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Ghosh A, Ninave S. Intraoperative Challenge: Managing Venous Air Embolism During Sitting Craniotomy. Cureus 2024; 16:e61484. [PMID: 38952595 PMCID: PMC11215929 DOI: 10.7759/cureus.61484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
Venous air embolism (VAE) represents a rare yet potentially life-threatening complication encountered during neurosurgical procedures, particularly craniotomy. Here, we present a case of a 30-year-old male undergoing excision of a cerebellar abscess who developed VAE midway through the procedure. Immediate recognition and intervention were paramount in managing the embolism effectively, ensuring a favorable surgical outcome. Vigilant monitoring, prompt cessation of the procedure, and implementation of preventive measures such as oxygen therapy and venous air aspiration were pivotal in mitigating the embolism's effects. This study underscores the critical importance of intraoperative vigilance, preparedness, and multidisciplinary teamwork in addressing rare but potentially catastrophic complications during neurosurgical interventions.
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Affiliation(s)
- Angan Ghosh
- Anaesthesia, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sanjot Ninave
- Anaesthesia, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Türk CÇ, Gediz T, Mutlucan UO, Konak Y, Duman ZN, Sügür T. Unexpected Bradycardia Related to Surgical Manipulation During Thoracolumbar Spinal Surgery. World Neurosurg 2023; 175:e1277-e1282. [PMID: 37146877 DOI: 10.1016/j.wneu.2023.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although spinal surgery can offer pain relief and functional improvements in daily life, it is often associated with various perioperative complications. The incidence of cardiac complications associated with spinal surgery is relatively low. We evaluated frequency and causes for bradycardia incidents in posterior thorocolumbar spinal surgeries. METHODS We retrospectively evaluated posterior thoracolumbar spinal surgeries between 2018-2022 for bradycardic events in our tertiary general hospital. Patients operated for degenerative changes or disk herniations are included, other cases for tumors, trauma, arteriovenous (AV) fistulae or previously operated are excluded. RESULTS The study reached 6 eligible patients (4 female and 2 male) aged between 45-75 years (mean: 63.3) among 550 patients operated between 2018-2022. The rate of bradycardia was 1.09%. Of these, 5 patients (lumbar discectomy: one; posterior stabilization:4) exhibited it following L2 and L3 root manipulation and one presented it following L4-5 discectomy. In each of these cases, bradycardia occurred during surgical manipulation and ceased upon removal of the insult. None of the cases exhibited accompanying hypotension. The patient's heart rates were seen to drop to lowest the of 30 beats/min, and all patients exhibited favorable outcomes and no postoperative cardiac complications over a mean follow-up period of 20 months (range: 10-40 months). CONCLUSIONS The current study examines the occurrence of unexpected bradycardia events associated with thoracolumbar spinal surgery during surgical handling of the dura mater. Awareness of such incidents among surgeons and anesthesiologists can help prevent catastrophic outcomes caused by adverse cardiac events.
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Affiliation(s)
- Cezmi Çağrı Türk
- Department of Neurosurgery, University of Health Sciences, Istanbul, Turkey; Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey.
