ABSTRACT
Superior vena cava (SVC) obstruction leads to a constellation of symptoms and signs that encompass the SVC syndrome. Today, malignancy accounts for 65% of all cases. The most common neoplastic causes are nonsmall cell lung cancer (50%), small cell lung cancer (25%), lymphoma, and metastasis. Primary cardiac tumors are an extremely rare cause of SVC obstruction. We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic. The diagnosis of SVC obstruction secondary to a primary cardiac sarcoma was established based on clinical, radiologic, and post-mortem findings. This is one of very few reported cases of a primary cardiac sarcoma causing SVC obstruction.
Subject(s)
Heart Neoplasms/complications , Sarcoma/complications , Superior Vena Cava Syndrome/etiology , Fatal Outcome , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/pathology , Humans , Male , Middle Aged , Myocardium/pathology , Sarcoma/diagnostic imaging , Sarcoma/pathology , Superior Vena Cava Syndrome/diagnosis , Superior Vena Cava Syndrome/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
STUDY OBJECTIVE: To determine whether adding ephedrine to propofol is as effective as adding lidocaine at reducing injection pain, and its effects on hemodynamics. DESIGN: Randomized, double-blinded, controlled trial. SETTING: District general hospital in the United Kingdom. PATIENTS: 156 adult, ASA physical status I, II, and III patients undergoing elective or emergency general anesthesia. INTERVENTIONS: Patients were randomized to one of three groups to receive one mL of 1% lidocaine per 20 mL of 1% propofol (Group L), 15 mg of ephedrine per 20 mL of propofol (Group E15), or 30 mg of ephedrine per 20 mL of propofol (Group E30). MEASUREMENTS AND MAIN RESULTS: Pain on injection, heart rate, and blood pressure at one-minute intervals for ten minutes were recorded. There was no significant difference in injection pain among groups. Group E30 had the least amount of hemodynamic change. CONCLUSION: Adding 30 mg of ephedrine to 20 mL of 1% propofol is as effective as adding lidocaine in preventing injection pain, and it results in a more stable hemodynamic profile.