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Shionoya Y, Hirayama K, Saito K, Kawasaki E, Kantake Y, Okamoto H, Goi T, Sunada K, Nakamura K. Anesthetic Management of a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia. Anesth Prog 2022; 69:24-29. [PMID: 35849806 DOI: 10.2344/anpr-68-04-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/23/2021] [Indexed: 11/11/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic disorder induced by adrenergic stress. Electrophysiologically, it is characterized by emotional stress- or exercise-induced bidirectional ventricular tachycardia that may result in cardiac arrest. Minimizing perioperative stress is critical as it can reduce fatal arrhythmias in patients with CPVT. Dexmedetomidine (DEX), a centrally acting sympatholytic anesthetic agent, was used in the successful intravenous (IV) moderate sedation of a 27-year-old female patient with CPVT, a history of cardiac events, and significant dental fear and anxiety scheduled to undergo mandibular left third molar extraction. Oral surgery was successfully performed under DEX-based IV sedation to reduce stress, and no arrhythmias were observed. IV sedation with DEX provided a sympatholytic effect with respiratory and cardiovascular stability in this patient with CPVT who underwent oral surgery.
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Affiliation(s)
- Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Kaoru Hirayama
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Kaho Saito
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Eriko Kawasaki
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Yoko Kantake
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Hazuki Okamoto
- Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry, Tokyo, Japan
| | - Takahiro Goi
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry, Tokyo, Japan
| | - Kiminari Nakamura
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
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Fujii E, Tanaka-Mizuno S, Fujino K, Fujii M, Furuno M, Sugimoto Y, Takabuchi S, Eguchi Y. Dexmedetomidine attenuates the positive chronotropic effects of intravenous atropine in patients with bradycardia during spinal anaesthesia: a retrospective study. JA Clin Rep 2018; 4:70. [PMID: 32025962 PMCID: PMC6966934 DOI: 10.1186/s40981-018-0207-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/21/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Dexmedetomidine is a sedative used during spinal anaesthesia. However, it frequently induces bradycardia. Although intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives. METHODS We examined the effects of atropine used for treating bradycardia during spinal anaesthesia among patients receiving dexmedetomidine (D group), propofol (P group), or neither (nonDnonP group) for sedation, retrospectively. RESULTS A total of 108 patients were included. Heart rate was significantly slower at all time points in the D group (n = 69) than in the nonDnonP group (n = 14) (p < 0.025 for all). On the other hand, heart rate was significantly slower only 60 min after administration of atropine in the P group (n = 25) than in the nonDnonP group (p = 0.002). There were differences in the overall values of heart rate (including all the values from time 0 to 60 min) among the three groups (p = 0.026). CONCLUSIONS The positive chronotropic effects of atropine might be attenuated with the use of dexmedetomidine or propofol during spinal anaesthesia. Although atropine may be administered when bradycardia occurs, a dose of atropine might result in an insufficient effect against the bradycardia. The sufficient number of subjects may change the results of the investigation, and large-scale randomised controlled trials will be necessary.
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Affiliation(s)
- Emi Fujii
- Department of Critical and Intensive Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu-shi, Shiga, 527-8505, Japan.
