Perioperative retinoic acid syndrome in a patient with acute promyelocytic leukemia.

All-trans retinoic acid (ATRA), a vitamin A derivative, is prescribed for induction of chemotherapy in patients with acute promyelocytic leukemia. Like other chemotherapy agents, ATRA has an adverse effect known as retinoic acid syndrome. The case of a 22 year old woman with acute promyelocytic leukemia, who received ATRA and subsequently developed retinoic acid syndrome, is presented.

Perioperative transient left ventricular apical ballooning syndrome: Takotsubo cardiomyopathy: a review.

Transient left ventricular apical ballooning syndrome (TLVAB), also known as Takotsubo cardiomyopathy, is a cardiac syndrome characterized by transient left ventricular dysfunction in the absence of obstructive atherosclerotic coronary artery disease. An episode of emotional and/or physiologic stress frequently precedes presentation of this syndrome. TLVAB may initially present as an acute coronary syndrome characterized by chest pain, pulmonary edema, electrocardiographic changes, elevated cardiac enzymes, and cardiogenic shock.

Ehlers-Danlos syndrome type IV: anesthetic considerations--case report.

This report describes the anesthetic management of a patient with Ehlers-Danlos syndrome type IV. This is one of the rare genetic disorder which can present both in emergency and as a scheduled surgical case.

The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation.

Unlabelled: Laryngoscopy and tracheal intubation (LTI) often provoke an undesirable increase in blood pressure (BP) and/or heart rate (HR). We tested the premise that nicardipine (NIC) and esmolol (ESM) in combination (COMB) would oppose both. Adult surgical patients received pretreatment (randomized) with IV bolus NIC 30 microg/kg (n = 31), ESM 1.

Electrosurgery-induced ventricular fibrillation during pacemaker replacement--a unique mechanism.

Arrhythmias and pacemaker malfunction are known to occur from the use of an electrosurgical device. The present case report describes a patient with sick sinus syndrome who experienced ventricular fibrillation while undergoing surgery. During replacement of his non-functioning cardiac pacemaker under general anesthesia, electrosurgery was used to ensure hemostasis.

Propofol in patients susceptible to malignant hyperthermia: a case report and review of the literature.

Propofol is an intravenous (IV) drug recently introduced into the United States for induction and maintenance of anesthesia. In spite of extensive laboratory evaluation, it is not possible to predict all the potential side effects that might be associated with a new drug. Because malignant hyperthermia (MH) remains a serious and potentially life-threatening complication of anesthesia, all new anesthetic drugs should be considered potential triggering drugs until proven otherwise.

Pulmonary artery occlusion pressure is not accurate immediately after cardiopulmonary bypass.

Elevated pulmonary vascular resistance (PVR), differential cardiac dynamics, and increased lung water following cardiopulmonary bypass (CPB) have been proposed as limitations to the accuracy of the pulmonary artery occlusion pressure (PAOP) in estimating left ventricular preload. A prospective study of 22 patients undergoing elective myocardial revascularization is described wherein PAOP was compared with directly measured left atrial pressure (LAP). The reliability of PAOP to estimate LAP in the hour immediately following CPB and at 1, 4, 8, and 12 hours post-CPB was examined with repeated measures analysis of variance.

Cardiovascular effects of pancuronium, vecuronium, and atracurium during induction of anesthesia with sufentanil and lorazepam for myocardial revascularization.

The hemodynamic effects of three commonly used muscle relaxants, pancuronium, vecuronium, and atracurium were investigated during induction of anesthesia with sufentanil and lorazepam in patients undergoing coronary artery bypass surgery. Direct hemodynamic variables were recorded, and indirect parameters were calculated using standard formulae. Changes in heart rate differed with the three muscle relaxants.

Anesthesia machine malfunction simulating spontaneous respiratory effort.

We present a case in which a dip in the capnogram of an anesthetized patient, which may indicate clinical complications such as spontaneous respiratory effort, was caused by a malfunction of the anesthesia delivery system. The rubber diaphragm of the ventilator relief valve was found to be coated with a sticky substance which may have caused adhesion at the valve seat. This adhesion blocked the flow of excess gas to the scavenging system during exhalation.

Mass spectrometer artifact: simultaneous detection of two volatile anesthetics.

In several cases, a mass spectrometer indicated that both enflurane and isoflurane were being detected while only isoflurane was in use. The concentration of expired enflurane reported was always higher than the inspired concentration, but never exceeded 0.66% regardless of the concentration of isoflurane.

A re-evaluation of the anxiolytic properties of intramuscular midazolam.

The observed effect of midazolam on anxiety is equivocal in part because previous studies have not ruled out pre-treatment differences in anxiety scores between patients who received midazolam and those who did not (controls). This study re-examines the anxiolytic effect of premedication with intramuscular midazolam using a sample size calculated to be of sufficient size to rule out population differences as a variable affecting treatment results. In the midazolam group (n = 49) anxiety scores were determined prior to administration of midazolam 0.

Technical note: Ventilator modified as an anesthesia delivery system.

It would be useful to have a ventilator that could be used with all types of patients, from neonates through adults, both for anesthesia and long term ventilation. This paper describes the modification of a Siemens 900C ventilator for this purpose. In the operating room, this machine can be used in conjunction with a complete anesthesia machine.