Cardiac arrest in unusual positions represents an additional challenge for anesthesiologists. This paper reports a successful cardiopulmonary resuscitation during neurosurgical procedure in which high-quality chest co...Cardiac arrest in unusual positions represents an additional challenge for anesthesiologists. This paper reports a successful cardiopulmonary resuscitation during neurosurgical procedure in which high-quality chest compressions was performed in the prone position. The aim of this report is disclose the knowledge of resuscitation maneuvers in a position other than supine. A 77-year-old female patient presented for excision of parietal-occipital meningioma in the prone position with the head fixed on a Mayfield head-holder. During the surgical procedure the sagittal sinus was disrupted. The patient presented an abrupt hemorrhagic shock leading to a cardiac arrest by hypovolemia despite vigorous volume replacement. Cardiac massage was promptly initiated in the prone position. After two minutes, there was a return of spontaneous circulation. The patient was discharged without sequelae. We concluded that high-quality chest compressions in the prone position were able to generate sufficient cardiac output.展开更多
Transcatheter aortic valve replacement (TAVR) is a new therapeutic option to treat patients with symptomatic severe aortic stenosis, and a prohibitive mortality risk for conventional surgical AVR2. A thorough understa...Transcatheter aortic valve replacement (TAVR) is a new therapeutic option to treat patients with symptomatic severe aortic stenosis, and a prohibitive mortality risk for conventional surgical AVR2. A thorough understanding of the procedural steps involved in TAVR is imperative for all components of the heart time. Balloon aortic valvuloplasty under rapid ventricular pacing is one of the main procedural steps, and is usually performed before valve insertion to enable passage of the prosthesis through the stenotic native aortic valve. Hemodynamic collapse necessitating prompt intervention may occur at different stages during the procedure.展开更多
In rare cases, rocuronium has been associated with dose-related tachycardia, probably by a cardiac muscarinic M2 receptor blockade mechanism. We report the case of a 30-year-old female who underwent excision of a bran...In rare cases, rocuronium has been associated with dose-related tachycardia, probably by a cardiac muscarinic M2 receptor blockade mechanism. We report the case of a 30-year-old female who underwent excision of a branchial cyst under general anesthesia. This patient presented an episode of sinus tachycardia (130 bpm) shortly after anesthesia induction with propofol, sufentanyl, and rocuronium. Tachycardia could not be explained by any cause other than the use of rocuronium, which was reverted with sugammadex. Two minutes after sugammadex administration, heart rate normalized, corroborating our hypothesis that rocuronium induced the sinus tachycardia observed in our patient. The patient recovered well from the anesthetic-surgical procedure and showed no further cardiovascular, ventilatory, or neurological changes, being transferred to the post-anesthesia care unit, and finally discharged to the ward.展开更多
Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly with prevalence less than 0.01% in autopsy series. It can be found as an isolated anomaly, and the patient may be asymptomatic, but is often associa...Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly with prevalence less than 0.01% in autopsy series. It can be found as an isolated anomaly, and the patient may be asymptomatic, but is often associated with aortic insufficiency in 68% of the cases. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are currently used as a diagnostic and follow-up method for this anomaly. The objective of the present paper is through the clinical case report of a 60 year old patient submitted to surgical correction of QAV, to relate some clinical aspects of the disease and to discuss the anesthetic management for this group of patients, in addition, emphasizing the importance and the increasing use of the TEE in the intraoperative period in cardiac surgeries.展开更多
文摘Cardiac arrest in unusual positions represents an additional challenge for anesthesiologists. This paper reports a successful cardiopulmonary resuscitation during neurosurgical procedure in which high-quality chest compressions was performed in the prone position. The aim of this report is disclose the knowledge of resuscitation maneuvers in a position other than supine. A 77-year-old female patient presented for excision of parietal-occipital meningioma in the prone position with the head fixed on a Mayfield head-holder. During the surgical procedure the sagittal sinus was disrupted. The patient presented an abrupt hemorrhagic shock leading to a cardiac arrest by hypovolemia despite vigorous volume replacement. Cardiac massage was promptly initiated in the prone position. After two minutes, there was a return of spontaneous circulation. The patient was discharged without sequelae. We concluded that high-quality chest compressions in the prone position were able to generate sufficient cardiac output.
文摘Transcatheter aortic valve replacement (TAVR) is a new therapeutic option to treat patients with symptomatic severe aortic stenosis, and a prohibitive mortality risk for conventional surgical AVR2. A thorough understanding of the procedural steps involved in TAVR is imperative for all components of the heart time. Balloon aortic valvuloplasty under rapid ventricular pacing is one of the main procedural steps, and is usually performed before valve insertion to enable passage of the prosthesis through the stenotic native aortic valve. Hemodynamic collapse necessitating prompt intervention may occur at different stages during the procedure.
文摘In rare cases, rocuronium has been associated with dose-related tachycardia, probably by a cardiac muscarinic M2 receptor blockade mechanism. We report the case of a 30-year-old female who underwent excision of a branchial cyst under general anesthesia. This patient presented an episode of sinus tachycardia (130 bpm) shortly after anesthesia induction with propofol, sufentanyl, and rocuronium. Tachycardia could not be explained by any cause other than the use of rocuronium, which was reverted with sugammadex. Two minutes after sugammadex administration, heart rate normalized, corroborating our hypothesis that rocuronium induced the sinus tachycardia observed in our patient. The patient recovered well from the anesthetic-surgical procedure and showed no further cardiovascular, ventilatory, or neurological changes, being transferred to the post-anesthesia care unit, and finally discharged to the ward.
文摘Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly with prevalence less than 0.01% in autopsy series. It can be found as an isolated anomaly, and the patient may be asymptomatic, but is often associated with aortic insufficiency in 68% of the cases. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are currently used as a diagnostic and follow-up method for this anomaly. The objective of the present paper is through the clinical case report of a 60 year old patient submitted to surgical correction of QAV, to relate some clinical aspects of the disease and to discuss the anesthetic management for this group of patients, in addition, emphasizing the importance and the increasing use of the TEE in the intraoperative period in cardiac surgeries.
