Tramadol use in a patient with Brugada syndrome and morphine allergy: a case report

Cengiz Sahutoglu, Seden Kocabas, Fatma Zekiye Askar Ege University School of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey Abstract: Brugada syndrome is a rare syndrome characterized by arrhythmias and sudden death, particularly in younger individuals. A mutation in a gene encoding the human cardiac sodium channels is responsible for this syndrome. In the literature, there are several case reports of Brugada syndrome in association with the use of several anesthetic agents. Herein, we present our anesthetic practice and the use of tramadol in a 75-year-old female patient who underwent pulmonary lobectomy under general anesthesia and was diagnosed with Brugada syndrome. Keywords: Brugada syndrome, tramadol, arrhythmia, analgesia, general anesthesia, postoperative complications, cardiac conduction defec

Elderly coronary artery bypass graft patients with left ventricular dysfunction are hemodynamically stable after two different doses of rocuronium

WOS: 000084306700004PubMed ID: 10622647Objective: To clarify the detailed hemodynamic responses to bolus administration of 2x 95% effective dose (ED95) and 3x ED95 of rocuronium in elderly patients with left ventricular dysfunction undergoing elective coronary artery bypass grafting (CABG). Design: Prospective, randomized, clinical study. Setting: University hospital, Participants: Twenty patients aged older than 65 who had coronary artery disease with left ventricular ejection fractions equal to or less than 40%. Interventions:Using invasive cardiac monitoring, the detailed hemodynamic profile was obtained before and at 2, 4, 6, 8, and 10 minutes after the injection of rocuronium. Measurements and Main Results: Minor changes in all the measured or derived hemodynamic variables within the two groups did not attain statistical significance. Except for a higher baseline and the subsequent mean arterial pressures in one group, there were neither statistically nor clinically significant differences between two different doses of rocuronium in any of the variables at any time. Conclusion: The results demonstrate that bolus administration of rocuronium (2x to 3x ED95) in combination with high-dose fentanyl provides sufficient cardiovascular stability among elderly CABG patients with left ventricular dysfunction. The cardiovascular profile of the two different bolus doses was similar. Rocuronium, in both doses, appears to be a suitable agent for muscle relaxation, especially for patients who require a high degree of cardiovascular stability. Copyright (C) 1999 by WB. Saunders Company

Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery

Cengiz Sahutoglu, Erbil Turksal, Seden Kocabas, Fatma Zekiye Askar Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey Background: Fluid management in critically ill patients usually relies on increasing preload to augment cardiac output. In the present study, we aimed to evaluate whether stroke volume variation (SVV) can guide fluid therapy and reduce complications.Patients and methods: In this retrospective study, a total of 88 patients who underwent lobectomy were divided into two groups: group 1 (SVV, n=43) and group 2 (conventional or central venous pressure [CVP], n=45). Heart rate, blood pressure, oxygen saturation, SVV (only group 1), CVP (all patients), urea, creatinine, and hemoglobin levels before and after surgery, use of fluid, blood and inotropic agents, and postoperative complications were recorded retrospectively.Results: The mean age of the study population was 56.9±14.4 years and 75% of the patients were male. SVV was used in fluid therapy in 48.9% of the patients. The use of SVV resulted in an increased use of crystalloids and colloids with increased urine output per hour (p<0.05). Of patients in the SVV group and the CVP group, 44.1% and 51.1% developed at least one complication, respectively (p=0.531). The rate of respiratory complications including atelectasis, pneumonia, hypoxemia, and an increased production of secretions was 21% in the SVV group and 37.7% in the CVP group (p=0.104). The rate of complications and the length of hospital stay were comparable between the groups (p>0.05).Conclusion: Our study results showed that the use of SVV increased the use of crystalloids and colloids and favorably affected urine output per hour but did not reduce complications in thoracic surgery. Keywords: central venous pressure, fluid management, lobectomy, one-lung ventilation, stroke volume variatio

Apolipoprotein E epsilon 4 allele and neurobehavioral status after on-pump coronary artery bypass grafting

WOS: 000232380400024PubMed ID: 16153291Background and Aim: The presence of apolipoprotein E epsilon 4 allele is being considered as a risk factor for cognitive decline after cardiac surgery. We sought the effect of apolipoprotein E epsilon 4 allele on neurobehavioral status after on-pump coronary artery bypass grafting. Methods: Prior to the operation, neurologic examination and neurobehavioral cognitive status test (COGNISTAT) were performed. Both procedures were repeated on the day of discharge and 3 months after surgery. Apolipoprotein E epsilon 4 allele positive and apolipoprotein E epsilon 4 allele negative patients' performance on COGNISTAT were compared. Results: There was no statistically significant demographic and operative data difference between two groups. No neurological impairment was observed on examinations. There was no statistically significant neurocognitive decline difference between two groups' postoperative performances. Conclusions: It seems that apolipoprotein E epsilon 4 allele may not affect neurobehavioral status in the intermediate period after on-pump coronary artery bypass grafting