scholarly journals Circulatory collapse during wound closure in spine surgery with an unknown cause: a possible adverse effect of topical application of vancomycin?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoqing Zhang ◽  
Wenwen Zhai ◽  
Min Li ◽  
Xiangyang Guo
Keyword(s):  
Cardiac Arrest ◽  
Topical Application ◽  
Orthopedic Surgery ◽  
Infusion Rate ◽  
Wound Closure ◽  
Local Application ◽  
Shock Onset ◽  
Circulatory Collapse ◽  
Rate Dependent ◽  
Severe Hypotension

Abstract Background Vancomycin (VCM) is effective in fighting Gram-positive bacteria related severe infections, and topical application of VCM powder is widely used in orthopedic surgery to prevent wound infection. However, VCM could lead to infusion rate-dependent antibody-and complement-independent anaphylaxis reaction by inducing direct release of histamine. Case presentation We retrospectively analyzed seven cases of severe hypotension and shock during wound closure or immediately after orthopedic surgery with unidentifiable reasons. We found that these cases were all associated with local application of VCM powder during wound closure process. Two patients experienced sudden cardiac arrest. Most of the cases (6/7) with circulatory collapse were discharged without severe sequelae. While one case with application of 3 g VCM developed cardiac arrest and remained in a coma due to hypoxic-hypoxic encephalopathy. The clinical presentations and the time of the shock onset were considered to be related with a VCM induced anaphylaxis reaction. However, as this was a retrospective study, and there was no laboratory examination performed, the conclusion was made upon differential diagnosis based on clinical manifestations and the timing of the shock. Conclusions Local application of VCM may not be as safe as was once believed and may lead to a related anaphylaxis. As VCM induced infusion-rate dependent, non-IgE mediated anaphylaxis is characterized by delayed occurrence, severe hypotension and even circulatory collapse, surgeons and anesthesiologists should be extra vigilant during and after VCM application.

scholarly journals Initial Experience of the Levodopa–Entacapone–Carbidopa Intestinal Gel in Clinical Practice

2021 ◽  
Vol 11 (4) ◽  
pp. 254
Author(s):  
Mezin Öthman ◽  
Erik Widman ◽  
Ingela Nygren ◽  
Dag Nyholm
Keyword(s):  
Cardiac Arrest ◽  
Clinical Practice ◽  
Observational Study ◽  
Prospective Studies ◽  
Infusion Rate ◽  
Treatment Duration ◽  
Initial Experience ◽  
Morning Dose ◽  
Efficacy And Safety ◽  
User Friendliness

Patients in fluctuating stages of Parkinson’s disease (PD) require device-aided treatments. Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is a well-proven option in clinical practice. We now report the first clinical experience of levodopa–entacapone–carbidopa intestinal gel (LECIG) therapy. An observational study of the first patients to start LECIG in our clinic was performed. Twenty-four patients (11 females, 13 males) were included. The median age was 71.5 years, and the median duration since PD diagnosis was 15.5 years. The median treatment duration was 305 days. Median doses were: 6.0 mL as morning dose, 2.5 mL/h as infusion rate, and 1.0 mL as extra dose. Half of the patients were switched directly from LCIG. These patients express improvements in the size and weight of the pump. Furthermore, most of them considered the new pump to be improved regarding user-friendliness. Six patients discontinued LECIG, three due to diarrhea, one due to hallucinations and two deceased (one cardiac arrest and one COVID-19). LECIG has shown to be possible to use in patients with PD, efficacy and safety as expected. Patients are generally happy with the size and usability of the pump, but some technical improvements of the software are warranted, as well as larger, prospective studies.

scholarly journals Role of Nitric Oxide in Regulation of Brain Stem Circulation during Hypotension

1997 ◽  
Vol 17 (10) ◽  
pp. 1089-1096 ◽  
Author(s):  
Kazunori Toyoda ◽  
Kenichiro Fujii ◽  
Setsuro Ibayashi ◽  
Tetsuhiko Nagao ◽  
Takanari Kitazono ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Brain Stem ◽  
Topical Application ◽  
Basilar Artery ◽  
Group Versus ◽  
Control Group ◽  
Cranial Window ◽  
Severe Hypotension ◽  
The Brain

We tested the hypothesis that nitric oxide (NO) plays a role in CBF autoregulation in the brain stem during hypotension. In anesthetized rats, local CBF to the brain stem was determined with laser-Doppler flowmetry, and diameters of the basilar artery and its branches were measured through an open cranial window during stepwise hemorrhagic hypotension. During topical application of 10−5 mol/L and 10−4 mol/L Nω-nitro-L-arginine (L-NNA), a nonselective inhibitor of nitric oxide synthase (NOS), CBF started to decrease at higher steps of mean arterial blood pressure in proportion to the concentration of L-NNA in stepwise hypotension (45 to 60 mm Hg in the 10−5 mol/L and 60 to 75 mm Hg in the 10−4 mol/L L-NNA group versus 30 to 45 mm Hg in the control group). Dilator response of the basilar artery to severe hypotension was significantly attenuated by topical application of L-NNA (maximum dilatation at 30 mm Hg: 16 ± 8% in the 10−5 mol/L and 12 ± 5% in the 10−4 mol/L L-NNA group versus 34 ± 4% in the control group), but that of the branches was similar between the control and L-NNA groups. Topical application of 10−5 mol/L 7-nitro indazole, a selective inhibitor of neuronal NOS, did not affect changes in CBF or vessel diameter through the entire pressure range. Thus, endothelial but not neuronal NO seems to take part in the regulation of CBF to the the brain stem during hypotension around the lower limits of CBF autoregulation. The role of NO in mediating dilatation in response to hypotension appears to be greater in large arteries than in small ones.

