Intraoperative cardiac arrest in a neurosurgical patient: what are the options?

Intraoperative cardiac arrest is uncommon. We describe a case of intraoperative cardiac arrest in a patient undergoing anesthesia for surgical repair of an intracranial arteriovenous malformation (AVM).     

Asystole during spinal anaesthesia after change from Trendelenburg to horizontal position

We present a case in which progressive bradycardia and sudden cardiac arrest developed in a 26-year-old healthy woman with an ovarian cyst during spinal anaesthesia, immediately after the patient was moved from the 15 degree Trendelenburg to the supine horizontal position. We postulate that a decrease in venous return was the main cause of the cardiac arrest. It should be stressed again that close monitoring during spinal anaesthesia is essential when the patient is subjected to postural changes.     

Sudden cardiac arrest immediately after aortic cross clamping during abdominal aortic aneurysm repair

We report a case of sudden cardiac arrest immediately after aortic cross clamping during surgery for infrarenal abdominal aortic aneurysm in a patient with coronary artery disease. The cause, treatment, and necessary monitoring for the case are discussed.     

Post-cardiac arrest syndrome after general anesthesia: role of therapeutic hypothermia and remifentanil

Moderate therapeutic hypothermia is often used in aneurysm surgery and is therefore a technique anesthesiologists are familiar with. We report the case of a patient who had entered into a coma after cardiac arrest in the postanesthetic recovery unit during central venous catheterization; the patient required 35 minutes of advanced cardiopulmonary resuscitation before heart rhythm and tissue perfusion were restored. The protocol for treating post-cardiac arrest syndrome included therapeutic hypothermia, which was maintained for 12 hours. The patient was extubated after 2 days, with no neurologic deficit. Post-cardiac arrest syndrome is associated with multiple biochemical reactions which are attenuated by hypothermia. Currently available evidence does not allow definitive recommendations regarding the different techniques for inducing therapeutic hypothermia, the ideal temperature to maintain, the duration, or the rewarming process. Further studies are required.     

Cardiac arrest due to succinylcholine-induced hyperkalemia in a patient with wound botulism

Cardiac arrest due to hyperkalemia is a known complication of succinylcholine administration in patients with neuromuscular disease, extensive burns, and prolonged immobility. We report a case of hyperkalemic cardiac arrest following the administration of succinylcholine in a patient suffering from wound botulism.     

A case of traumatic cardiopulmonary arrest with good neurological outcome predicted by amplitude-integrated electroencephalogram

IntroductionTraumatic cardiopulmonary arrest has a very high mortality, and survival of patients with this condition without neurological disability is rare.Presentation of caseWe herein report a case of traumatic cardiopulmonary arrest secondary to accidental amputation of the left lower leg that was successfully treated without any higher brain dysfunction. Although the long duration of cardiopulmonary arrest in this patient suggested hypoxic ischemic encephalopathy, amplitude-integrated electroencephalogram showed normal findings.DiscussionThis system may help intensivists evaluate the neurological conditions of patients with suspected hypoxic ischemic encephalopathy in the early stage of the clinical course and may assist in guiding therapeutic interventions.ConclusionOur case supports the usefulness of neurological monitoring using amplitude-integrated electroencephalogram.     

气肿性肾盂肾炎致突发呼吸心跳骤停1例及文献综述

目的 报告气肿性肾盂肾炎致突发呼吸心跳骤停1例及进行文献回顾总结。方法 报告1例气肿性肾盂肾炎导致突发呼吸心跳骤停患者的临床资料并总结既往文献报道。结果 本例患者由于延误就诊，病情危重，拟急诊行患肾切除术，在进入手术室后发生呼吸心跳骤停，抢救无效而死亡。结论 气肿性肾盂肾炎广泛气肿破坏肾实质需行肾切除术，延误治疗可导致突发呼吸心跳骤停，需密切监护及预防。     

Cardiac arrest after spinal anesthesia in a patient with neurally mediated syncope

We present the case of cardiac arrest in a patient with neurally mediated syncope (NMS). A 66-year-old male patient was scheduled to undergo right inguinal hernioplasty. He had a history of syncope, which occurred a few times a year in childhood and once a year recently. One minute after the second spinal injection, cardiac arrest (asystole) developed. Sinus rhythm was restored by cardiac massage and intravenous administration of atropine and ephedrine. The operation was cancelled. The patient was diagnosed as NMS by a cardiologist. Four months later, right inguinal hernioplasty was performed, uneventfully, under general anesthesia. High sympathetic blockade due to spinal anesthesia and transient withdrawal of sympathetic tone and increase in vagal discharge due to NMS could be the main causes of the cardiac arrest. If the patient has any possibility of NMS, anesthesiologists should consider the possibility of cardiac arrest after spinal anesthesia.     

