Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of postoperative convulsive seizure following tranexamic acid infusion during aortic valve replacement].
We present a case of postoperative convulsive seizure in an 84-year-old man who underwent an aortic valve replacement. The patient had hypertension associated with hyperaldosteronism and chronic interstitial nephritis. The duration of cardiopulmonary bypass was 74 min. ⋯ The blood sugar, sodium, and calcium levels were within the normal limits. The seizures were likely due to a total dose of 8 g of tranexamic acid (TXA) administered intraoperatively. Possible mechanisms of TXA-induced seizures include blockage of inhibitory cortical y -aminobutyric acid-A receptors.
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We studied the utility of Vigileo monitor for grasping hemodynamics with a patient in a state of anaphylactic shock. The stroke volume variation (SVV) predicts fluid responsiveness of normal cases. In the anaphylactic shock resulting from biased blood distribution, not only blood pressure but also pulse pressure markedly decreased within a couple of minutes. ⋯ A former version of Vigileo monitor underestimated the arterial pressure-based cardiac output (APCO) due to the underrating of a single stroke volume (SV) in a range of systemic vascular resistance (SVR) below 800 dyne x sec(-1) x cm(-5). The version 3.02 Vigileo monitor allowed for more accurate estimation of SV because its new algorithm was able to revise the apparently low SVR derived from the arterial waveform characteristics and hence provided more realistic SV and APCO values. It was thus concluded that this ver. 3.02 is useful for anesthetic management of the anaphylactic case.
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We report a case of awake intubation in a patient with a difficult airway combined with severe hemorrhagic shock using the Pentax-AWS Airwayscope (AWS). A 65-year-old man experienced severe hemorrhagic shock due to diaphragmatic hernia after extrapleural pneumonectomy and was scheduled for emergent exploratory thoracotomy under general anesthesia. ⋯ The patient underwent awake intubation with the AWS under dexmedetomidine sedation and lidocaine spray for laryngotracheal anesthesia. The patient did not buck during intubation and hemodynamic changes were minimal.
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We experienced a pulmonary artery injury which might have been caused by a pulmonary artery catheter (PAC). A 66-year-old woman after mitral valve replacement, developped massive tracheal bleeding during weaning from the cardiopulmonary bypass. Transesophageal echocardiography revealed the air bell in the right pulmonary artery synchronized with ventilation. ⋯ Surgical approach found the air leak from the erasure of the bronchus intermedius and the lobectomy led to lifesaving. A pulmonary artery injury caused by PAC is very rare, but life-threatening. In this case, she had some risk factors (i. e. 60 years or older, female, short statue, and mitral valve disease); however, it was hard to predict the pulmonary injury from these factors.
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We report a case of an 8-year-old girl with fulminant myocarditis successfully treated with percutaneous cardiopulmonary support (PCPS). She was first taken to our hospital for treatment of suspected infective enterocolitis since her main symptoms were fever, vomiting and diarrhea. On day 2 after admission, her ECG showed wide QRS and echocardiography demonstrated severe hypokinesis. ⋯ She was weaned from PCPS on day 6 after initiation of PCPS. The patient was finally discharged from the hospital without any neurological complications on day 68 after weaning from PCPS. The proportion of patients in whom cardiopulmonary resuscitation was performed or having ventricular tachycardia or fibrillation were higher in non-survivors than in survivors.