Outline of recent developments in CPR for children

2012 ◽  
Vol 19 (3) ◽  
pp. 146-149
Author(s):  
Nigel Turner
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Organ Damage ◽  
Circulatory Shock ◽  
Surgical Patients ◽  
Good Neurological Outcome ◽  
Circulatory Collapse ◽  
Poor Survival ◽  
Recent Developments

Cardiac arrest in children is more often due to hypoxaemia or circulatory shock, which may have been present for some time, than to cardiac causes (1). As a result, significant organ damage has already occurred by the time of circulatory collapse and survival is generally poor. Survival with a good neurological outcome from out-of-hospital arrest in children varies from 0–12% but outcomes of up to 25% of patients have been reported from in-hospital arrest of mixed aetiology (2). Perioperative cardiac arrest in paediatric cardiac surgical patients has a higher survival.

scholarly journals Transient Cardiac Arrest in Patient With Left Ventricular Noncompaction (Spongiform Cardiomyopathy)

2011 ◽  
Vol 58 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Shinya Yamazaki ◽  
Hiroshi Ito ◽  
Hiroyoshi Kawaai
Keyword(s):  
Cardiac Arrest ◽  
General Anesthesia ◽  
Life Support ◽  
Dental Treatment ◽  
Severe Disease ◽  
High Risk Patient ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
Severe Hypotension

Left ventricular noncompaction (LVNC), also known as spongiform cardiomyopathy, is a severe disease that has not previously been discussed with respect to general anesthesia. We treated a child with LVNC who experienced cardiac arrest. Dental treatment under general anesthesia was scheduled because the patient had a risk of endocarditis due to dental caries along with a history of being uncooperative for dental care. During sevoflurane induction, severe hypotension and laryngospasm resulted in cardiac arrest. Basic life support (cardiopulmonary resuscitation) was initiated to resuscitate the child, and his cardiorespiratory condition improved. Thereafter, an opioid-based anesthetic was performed, and recovery was smooth. In LVNC, opioid-based anesthesia is suggested to avoid the significant cardiac suppression seen with a volatile anesthetic, once intravenous access is established. Additionally, all operating room staff should master Advanced Cardiac Life Support/Pediatric Advanced Life Support (including intraosseous access), and more than 1 anesthesiologist should be present to induce general anesthesia, if possible, for this high-risk patient.

scholarly journals The infusion rate dependent influence of acute metabolic acidosis on pulmonary vascular resistance in broilers

1998 ◽  
Vol 77 (2) ◽  
pp. 309-321 ◽  
Author(s):  
R.F. Wideman ◽  
Y Kochera Kirby ◽  
M.F. Forman ◽  
N Marson ◽  
R.W. McNew ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Infusion Rate ◽  
Rate Dependent ◽  
Acute Metabolic Acidosis

scholarly journals Case Report on Cardiac Arrest Under Spinal Anesthesia in a Case of Caesarean Section

2008 ◽  
pp. 54-56
Author(s):  
Sumia Bari ◽  
Aminul Islam ◽  
Md Rafiqul Hasan Khan ◽  
SN Samad Chowdhury
Keyword(s):  
Cardiac Arrest ◽  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Previous History ◽  
Medical Institute ◽  
Close Monitoring ◽  
National Medical ◽  
Key Words Cardiac Arrest ◽  
Severe Hypotension ◽  
Hypotensive Syndrome

A 33 years old multiparous woman was admitted in Dhaka National Medical Institute Hospital with the complaints of 37 weeks pregnancy and less fetal movement. She was a known case of DM & had a previous history of caesarean section. She had under gone an emergency caesarean section under spinal anesthesia. Patient developed sudden severe hypotension with respiratory distress within 3-4 minutes after the anesthetic procedure, while she was in supine position. Subsequently she developed cardiac arrest. She was managed by cardiopulmonary resuscitation which included prompt tracheal intubation, ventilation with 100% oxygen, cardiac message & ionotropic drug. Cardiac arrest was revived. The operation was completed under general anaesthesia & was reversed uneventful. She was kept in CCU under close monitoring. The patient was discharged on her 7th postoperative day with a healthy baby and a healthy physical status. Key words: Cardiac arrest, Spinal anaesthesia, Supine hypotensive syndrome. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.54-56

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