Hipotermia terapéutica prolongada tras cirugía de drenaje de derrame pericárdico

Therapeutic hypothermia is an effective treatment for neurological protection after out-of-hospital cardiac arrest, and may also be beneficial for in-hospital cardiac arrest. Its use is limited in post-surgical patients due to the risk of specific complications, particularly bleeding. There are significant differences among previous publications regarding the time to reach the target temperature and the duration of therapy, so the optimal strategy is not yet established. We present the case of a patient who suffered a perioperative cardiac arrest related to a pericardial tamponade, and who underwent therapeutic hypothermia for 48 h.     

A simple method to remove a remnant sewing needle from the posterior pericardial cavity without cardiac arrest

We reported a case of removing a remnant sewing needle without cardiac arrest from the posterior pericardial cavity after open‐heart surgery for a 17‐year‐old male patient with atrial septal defect.     

Early intralipid therapy may have prevented bupivacaine-associated cardiac arrest

OBJECTIVE: Local anesthetic-induced cardiotoxicity remains a complication of regional anesthesia, with the potential to result in cardiac arrest refractory to resuscitation. Successful resuscitation using Intralipid (Baxter Pharmaceuticals by Fresenius Kabi, Uppsala, Sweden), has been reported in 2 patients with bupivacaine-induced cardiac arrest. CASE REPORT: We report another case for which Intralipid was used as part of a successful resuscitation in a patient with local anesthetic-induced cardiotoxicity. CONCLUSIONS: Early treatment with Intralipid may help prevent cardiac arrest and speed successful resuscitation efforts.     

Cardiac arrest attributable to dysfunction of the autonomic nervous system aftertraumatic cervical spinal cord injury

Bradycardia is the most common form of dysrhythmia developing after disruption of the sympathetic pathway by a spinal cord injury (SCI), and it can have fatal consequences, including cardiac arrest. Here, we report a case of cardiac arrest developing after cervical SCI attributable to sympathetic hypoactivity. A 26-year-old male pedestrian was admitted after a traffic accident. Radiologically, fractures were apparent at the C6e7 bilateral articular facets, and cord contusion with hemorrhage was evident at C4e7. During his stay in ICU, intermittent bradycardia was noted, but the symptoms were not specific. On the 22nd postoperative day, the patient was taken to the computed tomography suite for further evaluation and experienced cardiac arrest during a positional change. After immediate cardiac massage, the patient was resuscitated. We scheduled Holter monitoring, which detected 26 pauses, the longest of which was 17.9 s. The patient underwent cardiac pacemaker insertion. No further cardiac events were noted.     

Suizidale letale β-Blocker-Intoxikation

We report on the case of a 45-year-old female with beta receptor antagonist intoxication after swallowing about 30 tablets of Cordanum (Talinolol) with suicidal intent. The out of hospital and clinical management is discussed. Prior to admission to hospital the patient only showed a few signs of intoxication such as hypotension, central symptoms and cyanosis. There was no bradycardia but during treatment she developed cardiac arrest. Out of hospital it was possible to stabilise the circulation with catecholamines (norepinephrin) and the transport to hospital was uneventful but only a few minutes after hospital admission the patient developed cardiac arrest. After initially successful CPR the patient died some hours later in the intensive care unit.     

Amitriptyline poisoning in a 2-year old

We describe a case of a 2-year-old boy who ingested 35 mg.kg(-1) of amitriptyline. He developed central nervous system toxicity, as demonstrated by coma and seizures and cardiac toxicity (cardiac arrest) within 1 h of ingestion. The cardiac toxicity was refractory to standard therapy. His cardiac rhythm alternated between ventricular tachycardia and pulseless ventricular tachycardia/ventricular fibrillation for a period of 17 h. Following prolonged cardiopulmonary resuscitation and aggressive supportive management, the patient recovered both cardiovascularly and neurologically. An echocardiogram and MRI brain were subsequently performed and were normal. The patient was discharged 2 weeks later with normal cognitive, behavioral and motor function. We discuss the benefit of prolonged and effective cardiopulmonary resuscitation in the management of this potentially fatal poisoning.     

