1/57. A case of ventricular fibrillation in the prone position during back stabilisation surgery in a boy with Duchenne's muscular dystrophy.A 15-year-old boy with Duchenne's muscular dystrophy experienced prolonged cardiac arrest whilst in the prone position for spinal surgery. He was successfully resuscitated without apparent neurological sequelae by internal cardiac massage via a thoracotomy and external and internal direct current cardioversion. Recommendations are suggested for the pre- and peroperative management of such cases.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/57. Asystole during inadvertent high spinal anesthesia in a high risk patient without morbidity.Sudden cardiac arrest following high spinal anesthesia (SA) in young and healthy patients with poor outcome has been reported. Extreme bradycardia, hypotension and/or asystole during SA has recently received worldwide attention. We report a high risk patient who developed cardiac arrest associated with two other episodes of extreme bradycardia, hypotension and verbal unresponsiveness during SA without adverse outcome.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
3/57. Frightening dreams and spells: a case of ventricular asystole from lyme disease.We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. The combination of heart block and a predominantly lymphocytic cerebrospinal fluid led to the diagnosis of lyme disease. Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
4/57. bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases.Sudden, severe bradycardia/asystolic cardiac arrest are considered infrequent, but are certainly the most serious complications of spinal anaesthesia. We report four cases of primary asystole and one of severe bradycardia in young to middle-aged, healthy patients scheduled for minor surgery at the day surgery unit. bradycardia/asystole were not related to respiratory depression or hypoxaemia/hypercarbia; they occurred at different time intervals after the onset of spinal anaesthesia (10-70 min) and, apparently, were not dependent on the level of sensory block, which varied between T3 and T8. One patient was nauseated seconds before the asystole, otherwise there was no warning signs. All the patients were easily resuscitated with the prompt administration of atropine and ephedrine and, in the case of cardiac arrest, cardiac massage and ventilation with oxygen. One patient was treated with a small dose of adrenaline. Four patients had the surgery, as planned; one had the surgery postponed. All the patients were discharged from hospital in good health and did not suffer any sequelae.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
5/57. Autonomic failure in ALS with a novel SOD1 gene mutation.ARTICLE ABSTRACT: The authors report a patient with ALS and a novel SOD1 gene mutation who was in the totally locked-in state and developed autonomic failure followed by sudden cardiac arrest. A neuropathologic study showed widespread multisystem degeneration, including involvement of the autonomic nuclei in the medulla and spinal cord. SOD1 gene analysis detected a missense mutation of V118L in exon 4. These findings show notable phenotypic heterogeneity for SOD1-associated ALS.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
6/57. Lumbar epidural blocks: a case report of a life-threatening complication.A case of life-threatening complication resulting from a lumbar epidural block is presented. A 70-year-old woman with spinal stenosis developed cardiac and respiratory arrest 5 minutes after receiving a lumbar epidural block containing 80 mg of triamcinolone acetonide and 6mL of 1.5% lidocaine. The patient received cardiopulmonary resuscitation and recovered without any sequelae. It is suggested that this complication was caused by subdural or intravascular injection of local anesthetics. It might be preventable by injecting a test dose of local anesthetics before injecting a full dose of local anesthetics and by using fluoroscopy.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
7/57. Bilateral extracorporeal shock wave lithotripsy in a spinal cord injury patient with a cardiac pacemaker.OBJECTIVES: To review the precautions to be observed before and during extracorporeal shock wave lithotripsy (ESWL) in spinal cord injury (SCI) patients with a cardiac pacemaker and the safety of bilateral ESWL performed on the same day. DESIGN: A case report of bilateral ESWL in a SCI patient with a permanent cardiac pacemaker. SETTING: The Regional spinal injuries Centre, Southport, the lithotripsy Unit, the Royal Liverpool University hospitals NHS trust, Liverpool, and the Department of cardiology, Manchester Royal Infirmary, Manchester, UK. SUBJECT: A 43-year-old male sustained a T-4 fracture and developed paraplegia with a sensory level at T-2. During the post-injury period, he developed episodes of asystole requiring implantation of a dual chamber (DDD) permanent pacemaker. Twenty-one months later, he developed a right ureteric calculus with hydronephrosis. A radio-opaque shadow was seen in the left kidney with no hydronephrosis. During right ureteric stenting, the ureteric stone was pushed into the renal pelvis. 1,500 shock waves were delivered to this stone on the right side, followed by ESWL to the left intra-renal stone with 1250 shock waves. RESULTS: The patient tolerated ESWL to both kidneys. The pacemaker was reprogrammed to a single chamber ventricular pacing mode at 30 beats per minute with a reduced sensitivity during lithotripsy. There were no untoward cardiac events during or after lithotripsy. The serum creatinine was 45 micromol/l before lithotripsy and 44 micromol/l two weeks after ESWL. CONCLUSION: SCI patients with a cardiac pacemaker may be able to undergo extracorporeal shock wave lithotripsy following temporary reprogramming of the pacemaker. Bilateral, simultaneous ESWL is safe in the vast majority of patients provided that there is no risk of simultaneous ureteric obstruction by stone fragments. However, it should be remembered that a decrease in renal function could occur following bilateral ESWL of renal calculi.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
8/57. Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate.PURPOSE: This case report describes a cardiac arrest during a cemented hip arthroplasty procedure. Hemodynamic instability during methylmethacrylate use in arthroplasty surgery can be explained by fat embolization rather than the inherent toxicity of the monomer. CLINICAL FEATURES: A 78-yr-old woman required a cemented hemiarthroplasty for a pathologic left subcapital fracture. The patient's past medical history included stable angina, diet-controlled type II diabetes and metastatic breast cancer. During the cementing of the canal and insertion of the femoral prosthesis, desaturation, hypotension and cardiac arrest occurred. The patient underwent a successful intraoperative resuscitation and was transferred to the intensive care unit where she subsequently developed disseminated intravascular coagulopathy. The patient died 24 hr later and autopsy confirmed the cause of death as fat embolization. CONCLUSION: The deleterious cardiovascular effects of methylmethacrylate have been discussed in the literature. However, clinical evidence supports fat embolization during arthroplasty surgery as a greater determinant of hemodynamic compromise. Surgical precautions are paramount in minimizing the sequelae of Bone Implantation syndrome and anesthetic treatment consists of supportive care.- - - - - - - - - - ranking = 0.018829676747409keywords = canal (Clic here for more details about this article) |
9/57. Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review.We present a case report of successful resuscitation following cardiac arrest in a patient undergoing surgery in the prone position. A systematic review of the literature identified 22 further cases. risk factors for intra-operative cardiac arrest in patients in the prone position include: cardiac abnormalities in patients undergoing major spinal surgery, hypovolaemia, air embolism, wound irrigation with hydrogen peroxide, poor positioning and occluded venous return. Cardiac arrest is also a risk in the increasing number of patients with acute respiratory distress syndrome ventilated in the prone position. Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Suitable techniques for cardiopulmonary resuscitation including methods for chest compression, defibrillation and the management of air embolism are discussed.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
10/57. Neurological outcome prediction in a cardiorespiratory arrest survivor.Outcome prediction of neurological recovery in an unconscious survivor of cardiorespiratory arrest is difficult and uncertain. We describe the case of a 25-yr-old post-arrest survivor who made a remarkable neurological improvement despite a seemingly hopeless prognosis. Conventional clinical and neurophysiological assessments need to be interpreted with care in the presence of uncontrolled seizure activity and sedative medications. The measurement of biochemical markers in the serum and cerebrospinal fluid may be useful in helping the clinician to arrive at a more accurate neurological outcome prediction.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
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