- Development of severe junctional bradycardia after dexmedetomidine infusion in a polypharmacy patient: a case report and literature review
-
Soeun Jeon, Eunsoo Kim, Sun Hack Lee, Sung In Paek, Hyun-Su Ri, Dowon Lee
-
Kosin Med J. 2023;38(1):50-55. Published online December 7, 2022
-
DOI: https://doi.org/10.7180/kmj.22.113
-
-
Abstract
PDFPubReader ePub
- The authors report a case of newly manifested severe junctional bradycardia following dexmedetomidine administration during spinal anesthesia in a polypharmacy patient. A 77-year-old woman receiving multiple medications, including a beta-blocker and a calcium channel blocker, underwent right total knee arthroplasty. After spinal anesthesia, intravenous dexmedetomidine was initiated as a sedative; her heart rate decreased, followed by junctional bradycardia (heart rate, 37–41 beats/min). Dexmedetomidine was discontinued, and a dopamine infusion was initiated. Seven hours after surgery, junctional bradycardia persisted; a temporary transvenous pacemaker was inserted, and the beta-blocker and calcium channel blocker were discontinued. The patient was discharged on postoperative day 11 without any sequelae. Anesthesiologists should be aware of dexmedetomidine’s inhibitory effects on the cardiac conduction system, especially in geriatric patients taking medications with negative chronotropic effects and in combination with neuraxial anesthesia.
- The Effect of Patient-controlled Intravenous Analgesia (PCIA) on Postoperative Delirium in Patients with Liver Transplantation: a Propensity Score Matching Analysis
-
Hyo Jung Son, Ukjin Jeong, Kunwoong Choi, Ju Yeon Park, Eun-Ji Choi, Hyun-Su Ri, Tae Beom Lee, Byung Hyun Choi, Yoon Ji Choi
-
Kosin Med J. 2021;36(1):14-24. Published online June 30, 2021
-
DOI: https://doi.org/10.7180/kmj.2021.36.1.14
-
-
Abstract
PDFPubReader ePub
-
Objectives
Postoperative opioid use and pain are related to postoperative delirium. This study aims to compare the incidence of delirium in patients with and without patient-controlled intravenous analgesia (PCIA) among liver transplant recipients.
Methods
The medical records of 253 patients who received liver transplantation (LT) from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. Patients were divided into two groups: the patients who had used PCIA (P group, n = 71) and those who did not use PCIA (C group, n = 182) after LT in intensive care unit (ICU). The patient data were collected, which included demographic data, and details about perioperative management and postoperative complications.
Results
There was no difference in the model for end-stage liver disease (MELD) score between the two groups. Postoperative delirium occurred in 10 / 71 (14.08 %) in the P group and 26 / 182 (14.29 %) in the C group after LT, respectively (P = 0.97). After propensity score matching, no differences were observed in the incidence of delirium (P = 0.359) and the time from surgery to discharge (P = 0.26) between the two groups.
Conclusions
Patients with PCIA after LT exhibited no relationship with postoperative delirium. Therefore, it is necessary to actively control postoperative pain using PCIA.
- Persistent Complete Atrioventricular Block after Induction of General Anesthesia in a Healthy Patient
-
Gyeong-Jo Byeon, Hye-Jin Kim, Hyun-Su Ri, Su Sung Lee, Hee Young Kim
-
Kosin Med J. 2019;34(1):65-71. Published online June 30, 2019
-
DOI: https://doi.org/10.7180/kmj.2019.34.1.65
-
-
1,804
View
-
7
Download
-
1
Citations
-
Abstract
PDFPubReader ePub
A 38-year-old female patient had bradycardia in the preoperative electrocardiogram (ECG), and she showed severe bradycardia, with the heart rate (HR) under 40 beats per minute (bpm) even after arrival in the operating room. Immediately after endotracheal intubation, ventricular tachycardia with HR over 200 bpm occurred, but it disappeared voluntarily. The surgery was postponed for additional cardiac evaluation because of the persistent severe bradycardia. On postanesthesia day 2, complete atrioventricular (AV) block appeared. We expected spontaneous recovery over 2 weeks, but the complete AV block persisted. A permanent pacemaker was eventually inserted, and the patient was discharged without other complications on day 4 after insertion of the pacemaker. We report this case because complete AV block has commonly occurred in patients with risk factors such as first AV block, secondary AV block, or bundle branch block, but complete AV block has occurred despite the absence of arrhythmia in this patient.
-
Citations
Citations to this article as recorded by
- Repeated complete atrioventricular block during remifentanil administration in a pediatric patient with brain tumor and acute hydrocephalus: a case report
Akihiro Ura, Keisuke Fujii, Tadashi Tanioku, Tomoyuki Kawamata BMC Anesthesiology.2024;[Epub] CrossRef
- Fatal neurological complication after liver transplantation in acute hepatic failure patient with hepatic encephalopathy
-
Joo-Yun Kim, Hyun-Su Ri, Ji-Uk Yoon, Eun-Ji Choi, Hye-Jin Kim, Ju-Yeon Park
-
Kosin Med J. 2018;33(1):96-104. Published online January 21, 2018
-
DOI: https://doi.org/10.7180/kmj.2018.33.1.96
-
-
Abstract
PDFPubReader
Liver transplantation is a current definitive treatment for those with end-stage liver disease. Hepatic encephalopathy is a common complication of hepatic failure, which can be improved and aggravated by various causes. It is important to differentiate hepatic encephalopathy from other diseases causing brain dysfunction such as cerebral hemorrhage, which is also related to high mortality after liver transplant surgery. A 37-year-old patient was presented with acute liver failure and high ammonia levels and seizure-like symptoms. Computed tomography (CT) of his brain showed mild brain atrophy, regarded as a symptom of hepatic encephalopathy, and treated to decrease blood ammonia level. Deceased donor liver transplantation was performed and liver function and ammonia level normalized after surgery, but the patient showed symptoms of involuntary muscle contraction and showed loss of pupil reflex and fixation without recovery of consciousness. Brain CT showed brain edema and bilateral cerebral infarction, and the patient died after a few days. The purpose of this case report is to emphasize the importance of preoperative neurological evaluation, careful transplantation decision, and proper perioperative management of liver transplantation in patients with acute hepatic encephalopathy.
|