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Gaiser RR, Demetry DJ, Schlosser R. Ventricular Tachycardia as an Electrocardiography Artifact during Functional Endoscopic Sinus Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240301700203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Functional endoscopic sinus surgery is frequently performed during conscious sedation not provided by an anesthesiologist. Several monitors are used during conscious sedation, one of which is the electrocardiogram (EKG). Equipment used in the operating room may interfere with the EKG tracing. Methods A 30-year-old man underwent his fourth functional endoscopic sinus surgery during general anesthesia. For the procedure, a Xomed Straight Shot microdebrider was used. Results Because of stray electrical current, the use of the microdebrider caused the EKG waveform to resemble ventricular tachycardia. Conclusion This case alerts the clinician to this possible occurrence to prevent inappropriate therapeutics from being initiated.
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Affiliation(s)
| | | | - Rodney Schlosser
- Departments of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
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Sideris G, Magkoutis N, Sharma A, Rees J, McKnite S, Caldwell E, Sarraf M, Henry P, Lurie K, Garcia S, Yannopoulos D. Early coronary revascularization improves 24h survival and neurological function after ischemic cardiac arrest. A randomized animal study. Resuscitation 2013; 85:292-8. [PMID: 24200891 DOI: 10.1016/j.resuscitation.2013.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/05/2013] [Accepted: 10/15/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes. METHODS Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5min, VF was induced and left untreated for 8min. If return of spontaneous circulation (ROSC) was achieved within 15min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45min (group A) or 4h (group B) of LAD occlusion. Animals without ROSC after 15min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. RESULTS Early compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p=0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. CONCLUSIONS Early reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.
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Affiliation(s)
- Georgios Sideris
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France.
| | - Nikolaos Magkoutis
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France
| | - Alok Sharma
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Jennifer Rees
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Scott McKnite
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Emily Caldwell
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Mohammad Sarraf
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Patrick Henry
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France
| | - Keith Lurie
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Santiago Garcia
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
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Comparative study of nifekalant versus amiodarone for shock-resistant ventricular fibrillation in out-of-hospital cardiopulmonary arrest patients. J Cardiovasc Pharmacol 2010; 55:391-8. [PMID: 20147846 DOI: 10.1097/fjc.0b013e3181d3dcc7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND In Japan, intravenous nifekalant (NIF) was often used for direct current cardioversion-resistant ventricular fibrillation (VF), until the use of intravenous amiodarone (AMD) was approved in 2007. The defibrillatory efficacy of NIF and AMD has thus far not been compared for resuscitation. METHODS AND RESULTS Between August 2007 and April 2009, 403 consecutive out-of-hospital patients with cardiopulmonary arrest were transferred to the Emergency Medical Service of Tokai University. Of these, 30 patients with first defibrillation failure or VF recurrence were enrolled for this NIF/AMD study. The final defibrillation success (and hospital survival rate) was 67% (10/15) in the AMD and 47% (7/15) in the NIF group. The discharge survival rate was 53% (8/15) in the AMD and 21% (4/15) in the NIF group (P = 0.06). Notably, all 4 survivors in the NIF group could take up normal daily life again, whereas this was restricted to only 2 patients from the 11 survivors in the AMD group. The difference is probably partly attributable to longer time from AMD administration to defibrillation success compared with NIF. In the cases of defibrillation failure, VF continued in 4/8 by NIF, however, asystole or pulseless electrical activity occurred in 4/5 patients by AMD. CONCLUSIONS AMD may be borderline superior over NIF to facilitate defibrillation in out-of-hospital patients with cardiopulmonary arrest. However, from the view point of preservation of brain function, NIF is not inferior to AMD for CPR.
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Barrueto F, Chuang A, Cotter BW, Hoffman RS, Nelson LS. Amiodarone Fails to Improve Survival in Amitriptyline-Poisoned Mice. Clin Toxicol (Phila) 2009. [DOI: 10.1081/clt-53076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Effects of amiodarone in a swine model of nortryptiline toxicity. J Med Toxicol 2006; 2:147-51. [DOI: 10.1007/bf03161182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Shah RR, Hondeghem LM. Refining detection of drug-induced proarrhythmia: QT interval and TRIaD. Heart Rhythm 2005; 2:758-72. [PMID: 15992736 DOI: 10.1016/j.hrthm.2005.03.023] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2005] [Accepted: 03/27/2005] [Indexed: 01/10/2023]
Abstract
QT interval prolongation is so frequently associated with torsades de pointes (TdP) that it has come to be recognized as a surrogate marker of this unique tachyarrhythmia. However, not only does TdP not always follow QT interval prolongation, but TdP can occur even in the absence of a prolonged QT interval. Worse still, even shortening of the QT interval may be associated with serious arrhythmias (particularly ventricular tachycardia [VT] and ventricular fibrillation [VF]). It appears increasingly probable that the distinction between various ventricular tachyarrhythmias may be arbitrary, and drug-induced TdP, polymorphic VT, VT, catecholaminergic polymorphic VT, and VF may represent discrete entities within a spectrum of drug-induced proarrhythmia. Although they are differentiated by the coupling interval and the duration of QT interval, they appear to share a common substrate: a set of disturbances of repolarization characterized by Triangulation, Reverse use dependency, electrical Instability of the action potential, and Dispersion (TRIaD). It is becoming increasingly evident that augmentation of TRIaD, rather than changes in the duration of QT interval, provides the proarrhythmic substrate. In contrast, when not associated with an increase of TRIaD, QT interval prolongation can be an antiarrhythmic property. Electrophysiologically, augmentation of TRIaD can be explained by inhibition of hERG (human ether-a-go-go related gene) channel. Because drug-induced disturbances in repolarization commonly result from inhibition of hERG channels or I(Kr), hERG blockade and the resulting prolongation of QT interval are important properties of a drug to be studied. However, these need only be a concern if associated with TRIaD. More significantly, TRIaD so often precedes prolongation of action potential duration or QT interval and ventricular tachyarrhythmias that it should be considered a marker of proarrhythmia until proven otherwise, even in the absence of QT interval prolongation. Detecting drug-induced augmentation of TRIaD may offer an additional, more sensitive, and accurate indicator of the broader proarrhythmic potential of a drug than may QT interval prolongation alone.
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Affiliation(s)
- Rashmi R Shah
- Medicines and Healthcare Products Regulatory Agency, London, UK.
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Petr P, Verner M, Van Wyk CJ, Koeleman HA, Svítil P, Kalová H. Amiodarone - excellent antiarrhythmic drug? (Happy end after 40 years of problems). J Appl Biomed 2003. [DOI: 10.32725/jab.2003.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
The complications of failure, neural injury and local anaesthetic toxicity are common to all regional anaesthetic techniques, and individual techniques are associated with specific complications. All potential candidates for regional anaesthesia should be thoroughly evaluated and informed of potential complications. Central neural blockades still account for more than 70% of regional anaesthesia procedures. Permanent neurological injury is 0.02-0.07%. Pain on injection and paraesthesias while performing regional anaesthesia are danger signals of potential injury and must not be ignored. The incidence of systemic toxicity to local anaesthetics has significantly decreased in the past 30 years, from 0.2 to 0.01%. Peripheral nerve blocks are associated with the highest incidence of systemic toxicity (7.5 per 10,000) and the lowest incidence of serious neural injury (1.9 per 10,000).
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Affiliation(s)
- B Cox
- Department of Anesthesiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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