1/6. Idiopathic prolonged QT interval and QT dispersion: the effects of propofol during implantation of cardioverter-defibrillator.Local anaesthesia combined with conscious sedation is becoming a popular technique for implantation of cardioverter-defibrillator devices. propofol was given to provide loss of consciousness during defibrillation shock administration, for induced ventricular fibrillation testing. propofol was found to decrease QT interval and QT dispersion in two patients with idiopathic prolonged QT interval and QT dispersion. The findings of the procedure are reported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Duchenne muscular dystrophy and malignant hyperthermia--two case reports.The case histories are presented including the anaesthetic and postoperative management, of two children, a two-year-old with undiagnosed Duchenne muscular dystrophy (DMD) and a three-year-old with known DMD. The child with undiagnosed DMD had no symptoms of DMD and had received halothane twice before, without succinylcholine, with no apparent difficulty. Following an uneventful induction of anaesthesia with halothane, nitrous oxide and O2, succinylcholine resulted in bilateral masseter muscle spasm and then, in rapid sequence, ventricular tachycardia and cardiac arrest. resuscitation was difficult, prolonged and associated with hyperkalaemia (K = 12.57 mEq X L-1), severe metabolic and respiratory acidosis, high peripheral venous pressure and massive hepatosplenomegaly, but not hyperthermia. The patient was finally resuscitated but died two days later. Skeletal muscle biopsy results were consistent with malignant hyperthermia. The second patient was known to have DMD but did not receive prophylactic or intraoperative dantrolene nor have his anaesthetic machine flushed with oxygen for an extended period prior to induction of anaesthesia. This child was anaesthetized with fentanyl and N2O and, with the exception of a high intraoperative heart rate (155-160 beats X min-1), had an uncomplicated anaesthetic and operation (intraoperative axillary temperatures ranged between 36.8-37.9 degrees C). Postoperatively his temperature rapidly increased to 38.8 degrees C and then 40.3 degrees C and he became metabolically acidotic. Intravenous administration of dantrolene for 48 hours reduced the temperature and allowed normal recovery and discharge. A postoperative muscle biopsy was consistent with DMD.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/6. ventricular fibrillation during general anaesthesia in a seven-year-old patient with mitral valve prolapse.A case report is presented of a seven-year-old boy who developed ventricular fibrillation during general anaesthesia with atracurium, O2, N2O and halothane, following tracheal intubation for hypospadias revision. He spontaneously defibrillated and the surgery was cancelled. echocardiography done two days later was normal. The patient returned two weeks later for the same procedure. He developed nodal tachycardia, and premature ventricular contractions, which responded to lidocaine. A second echocardiographic examination done postoperatively while the child was crying showed mitral valve prolapse.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
4/6. ventricular fibrillation in a patient with unsuspected mitral valve prolapse and a prolonged Q-T interval.mitral valve prolapse is a common cardiac abnormality associated with arrhythmias and sudden death. In most instances it can be diagnosed on the basis of physical findings. Those patients who are symptomatic or who display electrocardiographic abnormalities appear to be most susceptible to arrhythmias and, therefore, may be at increased risk for anaesthesia. Because the syndrome is relatively common and may present a very innocent clinical picture, anaesthetists should be aware of this condition and the problems it may present. A case of mitral valve prolapse syndrome associated with ventricular fibrillation on induction of anaesthesia is reported. The symptoms and pathophysiology of the disorder are reviewed and the potential problems and the anaesthetic management are discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/6. Cardiac arrest under anaesthesia in a child with previously undiagnosed Jervell and Lange-Nielsen syndrome.A 7-year-old Sikh boy with a history of syncopal attacks and congenital deafness was admitted for elective adenoidectomy and examination of his ears under general anaesthesia. Immediately after induction of anaesthesia an ECG demonstrated T wave inversion in the CM5 lead. The child subsequently developed multifocal ventricular extrasystoles and later, ventricular fibrillation. Defibrillation was achieved using two 50 J DC shocks. A 12-lead ECG performed later demonstrated a prolonged Q-Tc interval (0.52 s). The child was diagnosed as having the Jervell and Lange-Nielsen syndrome.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
6/6. Sudden cardiorespiratory arrest after renal transplantation in a patient with diabetic autonomic neuropathy and prolonged QT interval.A 31-yr male with insulin dependent diabetes mellitus for 20 years underwent general anaesthesia for renal transplantation. During transfer from operating theatre to ICU he developed bradycardia advancing to ventricular fibrillation and had to be resuscitated. bradycardia did not respond to atropine. Postoperative autonomic nervous function tests showed advanced autonomic neuropathy. He was found to have constantly prolonged QTc interval in his pre- and postoperative ECGs (462-503 ms). Prolongation of QTc interval could be used as a valuable predictor of postoperative cardiac complications in diabetic patients with autonomic neuropathy.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |