1/218. Mild hypothermia for temporary brain ischemia during cardiopulmonary support systems: report of three cases.Recovery without residual neurological damage after cardiac arrest with temporary cerebral ischemia is rare. Therefore, it is most important that every effort is made to prevent brain damage occurring immediately after successful cardiopulmonary resuscitation. We report herein the cases of three patients who suffered either cardiogenic or hypovolemic shock and were resuscitated by a cardiopulmonary support system followed by mild hypothermia. All three patients recovered completely without any neurologic damage. The outcomes of these three patients demonstrated that mild hypothermia may be important for cerebral preservation after cardiopulmonary resuscitation.- - - - - - - - - - ranking = 1keywords = cerebral, brain (Clic here for more details about this article) |
2/218. Vanishing pulmonary hypertension in mixed connective tissue disease.A 29-year-old woman with mixed connective tissue disease presented with signs of progressive pulmonary hypertension. After admission to the hospital her condition worsened rapidly and she developed a cardiac arrest resistant to cardiopulmonary resuscitation. Therefore, emergency extracorporeal assist was performed. No pulmonary embolism was found. Right heart catheterisation showed severe pulmonary hypertension, which was treated with nitric oxide ventilation. She was weaned from the extracorporeal assist with high doses of inotropic agents. Because of suspicion of exacerbation of her underlying disease, which led to pulmonary hypertension, immunosuppressive treatment was started with high doses of corticosteroids and plasma exchange. This resulted in slow recovery over the next four weeks. Control echocardiography showed complete normalisation of cardiac function without signs of pulmonary hypertension. Two months after admission she was discharged from the hospital in good condition.- - - - - - - - - - ranking = 43.877890130023keywords = embolism (Clic here for more details about this article) |
3/218. Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes.A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation. On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8 degrees C (67.6 degrees F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1 degree C/hour. adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (< 20 degrees C; 68 degrees F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypothermia.- - - - - - - - - - ranking = 0.25219907221037keywords = cerebral (Clic here for more details about this article) |
4/218. Preliminary experience with a percutaneous cardiopulmonary support system.Percutaneous cardiopulmonary bypass has been introduced to support circulation in critical patients. In our preliminary experience we resuscitated two patients who sustained a prolonged cardiac arrest (52 min. and 31 min.) after coronary angiography and elective cardiac surgery, respectively. Cannulation was achieved percutaneously within 10 min. in both cases. Pump flow ranged from 2 to 31/m. Total support lasted from 52 min. to 180 min.. Both patients were successfully weaned. Patient 1 was declared brain dead and expired 17 days later. Patient 2 was discharged from the hospital and is doing well. Cannulation was attempted in a third patient after 30 min. of cardiac arrest. Despite surgical cut down of the femoral vessels, it was impossible to advance the arterial cannula because of bilateral occlusive disease. We conclude that PCPS is a powerful technique in selected patients to recover a stable cardiac function after prolonged cardiac arrest.- - - - - - - - - - ranking = 0.099120371115851keywords = brain (Clic here for more details about this article) |
5/218. Anoxic-hypotensive brain injury: neuropsychological performance at 1 month as an indicator of recovery.DESIGN: This case control study included assessments at 3 and 8 weeks post brain injury. Controls were the non-brain injured subjects whose normative data has been published for neuropsychological measures. Data and medical information were obtained with informed consent. OBJECTIVE: This study explored cognitive sequella of anoxic-hypotensive brain injury following cardiac arrest in a 49 year old man with high premorbid function. RESULTS: Improvement was noted at 3 weeks post-injury. By 8 weeks neuropsychological test scores including verbal and visual memory were in the normal range, although they were likely to be lower than premorbid levels. CONCLUSIONS: Relatively good cognitive function within the first month post-anoxia likely indicates improved recovery and benefit from continued rehabilitation. Despite initial presentation, steep recovery curves can be found among survivors of anoxia with eventual return to independent function including driving/child care and return to gainful employment. rehabilitation teams are encouraged to remember that good cognitive function is not predicted by initial Glasgow coma Scores, but may be predicted by return of recall memory during the first month post-anoxic event. Serial cognitive screens can identify individuals with the potential for better recovery.- - - - - - - - - - ranking = 0.69384259781096keywords = brain (Clic here for more details about this article) |
