A case of epileptic seizure due to lidocaine local anesthesia

Lidocaine is an amide-structured local anesthetic commonly used in practice in anesthesiology. Because of its rapid onset, it is frequently used in topical and infiltration anesthesia, regional blocks, regional intravenous anesthesia (RIVA) and general anesthesia to suppress hemodynamic responses to intubation, as well as some cardiac arrhythmias and epileptic seizures. Here, we present a case with seizures and impaired consciousness following iv lidocaine treatment during sedoanalgesia without a history of epilepsy. A thirty-seven-year-old female patient, who was scheduled for a cervical biopsy operation in the Gynecology and Obstetrics clinic, developed a loss of consciousness due to lidocaine with tonic-clonic epileptic seizures during treatment with sedoanalgesia. The patient was intubated with 2 mg midazolam, 200 mg propofol and 50 mg rocuronium intravenously, while oxygen was provided by mask at 6 liters / min. Anesthesia was maintained with 4 lt / min 50% oxygen and 50% air mixture and 2% sevoflurane. There were signs of respiratory acidosis in the blood gas analysis. She was intubated for half an hour by a mechanical ventilator. The operation was canceled. In blood gas monitoring the values were within normal limits. Sugammadex was applied by the gynecology and obstetrics department. In all cases where local anesthetic is planned, necessary precautions should be taken to cope with rare complications.

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Metoclopramide induced intermittent opisthotonos in infant

Open Medicine ◽

10.2478/s11536-009-0048-z ◽

2010 ◽

Vol 5 (2) ◽

pp. 224-226

Author(s):

Necati Balamtekin ◽

Mustafa Gulgun ◽

S. Sarici ◽

Bulent Unay ◽

M. Dundaroz

Keyword(s):

Side Effects ◽

Complete Blood Count ◽

Pediatric Population ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Normal Limits ◽

The Central Nervous System ◽

Therapeutic Doses ◽

Renal Function Tests

AbstractMetoclopramide is widely used as an antiemetic and a prokinetic agent. Both the antiemetic properties and side effects of the drug are the result of dopamine receptor antagonism within the central nervous system. Therapeutic doses of metoclopramide can produce adverse effects. A 5-month-old girl was referred to our emergency department with the pre-diagnosis of afebrile convulsion. In her medical history, she was mistakenly given 2 mg/kg metoclopramide within a 24 h period, after which she became hypertonic and exhibited intermittent opisthotonos. Complete blood count, electrolytes, liver and renal function tests, blood gas analysis, and urinalysis were all within normal limits. Electroencephalogram, brain CT and cerebrospinal fluid examination were normal. Metoclopramide treatment was discontinued and she was treated with biperiden, which led to an improvement in symptoms after 15 minutes and complete remission in 60 minutes. Intermittent opisthotonos may be confused with convulsion in infant and thus lead to an unnecessary hospital admission. Physicians should be aware that metoclopramide is widely used in the pediatric population and children are susceptible to the side effects of metoclopramide and the side effects may present as “intermittent opisthotonos” as observed in our patient.

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Gestation in a Mare with Facial Deviation (Wry Nose)

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.95448 ◽

2019 ◽

Vol 47 ◽

Author(s):

Mariana Andrade Mousquer ◽

Vitória Müller ◽

Fernanda Maria Pazinato ◽

Bruna Dos Santos Suñe Moraes ◽

Leandro Américo Rafael ◽

...

