this is very intersting case , however i have faced same case following reveral administration : atropine + prostigmine , wich showed first a sunden tachycardia followed by ventricular fibrallation , CPR recovered the patient ( was a 25 y old female undergoing SMR surgery ) , an Echocardio was performed and revealed undiagnosed mitral valev prolapse , did you do an Echocardio to rule out a mitral prolapse !?
i have a lesson from this case : never give a reversal on one shot , now in my department we give the half of reversal and after 2-3 min we give the other half .
Baraka showed in his great old study (Baraka A. Safe reversal. 2. Atropineneostigmine mixture: an electrocardiographic
study. British Journal of Anaesthesia 1968; 40: 30–6.)
showed that when the initial heart rate
is slow, the increase in rate is more than when the initial heart rate is rapid ,
can you tell us please the heart rate during reversal administration !?
the case is attached with this email.
regards,
Ahed zeidan .
--- On Sat, 11/21/09, Rajendra Joglekar <rjoglekar57@...> wrote:
From: Rajendra Joglekar <rjoglekar57@...> Subject: [ai] ventricular tachycardia on reversal- details To: Anesthideas@yahoogroups.com Date: Saturday, November 21, 2009, 5:57 PM
hello, thanks for the interest in the case. Pre op haemoglobin, wbc, platelets, blood suger, urea creatinine, pt, ptt, inr, ECG was within normal limits. Patient did not have history of hypertension, diabetes, symptom or signs suggestive of ischemic heart disease. Patient was not receiving any medication. horseness of voice was the only complain! Endotracheal tube of 5.5 mm was used for microlaryngeal surgery. patient was paralysed with atracurium. ventilated to keep etco2 of 35 mm. blood pressure, heart rate was stable throughout the procedure. At end of surgery (45 minuts after atracurium) patient had started breathing. respiration was assited after giving reversal, as the ET was small in size. etco2 was 40 mm when patient had first ventrular ectipic beats. followed by ventricular tachycardia. Sauration was 99% on pulse oxymetry, Blood presure was 150/80 when arrythmia developed. CPR continued for around 30 minuts. ET was changet
to 8.5 mm for ventilation. repeated DC shocks were required as patient maintained sinus rythm for 2-3 minuts every time. Blood for ABG was collected from femoral artery puncture. No rapid infusion of saline was given. Patient was extubated in icu after few hours. 12 lead ecg and echocardiography done in icu did not show any evidence of ischemic heart disease. patient underwent coronary angiography after 3 days. It was normal.
hello, thanks for the interest in the case. Pre op haemoglobin, wbc, platelets, blood suger, urea creatinine, pt, ptt, inr, ECG was within normal limits. Patient did not have history of hypertension, diabetes, symptom or signs suggestive of ischemic heart disease. Patient was not receiving any medication. horseness of voice was the only complain! Endotracheal tube of 5.5 mm was used for microlaryngeal surgery. patient was paralysed with atracurium. ventilated to keep etco2 of 35 mm. blood pressure, heart rate was stable throughout the procedure. At end of surgery (45 minuts after atracurium) patient had started breathing. respiration was assited after giving reversal, as the ET was small in size. etco2 was 40 mm when patient had first ventrular ectipic beats. followed by ventricular tachycardia. Sauration was 99% on pulse oxymetry, Blood presure was
150/80 when arrythmia developed. CPR continued for around 30 minuts. ET was changet to 8.5 mm for ventilation. repeated DC shocks were required as patient maintained sinus rythm for 2-3 minuts every time. Blood for ABG was collected from femoral artery puncture. No rapid infusion of saline was given. Patient was extubated in icu after few hours. 12 lead ecg and echocardiography done in icu did not show any evidence of ischemic heart disease. patient underwent coronary angiography after 3 days. It was normal.
the following are guideslines and papers on Lidocaine for intra and postoperative use of bolus/infusion of Lidocaine. It appears to me it is probably a good alternative ! No ?
Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note.
From: art <a.to.z@...> To: Anesthideas@yahoogroups.com Sent: Thu, November 19, 2009 3:17:54 PM Subject: [ai] lidocaine ambulatory [1 Attachment]
Not really enough information on this one. How long was the CPR, How was the
blood gas obtained-art/venous, do you have a formal ECG trace or Rythm strip
from the episode? No Art line involved? Where was the blood gas obtained and how
hard had the patient been ventilated (intubated?)and what was the CO2 in the
ABG? Was there a rapid infusion of saline in that limb diluting the K+? Was the
reversal really something else? Anaphylaxis? Was it V tach or abberant
conduction of SVT? How do we know? What does "all investigations normal" really
mean? What was the outcome and what follow up cardiac procedures were
instituted? How long was CPR and how long was BP not measured or obtained.
Thanks
P Kempen
"Inquiring minds want to know................."
National Inquirer
Posted by: "rjoglekar57" rjoglekar57@... rjoglekar57
Mon Nov 16, 2009 7:26 am (PST)
A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All
investigations within normal limits.(pre op electrolytes not done) Patient went
into ventrcular tacycardia 4 minuts after reversal with glycopyrolate &
neostigmine, just before extubation. repeated dc shocks , corderone, CPR
required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L
as most likely cause. ( post resuscitation ECG, 2D Echocardiography within
normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications
developed hypokalemia? Any suggestions?
Systemic Lidocaine Decreased the Perioperative Opioid Analgesic
Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery
Allannah
McKay, MD*, Antje Gottschalk, MD*<image001.gif>, Annette Ploppa, MD*<image002.gif>, Marcel E. Durieux, MD, PhD*,
and Danja S. Groves, MD, PhD*
From the *Department of Anesthesia,
University of Virginia, Charlottesville, Virginia; <image001.gif>Department of Anesthesiology and Intensive Care Medicine,
University of Muenster, Muenster; and <image002.gif>Department
of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University,
Tuebingen, Germany.
Address correspondence to Danja S. Groves,
MD, PhD, Department of Anesthesia, University of Virginia, PO Box 800710,
Charlottesville, VA 22908-0710. Address e-mail to dgroves@virginia.edu.
Abstract
BACKGROUND: In this randomized, blinded, placebo-controlledtrial,
we evaluated whether systemic lidocaine would reducepain and time
to discharge in ambulatory surgery patients.
METHODS: Sixty-seven patients were enrolled to receive lidocaineor saline infusion perioperatively.
RESULTS: Length of postanesthesia care unit (PACU) stay didnot
differ between groups. Intraoperative opioid use was significantlyless
in the lidocaine group, both in the PACU and during thetotal
study period but not after discharge. In the PACU, patientsin the
lidocaine group reported less pain (visual analog scalescore 3.1
± 2.04 vs 4.5 ± 2.9; P = 0.043). Therewere no differences
in postoperative nausea and vomiting.
CONCLUSION: Perioperative systemic lidocaine significantlyreduces
opioid requirements in the ambulatory setting withoutaffecting
time to discharge.
Seasonal influenza vaccines are not covered countermeasures under the CICP. If you received the seasonal influenza vaccine or other vaccines covered by the National Vaccine Injury Compensation Program (VICP) such as tetanus or the human papillomavirus vaccine and think that you had an adverse reaction from one or a combination of these covered vaccines, see the VICP.
The Countermeasures Injury Compensation Program (CICP), housed within the Health Resources and Services Administration (HRSA), administers the compensation program specified by the Public Readiness and Emergency Preparedness Act (PREP Act).
The PREP Act provides compensation to individuals for serious physical injuries or deaths from pandemic, epidemic, or security countermeasures identified in declarations issued by the Secretary pursuant to section 319F-3(b) of the Public Health Service Act (PHS Act) (42 U.S.C. 247d-6d).
