatening is similar with that of postherpetic neuralgia.An 83-year-old woman was admitted presenting aggravated pain, dyspnea and poor oral intake during treatment for postherpetic neuralgia involving the left T3 dermatome. She had a previous history of hypertension, congestive heart failure, and pulmonary embolism.Penetrating atherosclerotic ulceration involving the thoracic aorta was diagnosed by CT angiography and her clinical outcome improved through medical treatment.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Angiography , Aorta, Thoracic , Diagnosis, Differential , Dyspnea , Heart Failure , Hypertension , Neuralgia, Postherpetic , UlcerABSTRACT
Negative pressure induced pulmonary edema due to upper airway obstruction is a well-recognized problem. However, negative pressure pulmonary hemorrhage is extremely uncommon. We report a child who developed negative pressure pulmonary hemorrhage following acute airway obstruction caused by clench of endotracheal tube during emergence of anesthesia. The patient was treated with positive pressure ventilation and frequent tracheal suction. Hemorrhage from endotracheal tube was gradually decreased after 4 hours. The patient was extubated after 7 hours.