Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery

We report a case of junctional rhythm that occurred both preoperatively and later during a portion of general anesthesia. A 19-year-old woman was scheduled to undergo bilateral sagittal split ramus osteotomy after being diagnosed with a jaw deformity. Preoperative electrocardiography (ECG) revealed a junctional rhythm with a slow heart rate (HR). At 90 minutes after anesthesia induction, local anesthesia with 10 mL of 1% lidocaine and 1:100,000 adrenaline was administered. A junctional rhythm appeared 15 minutes after the local anesthesia. We believe that the atrioventricular nodal pacemaker cells accelerated because of the increased sympathetic activity due to the adrenaline. On the preoperative ECG, the junctional rhythm with slow HR appeared as an escaped beat caused by slowing of the primary pacemaker. Therefore, we think that the preoperative junctional rhythm and the junctional rhythm that appeared during general anesthesia were due to different causes. Understanding the cause of a junctional rhythm could lead to more appropriate treatment. We therefore believe that identifying the cause of the junctional rhythm is important in anesthetic management.

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General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00454-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuji Suzuki ◽

Matsuyuki Doi ◽

Yoshiki Nakajima

Keyword(s):

Lactic Acidosis ◽

General Anesthesia ◽

Mitochondrial Disease ◽

Muscle Relaxation ◽

Anesthetic Management ◽

Perioperative Period ◽

Mitochondrial Encephalomyopathy ◽

Anesthesia Induction ◽

General Anesthetic ◽

Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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Olfactory Dysfunction After Oral and Maxillofacial Surgery

10.21203/rs.3.rs-690029/v1 ◽

2021 ◽

Author(s):

Yaxi Wang ◽

Hua Li ◽

Xuanping Huang ◽

Nuo Zhou

Keyword(s):

General Anesthesia ◽

Nasal Septum ◽

Rare Complication ◽

Nasotracheal Intubation ◽

Maxillofacial Surgery ◽

Olfactory Dysfunction ◽

Oral And Maxillofacial Surgery ◽

General Anesthetic ◽

Anesthetic Drugs ◽

Nasal Septum Deviation

Abstract Background: Although anesthesia can contribute to olfactory dysfunction, it is a rare complication after oral and maxillofacial surgery by general anesthesia.Cases presentation: In this study, we introduced 3 cases of patient suffering from anosmia (complete loss of smell), after oral and maxillofacial surgery by general anesthesia. We also investigated possible etiologies of anosmia. Conclusions: There are some evidences that anosmia is caused by nasotracheal intubation, which may cause OM injury and/or swing of the nasal septum in patients with nasal septum deviation. Olfactory dysfunction via general anesthetic drugs, however, may have a different etiology.

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