Case Report: Anaesthetic Approach For Emergency Surgery In A Patient With Acute Myocardial Infarction

In this case report, we examined anaesthetic approach for emergency surgery in a patient with acute myocardial infarction and stomach perforation at the same time.Anaesthesia was induced with midazolam, propofol, fentanyl and vecuronium, and maintained with sevoflurane 1-2% in 100% oxygen, fentanyl and vecuronium. Patient controlled analgesia with morphine was used for postoperative analgesia. At postoperative 17th day, the patient was discharged from the hospital as health

Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso

ResumoJustificativa e objetivosA ocorrência de fibrilação ventricular em um paciente pode resultar em complicações inesperadas. Nosso objetivo é apresentar um caso de fibrilação ventricular que ocorreu após a indução anestésica com administração de etomidato.Relato de casoPaciente do sexo feminino, 56 anos, com pré‐diagnóstico de cálculos biliares, foi admitida na sala de cirurgia para colecistectomia laparoscópica. A anestesia foi induzida com a administração de etomidato com uma dose em bolus de 0,3mg/kg. A paciente apresentou uma grave e rápida adução dos braços logo após a indução. Taquicardia com QRS largo e frequência ventricular de 188bpm foram detectadas no monitor. O ritmo converteu‐se em fibrilação ventricular (FV) durante a preparação para a cardioversão. A paciente foi imediatamente submetida a desfibrilação. O ritmo sinusal foi obtido. Decidimos adiar a cirurgia por causa da condição de instabilidade da paciente.ConclusãoAlém dos efeitos secundários conhecidos de etomidato, taquicardia ventricular e fibrilação, embora muito raramente, também podem ser observadas. Até onde sabemos, esse é o primeiro caso na literatura de FV causado por etomidato.AbstractBackground and objectivesVentricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration.Case reportA fifty‐six‐year‐old female patient with a pre‐diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition.ConclusionIn addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature

Romatoid artritli hastada ilacın etkisiyle fatal intersitisyel pnömoni : Olgu sunumu

Acute interstitial pneumonia developed three weeks after the administration of leflunomide(LEF) in a 53-year-old woman with rheumatoid arthritis. She developed nausea and diarrhea as well as dyspnea before coming to the hospital and LEF treatment was stopped. She suddenly experienced severe dyspnea and her chest x-ray showed reticular shadows in her lower lung fields which had not been detected before. Partial oxygen pressure of her arterial blood fell all of a sudden, which necessitated an emergency admission to the intensive care unit. After endotracheal intubation, mechanical ventilation support was started due to acute respiratory failure. The patient died of respiratory failure 7 days after the onset of acute interstitial pneumoniaRomatoid artritli 53 yaşındaki kadın hastaya leflunomide verilmesinden 3 hafta sonar akut interstisyel pnömoni gelişti. Bulantı, diare ve dispne gelişen hastada LEF tedavisi kesildi. Hasta şiddetli dispnesi ve akciğer grafisinde retiküler görüntülerin ortaya çıkması ve arteryel parsiyel oksijen basıncının düşmesi üzerine acilen yoğun bakım ünitesine alındı. Akut respiratuar yetmezlik nedeniyle endotrakeal entubasyon ve mekanik ventilasyon desteğine başlandı. Hasta interstisyel pnömoni başlangıcından 7 gün sonra respiratuar yetmezliğe bağlı kaybedildi

Anesthesia management in pediatric patients undergoing percutaneous closure of atrial and ventricular septal defects in catheter laboratory: Retrospective clinical study