The PREP Act also confers broad liability protections as defined in section 319F-3(i)(2) of the PHS Act. Liability protections cover the manufacture, testing, development, distribution, or use of the designated covered countermeasure.
A Secretarial declaration specifies the categories of health threats or conditions for which countermeasures are recommended, the period liability protections are in effect, the population of individuals protected, and the geographic areas for which the protections are in effect.
On Nov 19, 2009, at 13:06, "ahed m.zeidan" <doczeidan@...> wrote:
Dear Ron
you mentioned that 350 children died this past month in USA , i agree with you , but ,
do you know how many children died from virus A ? ( usual influza ) ?
the problem with the vaccination for H1N1 , that the US government agreed that the companies are devoided from any responsibility concerning side effect ! do you find this logical ? , that the company will not take responsibility of any future possible complications ( e.g. guillan Barre' , MS ,... )
Regards ,
A.zeidan
--- On Tue, 11/17/09, ethersage <ethersage@yahoo.com> wrote:
From: ethersage <ethersage@yahoo.com> Subject: Re: [ai] Vaccination or not? To: Anesthideas@yahoogroups.com Date: Tuesday, November 17, 2009, 11:13 PM
350 children died this past month in the US from influenza
Ron Shenker
From: ahed m.zeidan <doczeidan@yahoo. com> To: Anesthideas@ yahoogroups. com Sent: Tue, November 17, 2009 12:30:27 PM Subject: Re: [ai] Vaccination or not?
I dont believe it is necessary, H1N1 is not dangerous as they like to say that .
i saw many patients recovered within few days ,
however, a freind of mine , after vaccination, complained from high grade fever for 48h + plus sensation of legs paralysis and severe general weakness for 7 days , others freinds toke it withou feelinfganything !
Ahed zeidan , M.D
--- On Tue, 11/17/09, JJ <achaeusz@hotmail. com> wrote:
From: JJ <achaeusz@hotmail. com> Subject: [ai] Vaccination or not? To: Anesthideas@ yahoogroups. com Date: Tuesday, November 17, 2009, 6:55 PM
Hello everyone. This week massive vaccination against H1N1 has begun in my country. Have you yet had your shot? Will you?
Vic: I think the vasopressors **are** being administered to fight hypotension,
and not just for the "fun of it". As for the metabolic rate, the other and most
important question is of "statistical vs clinical" relevance. A little metabolic
rate keeps us all alive and warm when coming out to the "pool".
P Kempen
Re: phenylephrine drips and BP
Posted by: "Vic Werlhof" werlhof@... vicwerlhof
Fri Nov 13, 2009 2:17 pm (PST)
As for the phenylephrine and vascular perfusion, I will state there is
simply a great deal of "voodoo medicine" and associated beliefs out there.
Take a look at the OB literature which is NOW proclaiming phenyleprine to be
superior to ephedrine! (personally, they both are only as good as they
create BP, some people resopnd to the one or other drug).<<<<<< <
If I am understanding the literature correctly, the support for
phenylephrine is not about BP control. During C-sections, ephedrine has
been shown to lower pH in the fetus by increasing metabolic rate. That is
why phenylephrine is being touted as superior.
Vic
you mentioned that 350 children died this past month in USA , i agree with you , but ,
do you know how many children died from virus A ? ( usual influza ) ?
the problem with the vaccination for H1N1 , that the US government agreed that the companies are devoided from any responsibility concerning side effect ! do you find this logical ? , that the company will not take responsibility of any future possible complications ( e.g. guillan Barre' , MS ,... )
Regards ,
A.zeidan
--- On Tue, 11/17/09, ethersage <ethersage@...> wrote:
From: ethersage <ethersage@...> Subject: Re: [ai] Vaccination or not? To: Anesthideas@yahoogroups.com Date: Tuesday, November 17, 2009, 11:13 PM
350 children died this past month in the US from influenza
Ron Shenker
From: ahed m.zeidan <doczeidan@yahoo. com> To: Anesthideas@ yahoogroups. com Sent: Tue, November 17, 2009 12:30:27 PM Subject: Re: [ai] Vaccination or not?
