ABSTRACT
Transesophageal echocardiography is a useful device to evaluate the posterior structure of heart with an advantage of enabling clearer images, as compared to transthoracic echocardiography. With intraoperative transesophageal echocardiography, we can reconfirm pre-diagnosed lesions, determine the success of the operation, and in particular, diagnose new lesions that are undetected in pre-operative evaluation. In the present case, undiagnosed patent ductus arteriosus was found on intraoperative transesophageal echocardiography during cardiopulmonary bypass. Subsequently, the patent ductus arteriosus was ligated successfully. With transesophageal echocardiography, we can diagnose the structural and functional abnormality of heart unidentified in the pre-operative evaluation. Also, transesophageal echocardiography can play the role of a rescuer to solve the problems that occur during cardiopulmonary bypass.
Subject(s)
Humans , Cardiopulmonary Bypass , Ductus Arteriosus, Patent , Echocardiography , Echocardiography, Transesophageal , HeartABSTRACT
OBJECTIVE: The potassium disturbance associated with thiopental continuous infusion in neurosurgical patients is well known. However, the effect of propofol continuous infusion on serum potassium levels has not been investigated extensively. METHODS: We reviewed the medical records of 60 consecutive patients who received coma therapy or deep sedation for intracranial pressure control using either thiopental or propofol between January 2010 and January 2012. RESULTS: The overall incidence of hypokalemia (K5.0 mmol/L, 32.4% vs. 4.3%, p=0.010) and the peak potassium concentration (4.8 mmol/L vs. 4.2 mmol/L, p=0.037) after the cessation of therapy were higher in thiopental group. On multivariate analysis, thiopental [8.82 (1.00-77.81); p=0.049] and duration of continuous infusion [1.02 (1.00-1.04); p=0.016] were associated with rebound hyperkalemia once therapy was discontinued. CONCLUSION: Propofol was less frequently associated with moderate to severe hypokalemia after induction and rebound hyperkalemia following the cessation of continuous infusion than thiopental.
Subject(s)
Humans , Coma , Deep Sedation , Hyperkalemia , Hypokalemia , Incidence , Intracranial Hypertension , Intracranial Pressure , Medical Records , Multivariate Analysis , Potassium , Propofol , ThiopentalABSTRACT
BACKGROUND: Palonosetron is a recently introduced 5-hydroxytryptamine-3 (5-HT3) receptor antagonist useful for postoperative nausea and vomiting prophylaxis. However, 5-HT3 receptor antagonists increase the corrected QT (QTc) interval in patients who undergo general anesthesia. This retrospective study was performed to evaluate whether palonosetron would induce a QTc prolongation in patients undergoing general anesthesia with sevoflurane. METHODS: We reviewed a database of 81 patients who underwent general anesthesia with sevoflurane. We divided the records into palonosetron (n = 41) and control (n = 40) groups according to the use of intraoperative palonosetron, and analyzed the electrocardiographic data before anesthesia and 30, 60, 90, and 120 min after skin incision. Changes in the QTc interval from baseline, mean blood pressure, heart rate, body temperature, and sevoflurane concentrations at each time point were compared between the two groups. RESULTS: The QTc intervals at skin incision, and 30, 60, 90, and 120 min after the skin incision during general anesthesia were significantly longer than those at baseline in the two groups (P 500 ms 30 min after skin incision, whereas no patient did in the control group (P = 0.01). No significant differences were observed between the two groups in mean blood pressure, body temperature, heart rate, or sevoflurane concentrations. CONCLUSIONS: Palonosetron may induce QTc prolongation during the early general anesthesia period with sevoflurane.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Arrhythmias, Cardiac , Blood Pressure , Body Temperature , Electrocardiography , Heart Rate , Incidence , Isoquinolines , Laparotomy , Methyl Ethers , Patient Safety , Postoperative Nausea and Vomiting , Quinuclidines , Receptors, Serotonin, 5-HT3 , Retrospective Studies , SkinABSTRACT
BACKGROUND: In liver transplantation, an increase of serum potassium [K+] after reperfusion is related to components of the preservation solution. However, the histidine-tryptophan-ketoglutarate (HTK) solution, which is now popularly used, has a twelve times lower [K+] as compared to the UW solution. This retrospective study was performed to compare the use of the UW solution with the HTK solution for changes in the serum [K+] during the early reperfusion period in liver transplantation recipients. METHODS: Anesthesia medical records of 366 liver transplant patients were reviewed and patients were enrolled in one of the two groups; recipients who received a transplanted liver preserved with the UW solution (UW group), and recipients received a liver preserved with the HTK solution (HTK group). Serum [K+] changes 5 min before, 5 min after, and 20 min after reperfusion for recipients in each group were compared. RESULTS: In the UW group, [K+] increased 5 min after reperfusion and decreased 20 min after reperfusion as compared to [K+] 5 min before reperfusion (3.93, 4.07, and 3.76 mM in 5 min before, 5 min after, and 20 min after reperfusion respectively; P < 0.001). In the HTK group, [K+] significantly decreased 5 min and 20 min after reperfusion as compared to [K+] 5 min before reperfusion (4.12, 3.79, and 3.75 mM; P < 0.001). CONCLUSIONS: When the HTK solution was used, the serum [K+] 5 min after reperfusion decreased as compared to the [K+] before reperfusion and didn't further decrease until 20 min after reperfusion.