| | - Tolga Gediz
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Umut Ogün Mutlucan
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Yusuf Konak
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Zeynep Nur Duman
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Tayfun Sügür
- Antalya Training and Research Hospital, Anesthesiology Clinic, Antalya, Turkey
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Sultan KA, Ashraf M, Chaudhary A, Al Salloum L, Ghulam N, Ahmed N, Ismahel H, Farooq M, Iqbal J, Ashraf N. Negative Chronotropic Cardiovascular Changes in Lumbar Spine Surgery: A Potential Spinal-Cardiac Reflex? Asian J Neurosurg 2023; 18:404-409. [PMID: 37397037 PMCID: PMC10313433 DOI: 10.1055/s-0043-1769894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Cardiovascular changes following lumbar spine surgery in a prone position are exceedingly rare. Over the past 20 years, a total of six cases have been published where patients experienced varying degrees of bradycardia, hypotension, and asystole, which could be attributed to intraoperative dural manipulation. As such, there is emerging evidence for a potential neural-mediated spinal-cardiac reflex. The authors report their experience of negative chronotropy during an elective lumbar spine surgery that coincided with dural manipulation and review the available literature. A 34-year-old male presented with a long-standing history of lower back pain recently deteriorating to bilaterally radiating leg pain, with restricted left leg raise, and numbness at the left L5 dermatomal territory. The patient was an athletic police officer with no comorbidities or past medical history. Magnetic resonance imaging lumbosacral spine revealed spinal stenosis most pronounced at L4/L5 and disc bulges at L3/L4 and L5/S1. The patient opted for lumbar decompression surgery. After an unremarkable comprehensive preoperative workup, including cardiac evaluation (electrocardiogram, echocardiogram), the patient was induced general anesthesia in a prone position. A lumbar incision was made from L2 to S1. When the left L4 nerve root was retracted while removing the prolapsed disc at L4/L5, the anesthetist cautioned the surgeon of bradycardia (34 beats per minute [bpm]), and the surgery was immediately stopped. The heart rate improved to 60 bpm within 30 seconds. When the root was later retracted again, a second episode of bradycardia occurred for 4 minutes with heart rate declining to 48 bpm. The surgery was stopped, and after 4 minutes, the anesthetist administered 600 µg of atropine. The heart rate then rose to 73 bpm within 1 minute. Other potential causes for bradycardia were excluded. The total blood loss was estimated to be 100 mL. He remains well at his 6-month follow-up and has returned to work as normal. Akin to previously published cases, each episode of bradycardia coincided with dural manipulation, which may indicate a possible reflex between the spinal dura mater and the cardiovascular system. Such a rare adverse event may occur even in seemingly healthy, young individuals, and anesthetists should caution the operating surgeon of bradycardias to exclude operative manipulation of the dura as the cause. While this phenomenon is only reported in a handful of lumbar spine surgery cases, it provides evidence for a potential spinal-cardiac physiological reflex in the lumbar spine that may be neural mediated and should be investigated further.
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Affiliation(s)
- Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Attika Chaudhary
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Laulwa Al Salloum
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Naseeruddin Ghulam
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Nazir Ahmed
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Hassan Ismahel
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Geoghegan AC, Leonard IE. Intraoperative cardiac arrest in the lateral position: Is rapid repositioning always necessary? Anaesth Intensive Care 2023; 51:217-218. [PMID: 36883441 DOI: 10.1177/0310057x221129631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
| | - Irene E Leonard
- Department of Anaesthesia, Beaumont Hospital, Dublin 9, Ireland
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Yamamura K, Kiriu N, Tomura S, Kawauchi S, Murakami K, Sato S, Saitoh D, Yokoe H. The cause of acute lethality of mice exposed to a laser-induced shock wave to the brainstem. Sci Rep 2022; 12:9490. [PMID: 35676447 PMCID: PMC9177849 DOI: 10.1038/s41598-022-13826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Air embolism is generally considered the most common cause of death within 1 h of a blast injury. Shock lung, respiratory arrest, and circulatory failure caused by vagal reflexes contribute to fatal injuries that lead to immediate death; however, informative mechanistic data are insufficient. Here we used a laser-induced shock wave (LISW) to determine the mechanism of acute fatalities associated with blast injuries. We applied the LISW to the forehead, upper neck, and thoracic dorsum of mice and examined their vital signs. Moreover, the LISW method is well suited for creating site-specific damage. Here we show that only mice with upper neck exposure, without damage elsewhere, died more frequently compared with the other injured groups. The peripheral oxygen saturation (SpO2) of the former mice significantly decreased for < 1 min [p < 0.05] but improved within 3 min. The LISW exposure to the upper neck region was the most lethal factor, affecting the respiratory function. Protecting the upper neck region may reduce fatalities that are related to blast injuries.
