Cardiac arrest attributable to dysfunction of the autonomic nervous system after traumatic cervical spinal cord injury / 中华创伤杂志(英文版)

Bradycardia is the most common form of dysrhythmia developing after disruption of the sympathetic pathway by a spinal cord injury (SCI), and it can have fatal consequences, including cardiac arrest. Here, we report a case of cardiac arrest developing after cervical SCI attributable to sympathetic hypoactivity. A 26-year-old male pedestrian was admitted after a traffic accident. Radiologically, fractures were apparent at the Cbilateral articular facets, and cord contusion with hemorrhage was evident at C. During his stay in ICU, intermittent bradycardia was noted, but the symptoms were not specific. On the 22nd postoperative day, the patient was taken to the computed tomography suite for further evaluation and experienced cardiac arrest during a positional change. After immediate cardiac massage, the patient was resuscitated. We scheduled Holter monitoring, which detected 26 pauses, the longest of which was 17.9 s. The patient underwent cardiac pacemaker insertion. No further cardiac events were noted.

Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia

We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia's syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.

Effects of Thiopental or Midazolam , Alone and in Combination , on the Induction Time and the Cardiovacular Responses / 대한마취과학회지

There was a report that midazolam-thiopental coinduction reduced ED99 of thiopental for hypnosis from 5.75 mg to 2.37 mg. This study was designed to test whether the former study can be used clinically and to compare midazolam-thiopental coinduction with thiopental or midazolam induction. After 120 patients of ASA calss I, II classified into 3 groups randomly, 5.75 mg/kg of thiopental was injected intravenously to each patient for Group I while 0.23 mg/kg of midazolam was injected intravenously to each patient for Group II. For Group III, 2.37 mg/kg of thiopental was injected intravenously to each patient one minute after 0.02 mg/kg of midazolam was injected. Induction rate, induction time, and the changes of cardiovascular response for each group have been compared and the results are as follows: 1) Induction rate was 100%, 75%, 75% for each group. 2) Time for the spontaneous eye closure and loss of the eyelid reflex for Group I were 12.2+/-8.0 seconds, 20.36.9 seconds respectively, while for Group II 51.5+/-26.5 seconds, 69.3+/-29.5 seconds, and for Group III, 25.3+/-7.4 seconds, 37.0+/-10.8 seconds (G. I< G. III < G. II). 3) However, heart rate was relatively higher in Group I at the point of induction but there were no significant differences between groups statistically. 4) It was also impossible to prove that the changes of blood pressure were more stable in one group than others statistically. By judging from the results above, midazolam-pentothal coinduction can be a useful means of induction but coinduction is not superior to thiopental or midazolam induction.