I dont believe it is necessary, H1N1 is not dangerous as they like to say that .
i saw many patients recovered within few days ,
however, a freind of mine , after vaccination, complained from high grade fever for 48h + plus sensation of legs paralysis and severe general weakness for 7 days , others freinds toke it withou feelinfganything !
Ahed zeidan , M.D
--- On Tue, 11/17/09, JJ <achaeusz@hotmail. com> wrote:
From: JJ <achaeusz@hotmail. com> Subject: [ai] Vaccination or not? To: Anesthideas@ yahoogroups. com Date: Tuesday, November 17, 2009, 6:55 PM
Hello everyone. This week massive vaccination against H1N1 has begun in my country. Have you yet had your shot? Will you?
Systemic Lidocaine Decreased the Perioperative Opioid Analgesic
Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery
Allannah
McKay, MD*, Antje Gottschalk, MD*, Annette Ploppa, MD*, Marcel E. Durieux, MD, PhD*,
and Danja S. Groves, MD, PhD*
From the *Department of Anesthesia,
University of Virginia, Charlottesville, Virginia; Department of Anesthesiology and Intensive Care Medicine,
University of Muenster, Muenster; and Department
of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University,
Tuebingen, Germany.
Address correspondence to Danja S. Groves,
MD, PhD, Department of Anesthesia, University of Virginia, PO Box 800710,
Charlottesville, VA 22908-0710. Address e-mail to dgroves@....
Abstract
BACKGROUND: In this randomized, blinded, placebo-controlledtrial,
we evaluated whether systemic lidocaine would reducepain and time
to discharge in ambulatory surgery patients.
METHODS: Sixty-seven patients were enrolled to receive lidocaineor saline infusion perioperatively.
RESULTS: Length of postanesthesia care unit (PACU) stay didnot
differ between groups. Intraoperative opioid use was significantlyless
in the lidocaine group, both in the PACU and during thetotal
study period but not after discharge. In the PACU, patientsin the
lidocaine group reported less pain (visual analog scalescore 3.1
2.04 vs 4.5 2.9; P = 0.043). Therewere no differences
in postoperative nausea and vomiting.
CONCLUSION: Perioperative systemic lidocaine significantlyreduces
opioid requirements in the ambulatory setting withoutaffecting
time to discharge.
I
don’t know: I heard many being “sick” for a few days and then
returning to activity ( Children included ) . In some cases I Heard half class
with children absent and so on . They cannot test everybody for H1N1 –so practically
we don’t know how many got it ( H1N1).
Regarding
the 350 children that died in the US due to H1N1 – for the US population –
this is very , very small number.
On
the other hand , the two case I know from our ICU – Extremely Serious .
One of them – remain to be seen if he’ll survive .
Again
– maybe we could paint a bit more precise picture is all of our
colleagues would send what they know from their respective places.
It
seems that in Ukraine there was some sort of mutation of the virus and there is
a combination of Para influenza and H1N1….
I
was in Bucharest/ Romania , about a month ago and Tamiflu was nowhere to be
found on the market – the Government stocked up all there was available ….
Here ( in Israel) vaccination begun as well , a short time
ago .
Medical personnel has priority and in my hospital where
vaccination is available for a week or so .
Many did not vaccinate .
Many did .
In our Sterilization unit , all got the vaccine and
two days after ,half of them did not show for work .
Two came to the Emergency Room with a fever of 4o ( Celsius)
.
The Surgeon Head of Trauma Unit got very sick after the
vaccine as well as one of our secretaries.
Personally I did not took the shot and I do not intend
to .
As far as I know , there were some examination done in one
of the big Hospitals here, and the level of antibodies after the vaccine
was very low ( Insufficient for any protection as far as I understood ) .
Maybe I am wrong , but it seems to me that the reaction
of the officials are in disproportion with what we know from the press.
