Paradoxical hemodynamic collapse after subxiphoid pericardial window.

A 56-year-old man with a history of coronary artery disease, 4 months of cough and shortness of breath, a new lung mass, and increasing hypoxemia presented to the operating room emergently for a subxiphoid pericardial window for cardiac tamponade. After 1200 mL of pericardial fluid was drained, the patient immediately went into acutely decompensated right heart failure as seen on a transesophageal echocardiogram. The patient had cardiovascular collapse refractory to high-dose vasopressors, necessitating emergent venous-arterial extracorporeal membrane oxygenation for successful resuscitation.

Anesthetic-specific electroencephalographic patterns during emergence from sevoflurane and isoflurane in infants and children.

Background: Devices that monitor the depth of anesthesia are increasingly used to titrate sedation and avoid awareness during anesthesia. Many of these monitors are based upon electroencephalography (EEG) collected from large adult reference populations and not pediatric populations (Anesthesiology, 86, 1997, 836; Journal of Anaesthesia, 92, 2004, 393; Anesthesiology, 99, 2003, 34). We hypothesized that EEG patterns in children would be different from those previously reported in adults and that they would show anesthetic-specific characteristics.