Fulminant peripartum cardiomyopathy rescue with extracorporeal membranous oxygenation.

We report the successful use of extracorporeal membranous oxygenation in a previously healthy parturient with fulminant peripartum cardiomyopathy. Native cardiac function recovered rapidly, with weaning from extracorporeal membranous oxygenation after only 68 h. This case highlights the potential of this lifesaving treatment, in appropriately selected patients, where death seems inevitable. No major complications of extracorporeal membranous oxygenation occurred in this patient.

Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study.

BACKGROUND: ERCP requires patient cooperation and often prolonged sedation. In different areas of anesthetic practice, patient-controlled sedation with a target-controlled infusion (TCI) of propofol provides effective sedation. The aim of this study was to assess the safety and efficacy of the same system in patients undergoing ERCP. METHODS: Twenty patients used the TCI system. Patients received oxygen at 2 L/min via nasal cannulae. By using pharmacokinetic TCI software modeling, an initial propofol target blood concentration (Ct) of 1.0 microg/mL was supplemented on patient demand with a handset that, when pressed twice within 1 second, increased the Ct of propofol by 0.2 microg/mL. The maximum permissible target concentration was set at 3.0 microg/mL to prevent oversedation. RESULTS: Sixteen patients used the system successfully throughout the procedure. The Ct propofol ranged from 1.2 to 2.6 microg/mL, and the number of successful handset activations (after commencement of the ERCP) ranged from 0 to 3. In 3 patients, the ceiling Ct propofol was attained without adequate sedation and the system was manually overridden. The system failed in 1 case because of patient confusion. There were no episodes of hemodynamic instability, airway obstruction, or significant oxygen desaturation. Endoscopist and patient satisfaction were high. Four patients were oversedated according to our criteria at the end of the procedure, but all were awake within 5 minutes of arrival in the recovery area. CONCLUSIONS: Patient-maintained sedation with TCI propofol was safe and fully effective in 16 patients. Ease of endoscopy was rated high by the endoscopists, and all patients were well satisfied with their sedation. Adjustments to the software programming are being evaluated to increase the safety profile to avoid oversedation.

Diagnosis by intraoperative transesophageal echocardiography of acute thrombosis of mechanical aortic valve prosthesis associated with the use of biological glue.

Mechanical aortic valve thrombosis is an uncommon complication of valve replacement. Inadequate anticoagulation is observed in 45% of patients presenting with this complication and it occurs as close as 15 days postoperation (1). Failure to wean from cardiopulmonary bypass (CPB) after aortic valve replacement may be because of a multitude of pathologies. We present a case where easy access to transesophageal echocardiography (TEE) allowed a rapid diagnosis of acute mechanical aortic valve occlusion with subsequent successful surgical management.