[A case of torsade de pointes in a patient with severe aortic stenosis during carotid endarterectomy].

An 87-year-old man with severe aortic stenosis developed torsade de pointes (TdP) during carotid endarterectomy before carotid artery stenosis. By prompt resuscitation and medication including lidocaine and magnesium, the patient recovered without complications in spite of high risk for refractory cardiac arrest or brain infarction. There was no other history or laboratory data suggesting arrhythmia except elongation on preoperative electrocardiogram. Inhaled anesthetics, catecholamine and sympathetic nerve stimulation were possible causes of QT elongation and induce TdP. Particularly in a patient with carotid and cardiac diseases, cardiac arrest is critical. Therefore we should avoid exacerbating factors of QT elongation or TdP even if patients have no particular history of arrhythmia.

[Fast-track cardiac anesthesia and perioperative management appropriate for early rehabilitation after coronary artery bypass graft (CABG) surgery].

BACKGROUND: Rapid mobilization and rehabilitation after CABG has a potential benefit of reducing both costs and pulmonary complications (such as atelectasis and pulmonary embolism). Moreover, it improves the patient's emotional recovery. We performed fast-track cardiac anesthesia aiming toward early rehabilitation. METHODS: Patients undergoing CABG surgery (total, 140: on-pump 97, off-pump 43) were studied. Anesthesia was induced and maintained with low doses of fentanyl and propofol. The outcome of our perioperative management was retrospectively reviewed on the basis of clinical records. RESULTS: The duration of the operation was 282 +/- 71 min. Anesthesia time was 353 +/- 72 min. The doses of fentanyl and propofol were 11.9 +/- 2.9 microg x kg(-1) and 16.8 +/- 5.4 mg x kg(-1), respectively. Time to extubation was 213 +/- 676 min, and the percentage of cases extubated within 3 h was 82%. As for outcome, the percentages of first oral intake, first rising from bed, and first gait performed on postoperative day 1 were 92%, 78%, 61%, respectively. The period of ICU stay was 2 days (median value). There were no perioperative complications related to early rehabilitation. CONCLUSIONS: We can safely manage fast-track cardiac anesthesia and perioperative management aiming toward early rehabilitation after CABG surgery.