Cardiac herniation after resection of pericardial thymic cyst

Cardiac herniation following pericardial resection is a rare and potentially fatal complication. We present a case of a cardiac herniation after excision of pericardial thymic cyst. The patient had cardiac arrest one hour after surgery. Re-thoracotomy in the high dependency care unit, and reduction of cardiac herniation were done. There was no case report in the literature of cardiac herniation after excision of pericardial tumor.     

Radical surgery of a giant Galen's vein aneurysm using total circulatory arrest: case report

BACKGROUND: Arteriovenous malformations of Galen's vein are a rare type of vascular anomaly. The complex anatomy of these lesions creates an extremely difficult management dilemma. We report successful surgical treatment of a 7-year-old patient with a Galen's vein aneurysm. METHODS AND RESULTS: A 7-year-old patient with slowly progressing gait disturbance, emotional instability, and strange behaviour is presented. A computed tomography scan revealed a high-density mass in the pineal region and cerebral angiography showed an aneurysm of Galen's vein. We decided to perform surgical excision of the aneurysm. The operation was performed under hypothermic circulatory arrest with barbiturate cerebral protection. The patient had no signs of postoperative ischemic deficits, hemorrhage, or neurologic deterioration. CONCLUSIONS: Various techniques have been described for the obliteration of Galen's vein aneurysms, including direct surgical approach, staged operation, and transarterial, transvenous or transtorcular embolization. We present this patient to illustrate the use of hypothermic circulatory arrest and barbiturate cerebral protection for successful surgical excision of this complex vascular lesion. The combination of these techniques allowed us, in this case, to operate with reasonable safety on otherwise, difficult to treat aneurysm of Galen's vein.     

Successful but prolonged resuscitation after local anesthetic-induced cardiac arrest: is clonidine effective?

Local anesthetics when injected intravascularly result in serious cardiac complications including therapy-resistant cardiac arrest. We report a case of cardiac arrest after lumbar plexus block using a combination of 0.5% bupivacaine and 2% lidocaine with epinephrine (1:200.000). Resuscitation was performed by a combination of chest compression, repeated external countershocks and i.v.epinephrine. Clonidine had poor effect. The whole resuscitation required 90 minutes. The patient was discharged four days later without any sequelae. Blood sampling at 10 minutes showed a concentration of 2.02 mg/l lidocaine and 0.87 mg/l bupivacaine. Prolonged resuscitation is necessary in local anesthetic-induced cardiac arrest.     

Épiglottite aiguë obstructive en réanimation : stratégie pour une intubation à haut risque

Acute epiglottitis is an infection of supraglottic structures, with a high risk of life-threatening respiratory obstruction. We report a case of a 52-year-old patient who presented with a prehospital hypoxic respiratory arrest caused by obstructive oedema with a successful resuscitation. Laryngoscopy after a sudden unplanned extubation permits diagnosis of acute obstructive epiglottitis. The growing threat of laryngeal dyspnea prompts emergency tracheal airway protection, by means of the combined preparation of transtracheal oxygenation access and the use of fiber-optic laryngoscopy. This case report emphasises the airway management strategy successfully used in this patient.     

Cardiac arrest in a traumatized child from an unusual cause: atlanto-occipital luxation

We report the case of a trauma child who developed a cardiac arrest due to atlanto-occipital luxation of the cervical spine. The occurrence of a rapidly reversible cardiac arrest in a trauma patient should alert physicians about cervical trauma. Adequate resuscitation of these patients require endotracheal intubation with concomitant full immobilisation of the cervical spine, plasma expansion to prevent arterial hypotension and immobilisation of the cervical spine during transport. Thorough application of these resuscitation techniques should increase the survival rate on admission to trauma centres of paediatric patients presenting with such a severe condition. Nevertheless, atlanto-occipital luxation is a major cause of paediatric cervical trauma mortality and our patient did not survive this condition.