Keyword(s):

Fetal Development ◽

Post Partum ◽

Venous Blood ◽

Respiratory Acidosis ◽

Blood Gases ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Aorta Diameter ◽

Uterine Body

Background: Wry nose is a congenital deformity that causes respiratory obstruction and decreased oxygenation rate. Gestation in a wry nose mare may be considered a risk to the neonate since it depends on the maternal environment for development. Compromised oxygenation during pregnancy can lead to fetal distress and cause consequences on fetal development. However, depending on the degree of the impairment, the fetus may still be able to adapt. The aim of the present study was to report the gestation in a mare with facial deviation until term and to assess blood gases in the mare and neonate, and to evaluate the histomorphometry of the placenta.Case: A Criollo breed mare presenting facial deviation (Wry Nose) was donated to Equine Medicine Research Group (ClinEq) of the Federal University of Pelotas (UFPel) due to the presence of the physical deformity. When the mare was five years old, it was inseminated and had a pregnancy confirmed. At the fifth month of gestation, evaluation of fetal aorta diameter, fetal orbital diameter and combined thickness of the uterus and placenta (CTUP) started to be performed monthly to assess gestation health. The assessment of the fetal orbit and aorta diameter revealed a linear increase of both variables with the progress of gestation indicating a normal fetal development. CTUP remained in the normal reference range, presenting no alterations during the gestational length. The mare foaled at 324 days of gestation a coat showing no congenital deformities. The foaling was monitored until the complete passage of fetal membranes. A complete clinical and hematological evaluation of the foal was carried out after birth. The foal showed normal adaptive behavior, clinical and hematological parameters during the first hours of life, although presenting physical signs of immaturity. Venous blood samples were collected from the mare at 315 days of gestation, immediately after foaling and 24 h post-partum for lactate and blood gas analysis. Mild changes were observed in the mare’s blood gas analysis at foaling that were compensated within 24 h post-partum. Venous blood samples were collected from the umbilical cord and from the foal after birth, at 12 and 24 h post-partum to measure blood gases and lactate. The newborn foal presented respiratory acidosis immediately after birth, which was metabolically compensated at 24 h post-partum. Both mare’s and foal’s lactate evaluation were within the normal reference ranges. After expulsion of the placenta, samples from the gravid horn, uterine body and non-gravid horn were collected for histological and histomorphometric evaluation. In the histological evaluation, avillous areas were detected in the gravid horn and uterine body and mild hypoplasia was found in the uterine body. Placental histomorphometry revealed larger total microcotiledonary and capillary areas on the non-gravid horn when compared to the remaining areas of the placenta (gravid horn and uterine body). No abnormalities on the placental vasculature were detected. Discussion: To date, there are no reports of a pregnancy in a mare with facial deviation in the literature. This report showed that the wry nose mare gave birth to a viable foal showing no congenital abnormalities, which suggests that wry nose animals can be bred normally. The mare presented a healthy pregnancy, with mild changes in the blood gas analysis at foaling that were compensated at 24 h postpartum. Similarly, despite the foal showed physical signs of immaturity and respiratory acidosis at birth, these changes were compensated in the later assessments. Furthermore, no abnormalities on the placental vasculature were detected.

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23 NEONATAL SUPPORT THERAPY AND BLOOD GAS EVALUATION IN CLONED AND ARTIFICIAL INSEMINATION-DERIVED NEWBORN CALVES

Reproduction Fertility and Development ◽

10.1071/rdv27n1ab23 ◽

2015 ◽

Vol 27 (1) ◽

pp. 104

Author(s):

P. Fantinato-Neto ◽

A. T. Zanluchi ◽

M. M. Yasuoka ◽

F. J. M. Marchese ◽

J. R. V. Pimentel ◽

...

Keyword(s):

Carbon Dioxide ◽

Point Of Care ◽

Respiratory Acidosis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Oxygenation ◽

