scholarly journals Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Minako Furuta ◽  
Hisakatsu Ito ◽  
Mitsuaki Yamazaki
Keyword(s):  
Cardiac Index ◽  
Aortic Stenosis ◽  
General Anaesthesia ◽  
Low Dose ◽  
Severe Aortic Stenosis ◽  
Anaesthetic Management ◽  
Total Mastectomy ◽  
Case Presentation ◽  
Intravenous Anaesthesia ◽  
Haemodynamic Changes

Abstract Background The administration of general anaesthesia in patients with aortic stenosis (AS) requires careful attention to haemodynamics. We used remimazolam for the induction and maintenance of anaesthesia in a woman with severe AS undergoing a total mastectomy. Case presentation An 81-year-old woman with severe AS was scheduled to undergo a total mastectomy. We decided to administer total intravenous anaesthesia with remimazolam to minimize haemodynamic changes. Although the patient showed transient hypotension after anaesthesia induction, the cardiac index was preserved with a low dose of continuous noradrenaline. The anaesthesia was then safely maintained without a decrease in the patient’s cardiac index. Conclusions General anaesthesia using remimazolam preserved cardiac output in this patient; therefore, remimazolam can be safely used to avoid the risk of cardiac suppression in patients with severe AS.

Short-term effects of low-dose tolvaptan in acute decompensated heart failure patients with severe aortic stenosis: the LOHAS registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Watanabe ◽  
Y Nara ◽  
H Hioki ◽  
H Kawashima ◽  
A Kataoka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Low Dose ◽  
Acute Decompensated Heart Failure ◽  
Severe Aortic Stenosis ◽  
Decompensated Heart Failure ◽  
Funding Source ◽  
Short Term ◽  
Heart Failure Patients ◽  
Short Term Effects

Abstract Background Tolvaptan exerts potent diuretic effects in heart failure patients without hemodynamic instability. Nonetheless, its clinical efficacy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) remains unclear. This study aimed to evaluate the short-term effects of tolvaptan in ADHF patients with severe AS. Methods The LOw-Dose Tolvaptan (7.5 mg) in Decompensated Heart Failure Patients with Severe Aortic Stenosis (LOHAS) registry is a multicenter (7 centers) prospective registry that assessed the short-term effects of tolvaptan in subjects hospitalized for ADHF with severe AS. A total of 59 subjects were enrolled between September 2014 and December 2017. The primary endpoints were changes in body weight and fluid balance measured daily from baseline up to 4 days. Results The median [interquartile range] patient age and aortic valve area were 85.0 [81.0–89.0] years and 0.58 [0.42–0.74] cm2, respectively. Body weight continuously decreased, and fluid balance was maintained from baseline to day 4 (p<0.001, p=0.194, respectively). Median serum B-type natriuretic peptide concentration significantly decreased from 910.5 to 740.0 pg/mL by day 4 (p=0.002). However, systolic blood pressure and heart rate were non-significantly changed (p=0.250, p=0.656, respectively). Hypernatremia (>150 mEq/L) and worsening renal function occurred in 2 (3.4%) and 4 (6.8%) patients, respectively. Conclusions Short-term treatment with low-dose tolvaptan is safe and effective, providing stable hemodynamic parameters in patients with ADHF and severe AS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This research was supported by Otsuka Pharmaceutical Co., Ltd.

scholarly journals Elderly COVID-19 Pneumonic Patient with both Graded and Movable-weaning off Phenomenon or Yasser's Phenomena in a Surgical Severe Aortic Stenosis; at-home Dilemma Management

2021 ◽  
Vol 4 (5) ◽  
pp. 01-05
Author(s):  
Yasser Elsayed
Keyword(s):  
Risk Factors ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Chest Ct ◽  
Dynamic Changes ◽  
Case Presentation ◽  
Elderly Female ◽  
Patient Concerns ◽  
Chest Ct Scan