On the other hand , in the last month , there were two cases
of H1N1 admitted to our Intensive care unit :
One 30 Y old , no previous conditions , except obesity
( not morbid) that was on a respirator for three weeks , tracheotomy , two
toracotomies for abscesses and as far as I know transferred to an Internal Medicine
Dpt.
The other one admitted 36 hours ago – 17 Y old , Bronchial
Asthma . Deteriorated very bad , put on a Heart- Lung machine , at this point
ventilated volume controlled WITH Isoflurane – and his PaO2 got from 60
to 80 since yesterday ( on an FiO2 of 1 , of course) …
I don’t remember cases of Flu being admitted to the ICU
and in such bad condition – on a respirator , etc .
We also had an emergency Caesarean Section which was with
H1N1. Undergo uneventfully with Spinal Anesthesia .
What is the feed-back from you guys in your corner of woods
??
It is my impression that the media is not exactly
forthcoming ….
Palliative Sedation to Alleviate Intractable Distress of the Dying
Patient
A review of treatment options
Patients who are dying can experience physical and emotional
suffering,
such as anxiety, agitated depression, or insomnia. Physicians often
administer nonopioid drugs to alleviate such symptoms (ordinary
sedation).
However, in some instances, suffering is severe and refractory to
conventional treatment, and further palliative sedation is medically
indicated. In a review of palliative sedation options, palliative
care
specialists distinguish treatment for refractory symptoms as either
proportionate palliative sedation (PPS) or palliative sedation to
unconsciousness (PSU).
With PPS, sedation at the lowest possible level is administered to
relieve
suffering, and increases in dosage are tied to persistent signs and
symptoms of distress. Unconsciousness is a foreseen but unintended
side
effect. Patients with refractory symptoms often respond to increasing
doses
of benzodiazepines, haloperidol, chlorpromazine, barbiturates, or
propofol.
Because opiates can lead to development of tolerance and
neurotoxicity,
their use should be restricted to patients in whom pain or dyspnea
cannot
be controlled with other medications.
With PSU, sedation is increased rapidly until the patient is no
longer
responsive. Unconsciousness is the intended goal, rather than a side
effect. PSU might be applicable for patients with refractory
symptoms,
such
as severe respiratory secretions or severe nausea, or for those with
predominantly existential suffering, such as anguish and fear, that
often
accompany the dying process.
Both types of sedation, although legal, raise ethical concerns and
are
challenged by those who fear that such practices hasten death.
However,
unlike physician-assisted suicide or euthanasia, the intent of PPS
and PSU
is to relieve refractory suffering in patients who are dying. Death
is
secondary to the underlying disease process, and data show that
palliative
sedation does not shorten survival. In addition, we must distinguish
related questions about provision of or withholding nutrition and
hydration
as separate and distinct from administration of PPS and PSU: Many
patients
and their surrogates make informed decisions to discontinue
nutritional
support when it is not within their goals of care or because of
unacceptable side effects, such as nausea or excessive respiratory
secretions. Nevertheless, withholding nutrition and hydration is not
a
requirement for effective palliative sedation.
National policies and guidelines support both conscious and
unconscious
palliative sedation. Either one can be offered to terminal patients
who
are
experiencing refractory suffering, with safeguards and internal
institutional review to guide the practice. Safeguards include peer
consultation to confirm that a patient is near death and is
experiencing
refractory symptoms. Institutional policies and procedures can help
standardize practice, remove moral ambiguity that is related to
sedation,
and, ultimately, improve the quality of symptom management for
terminally
ill patients.
-- Stephanie Grossman, MD, FHM, FAAPM
Dr. Grossman is an Assistant Professor in the School of Medicine at
Emory
University and Director of Palliative Care at Emory University
Hospital
and
Emory University Hospital Midtown in Atlanta, Georgia.
