Tachyarrhythmia including atrial fibrillation is a major complication in respiratory surgery. In this study, we investigated the preventive effect of landiolol hydrochloride on atrial fibrillation and tachyarrhythmia in 50 patients who underwent pulmonary resection for lung cancer between June 2008 and October 2009. The patients included 33 males and 17 females and had a mean age of 70.3±8.6 years. Continuous administration of landiolol at 5μg/kg/min for 48 hours was initiated immediately after induction of anesthesia. Heart rate was monitored during and after surgery for detection of arrhythmia. No atrial fibrillation or tachyarrhythmia occurred in any patients. Our results suggest that intraoperative initiation of landiolol may prevent postoperative atrial fibrillation and tachyarrhythmia, which are common complications following pulmonary resection.
We studied 21 adult cardiac surgical patients to assess the accuracy of continuous thermodilution method in comparison with bolus cardiac output measurement using room temperature versus cold injectates. An 8-French gauge thermal filament-wrapped, flow directed, pulmonary artery catheter was placed and connected to a computer system to measure continuous cardiac output(CCO) automatically. Both CCO and bolus cardiac output(BCO) measurements were performed at stable conditions after induction of anesthesia and also after weaning from cardiopulmonary bypass in each patient. As BCO measurement, 10 ml of ice-cold solution (BCO-IC) or room-temperature solution (BCO-RT) were injected using a closed delivery system with in-line temperature measurement. A total of 41 measurements were carried out. BCO-IC ranged from 2.2 to 9.7 L/min, BCO-RT from 2.1 to 9.9 L/min, and CCO from 2.3 to 12.4 L/min. Regression analysis demonstrated a close relationship between either two of three methods; correlation coefficients of [BCO-IC−BCO-RT], [BCO-IC−CCO], and [BCO-RT−CCO] were 0.986, 0.962 and 0.962, respectively. By the Bland and Altman analysis, biases (mean differences) were negligible among the three measurements(0.10-0.38 L/min), although precisions (standard deviation of differences) between [BCO-IC−CCO](0.59 L/min) and [BCO-RT−CCO](0.59 L/min) were slightly larger than that between [BCO-IC−BCO-RT](0.31 L/min). In conclusion, CCO methods are practically acceptable during cardiac surgery, and BCO-RT is equivalent in accuracy with BCO-IC, suggesting that BCO-RT can be used instead of BCO-IC because it is more convenient and less expensive.
We report a case of a 15-year-old girl who underwent the left lower lobectomy for a complex type of pulmonary arteriovenous fistula, which caused a huge right-to-left shunt in the pulmonary circulation. During the operation with one-lung ventilation anesthesia, the right heart failure in company with severe hypoxemia or malignant ventricular arrhythmias, might be induced as the result of the sudden reduction of shunt flow. Furthermore, possible pulmonary edema due to ischemic reperfusion-like injury might be possible to develop by fluid overload, after the normal pulmonary perfusion restarted. FloTrac/Vigilleo SystemTM can provide useful hemodynamic parameters such as arterial pressure-based cardiac output and stroke volume variation based on the concept of fluid responsiveness. In our case, this system was successfully applied to achieve optimal cardiac preload for organ perfusion without transfusion and to prevent the right heart failure and pulmonary edema.
Background: The rate of implantation of the cardiac pacing system and implantable cardioverter defibrillator is increasing with aging and new indications. Although obvious benefits, the use of these devices is associated with serious complications, including device infection. Case: Between 1989 and 2008, 947 patients were performed implantation therapy with permanent pacemakers and implantable cardioverter defibrillators. Blood stream infection was found at 16 patients. Four patients underwent surgical pacemaker lead extraction using extracorporeal circulation. Their average age was 75.5 yeas old. One patient died at third post operated day due to systemic inflammatory response syndrome(SIRS). Summary: It is obvious that the open heart surgery using extracorporeal circulation is a high risk therapy for the patient with infected endocarditis. The guidelines for management of cardiac device infection must be proposed and discussed as soon as possible, including direct extraction.
We managed a male infant(1 year 9 months old, 87 cm, 13.2 kg) who was diagnosed with congenital long QT interval syndrome just after birth. Markedly long QT(QTc interval, 700 msec) was shown in electrocardiogram findings, and frequent torsades de pointes-type ventricular arrhythmia and non-sustained ventricular tachycardia were observed from birth. He was administered a combination of mexiletine and propranolol, after which arrhythmia disappeared and the QTc interval became stable at 420-450 msec. For ophthalmic surgery, we conducted total intravenous general anesthesia with remifentanil and propofol using laryngeal mask airway management. During the operation, HR was 100-110 bpm and non-invasive blood pressure was 80-100/35-40 mmHg, while the QTc interval was 460 msec without further QT lengthening.