Rationale: Coronavirus disease is a leading remarkable critical pandemic global infection. Graded phenomenon or Yasser's phenomenon is a novel electrocardiographic phenomenon that changes the arrhythmia didactic. It is decisive progress in understanding arrhythmia. The phenomenon is a contemporary vigorous instructor for monitoring and follows up the arrhythmic patients. Movable-weaning off phenomenon or Yasser's phenomenon is another novel electrocardiographic phenomenon characterized by serial dynamic changes in all cases of either Wavy triple or double electrocardiographic signs (Yasser signs) of hypocalcemia. Movable-weaning off phenomenon is a guide for both Wavy triple and double an electrocardiographic. Severe symptomatic aortic stenosis has a bad outcome after the evolution of symptoms, and prompt operative intervention is advisable. Patient concerns: An elderly female COVID-19 pneumonic patient presented to physician outpatient clinic with bilateral peripheral pneumonia and both Graded and Movable-weaning off phenomenon or Yasser's phenomena in severe aortic stenosis. Diagnosis: Elderly COVID-19 pneumonia with both Graded and Movable-weaning off phenomenon or Yasser's phenomena. Interventions: Oxygenation, electrocardiography, chest CT scan, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: It denotes the role of the anticoagulants, the antiplatelets, steroids, and antimicrobial therapy in the management of COVID-19 pneumonia with Graded and Movable-weaning off phenomenon or Yasser's phenomena in severe aortic stenosis. The presence of Graded and Movable-weaning off phenomenon or Yasser's phenomena, elderly, and pneumonia, in the case presentation, represent new complicated risk factors especially, with an associated severe sclerotic aortic stenosis. Short title: A case report article in cardiology, critical care, emergency medicine, and infectious diseases

Effects of Low Dose Ketamine on Tourniquet-induced Haemodynamic Responses during General Anaesthesia

2007 ◽  
Vol 35 (5) ◽  
pp. 600-608 ◽  
Author(s):  
J-W Park ◽  
Y-H Jung ◽  
C-W Baek ◽  
H Kang ◽  
S-M Cha
Keyword(s):  
General Anaesthesia ◽  
Low Dose ◽  
Systemic Arterial Pressure ◽  
Saline Control ◽  
Control Group ◽  
Haemodynamic Changes ◽  
Blood Pressures ◽  
Intravenous Ketamine ◽  
Observation Period ◽  
Tourniquet Inflation

This study investigated the effect of a pre-operative low dose of intravenous ketamine on tourniquet-induced haemodynamic changes. Ten minutes after induction of general anaesthesia, 0.1 mg/kg ketamine in 10 ml of saline (ketamine group, n = 14) or 10 ml of normal saline (control group, n = 14) were administered intravenously. Systolic and diastolic blood pressures, and heart rate relative to tourniquet inflation and deflation were recorded and compared within and between groups. Systolic and diastolic blood pressures in the control group significantly increased relative to baseline during the observation period following tourniquet inflation, but generally did not significantly increase in the ketamine group. The control group had a greater percentage of patients with a 30% rise in blood pressure at 60 min after tourniquet inflation compared with the ketamine group (28.6% vs 7.1%), but this was not statistically significant. We conclude that a pre-operative low dose (0.1 mg/kg) of intravenous ketamine can prevent a systemic arterial pressure increase for at least 60 min after tourniquet inflation under general anaesthesia.

scholarly journals Regulation and Clinical Implication of Arginine Vasopressin in Patients with Severe Aortic Stenosis Referred to Trans-Catheter Aortic Valve Implantation

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 165
Author(s):  
Hiroyuki Kuwahara ◽  
Teruhiko Imamura ◽  
Mitsuo Sobajima ◽  
Hiroshi Ueno ◽  
Koichiro Kinugawa
Keyword(s):  
Aortic Valve ◽  
Cardiac Index ◽  
Aortic Stenosis ◽  
Arginine Vasopressin ◽  
Clinical Implication ◽  
Severe Aortic Stenosis ◽  
Plasma Osmolality ◽  
Reduced Ejection Fraction ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background and objectives: Plasma arginine vasopressin (P-AVP) is regulated by the non-osmotic pathway in patients with heart failure (HF) and reduced ejection fraction. However, the regulation of P-AVP in patients with severe aortic stenosis (AS) remains unknown. Materials and Methods: Consecutive patients with severe AS who received trans-catheter aortic valve implantation (TAVI) between Apr 2016 and Apr 2019 were enrolled in this prospective study. Clinical data including P-AVP were obtained just before TAVI, and the correlation between P-AVP and other variables was investigated. Results: In total, 159 patients with severe AS (85.3 ± 4.6 years, male 26%) were enrolled. P-AVP was 1.45 ± 1.13 ng/mL and cardiac index was relatively preserved (2.76 ± 0.54 L/min/m2). There was no significant correlation between cardiac index and P-AVP (p > 0.05), whereas plasma osmolality had a moderate positive correlation with P-AVP (r = 0.35, p < 0.01), predominantly due to blood urea nitrogen (r = 0.27, p < 0.01). Patients with diuretics had significantly higher P-AVP than those without diuretics (1.65 ± 1.43 vs. 1.22 ± 0.57 pg/mL, p < 0.01). Two-year survivals free from HF readmission were statistically comparable irrespective of the level of pre-procedural P-AVP (p = 0.44). Conclusion: In patients with severe high-gradient AS who received TAVI, the P-AVP level was dominantly regulated by plasma osmolality instead of arterial underfilling. The clinical implication of elevated P-AVP in the TAVI candidates is the next concern.

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