6/218. Gas embolism during hysteroscopy.PURPOSE: Gas embolism during hysteroscopy is rare but sometimes fatal. A fatal case of gas embolism during diagnostic hysteroscopy using carbon dioxide (CO2) is presented. CLINICAL FEATURES: A 68 yr old woman was admitted for treatment of myoma and cancer of the uterus. hysteroscopy using CO2 was performed without monitoring or anesthesia on the ward. At the end of the examination, just after the hysteroscope was removed, she developed tonic convulsions, lost consciousness, and her pulse was impalpable. Cardiac massage was started, anesthesiologists were called and the trachea was intubated. She was transferred to the intensive care unit with continuous cardiac massage. Cardiac resuscitation was successful. A central venous line was inserted into the right ventricle under echocardiography in an attempt to aspirate gas with the patient in the Trendelenberg position, but the aspiration failed. Positive end expiratory pressure and heparin for emboli, midazolam for brain protection, and catecholamines were administered. Fifteen hours after resuscitation, the pupils were enlarged and she died 25 hr after resuscitation. CONCLUSION: Gas embolism is a rare complication of hysteroscopy. The procedure should be performed with monitoring of blood pressure, heart rate, oxygen saturation and end-tidal CO2 concentration.- - - - - - - - - - ranking = 307.24435128128keywords = embolism, brain (Clic here for more details about this article) |
7/218. ephedrine-induced complete atrioventricular block with ventricular asystole during rapid concomitant phenytoin infusion: a case report.ephedrine is widely used to elevate blood pressure, however, one should be cautious to use it concomitantly with phenytoin infusion in neurosurgical procedures. A 59-year-old female was admitted for craniotomy with removal of metastatic brain tumor. During operation phenytoin infusion was given to forestall postoperative seizure. hypotension, bradycardia and complete atrioventricular block followed by ventricular asystole suddenly occurred when the patient was given ephedrine to elevate the blood pressure to see the hemostatic effect close to the end of operation. We discontinued the phenytoin infusion and immediately injected 1.5 mg epinephrine. She was successfully resuscitated. We conclude that when phenytoin is used intraoperatively it should be administered by an infusion pump at a rate of less than 25 mg/min and under continuous monitoring of cardiac rhythm, heart rate, and blood pressure. When pressure support is required, the use of a pure alpha-agonist may minimize the risk of adverse reactions in the presence of phenytoin infusion.- - - - - - - - - - ranking = 0.099120371115851keywords = brain (Clic here for more details about this article) |
8/218. Sudden death and cerebral anoxia in a young woman with congenital ostial stenosis of the left main coronary artery.We report a 36-year-old woman with ventricular fibrillation, subsequent sudden clinical cardiac death, and a prolonged brain anoxia. After a successful resuscitation coronary angiography revealed congenital ostial left main coronary artery (LMCA) stenosis. Surgical anastomosis of the left internal mammary artery (LIMA) to LAD led to a complete recovery. Postoperative electrophysiological examination, mainly programmed ventricular stimulation, failed to excite any rhythm disturbances. Cathet. Cardiovasc. Intervent. 48:67-70, 1999.- - - - - - - - - - ranking = 1.1079166599573keywords = cerebral, brain (Clic here for more details about this article) |
9/218. Use of inhaled nitric oxide in pulmonary embolism.Acute massive pulmonary embolism carries a high mortality with the majority of deaths occurring during the early phase. We describe a case of massive pulmonary embolism resulting in severe cardiovascular collapse and cardiac arrest which was treated successfully with inhaled nitric oxide.- - - - - - - - - - ranking = 263.26734078014keywords = embolism (Clic here for more details about this article) |
10/218. Gas embolism produced by hydrogen peroxide abscess irrigation in an infant.The production of gaseous oxygen when hydrogen peroxide interacts with tissue is a well-known phenomenon that has been reported as a rare cause of gas embolism. We present the case of an 11-month-old infant who sustained an immediate cardiorespiratory arrest following the use of this agent during a minor surgical procedure. Clinical features, radiological findings and the rapid response to resuscitation were strongly suggestive of major gas embolism. Adverse effects of inappropriate use of hydrogen peroxide, and the diagnosis and management of these problems are discussed.- - - - - - - - - - ranking = 263.26734078014keywords = embolism (Clic here for more details about this article) |
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