Blood Gas ◽

Acid Base Balance ◽

Reproductive Techniques ◽

Newborn Calves

Offspring derived from artificial reproductive techniques are already known to present several postnatal undesirable phenotypes and clinical disorders. Despite its benefits, cloning by somatic cell nuclear transfer (SCNT) is extremely inefficient. The birth rate in cattle is around 5% of the transferred blastocysts, and ~50% of delivered calves die in the first 48 h. Neonatal respiratory distress is reported to be one of the main causes of such deaths. Veterinary intervention is often needed to promote or improve blood oxygenation, avoiding respiratory acidosis and improving carbon dioxide delivery from blood/lungs to the environment. This study aimed to evaluate a neonatal support therapy over the blood gas and acid-base balance on newborn calves derived from SCNT or AI. Four cloned and 3 AI-derived calves delivered by Caesarean section were used for the experiment. Postnatal therapeutic procedures were comprised 4 doses of 400 mg of intratracheal surfactant every 15 min, 25 mg of oral sildenafil every 8 h for 3 days, and 5 L min–1 intranasal oxygen. Blood collections were performed within 30 min (T0), at 12 (T12), 24 (T24) and 48 (T48) hours after delivery. Blood samples were collected from the caudal auricular artery with a butterfly and a blood gas syringe. Oxygen saturation (sO2), arterial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), pH, and bicarbonate (HCO3–) were evaluated with a portable blood gas analyzer (i-STAT, Abbott Point of Care Inc., Princeton, NJ, USA). Data obtained were submitted to ANOVA (Proc MIXED; SAS/STAT, version 9; SAS Institute Inc., Cary, NC, USA). There were significant differences between groups in blood pH (P = 0.0182) and between groups (P = 0.0281) and time of collection (P = 0.0303) in blood bicarbonate (HCO3–). The AI calves were born with normal pH (7.468 ± 0.033) and the cloned calves were born in acidosis (7.216 ± 0.166). These calves were stabilised in T48 (7.427 ± 0.017) using their own HCO3– that increased over time. Although there were no differences in sO2 (P = 0.4525), PaO2 (P = 0.3086), or PaCO2 (P = 0.2514), sO2 and PaO2 were numerically increased at the same time that PaCO2 decreased in both groups. In the cloned calves, the sO2, PaO2, and PaCO2 at T0 were 61.3 ± 28.6%, 39.8 ± 18.5 mmHg, and 65.8 ± 29.3 mmHg, respectively and reached 90.0 ± 3.4%, 57.7 ± 15.8 mmHg, and 42.0 ± 3.7 mmHg. In the AI calves, T0 blood gas analysis were 79.8 ± 19.4%, 56.1 ± 42.1 mmHg, and 39.1 ± 4.8 mmHg, and at T48 were 89.0 ± 2.6%, 82.3 ± 43.5 mmHg, and 43.0 ± 4.9 mmHg for sO2, PaO2, and PaCO2 respectively. The neonate support therapy improved calves' oxygenation and helped to eliminate the carbon dioxide from the blood. In our experience, the neonatal treatment was essential in supporting the lives of the cloned calves.Funding support was received from FAPESP 2011/19543–9.

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Anestesia untuk Seksio Sesarea pada Pasien dengan Korioamnionitis dan Trombositopenia

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v3i2.50 ◽

2020 ◽

Vol 3 (2) ◽

pp. 96-101

Author(s):

Dina Paramita ◽

Ery Laksana

Keyword(s):

