Introduction: Modified electroconvulsive therapy (m-ECT) is mainly used to induce seizures. The use of anesthetic agents during m-ECT should be minimized because they could inhibit the development of seizures. Modifying the method of administration of anesthetic in combination with opioid use is known to help in reduction of the anesthetic dose. However, the effect of this dose reduction on circulatory dynamics during m-ECT has not been studied in detail. Therefore, we conducted this study to investigate the changes in blood pressure associated with anesthetic dose reduction during m-ECT. Methods: Ninety-one patients who underwent m-ECT eight or more times per course (455 m-ECT procedures in total) were included. The data were extracted retrospectively from anesthesia and electronic medical records from September 2015 to February 2020. The changes in blood pressure during m-ECT were compared between the following groups: propofol and remifentanil (PR group: remifentanil followed by propofol [1 µg/mL] based on target control infusion until loss of consciousness) and propofol alone (P group: propofol [2 µg/mL] based on target control infusion until loss of consciousness). Results: Of the 455 procedures (91 patients), 325 (65 patients) were performed in the PR group and 130 (26 patients) in the P group. Systolic blood pressure ≥180 mmHg during m-ECT was significantly more in the PR group than in the P group (73/325 vs. 14/130, p＝0.004). Conclusion: The use of a reduced dose of propofol in combination with remifentanil significantly increased blood pressure and the use of nicardipine than did propofol alone during m-ECT.
Purpose: High-flow nasal cannula oxygen therapy (HFNC) in children undergoing Fontan surgery may reduce intrathoracic pressure and improve hemodynamics by improving oxygenation and thoraco-abdominal synchrony and reducing atelectasis. We aimed to determine the effect of HFNC on post-Fontan procedure hemodynamics.
Methods: Patients who underwent Fontan surgery between November 1, 2014 and December 31, 2020 were enrolled. The change in central venous pressure (CVP) after surgery; both CVP and mean arterial pressure (ABP) 1, 2, 4, 6, 12, and 24 h post-extubation; partial pressures of arterial oxygen (PaO2) and carbon dioxide (PaCO2) 1 h after extubation; urine output and chest drainage and infusion volumes 6 h after extubation; vasoactive inotropic score (VIS); and other outcomes were compared between patients receiving conventional oxygen therapy (COT; C group) and those receiving HFNC (H group). After adjusting for confounding factors, the CVP 1 h pre- and post-extubation were compared between the groups.
Results: Of the 199 included patients, 61 in each group were analyzed after propensity score matching. There were no significant between-group differences in the change in CVP from 1 h pre-extubation to 1 h post-extubation (COT: 2.9 ± 2.2 mmHg vs. HFNC: 2.5 ± 1.9 mmHg, p＝0.66), PaCO2, mean ABP, use of vasoactive or inotropic drugs, the level of aspartate aminotransferase or alanine aminotransferase, reintubation rate, or postoperative length of intensive care unit stay. The H group had a significantly higher PaO2 1 h post-extubation (241 mmHg vs. 183 mmHg, p＝0.02).
Conclusion: HFNC does not significantly improve hemodynamics after the Fontan procedure.
Femoral arterial and venous cannulation during cardiopulmonary bypass (CPB) can cause restriction of blood flow to the lower limb. To avoid complications, monitoring tissue oxygen saturation (StO2) of the lower limb and ensuring adequate blood flow by distal perfusion (DP) are essential.
A 78-year-old man underwent mitral valve replacement via a mini-right thoracotomy. During CPB, the StO2 of the ipsilateral cannulated lower limb was decreased. Although the DP catheter was inserted into the ipsilateral femoral artery, the effect on the lower limb StO2 was transient. Because the StO2 of the ipsilateral lower limb improved by replacing the catheter, it was thought that the DP catheter had migrated into the deep femoral artery where collateral circulation was not developed. Among cases in which the StO2 does not improve, even with the use of DP, it is important to confirm whether the DP is sufficiently effective.