Published in Journal Watch Hospital Medicine November 16, 2009
Citation(s):
Quill TE et al. Last-resort options for palliative sedation. Ann
Intern Med 2009 Sep 15; 151:421. (Subscription may be required)
(Free)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
We’re still waiting for an
adequate supply, for anyone more than pregnant women and people in direct
contact with the disease. The story I’ve heard in that it’s either minor or
extremely serious, with few cases in between.
However, there has been a sort of
epidemic (at least among people I know) of pneumonia. I wonder if that isn’t
H1N1—nobody’s been tested for it.
Sanford M.
Miller, MD
sanford.miller@...
From:
Anesthideas@yahoogroups.com [mailto:Anesthideas@yahoogroups.com] On Behalf
Of ethersage Sent: Tuesday, November 17, 2009 4:14 PM To: Anesthideas@yahoogroups.com Subject: Re: [ai] Vaccination or not?
350 children
died this past month in the US from influenza
Ron
Shenker
------------------------------------------------------------
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=================================
350 children died this past month in the US from influenza
Ron Shenker
From: ahed m.zeidan <doczeidan@...> To: Anesthideas@yahoogroups.com Sent: Tue, November 17, 2009 12:30:27 PM Subject: Re: [ai] Vaccination or not?
I dont believe it is necessary, H1N1 is not dangerous as they like to say that .
i saw many patients recovered within few days ,
however, a freind of mine , after vaccination, complained from high grade fever for 48h + plus sensation of legs paralysis and severe general weakness for 7 days , others freinds toke it withou feelinfganything !
Ahed zeidan , M.D
--- On Tue, 11/17/09, JJ <achaeusz@hotmail. com> wrote:
From: JJ <achaeusz@hotmail. com> Subject: [ai] Vaccination or not? To: Anesthideas@ yahoogroups. com Date: Tuesday, November 17, 2009, 6:55 PM
Hello everyone. This week massive vaccination against H1N1 has begun in my country. Have you yet had your shot? Will you?
I dont believe it is necessary, H1N1 is not dangerous as they like to say that .
i saw many patients recovered within few days ,
however, a freind of mine , after vaccination, complained from high grade fever for 48h + plus sensation of legs paralysis and severe general weakness for 7 days , others freinds toke it withou feelinfganything !
Ahed zeidan , M.D
--- On Tue, 11/17/09, JJ <achaeusz@...> wrote:
From: JJ <achaeusz@...> Subject: [ai] Vaccination or not? To: Anesthideas@yahoogroups.com Date: Tuesday, November 17, 2009, 6:55 PM
Hello everyone. This week massive vaccination against H1N1 has begun in my country. Have you yet had your shot? Will you?
Hello everyone.
This week massive vaccination against H1N1 has begun in my country. Have you yet
had your shot? Will you?
Thank you for your response
Ioannis Zogogiannis
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Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note.
I agree with Ivan - coronaries need investigating.
We have had two patients in the last few years present with ventricular fibrillation or acute pulmonary edema in the immediate post-op period. One had a tight left main lesion and one had severe multivessel coronary diseae. Both were asymptomatic preoperatively and had been "cleared" medically.
Steve Anderson, MD
Sent from my iPhone 3GS
On Nov 16, 2009, at 11:08, Terry Webber <tjwebber152@...> wrote:
Wow,
Thought this stuff was not supposed to happen?? Maybe herbal teas or meds and diuretics?
A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All investigations within normal limits.(pre op electrolytes not done) Patient went into ventrcular tacycardia 4 minuts after reversal with glycopyrolate & neostigmine,just before extubation. repeated dc shocks , corderone, CPR required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most likely cause. ( post resuscitation ECG, 2D Echocardiography within normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications developed hypokalemia? Any suggestions?
-- Terry Webber, MD, JD Anesthesiology 12600 Braddock Drive, C-205 Los Angeles, CA 90066 Phone: 720 490 6824
Fax: 310 733 1770
Thought this stuff was not supposed to happen?? Maybe herbal teas or meds and diuretics?