Blood Gas Analysis ◽

Developed Countries ◽

The United States ◽

Gas Analysis ◽

Blood Gas ◽

Maternal Infection ◽

Perinatal Complications ◽

Laboratory Examination ◽

High Risk Infant ◽

Normal Limits

Infeksi maternal adalah salah satu komplikasi perinatal yang paling umum terjadi. Kejadian kehamilan dengan korioamnionitis merupakan 1% dari kasus di Amerika atau di negara maju sedangkan di negara berkembang kasus ini lebih tinggi. Pasien G3P1A1 31 minggu, umur 23 tahun. Pada pemeriksaan didapatkan hemodinamik stabil dengan tekanan darah:110/70 mmHg, laju nadi: 76x/menit, laju nafas:18 x/menit, suhu 38oC, kesadaran compos mentis, kontak baik. Pada pemeriksaan jantung dan paru dalam batas normal. Pemeriksaan laboratorium didapatkan Hb: 7,2 g/dl, trombosit: 12.000 /ul, lekosit: 27,5/ul, SGOT: 210/ul, SGPT: 141/ul. Pasien diputuskan untuk dilakukan seksio sesarea emergensi. Persiapan operasi yang sebelumnya dilakukan transfusi dengan trombosit konsentrat 3 kolf. Pada saat induksi hemodinamik stabil dilakukan induksi di ruang operasi dengan fentanyl 50 ug, propofol 2 mg/kg BB, rokuronium 0,6 mg/kgBB, dan pemeliharaan anestesi dengan sevofluran, N2O/O2. Selama operasi hemodinamik pasien stabil, saturasi oksigen [SpO2] 99 %, operasi dilakukan selama 1 jam, lahir bayi dengan berat badan 1200 gram, dan dirawat di bangsal bayi resiko tinggi. Pasca bedah pasien sadar penuh dilakukan ekstubasi dan diberikan masker oksigen 6 lt/ mnt dan pasien dirawat di ICU. Pada pemeriksan didapatkan hasil analisa gas darah normal dan kenaikan trombosit yang bertahap. Pada hari ke 3 mencapai 40/ul disertai dengan menurunnya jumlah lekosit dan suhu pasien normal. Pasien diputuskan pindah bangsal dengan rawat bersama dengan penyakit dalam. Anaesthetic for Caesarean Section in Patient with Chorioamnionitis and Thrombositopenia Abstract Maternal infection is one of the most common perinatal complications. The incidence of pregnancy with chorioamnionitis constitutes 1% of cases in the United States or in developed countries whereas in developing countries this case is higher. G3P1A1 patient 31 weeks, age 23 years. on examination, hemodynamically stable blood pressure: 110/70 mmHg, pulse rate: 76x / min, respiratory rate: 18 x / min, temperature 38 oC, composmentis awareness, good contact, on heart and lung examination are within normal limits. Laboratory examination obtained Hb: 7.2 g / dl, platelets: 12,000 / ul, leukocytes: 27.5 / ul, SGOT: 210 / ul, SGPT: 141 / ul. The patient was decided to do cesarean section. Preparation of surgery was done before transfusion with platelet concentrate 3 colf. At the time of stable hemodynamic induction, then induction was carried out in the operating room with 50 ug fentanyl, propofol 2 mg / kg BW, rocuronium 0.6 mg / kgBW and maintenance of anesthesia with sevoflurane, N2O / O2. During hemodynamic surgery the patient is stable, SpO2 is 99%, surgery is carried out for 1 hour, a baby is born weighing 1200 grams and is treated in a high-risk infant ward. After surgery the patient was fully conscious, extubated, and the patient was treated in the ICU. In the examination, the result of normal blood gas analysis and increased a platelets accompanied by a decrease in the number of leukocytes and normal temperature. The patient was decided to move the ward with care together with internal medicine.

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Accuracy of transcutaneous carbon dioxide monitoring in hypotensive patients

Emergency Medicine Journal ◽

10.1136/emermed-2012-202228 ◽

2013 ◽

Vol 31 (4) ◽

pp. 323-326 ◽

Cited By ~ 3

Author(s):

Jung-Youn Kim ◽

Young-Hoon Yoon ◽

Sung-Woo Lee ◽

Sung-Hyuk Choi ◽

Young-Duck Cho ◽

...

Keyword(s):

