RESUMO
Resection and reconstruction of the SVC is a challenging Intraoperative situation owing to the potential complications after clamping a patent vessel. Hemodynamic imbalance and neurological effects of SVC clamping can be life threatening. These complications can be prevented by careful intraoperative monitoring and management. Anaesthesiologist must be aware of different options to manage such challenging situations.
Assuntos
Anestesiologistas , Procedimentos Cirúrgicos Torácicos , Veia Cava Superior/cirurgia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização IntraoperatóriaRESUMO
Postoperative malignant hyperthermia (MH) is a very rare phenomena. It is generally observed within less than an hour after discontinuation of the anesthetic trigger. Present case describes rare delayed postoperative presentation of MH after off-pump coronary bypass surgery. Prompt recognition and immediate treatment with dantrolene can effectively treat the fatal syndrome. Family education and genetic counseling should be encouraged.
Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Hipertermia Maligna/etiologia , Hipertermia Maligna/terapia , Complicações Pós-Operatórias/terapia , Idoso , Anestesia Geral/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Dantroleno/uso terapêutico , Humanos , Masculino , Relaxantes Musculares Centrais/uso terapêuticoRESUMO
Optimal anticoagulation plays a pivotal role in successful outcome of extracorporeal membrane oxygenation (ECMO). Heparin has been the anticoagulant of choice owing to its advantages like easy monitoring and reversibility. However, if heparin resistance is encountered, one has to decide whether to treat heparin resistance with fresh-frozen plasma or antithrombin concentrates or to choose one of the heparin alternatives for anticoagulation. We report a case of heparin resistance resulting from antithrombin III deficiency in a patient on venovenous ECMO, in which anticoagulation was managed with bivalirudin. The dose of bivalirudin for anticoagulation in ECMO has not been standardized and different authors have reported different doses. We found a bivalirudin dose of .1-.2 mg/kg/h to be adequate to maintain a target activated clotting time of 200-220 seconds. Platelet counts were stable throughout and no major bleeding or thrombotic complications took place. We found bivalirudin to be a feasible and effective anticoagulant and safe to use for long durations in ECMO without any major complications.