| | - Sachiko Tanaka-Mizuno
- Department of Medical Statistics, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu-shi, Shiga, 527-8505, Japan
| | - Kazunori Fujino
- Department of Critical and Intensive Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu-shi, Shiga, 527-8505, Japan
| | - Masashi Fujii
- Department of Anaesthesiology, Nagahama Red Cross Hospital, 14-7 Miyamae-cho, Nagahama-shi, Shiga, 526-8585, Japan
| | - Masae Furuno
- Department of Anaesthesiology, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga, 522-8539, Japan
| | - Yasushi Sugimoto
- Department of Anaesthesiology, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga, 522-8539, Japan
| | - Satoshi Takabuchi
- Department of Anaesthesiology, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga, 522-8539, Japan
| | - Yutaka Eguchi
- Department of Critical and Intensive Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu-shi, Shiga, 527-8505, Japan
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Khandelwal A, Kumar N. Sustained intraoperative bradycardia revealing Sengers syndrome. Indian J Anaesth 2018; 62:86. [PMID: 29416160 PMCID: PMC5787901 DOI: 10.4103/ija.ija_706_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ankur Khandelwal
- Department of Neuroanaesthesiology and Critical Care, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Kumar
- Department of Neuroanaesthesiology and Critical Care, CN Centre, All India Institute of Medical Sciences, New Delhi, India
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Chen Z, Liu L, Tu J, Qin G, Su W, Geng X, Chen X, Wu H, Pan W. Improvement of atropine on esophagogastric junction observation during sedative esophagogastroduodenoscopy. PLoS One 2017; 12:e0179490. [PMID: 28654639 PMCID: PMC5487030 DOI: 10.1371/journal.pone.0179490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/31/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Although sedation esophagogastroduodenoscopy (EGD) is now widely used, previous research has reported that sedation during EGD exhibits a negative effect on esophagogastric junction (EGJ) exposure. Atropine might improve EGJ exposure, as noted in clinical practice. The aim of this study was to examine whether sedation had a negative effect on EGJ observation in the Chinese population, and whether atropine had some ability to act as an antidote to this unexpected secondary effect of sedation. PATIENTS AND METHODS In this cross-sectional study, subjects were divided into the following three groups according to the methods of EGD examination: the non-sedation group, the propofol-fentanyl combined sedation group and the combined sedation with atropine administration group. The EGJ observation was assessed by a key photograph taken with the endoscopic camera 1 cm from the EGJ, which was rated on the following four-degree scale: excellent (score = 4), good (score = 3), fair (score = 2) and poor (score = 1). RESULTS The EGJ exposure was better in the sedation group administered atropine (score = 2.64±1.05) than in the sedation group (score = 1.99±1.08, P<0.05) but not as good as in the non-sedation group (score = 3.24±1.12, P<0.05). Reduced detection of EGJ diseases in the sedation group was also found, compared to the non-sedation group (P<0.05). Only the use of atropine (OR = 2.381, 95%CI: 1.297-4.371, P = 0.005) was independently associated with excellent observation of the EGJ during sedation EGD. CONCLUSIONS Combined propofol-fentanyl sedation reduces the extent of exposure of the EGJ during EGD and reduces the detection of EGJ diseases. The application of atropine in the sedation endoscopy examination helped to achieve better EGJ observation, but still cannot achieve an equal extent of exposure compared to non-sedation EGD.
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Affiliation(s)
- Zhihao Chen
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingang Liu
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Gastroenterology, Longsai Hospital, Ningbo, China
| | - Jiangfeng Tu
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Guangming Qin
- Department of Laboratory, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weiwei Su
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoge Geng
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaojun Chen
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongguang Wu
- Department of Gastroenterology, Quzhou Second People's Hospital, Quzhou, China
| | - Wensheng Pan
- Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou, China
- * E-mail:
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Computational Depth of Anesthesia via Multiple Vital Signs Based on Artificial Neural Networks. BIOMED RESEARCH INTERNATIONAL 2015; 2015:536863. [PMID: 26568957 PMCID: PMC4621366 DOI: 10.1155/2015/536863] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
This study evaluated the depth of anesthesia (DoA) index using artificial neural networks (ANN) which is performed as the modeling technique. Totally 63-patient data is addressed, for both modeling and testing of 17 and 46 patients, respectively. The empirical mode decomposition (EMD) is utilized to purify between the electroencephalography (EEG) signal and the noise. The filtered EEG signal is subsequently extracted to achieve a sample entropy index by every 5-second signal. Then, it is combined with other mean values of vital signs, that is, electromyography (EMG), heart rate (HR), pulse, systolic blood pressure (SBP), diastolic blood pressure (DBP), and signal quality index (SQI) to evaluate the DoA index as the input. The 5 doctor scores are averaged to obtain an output index. The mean absolute error (MAE) is utilized as the performance evaluation. 10-fold cross-validation is performed in order to generalize the model. The ANN model is compared with the bispectral index (BIS). The results show that the ANN is able to produce lower MAE than BIS. For the correlation coefficient, ANN also has higher value than BIS tested on the 46-patient testing data. Sensitivity analysis and cross-validation method are applied in advance. The results state that EMG has the most effecting parameter, significantly.
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