Blood Gas Analysis ◽

Gas Analysis ◽

Mean Difference ◽

Blood Gas ◽

Limits Of Agreement ◽

Arterial Blood Gas ◽

Blood Gas Monitoring ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

The Mean

ObjectivesContinuous blood gas monitoring is frequently necessary in critically ill patients. Our aim was to assess the accuracy of transcutaneous CO2 tension (PtcCO2) monitoring in the emergency department (ED) assessment of hypotensive patients by comparing it with the gold standard of arterial blood gas analysis (ABGA).MethodsAll patients receiving PtcCO2 monitoring in the ED were included. We excluded paediatric patients, patients with no ABGA results during a hypotensive event, patients whose ABGA was not performed simultaneously with PtcCO2 monitoring, and patients who received sodium bicarbonate for resuscitation. The included patients were classified into hypotensive patients and normotensive patients. A hypotensive patient was defined as a patient showing a mean arterial pressure under 60 mm Hg. The agreement in measurement between PaCO2 tension (PaCO2) and PtcCO2 were investigated in both groups.ResultsThe mean difference between PaCO2 and PtcCO2 was 2.1 mm Hg, and the Bland–Altman limits of agreement (bias±1.96 SD) ranged from −15.6 to 19.7 mm Hg in the 28 normotensive patients. The mean difference between PaCO2 and PtcCO2 was 1.1 mm Hg, and the Bland–Altman limits of agreement (bias±1.96 SD) ranged from −19.5 to 21.7 mm Hg in the 26 hypotensive patients. The weighted κ values were 0.64 in the normotensive patients and 0.60 in the hypotensive patients.ConclusionsPtcCO2 monitoring showed wider limits of agreement with PaCO2 in urgent situations in the ED environment. However, acutely developed hypotension does not affect the accuracy of PtcCO2 monitoring.

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Difficult airway leading to carbon dioxide narcosis in a case of fixed cervical spine

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.173248 ◽

2016 ◽

Vol 03 (01) ◽

pp. 046-048

Author(s):

Rahul Yadav ◽

Mihir Pandia ◽

Parmod Bithal ◽

Sachidanand Bharati ◽

Indu Kapoor

Keyword(s):

Carbon Dioxide ◽

Anaesthetic Agent ◽

Respiratory Acidosis ◽

Blood Gas Analysis ◽

Face Mask ◽

Craniovertebral Junction ◽

Gas Analysis ◽

Blood Gas ◽

Muscle Paralysis ◽

Induction Of Anaesthesia

AbstractInability to secure the airway of a patient after induction of anaesthesia may lead to serious consequences including permanent brain damage and even death. Hypoxia is quite common in difficult intubations especially when it is difficult to ventilate the patient. However, carbon dioxide retention severe enough to cause carbon dioxide narcosis and delayed recovery is a rare occurrence. Here, we report a case of a craniovertebral junction anomaly where inadequate ventilation after induction of anaesthesia resulted in carbon dioxide narcosis and delayed awakening. A 54-year-old, American Society of Anesthesiologists II female patient weighing 70 kg with a diagnosis of craniovertebral junction was scheduled for implant removal for dislodged occipital screw. Fibreoptic intubation was attempted after induction of anaesthesia and muscle paralysis. Even after multiple attempts, intubation could not be done and ventilation by face mask became difficult. Though oxygen saturation could be maintained with the insertion of a laryngeal mask airway (LMA), ventilation was not adequate. The patient remained unresponsive long after discontinuation of anaesthetic agent and reversal of muscle paralysis. Subsequent blood gas analysis showed severe carbon dioxide retention and respiratory acidosis. Patient was given assist control mechanical ventilation through LMA. LMA was removed after improvement in sensorium and the blood gas picture.

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Possible silent hypoxemia in a COVID-19 patient: a case report

10.21203/rs.3.rs-58296/v1 ◽

2020 ◽

Author(s):

Siswanto ◽

Munawar Gani ◽

Aditya Rifqi Fauzi ◽

Bagus Nugroho ◽

Denny Agustiningsih ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Life Support ◽

