RESUMO
Surgery for the repair of a type I aortic dissection presents several difficulties for the surgeon and the perfusionist. One must safely support the patient, while at the same time provide the surgeon with a bloodless field in which to operate. Often, this requires cessation of the circulation for varying amounts of time. Deep hypothermia allows for an extension of the arrest period, while other techniques-- retrograde cerebral perfusion and antegrade cerebral perfusion--provide an additional degree of cerebral protection. Recently, we utilized these techniques concurrently on a 43-year-old female who presented for a reoperation for a type I aortic dissection. Combining these techniques allowed us to adequately support the patient during an anticipated lengthy period of circulatory arrest and insured a successful operation without any adverse cerebral or other organ dysfunction.
Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Ponte Cardiopulmonar/instrumentação , Parada Cardíaca Induzida , Hipotermia Induzida , Adulto , Dissecção Aórtica/complicações , Aneurisma Aórtico/complicações , Implante de Prótese Vascular , Circulação Cerebrovascular , Transtornos Relacionados ao Uso de Cocaína/complicações , Desenho de Equipamento , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Humanos , Hipertensão/induzido quimicamente , Hipertensão/complicações , Infarto da Artéria Cerebral Média/complicações , ReoperaçãoRESUMO
The use of intravenous procaine in the treatment of hyperpyrexia in a patient with hyperparathyroidism has not been previously reported. A case of metastatic malignant melanoma precipitating the syndrome of hypertonicity of muscle, hyperpyrexia, acidemia, hypercalcemia and elevated serum parathormone levels is presented. Mithramycin was used in an attempt to reduce elevated serum calcium concentrations. The use of intravenous procaine in "caffeine rigor" and malignant hyperthermia due to succinylcholine and halothane formed the basis for its trial in this case. The relationship between cyclic AMP and calcium ions is discussed in postulating mechanism of procaine action.