Journal of clinical anesthesia
-
Clinical Trial
Effects of aging and propofol on the cardiovascular component of the autonomic nervous system.
To determine the combined effects of aging and propofol on autonomic nervous system activity using heart rate variability (HRV) analysis. ⋯ Propofol and aging act in synergy to depress the activity of the cardiovascular component of the autonomic nervous system. However, a compensatory increase in sympathetic outflow was seen in young patients. Such counterbalance was not observed in the older group.
-
Case Reports
Refractory hypotension during spinal anesthesia for Cesarean delivery due to undiagnosed pheochromocytoma.
Profound hypotension and resistance to conventional vasopressor therapy following administration of spinal anesthesia for Cesarean delivery occurred in a multiparous parturient. Postpartum evaluation for secondary hypertension showed a diagnosis of pheochromocytoma. Pheochromocytoma was mistaken for preeclampsia with significant vasopressor requirement to treat hypotension from spinal anesthesia. If pheochromocytoma is diagnosed during pregnancy and Cesarean delivery is required, spinal anesthesia may not be the optimal choice of anesthesia.
-
Serotonin syndrome is gaining attention in perioperative and chronic pain settings due to the growing prevalence of multimodal therapies that increase serotonin levels and thereby heighten patient risk. A patient's genetic make-up may further increase the risk of serotonin syndrome. ⋯ A subsequent cytochrome P4502D6 genetic test result suggested a potential alteration in metabolism. For this patient, who was taking combination antidepressant medications and receiving common perioperative medicines, additive pharmacodynamic effects converged with a pharmacogenetic predisposition, resulting in serotonin syndrome.
-
A patient developed brisk airway bleeding after being discharged earlier that day following an uneventful partial vocal cord cordectomy. This emergent complication required management by the team of anesthesiologists and otorhinolaryngologists. A plausible explanation for the occurrence of this complication was the presence of aberrant arterial blood supply in the area of the vocal cords where the surgery was performed.