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Affiliation(s)
- Koji Yamamura
- Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan.
| | - Nobuaki Kiriu
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.,Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Tomura
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Satoko Kawauchi
- Division of Bioinformation and Therapeutic Systems, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kaoru Murakami
- Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shunichi Sato
- Division of Bioinformation and Therapeutic Systems, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.,Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hidetaka Yokoe
- Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan
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Agarwal A, Mittal G, Garg R, Rathi A. Trigeminocardiac reflex during maxillary third molar extraction: Our experience. Natl J Maxillofac Surg 2022; 13:311-314. [PMID: 36051807 PMCID: PMC9426688 DOI: 10.4103/njms.njms_260_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 12/04/2022] Open
Abstract
Trigeminocardiac reflex (TCR) is a cascade of physiological response secondary to the stimulation of any of the sensory divisions of the trigeminal nerve, which is the largest cranial nerve and provides sensory supply to the face, scalp, mucosa of the nose, and mouth. This response usually presents as a triad including bradycardia, apnea, and gastric motility changes. On the another side, transient loss of consciousness or vasovagal syncope, a well-known phenomenon in dentomaxillofacial surgery with its pathophysiology fully elucidated, is thought to be mediated by TCR and sometimes termed as dentocardiac reflex. Thus, it is imperative to know about TCR and its association with routine dental and maxillofacial surgery procedures. It can potentially happen during any minor or major oral surgical procedures ranging from simple third molar extractions, soft tissue surgeries, root canal treatments, or management of maxillofacial fractures. This paper presents two case reports demonstrating TCR which presented during maxillary third molar extraction and author(s) own experience in managing the same.
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Hajimohammadebrahim-Ketabforoush M, Shahmohammadi M, Keikhaee M, Eslamian G, Vahdat Shariatpanahi Z. Single high-dose vitamin D3 injection and clinical outcomes in brain tumor resection: A randomized, controlled clinical trial. Clin Nutr ESPEN 2021; 41:153-159. [PMID: 33487259 DOI: 10.1016/j.clnesp.2020.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND & AIMS Vitamin D is known as a neuroprotective hormone with anti-inflammatory and immune-modulatory properties. We evaluated the effect of vitamin D3 injection on vitamin D status and clinical outcomes in patients with low serum levels of 25-hydroxyvitamin D [25(OH)D] undergoing craniotomy for brain tumor resection. METHODS Patients with benign brain tumors and serum 25(OH)D levels ≤20 ng/mL were randomized to two groups with an equal number of subjects. The study group (n = 30) received intramuscular injection of 300,000 IU vitamin D3 prior to surgery. The control group (n = 30) was left without intervention, and both groups underwent routine therapies. RESULTS On day 5 after craniotomy, the serum 25(OH)D levels increased significantly in the study group (P= <0.001). The length of ICU and hospital stay was significantly lower in the study group compared to the control group (P = 0.01 and P = 0.008, respectively). It was true when the age, tumor size, tumor type, Karnofsky Performance Scale (KPS) score, and calcium and albumin levels at baseline entered the logistic regression model (OR = 0.17 (95%CI = 0.04-0.72, P = 0.01), and OR = 0.19 (95%CI = 0.04-0.82, P = 0.02), respectively). With and without the application of logistic regression analysis, there was no significant difference in perioperative complications. CONCLUSIONS Intramuscular injection of 300,000 IU of vitamin D3 in patients with low serum levels of 25(OH)D undergoing craniotomy, could rise safely the serum 25(OH)D level. This intervention, significantly reduced the length of ICU stay and hospitalization. REGISTERED UNDER Clinicaltrials.gov.identifier no: NCT03248544. Date: 8/14/2017.
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Affiliation(s)
- Melika Hajimohammadebrahim-Ketabforoush
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Keikhaee
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Eslamian
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ahmed SS, Ejaimi GAM, Yousif AIA. Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cardiac arrest during surgery is rare but is one of the most dreaded complications. Precordial thump (PT) had been used for a long time, but in the present day it has become obsolete. In regard to the witnessed onset of asystole, there is insufficient evidence to recommend for or against the use of the PT. This case report is of a 17-year-old male who presented to hospital with a congenital haemangioma on the right calf. He had no other significant medical conditions and was on no other medications. The patient history, clinical examination, and investigations were normal. He had undergone an operation 3 weeks previously where a section of his haemangioma was excised, and an appointment was made for excision of the remaining haemangioma. Anaesthesia induction and endotracheal intubation were smooth and uneventful. Following lifting and exsanguination of the patient’s leg by Esmarch bandage, he developed ventricular fibrillation and arrested with asystole. Cardiopulmonary resuscitation was performed, with no good response, for approximately 50 minutes. Lastly, a PT was performed, and the patient’s heart rate immediately returned. The operation was postponed. Postresuscitation care was conducted in an intensive care unit. The patient was later discharged without complications.
