We present a case of stress-induced myocardial stunning, also known as tako-Tsubo syndrome, in an anaesthetised patient undergoing arthroscopic replacement of the cruciate ligament. The patient's (44 y male, ASA class II) had a history of hypertension with no other known disease. He underwent a femoral nerve block with 20 ml of 0.5% ropivacaine before receiving a balanced general anaesthesia (propofol induction, sevoflurane maintenance, 10 µg/kg sufentanil). Ten min after the beginning of surgery during endoscopic intra-articular manipulation, the patient suffered from bradycardia and hypotension; following the administration of ephedrine and atropine, he developed tachycardia, hypertension and ST segment depression. Subsequently, his systemic blood pressure dropped necessitating inotropic drug support and - later - intraaortic balloon counterpulsation; a TEE revealed no evidence of hypovolemia, anterior and antero-septal hypokinesia with an ejection fraction of 25%. Surgery was finished whilst stabilising the patient haemodynamically. Postoperative cardiac enzymes showed little elevation, an emergency coronary angiogram apical akinesia with typical ballooning and basal hyperkinesias, compatible with Tako-tsubo syndrome. The patient's postoperative course was uneventful. We theorize that stress caused by sudden surgical pain stimulus (introduction of the endoscope into the articulation), superficial anaesthesia and insufficient analgesia created a stressful event which probably might have caused a catecholamine surge as basis of Tako-tsubo syndrome.
Extracorporeal Shockwave Lithotripsy (ESWL) is an effective and safe way for treatment of upper urinary system stones. For pediatric patients, throughout ESWL, sufficient sedation and analgesia is needed to cope with the procedural pain. In this study, our goal was to compare 2 methods of intravenous anesthesia, applied to pediatric patients during ESWL.Forty patients, between 3 months and 15 years of age who were admitted to the Faculty of Medicine, Hacettepe University, Turkey between September 2003 to September 2004 with upper urinary system calculi were randomized into 2 groups. All patients received intranasal midazolam 0.3 mg/kg premedication. Group K received intravenous (iv) ketamine 2 mg/kg; Group PF received a bolus of iv propofol 3 mg/kg and iv fentanyl 1 microg/kg along with a propofol infusion of 1 mg/kg/hr throughout the procedure. Procedural, recovery and discharge times, incidences of intra and post-procedural complications were compared.Demographics, procedural and discharge times were similar in 2 groups. While recovery times and post-procedural complication incidence was higher for the Group K, intra-procedural complication incidence was higher for the Group PF.Although both protocols do not differ much according to ease of application and efficacy in providing sufficient analgesia for ESWL, they have their corresponding side effects and they can only be practiced safely by experienced anesthesiologists in a monitorized and well equipped setting.
To compare the effects of esmolol and remifentanil, used as adjuncts for induced hypotension on surgical conditions and short-term cognitive functions, during tympanoplasty.The study was conducted in Hacettepe University, School of Medicine, Ankara, Turkey between January 2005 and December 2006 following Institutional Ethical Committee approval, 40 ASA I-II patients, between 18 and 60 years of age were included in this study. With the induction of anesthesia, for group E, an esmolol infusion of 50-250 ug.kg-1.min-1 was titrated, following a bolus of 0.5 mgxkg-1; for group R, a remifentanil infusion of 0.2-0.5 ugxkg-1xmin-1 was titrated; to achieve a mean blood pressure (BP) of 55-65 mm Hg. Arterial BP were recorded continuously throughout the operation. Mini Mental State Test (MMS) was performed at the preoperative 30th minute (MMSP), postoperative 30th minute (MMS30), 60th minute (MMS60) and 24th hour (MMS24). Surgical field was evaluated by the blinded surgeon, using a 6 point category scale.Patient demographics were similar in both groups. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Surgical field scores were lower in group R (p<0.05), although the scores were
Abstract BACKGROUND: Chest CT screening for COVID-19 in preoperative patients is recommended in selected patients. The aim of this retrospective study is to evaluate the preoperative screening performance of chest CT (computerized tomography) examination to detect COVID-19 positive individuals. STUDY DESIGN: In this retrospective study 218 adult patients who had preoperative chest CT and RT-PCR were enrolled. CT imaging results, which have been reported according to the Radiological Society of North America (RSNA) expert consensus on COVID-19, were collected from the picture archiving and communicating system (PACS). Demographic data, planned surgeries, and postoperative outcomes were collected from the electronic patient records. RESULTS: One patient (0.5%) showed typical CT features for COVID-19 pneumonia; 12 patients (5.5%) were reported as indeterminate, and eight (3.7%) were reported as atypical for COVID-19 pneumonia. Only one of the three patients with positive RT-PCR had abnormalities on CT. When RT-PCR tests were taken as reference, the sensitivity, specificity, and accuracy of chest CT in showing COVID-19 infection in asymptomatic patients were 33.3%, 90.7%, and 90.0% respectively. CONCLUSION: Chest CT screening for COVID-19 has a very low yield in asymptomatic preoperative patients and shows false positive findings in 9.2% of cases, potentially leading to unnecessary postponing of the surgery.