Along with technological and medical advances, diagnostic and therapeutic cardiac catheterization commonly used in pediatric patients; it is frequently preferred the percutaneous closure of ASD/VSD. In this study, it was aimed to evaluate anesthesia management of pediatric patients undergoing percutaneous closure of ASD/VSD in catheter laboratory. This was a retrospective review of pediatric patients undergoing percutaneous closure of ASD/VSD in catheter laboratory between 20122017. Demographic and clinical characteristics were recorded, and all results of anesthesia management were evaluated. Thirty-eight patients (18 males, 20 females) with a mean age of 7,71 ± 3,57 years underwent percutaneous closure of ASD/VSD. Of the cases; 78,4% diagnosed ASD, 21,6% diagnosed VSD were operated. The most common presenting symptoms were murmur (55,3%), chest pain (21,1%) and palpitation (10,5%), Mean defect size was 11.60 ± 6.27 mm for ASD and 6.00 ± 4.64 mm for VSD. Mean anesthesia time was 71.33 ± 22.77 minutes for ASD and 85.83 ± 26.91 minutes for VSD. Mean procedure time was 56.00 ± 20.56 minutes for ASD and 69.16 ± 28.70 minutes for VSD. Premedication was performed for 94,7%, anesthesia induction was performed with propofol (94,7%), fentanyl (63,2%), rocuronium (65,8%). Sevoflurane was used for anesthesia maintenance. TEE was used in 86,8% of the cases. Complications developed for 3 cases. IV paracetamol was preferred in 84,2%. Anesthetist must consider carefully premedication, anesthetic agent preferences, general anesthesia or sedation, complications by catheterization, discomforts of transesophageal echocardiography, hemodynamic instability, requirement of immobility and adequate analgesia. [Med-Science 2018; 7(3.000): 486-490

Anesthetic management in a patient with Friedreichs Ataxia: a different approach

Friedreich's Ataxia (FA) is a rare autosomal recessive disease. FA is clinically characterized by progressive ataxia, especially loss of reflex and power in the lower extremities, spasticity and loss of proprioceptive sensory. There is an increased sensitivity to non-depolarizing muscle relaxants in neurodegenerative diseases. Care must be taken of anesthesia management for the use of volatile anesthetics and muscle relaxants, and precautions should be taken for difficult airway management which is due to secondary to kyphoscoliosis and comorbidities. In this case, anesthesia management of emergency operation for septal hematoma by TIVA without using of muscle relaxants and minimalized hemodynamic response depending on the intubation by videolaryngoscope were presented. [Med-Science 2017; 6(1.000): 109-10

General anesthesia management in 15 preterm infant undergoing diode laser photocoagulation for retinopathy of prematurity: a retrospective study

Anesthesia management of preterm infants is challenging for the anesthesiologist. Because of the rudimentary build of the infants, many medical and physical problems have been observed in the treatment of the disease such as complications, airway problems, temperature disregulation and deficient drug metabolism. This retrospective study evaluates the perioperative management and postoperative course in premature infants undergoing diode laser photocoagulation (DLP) for retinopathy of prematurity (ROP). We analyzed the preoperative data, anesthesia chart, and postoperative course of 15 preterm infants for general anesthesia exposures for ROP surgery. Minimum weight and gestational age at birth were 480 g and 23 weeks, respectively. Mean value of weight at birth was less than 1000 g (886,3g) differently from other studies. The mean anesthesia and surgery duration were 80,9 and 60,4 min, respectively. Paracetamol was implemented for postoperative analgesia through rectal route in 5 infants and intravenous route in 10 infants at the start of surgery. Eleven patients were extubated in the operating room and 4 infants were extubated in the following days. Birth weights of infants were between 480 and 1240 g. Supraglottic airway such as I-gel was applied in 5 infants, laryngeal mask airway (LMA) in 5 infants and endotracheal intubation (ETI) was applied in 4 infants. In the present study, we found that intraoperative complications, duration of anesthesia and surgery were acceptable and similar to those of other studies. However, the value of apnea in current study was less significant when compared to other studies,which can be correlated with intubation without muscle relaxant or post-conceptual age over 35 weeks. [Med-Science 2018; 7(1.000): 65-68

A calipers-free intravitreal anti-VEGF injection technique

WOS: 000354050800017PubMed ID: 2594553