1/60. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/60. Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura.A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complained of severe chest pain. electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myocardial infarction (AMI), urgent coronary angiography revealed 99% organic stenosis with delayed flow in the proximal segment and 50% in the middle segment of the left anterior descending artery (LAD). Subsequently, percutaneous transluminal coronary angioplasty (PTCA) for the stenosis in the proximal LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count was 28,000/mm3. After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occlusion in the middle segment of the LAD. Subsequently, PTCA was performed successfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strategy, but careful attention must be paid to hemostasis and to managing the platelet count.- - - - - - - - - - ranking = 7keywords = coronary (Clic here for more details about this article) |
3/60. Coronary artery spasm induced by trigeminal nerve stimulation and vagal reflex during intracranial operation.This report describes a case of ventricular fibrillation resulting from coronary vasospasm during intracranial operation under general anesthesia. An autonomic response associated with the intracranial procedure caused a coronary spasm, which was worsened by alpha-agonists. nitroglycerin effectively resolved the coronary spasm and co-complications persisted.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
4/60. Hypotensive hemorrhagic necrosis in basal ganglia and brainstem.Hypotensive hemorrhagic necrosis of the basal ganglia and brainstem has only occasionally been described. Three such cases are reported. Cardiac arrest had occurred in all cases, and it took at least 1 hour to restore adequate circulation. The patients remained comatose for 2 days to 2 weeks until death. Persistent hypotension causing ischemia in the distribution of deep perforating arteries is considered to have been the key underlying mechanism. hemorrhage is thought to have been caused by extravasation of red blood cells through damaged blood vessels.- - - - - - - - - - ranking = 0.28245982364784keywords = circulation (Clic here for more details about this article) |
5/60. myocardial infarction in the newborn: a case report complicated by cardiogenic shock and associated with normal coronary arteries.Fatal myocardial infarction occurring in a neonate is reported. The patient presented with a clinical picture of cardiogenic shock simulating a hypoplastic left heart syndrome. Etiology of the myocardial infarction is uncertain for the coronary arteries were patent, anatomically and histologically normal, and there was no significant associated cardiac defect. The possible etiologies in relationship to myocardial infarction in the neonatal period are presented.- - - - - - - - - - ranking = 5keywords = coronary (Clic here for more details about this article) |
6/60. Terlipressin for treating intraoperative hypotension: can it unmask myocardial ischemia?IMPLICATIONS: After administration of terlipressin to treat hypotension related to induction of general anesthesia, profound hypertension occurred in association with myocardial ischemia and occlusion of the left anterior descending coronary artery. The authors emphasize cautious use of this drug because of such adverse events.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
7/60. hypotension and functional left ventricular obstruction during dobutamine stress echocardiography--two case reports.Although hypotension during dobutamine stress echocardiography has been reported, the mechanism of this response is still controversial. In two patients, a 72-year-old woman and 64-year-old man, with exercise-induced ST-T change, continuous-wave Doppler examination of the left ventricular cavity was performed at baseline and peak dobutamine infusion. No echocardiographic abnormalities at rest or angiographic coronary lesions were observed in either patient. The intracavitary pressure gradient at peak dosage of dobutamine for both patients was 121 mm Hg and 100 mm Hg, and was reproducibly confirmed by cardiac catheterization. During dobutamine infusion, echocardiography or left ventriculography revealed that papillary muscle motion was dramatically augmented by dobutamine and mid-left ventricular obstruction was produced at the systolic phase. Although blood pressure response improved following beta-blocker treatment, intracavitary pressure gradient during dobutamine infusion remained the same. A hypotensive response during dobutamine stress echocardiography may be produced by the development of dynamic intraventricular obstruction and a vasodepression reflex. The exercise-induced electrocardiographic changes may have been related to the systolic pressure augmentation in the mid-to-apical left ventricular cavity.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
8/60. Ischemia of ciliary arterial circulation from ocular compression.Two patients developed unilateral central retinal artery and posterior ciliary artery occlusions related to ocular compression during general anesthesia. One patient had evidence of extensive choroidal ischemia with diffuse hypopigmentation, pigmentary mottling of the posterior pole, and disc edema. electroretinography showed diminution of the A and B waves. The other patient showed patchy choroidal ischemia with subsequent development of wedge-shaped areas of pigmentary atrophy and mottling in the midperiphery. iridocyclitis and prolonged hypotony were also present. Retinal and posterior ciliary artery occlusion (perhaps at the level of the ophthalmic artery) can occur as a result of ocular compression by a face mask or an improperly positioned headrest. Systemic hypotension is a factor in many cases. Proper positioning of the head on an adequate headrest and avoidance of ocular compression will prevent the occurrence of retinal and choroidal occlusion during general anesthesia.- - - - - - - - - - ranking = 1.1298392945914keywords = circulation (Clic here for more details about this article) |
9/60. Eptifibatide-induced acute profound thrombocytopenia presenting as refractory hypotension.A 61-year-old woman presented with acute coronary syndrome and was given heparin and eptifibatide in conjunction with coronary angioplasty. Shortly thereafter she became profoundly thrombocytopenic (platelets 2.0 x 10(9)/L) and developed severe refractory hypotension. heparin-induced antibodies were not detected, but the patient developed strong eptifibatide-dependent antibodies specific for platelets that appear to explain both the thrombocytopenia and the hypotensive episode.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
10/60. Haemodynamic and electrocardiographic consequences of severe nicorandil toxicity.A 35 year old woman was admitted to the emergency department two hours after ingesting 60x20 mg tablets of nicorandil, total 1.2 g. The dominant feature of icorandil toxicity was profound peripheral vasodilatation associated with coronary hypoperfusion. Despite widespread electrocardiographic signs of myocardial ischaemia, there was no evidence of myocardial damage and no serious cardiac arrhythmia. Volume loading and pressor support proved to be an effective treatment strategy.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
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