On Mon, Nov 16, 2009 at 7:26 AM, rjoglekar57 <rjoglekar57@...> wrote:
A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All investigations within normal limits.(pre op electrolytes not done) Patient went into ventrcular tacycardia 4 minuts after reversal with glycopyrolate & neostigmine,just before extubation. repeated dc shocks , corderone, CPR required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most likely cause. ( post resuscitation ECG, 2D Echocardiography within normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications developed hypokalemia? Any suggestions?
-- Terry Webber, MD, JD Anesthesiology 12600 Braddock Drive, C-205 Los Angeles, CA 90066 Phone: 720 490 6824
Fax: 310 733 1770
Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note.
From: aikoonpek <aikoonpek@...> To: "Anesthideas@yahoogroups.com" <Anesthideas@yahoogroups.com> Cc: "Anesthideas@yahoogroups.com" <Anesthideas@yahoogroups.com> Sent: Mon, November 16, 2009 5:51:09 AM Subject: [ai] Syringomyelia
syrinx c1-c3 13y male for decompression
would you allow the patient's temperature to drop intraoperatively, and rewarm at 34deg c?
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in the way suggested in this note.
The stress of cardiac arrest leading to massive release of catecholamines plus potential exogenous administration of epinephrine
may lead to hypokalemia, but this is a result of the cardiac arrest/VF, not the cause (catecholamines cause potassium to shift intracellularly, this is used in treatment of hyperkalemia by administering beta-stimulants such as albuterol).
Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
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From: Ivan Hronek <ivanhronek@...> To: "Anesthideas@yahoogroups.com" <Anesthideas@yahoogroups.com> Sent: Mon, November 16, 2009 7:41:41 AM Subject: Re: [ai] Unexplained hypokalemia leading to arrythmia
Post-CPR potassium are typically off and often appear to be the cause of arrhythmias.
I bet his coronary angio will require an intervention, let us know !
A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All investigations within normal limits.(pre op electrolytes not done) Patient went into ventrcular tacycardia 4 minuts after reversal with glycopyrolate & neostigmine, just before extubation. repeated dc shocks , corderone, CPR required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most likely cause. ( post resuscitation ECG, 2D Echocardiography within normal limits, angiography awaited) Question is why a patient in absence of renal/ GI disturbance or medications developed hypokalemia? Any suggestions?
Post-CPR potassium are typically off and often appear to be the cause of arrhythmias.
I bet his coronary angio will require an intervention, let us know !
Ivan Hronek MD
On Nov 16, 2009, at 7:26 AM, "rjoglekar57" <rjoglekar57@...> wrote:
A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All investigations within normal limits.(pre op electrolytes not done) Patient went into ventrcular tacycardia 4 minuts after reversal with glycopyrolate & neostigmine,just before extubation. repeated dc shocks , corderone, CPR required to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most likely cause. ( post resuscitation ECG, 2D Echocardiography within normal limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications developed hypokalemia? Any suggestions?
A 40 year old male operated for a nodule on vocal cord. ASA grade 1. All
investigations within normal limits.(pre op electrolytes not done) Patient went
into ventrcular tacycardia 4 minuts after reversal with glycopyrolate &
neostigmine,just before extubation. repeated dc shocks , corderone, CPR required
to get sinus sythm. subsequent investigations revealed K+ of 2.2 mEq/L as most
likely cause. ( post resuscitation ECG, 2D Echocardiography within normal
limits, angiography awaited)
Question is why a patient in absence of renal/ GI disturbance or medications
developed hypokalemia? Any suggestions?
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note.
Anyone knows the cost of this ? What do you think about it ?
Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
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Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note.
Any members utilize massive transfusion protocols ? What's yur experience with them ?
Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying, using, or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept our apologies and notify me at ivanhronek@... and delete the entire message and its attachments. Thank you. Disclaimer: this message contains the personal views of the author. The author will not be responsible in any way for procedures or approaches performed in the way suggested in this note.