Ventricular tachycardia without preceding electrocardiogram change after hypertonic mannitol administration: a case report

Abstract Background Mannitol is widely used during neurosurgery, but it has a serious complication including lethal arrhythmia due to mannitol-induced hyperkalemia. Case presentation We report on a 62-year-old man scheduled for the clipping of an unruptured cerebral artery aneurysm. During surgery, approximately 20 min after the end of 200-mL 20% hypertonic mannitol administration, ventricular tachycardia (VT) occurred without preceding electrocardiogram (ECG) change, such as peaked T waves, and VT was recovered to sinus rhythm after chest compression. A potassium concentration after recovery from VT was 6.4 mEq/L, which was normalized by the administration of calcium gluconate, furosemide, and insulin with glucose. Conclusions Physicians must be aware that VT without preceding ECG change can occur after hypertonic mannitol administration

Ⅵ PAIN AND REGIONAL ANESTHESIA Retropharyngeal Hematoma after Stellate Ganglion Block Analysis of 27 Patients Reported in the Literature

Background: Retropharyngeal hematoma (RPH) is rare; however, it causes airway obstruction and can be fatal. Stellate ganglion block (SGB) can cause RPH. The authors analyzed reports of patients with RPH after SGB to clarify the initial symptoms and signs, and the urgency of airway management. Methods: MEDLINE and Japana Centra Revuo Medicina were searched for reports of RPH after SGB using the following terms and key words: stellate ganglion block, complication, hematoma, and retropharyngeal hematoma. Results: The authors found 27 patients with RPH after SGB in the past 40 yr. The initial symptoms included neck pain (n ‫؍‬ 10), dyspnea (n ‫؍‬ 10), neck swelling (n ‫؍‬ 8), and hoarseness (n ‫؍‬ 5). The symptoms occurred 2 h or more after SGB in 14 patients (52%). Emergency airway management was needed in 21 patients (78%) because of airway obstruction. Among the 21 patients, orotracheal intubation was attempted first in 17 patients; however, it was unsuccessful in 5 patients who immediately needed emergency tracheostomy. Tracheal intubation was impossible by distortion of the anatomy of the markedly edematous pharyngolarynx. Failed airway management caused one death. There were no statistically significant predictors of the initial symptoms or signs for later emergency airway management. Conclusions: RPH after SGB necessitates emergency airway management. Because airway obstruction cannot be predicted by the initial symptoms or signs, emergency airway management tools should be at hand, and the patency of the airway should be continuously evaluated after onset of RPH after SGB