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Affiliation(s)
| | | | - Areeg Izzeldin Ahmed Yousif
- Department of Anesthesia and Intensive Care, Ahmed Gasim Hospital Heart Surgery and Kidney Transplant Center, Khartoum North, Sudan
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9
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Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/10.33590/emj/20-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cardiac arrest during surgery is rare but is one of the most dreaded complications. Precordial thump (PT) had been used for a long time, but in the present day it has become obsolete. In regard to the witnessed onset of asystole, there is insufficient evidence to recommend for or against the use of the PT. This case report is of a 17-year-old male who presented to hospital with a congenital haemangioma on the right calf. He had no other significant medical conditions and was on no other medications. The patient history, clinical examination, and investigations were normal. He had undergone an operation 3 weeks previously where a section of his haemangioma was excised, and an appointment was made for excision of the remaining haemangioma. Anaesthesia induction and endotracheal intubation were smooth and uneventful. Following lifting and exsanguination of the patient’s leg by Esmarch bandage, he developed ventricular fibrillation and arrested with asystole. Cardiopulmonary resuscitation was performed, with no good response, for approximately 50 minutes. Lastly, a PT was performed, and the patient’s heart rate immediately returned. The operation was postponed. Postresuscitation care was conducted in an intensive care unit. The patient was later discharged without complications.
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Reisener MJ, Shue J, Hughes AP, Sama AA, Emerson RG, Guheen C, Beckman JD, Soffin EM. Hemodynamically significant cardiac arrhythmias during general anesthesia for spine surgery: A case series and literature review. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2020; 2:100010. [PMID: 35141581 PMCID: PMC8819968 DOI: 10.1016/j.xnsj.2020.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022]
Abstract
Although multiple factors have been implicated, our case series highlights SSEP stimulation as a common etiology of arrhythmia. Significant bradycardia and CA during spine surgery does not always require termination of the surgical procedure. Decision making should be undertaken in each case individually based on patient condition and circumstances of each event. Surgeons and anesthesiologists should be aware of and prepared to treat significant cardiac arrhythmias during spine surgery even in otherwise healthy patients without known risk factors.
Background context Hemodynamically significant bradycardia and cardiac arrest (CA) are rare under general anesthesia (GA) for spine surgery. Although patient risks are well defined, emerging data implicate surgical, anesthetic and neurologic factors which should be considered in the immediate management and decision to continue or terminate surgery. Purpose To characterize causes and contributors to significant arrhythmias during spine surgery. We also provide an updated literature review to inform spine care teams and aid in the management of intraoperative bradycardia and CA. Study design Case series and literature review Patient sample Six patients who underwent spine surgery from 03/2016 to 01/2020 at a single institution and developed unexpected hemodynamically significant arrhythmia Outcome measures Our primary outcome was to identify potential risk factors of interest for significant arrhythmia during spine surgery. Methods Medical records of patients who underwent spine surgery from 03/2016 to 01/2020 at a single institution and developed unexpected hemodynamically significant arrhythmia during spine surgery were identified from a departmental Quality Assurance Database. We evaluated the presence/absence of patient, surgical, anesthetic and neurologic risk factors and estimated the most likely etiology of the event, immediate and subsequent management, whether surgery was postponed or continued and outcomes. Results We found a temporal relationship of bradyarrhythmia and CA after somatosensory evoked potential (SSEP) stimulation in 4/6 cases and pharmacy/polypharmacy in 2/6. Surgery was completed in 4/6 patients, and terminated in 2/6 (subsequently completed in both). We found no adverse outcomes in any patients. Our literature review predominately identified case reports for guidance to support decision making. New literaure suggests peripheral nerve blocks and opioid-sparing anesthetic agents should also be considered. Conclusions Significant bradycardia and CA during spine surgery does not always require termination of the surgical procedure. Decision making should be undertaken in each case individually, with an updated awareness of potential causes. The study also suggests the need for large prospective studies to adequately assess incidence, risk factors and outcomes.