Vital Signs ◽

Respiratory Acidosis ◽

Blood Gas Analysis ◽

Respiratory Alkalosis ◽

Gas Analysis ◽

Shortness Of Breath ◽

Blood Gas

Abstract Background: It has been hypothesized that silent hypoxemia is the cause of the rapid progressive respiratory failure with severe hypoxia that occurs in some patients with COVID-19 without warning. Here, we reported one COVID-19 case with the possibility of silent hypoxemia. Case presentation: A 60-year-old male presented with complaints of cough that he felt starting two weeks before admission without any breathing difficulty. Complaints were accompanied by fever, runny nose and sore throat. Vital signs examination showed blood pressure 130/75 mmHg, pulse 84 times per minute, normal respiratory rate (RR) of 21 times per minute, body temperature 36.5 C, and 99% oxygen saturation with oxygen via nasal cannula 3 liters per minute were recorded. On physical examination, an increase in vesicular sounds and crackles in both lungs were identified. Chest x-ray showed bilateral pneumonia. Nasopharyngeal and oropharyngeal swab real-time polymerase chain reaction tests for COVID-19 were positive. On the third day of treatment, the patient complained of worsening of shortness of breath, but his RR was still normal with 22 times per minute. On the fifth day of treatment, the patient experienced severe shortness of breath with a RR of 38 times per minute. The patient was then intubated and his blood gas analysis showed respiratory alkalosis (pH 7.54, PaO2 58.9 mmHg, PaCO2 31.1 mmHg, HCO3 26.9 mEq/L, SaO2 94.7%). On the eighth day of treatment, his condition deteriorated starting in the morning, with blood pressure 80/40 mmHg with norepinephrine support, pulse 109 times per minute, and 72% SpO2 with ventilator. In the afternoon, the patient experienced cardiac arrest and underwent basic life support, then resumed strained breathing with return of spontaneous circulation. Blood gas analysis showed severe respiratory acidosis (pH 7.07, PaO2 58.1 mmHg, PaCO2 108.9 mmHg, HCO3 32.1 mEq /L, SaO2 78.7%). Three hours later, he suffered cardiac arrest again, but was unable to be resuscitated. The patient eventually died.Conclusions: Silent hypoxemia might be considered as an early clinical sign of deterioration of patients with COVID-19, thus, the physician may be able to intervene early and decrease its morbidity and mortality.

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CHANGES ON OXIDATIVE STRESS-RELATED BIOMARKERS IN PLASMA AND CARDIAC TISSUE DUE TO PROLONGED EXPOSURE TO NORMOBARIC HYPEROXIA

Acta Biochimica Indonesiana ◽

10.32889/actabioina.v2i1.31 ◽

2019 ◽

Vol 2 (1) ◽

pp. 1-7

Author(s):

Maria Christina Dwiyanti ◽

R Benettan ◽

F Wandy ◽

M Lirendra ◽

Frans Ferdinal ◽

...

Keyword(s):

Oxidative Stress ◽

Cardiac Tissue ◽

Specific Activity ◽

Respiratory Acidosis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Cardiac Cells ◽

Control Group ◽

Activity Measurement ◽

Blood Gas

Background: Hyperoxia is a state of oversupply of oxygen in tissues and organs that can increase reactive oxygen species (ROS). When antioxidants cannot balance ROS levels, oxidative stress occurs. Catalase and reduced glutathione (GSH) are two of the antioxidants that can be very useful to counteract ROS. Increased production of ROS subsequently results in lipids damage and generates malondialdehyde (MDA). ROS interaction with cardiac cells causes remodeling thus leads to heart failure.Objectives: The purpose of this study was to find out the changes on oxidative stress-related biomarkers in plasma and cardiac tissue. Methods: Sprague Dawley rats were divided into 5 groups (n=6/group). Control group was exposed to normoxia (21% O2), while each treatment group was exposed to hyperoxia (75% O2) for 1, 3, 7, and 14 days. Blood and heart samples were used for blood gas analysis and hematology test, also for catalase specific activity measurement, GSH level, and MDA level measurement. Results: Blood gas analysis of pO2, pCO2, and HCO3 were increased, while the O2 saturation and all hematological parameters were decreased. Plasma and cardiac tissue’s catalase specific activity increased in day 1 to day 7 but declined in day 14. Cardiac tissue’s GSH has the same result. Plasma GSH level increased in day 1 but decreased afterward. MDA level in plasma and cardiac tissue increased significantly since day 1.Conclusion: Hyperoxia causes oxidative stress, marked by the increase of oxidative stress-related markers, and partially compensated respiratory acidosis.

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