Journal of anesthesia
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Journal of anesthesia · Jan 2007
Case ReportsProlonged cardiac arrest unveiled silent sick sinus syndrome during general and epidural anesthesia.
Patients who have silent sick sinus syndrome (SSS) can show various unexpected arrhythmias during surgery. The severity of these bradyarrythmias is affected by anesthetic methods. We report a unique case of a patient with silent SSS who developed 40 s of asystole under combined general and epidural anesthesia. ⋯ During surgery, severe bradycardia, triggered by peritoneal manipulation, occurred, leading to 40 s of asystole. She was diagnosed as having SSS by a postoperative 24-h Holter electrocardiogram. We propose that the possible existence of SSS should be kept in mind even in a patient who shows no abnormalities on routine preoperative examination, especially in those in whom vagomimetic anesthetic methods are used.
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Journal of anesthesia · Jan 2007
Effects of nicardipine-induced hypotension on cerebrovascular carbon dioxide reactivity in patients with diabetes mellitus under sevoflurane anesthesia.
The purpose of this study was to examine the effects of nicardipine-induced hypotension on cerebrovascular CO2 reactivity in patients with diabetes mellitus under sevoflurane anesthesia. ⋯ We concluded that cerebrovascular CO2 reactivity in insulin-dependent patients is impaired during nicardipine-induced hypotension under sevoflurane anesthesia.
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Journal of anesthesia · Jan 2007
Case ReportsAnesthetic management of a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) during laparotomy.
A 53-year-old man with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) underwent a gastrectomy. We administered bicarbonated Ringer's solution, which has a physiological concentration of bicarbonate. ⋯ Aggressive warming was needed to maintain normothermia, presumably because the mitochondrial respiratory chain, which is responsible for thermogenesis, is impaired in MELAS patients. It is important to maintain normothermia in MELAS patients in order to avoid further mitochondrial metabolic depression.
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We compared jugular venous blood oxygen saturation (Sj(O) (2)) and the arterial-to-jugular-bulb venous oxygen content difference (AjD(O) (2)) between bispectral index (BIS) values of 40 and 60, adjusted by the infusion rate of propofol. Eighteen postoperative neurosurgical patients (Glasgow Coma Scale [GCS] scores, 11-15) were enrolled. Normocapnia, normothermia, and a mean arterial blood pressure greater than 70 mmHg were maintained. ⋯ Sj(O) (2) at BIS40 (58 +/- 9%) was significantly (P < 0.01) lower than that at BIS60 (63 +/- 10%), and AjD(O) (2) at BIS40 (6.3 +/- 1.5 ml.dl(-1)) was significantly (P < 0.01) higher than that at BIS60 (5.7 +/- 1.5 ml.dl(-1); mean +/- SD). At BIS40, status defined as Sj(O) (2) less than 50% was observed in 3 patients, while this status was observed in 1 patient at BIS60. In conclusion, in patients with postoperative neurosurgical surgery (GCS scores, 11-15), decreases of propofol infusion to adjust the BIS value from 40 to 60 increase the cerebral oxygen balance.