ABSTRACT
In the original article contained an error in Accepted date.
ABSTRACT
Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction. We suggest that echocardiography should be performed in a patient with suspected pulmonary thromboembolism to evaluate right heart function and diagnose emboli in transit.
Subject(s)
Aged , Female , Humans , Cerebral Infarction , Echocardiography , Foramen Ovale, Patent , Heart , Mortality , Pulmonary Embolism , ThrombosisABSTRACT
BACKGROUND: The effects of head-down position on dynamic hemodynamic variables remain without full understanding. We evaluated the effects of steep head-down position on the pulse pressure variation (PPV). METHODS: Forty patients were positioned at 30degrees head-down position after anesthesia induction. We measured the heart rate (HR), arterial blood pressure (BP) and PPV before and 2 minutes after the position change. RESULTS: PPV and HR decreased (9.3 +/- 3.2% to 4.6 +/- 1.8%, 67.2 +/- 11.4 to 62.4 +/- 7.8, respectively) after steep head-down position, whereas the BP increased. Baseline PPV was related with decreases of PPV (r2 = -0.83, P < 0.0001). An 8% PPV threshold discriminated the patients with more than 5% decreases of absolute PPV value. The area under the receiver operating characteristic curve was 0.98 (95% CI = 0.88 to 1.00, P < 0001). CONCLUSIONS: Steep head-down position caused decreases in PPV. Higher PPV at the supine position decreased more after the position change. Further investigations are required to assess the significance, the duration and the relationship with fluid responsiveness of this change.
Subject(s)
Humans , Anesthesia , Arterial Pressure , Blood Pressure , Heart Rate , Hemodynamics , ROC Curve , Supine PositionABSTRACT
BACKGROUND: Hypotension is a common phenomenon after spinal anesthesia in hypertensive patients. We investigated whether heart rate variability could predict the occurrence of hypotension after spinal anesthesia in hypertensive patients. METHODS: Forty-one patients undergoing spinal anesthesia were included. Heart rate variability was measured at five different time points such as before fluid loading (baseline), after fluid loading as well as 5 min, 15 min and 30 min after spinal anesthesia. Fluid loading was performed using 5 ml/kg of a crystalloid solution. Baseline total power and low to high frequency ratio (LF/HF) in predicting hypotension after spinal anesthesia were analyzed by calculating the area under the receiver operating characteristic curves (AUC). RESULTS: Moderate hypotension, defined as a decrease of mean arterial pressure to below 20-30% of the baseline, occurred in 13 patients and severe hypotension, defined as a decrease of mean arterial pressure greater than 30% below the baseline, occurred in 7 patients. LF/HF ratiosand total powers did not significantly change after spinal anesthesia. AUCs of LF/HF ratio for predicting moderate hypotension was 0.685 (P = 0.074), severe hypotension was 0.579 (P = 0.560) and moderate or severe hypotension was 0.652 (P = 0.101), respectively. AUCs of total power for predicting moderate hypotension was 0.571 (P = 0.490), severe hypotension was 0.672 (P = 0.351) and moderate or severe hypotension was 0.509 (P = 0.924), respectively. CONCLUSIONS: Heart rate variability is not a reliable predictor of hypotension after spinal block in hypertensive patients whose sympathetic activity is already depressed.
Subject(s)
Humans , Anesthesia, Spinal , Area Under Curve , Arterial Pressure , Heart Rate , Heart , Hypertension , Hypotension , Isotonic Solutions , Parasympathetic Nervous System , ROC Curve , Sympathetic Nervous SystemABSTRACT
Duchenne muscular dystrophy is a hereditary disorder characterized by progressive muscle weakness and contracture, and special care during anesthesia is needed in these patients. Because inhalational anesthetics and succinylcholine can cause fatal results, intravenous anesthetics are commonly used. However, monitorings for the pediatric population are not otherwise specified. We report our experience of a 6 year-old boy that underwent muscle biopsy suspicious of muscle dystrophy under general anesthesia. The patient received midazolam, fentanyl, propofol and a small dose of rocuronium. He was monitored with bispectral index (BIS), acceleromyography (TOF). At the end of surgery, recovery of TOF ratio to 90% was evaluated, followed by injection of pyridostigmine and glycopyrrolate. When reversal of neuromuscular block was confirmed quantitatively and clinically, the patient was extubated and he experienced no complication.
Subject(s)
Humans , Androstanols , Anesthesia , Anesthesia, General , Anesthetics , Anesthetics, Intravenous , Biopsy , Contracture , Fentanyl , Glycopyrrolate , Midazolam , Muscle Weakness , Muscles , Muscular Dystrophies , Muscular Dystrophy, Duchenne , Neuromuscular Blockade , Organothiophosphorus Compounds , Propofol , Pyridostigmine Bromide , SuccinylcholineABSTRACT
Postoperative respiratory complications following scoliosis surgery are high incidence. In this case, fifty year-old male patient was admitted for thoracolumbar screw fixations and developed postoperative pulmonary edema. This was most likely due to prolonged administration of nicardipine, which over time may inadvertently cause hypotension. As a result of volume overload, interstitial pulmonary edema and pleural effusion occurred. Moreover, pulmonary edema and pleural effusion appeared on the right side first and spread to the left. This phenomenon could be explained by the positioning of scoliosis patient. The cause of pulmonary edema was volume overload initiated by prolonged effect of nicardipine.