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Kim Y, Kim J, Shin SA. Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: A cross-sectional analysis of Korean administrative data. Int J Nurs Stud 2019; 89:104-111. [DOI: 10.1016/j.ijnurstu.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022]
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Lamperti M, Jain A, Dharmalingam S. Neuroanesthesia and Coexisting Cardiac Problems: Acquired. CO-EXISTING DISEASES AND NEUROANESTHESIA 2019:37-62. [DOI: 10.1007/978-981-13-2086-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine. Case Rep Crit Care 2017; 2017:3748930. [PMID: 29158921 PMCID: PMC5660772 DOI: 10.1155/2017/3748930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/06/2017] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF) of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR). Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.
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Factors associated with an increased risk of perioperative cardiac arrest in emergent and elective craniotomy and spine surgery. Clin Neurol Neurosurg 2017; 161:6-13. [DOI: 10.1016/j.clineuro.2017.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/28/2017] [Accepted: 07/23/2017] [Indexed: 11/20/2022]
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Sandu N, Chowdhury T, Meuwly C, Schaller B. Trigeminocardiac reflex in cerebrovascular surgery: a review and an attempt of a predictive analysis. Expert Rev Cardiovasc Ther 2017; 15:203-209. [DOI: 10.1080/14779072.2017.1286983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nora Sandu
- Department of Research, University of Southampton, Southampton, UK
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba (UOM)/Winnipeg Regional Health Authority (WRHA), Winnipeg, Manitoba, Canada
| | | | - Bernhard Schaller
- Department of Research, University of Southampton, Southampton, UK
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
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Chowdhury T, Schaller B. The negative chronotropic effect during lumbar spine surgery: A systemic review and aggregation of an emerging model of spinal cardiac reflex. Medicine (Baltimore) 2017; 96:e5436. [PMID: 28072687 PMCID: PMC5228647 DOI: 10.1097/md.0000000000005436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hemodynamic perturbations in spine surgeries are predominantly reported in cervical and thoracic level procedures. The literature related to negative cardiovascular changes (decrease of heart rate and blood pressure) in lumbar spine procedures is still scarce and only highlighted in few case reports/letters until now. METHODS With the help of a systematic literature review with predefined criteria, we, therefore, examined and synthesized here the probable underlying common cause of these hemodynamic disturbances in lumbar spine surgeries. Data aggregation to a model was done by a case survey method and established by a cause-effect relationship. RESULTS There are only 5 cases that met our strict predefined criteria and that were aggregated to an emergent model of an autonomous reflex arc. CONCLUSION This review and consecutive data aggregation provides, for the first time, a concept of spinal cardiac reflex in lumbar spine surgeries.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bernhard Schaller
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Research, University of Southampton, Southampton, UK
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Chowdhury T, Schaller B. The Role of Acute Trigemino-Cardiac Reflex in Unusual, Non-Surgical Cases: A Review. Front Neurol 2016; 7:186. [PMID: 27833585 PMCID: PMC5080283 DOI: 10.3389/fneur.2016.00186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/11/2016] [Indexed: 11/13/2022] Open
Abstract
Trigemino-cardiac reflex (TCR) is a well-established phenomenon that is mainly reported in the various surgical specialties. However, the role of this unique reflex is entirely unknown in other medicine domains. Therefore, the present mini-review aims to explore the role of TCR in such unusual cases and also highlights the importance of case reports for knowledge creation in such context.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
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An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery. Case Rep Neurol Med 2016; 2016:8930296. [PMID: 27217962 PMCID: PMC4863081 DOI: 10.1155/2016/8930296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.
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