Treatment of Transradial Angiogram Catheter Entrapment by Axillary Artery Spasm With Supraclavicular Brachial Plexus Block: A Case Report.

We present a 36-year-old female patient who underwent transradial cerebrovascular angiography because of acute putaminal hemorrhage. Catheter entrapment occurred with severe pain in the right upper arm proximal to the elbow. A subclavian artery angiogram by way of a transfemoral crossover catheter revealed severe vasospasm in the axillary artery distal to the branch point between it and the posterior brachial circumflex artery. Diazepam 5 mg intravenously (IV) through a peripheral catheter, lidocaine 0.5% 5 mL injected subcutaneously, and lidocaine 2% 4 mL IV isosorbide dinitrate 2 mg IV through the angiographic crossover catheter failed to relieve the pain and catheter entrapment. An ultrasound-guided supraclavicular brachial plexus block relieved both within 3 minutes. In the past, general anesthesia would have been administered.

[Two cases of diaphragmatic surgery in children under artificial pneumothorax].

We reported two cases of thoracoscopic diaphragm repair in children. The first case was a 6-day old neonate undergoing thoracoscopic repair of congenital diaphragmatic hernia under general anesthesia. During operation, CO2 was insufflated with a pressure of 4 cmH2O into the thoracic cavity. Although end-tidal CO2 increased to 90 mmHg, Sp(O2) and blood pressure were maintained within normal ranges. The second case was a 20-month-old infant undergoing thoracoscopic repair of diaphragmatic laxity. During operation, end-tidal CO2 increased to around 50 mmHg. Sp(O2) and blood pressure were normal. But during the procedure, insufflation pressure increased up to 10 cmH2O accidentally and arterial blood pressure curve disappeared. Insufflation pressure was corrected quickly and the arterial blood pressure recovered to normal within 10 seconds. The physiological changes of CO2 insufflation in thoracic cavity is similar to tension pneumothorax and we must take care to keep insufflation pressure under 4 cmH2O.

[QT dispersion increases during hemodialysis procedures in patients undergoing maintenance dialysis: association with an RA system and holter electrocardiogram].

BACKGROUND: Patients undergoing maintenance dialysis have been associated with a high incidence of arrhythmias, which increases with hemodialysis (HD) procedures. In recent years, QT dispersion (QT-d), which is defined as the difference between the maximum and minimum QT intervals (QTmax, QTmin) on an electrocardiogram (ECG), has attracted attention as a useful tool for predicting and evaluating ventricular arrhythmias. AIM: To determine the QT interval and QT-d before and after HD in stable subjects on maintenance dialysis. Further, to analyze the association of changes (Delta) in the QT interval and QT-d with the fluid removal ratio and changes in laboratory data. PATIENTS AND METHODS: We selected 82 patients undergoing maintenance dialysis who were less than 80 years of age. QT intervals before and after HD were obtained, and laboratory data including neurohumoral factors and the RA system were carried out. Of all the patients, 63 underwent a 24-hour holter-monitoring ECG. RESULTS: QTmax was significantly prolonged with QTmin remaining unchanged, and QT-d was significantly increased. DeltaQT-d demonstrated a significant correlation with DeltaQTmax, DeltaQTmin and Deltaaldosterone, but showed no correlation with the fluid removal ratio and changes in laboratory data. Results of the holter ECG revealed that in the grade 0 (Lown's classification) group, no change was obtained in DeltaQTmax, DeltaQTmin and DeltaQT-d, and in groups 1 to 5, significant increases were noted in DeltaQTmax and DeltaQT-d. CONCLUSIONS: The increase in QT-d has a possible link with arrhythmia inducibility during HD, and the results of the holter ECG suggest that an increase in QT-d may predict the frequency of arrhythmias. Change in the RA system appeared to have an impact on QT-d, but there was no impact of this parameter on the fluid removal ratio or changes in the laboratory data.