Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.
Animals ; Bradycardia ; complications ; diagnosis ; Ciguatera Poisoning ; complications ; diagnosis ; therapy ; Ciguatoxins ; adverse effects ; Fishes ; Humans ; Hypotension ; complications ; diagnosis ; Male ; Middle Aged

Bradycardia/etiology* ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms/complications*

Bradycardia ; complications ; Carcinoma ; Carotid Sinus ; Head and Neck Neoplasms ; complications ; secondary ; Humans ; Hypotension ; complications ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; complications ; pathology ; Neoplasm Metastasis

Adult ; Angina Pectoris ; etiology ; Aortic Valve Insufficiency ; complications ; Bradycardia ; etiology ; Female ; Heart Valve Prosthesis ; Humans ; Prosthesis Failure

\BACKGROUND: Bupivacaine with fentanyl might be suitable as the spinal anesthesia for performing ambulatory surgery to treat varicose vein. MATERIAL AND METHOD: Thirty patients who underwent spinal anesthesia for a varicose vein operation were enrolled in this study. They were classified into 2 groups of either fentanyl 25 ug mixed with bupivacaine 4 mg (group FB4) or bupivacaine 8 mg (group B8). We compared the groups for the success of the analgesia, the recovery time from sensory and motor block, the side effects and the postoperative complications. RESULT: The groups did not differ significantly regarding the success of analgesia (13 of 15 [group FB4], 15 of 15 [group B8]). None of the patients were converted to general anesthesia due to surgical pain. None of the patients required medication for hypotension and/or bradycardia. The operative and nonoperative side effects of motor block (tested for by using a modified Bromage scale) was significantly lower in group FB4 than that in group B8, as checked at 2 hours after spinal anesthesia (p<0.05). Recovery from spinal block was significantly quicker in group FB4 than that in group B8 (p<0.05). The first voluntary micturition time did not differ significantly (6.5 hours v 4.5 hours [p=0.143]) between the groups, but a nelatone catheter was inserted into 2 of the group B8 patients due to dysuria. CONCLUSION: Adequate intraoperative analgesia and hemodynamic stability and faster mobilization were achieved using bupivacaine 4 mg with fentanyl 25 ug. Low dose spinal anesthesia with fentanyl is suitable for performing ambulatory surgery to treat varicose vein.
Ambulatory Surgical Procedures ; Analgesia ; Anesthesia, General ; Anesthesia, Spinal ; Bradycardia ; Bupivacaine ; Catheters ; Dysuria ; Fentanyl ; Hemodynamics ; Humans ; Hypotension ; Postoperative Complications ; Urination ; Varicose Veins

BACKGROUND: Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in the inguinal and perineal areas. The object of this study was to compare the general (n=55) with caudal anesthesia (n=41) in pediatric inguinal herniorrhaphy during surgery and postoperative 24 hours in their changes of behaviors in the recovery room, and other complications. METHODS: Ninety six children who underwent to inguinal herniorrhaphy were devided into two groups. Group I was given general anesthesia as usual methods using endotracheal intubation. Group II was given caudal block using 1% lidocaine 1 ml/kg or 0.25% bupivacaine 1 ml/kg, or a mixture of both of them at the ratio of 1:1, 1 ml/kg. All caudal blocks were carried out in left lateral position after ketamine 1-1.5 mg/kg intravenous injection. The side effects during and after operation and postoperative behavior in the recovery room, neurologic complications and postoperative fever incidence were observed and compared with the two groups. RESULTS: In group I (n=55), 13 cases (23.6%) showed hoarseness after extubation. 78.2% of 55 patients were irritable and cryng in the recovery room. Postoperative fever incidence was over 69%. In group II (n=41), almost all patients were calm and stayed quiet in the recovery room. However there were 3 cases of bradycardia and 2 cases of hypotension during operation. Postoperative complications were rare and the mumber of patients with fever was 36.6% which was significantly low compared to group I. CONCLUSIONS: As the results of this study, we report that caudal anesthesia is a safe, simple practical method with few complications for inguinal herniorraphy in children compared with general anesthesia. We also recommend that the caudal block can be used safely in pediatric outpatient surgery.
Ambulatory Surgical Procedures ; Analgesia ; Anesthesia, Caudal* ; Anesthesia, General ; Bradycardia ; Bupivacaine ; Child* ; Fever ; Herniorrhaphy* ; Hoarseness ; Humans ; Hypotension ; Incidence ; Injections, Intravenous ; Intubation, Intratracheal ; Ketamine ; Lidocaine ; Postoperative Complications ; Recovery Room

BACKGROUND: New complications associated with sugammadex have been increased since its widespread use. We report a case of an 80-year-old male who experienced profound bradycardia and sustained hypotension after administration of sugammadex. CASE: Following administration of 200 mg sugammadex after laparoscopic cholecystectomy, sudden bradycardia (29 beats/min) developed for 10 seconds and his train-of-four (TOF) ratio remained at 0.2 for 5 min. An additional 200 mg sugammadex was administered and profound bradycardia (21–30 beats/min) and hypotension (60/40 mmHg) developed. Atropine at 0.5 mg was administered, but the effect lasted only 30 s. Profound bradycardia occurred four more times at 30 s intervals, and ephedrine and phenylephrine were injected intermittently to increase the patient's heart rate and blood pressure. The TOF ratio became 0.9 about 10 min after administration of additional sugammadex. CONCLUSIONS: Awareness must be heightened regarding the possibility of sugammadexinduced bradycardia and hypotension, and more attention should be paid to patients with slow recovery times following muscle relaxation, despite the use of sugammadex.
Aged, 80 and over ; Atropine ; Blood Pressure ; Bradycardia ; Cholecystectomy, Laparoscopic ; Ephedrine ; Heart Rate ; Humans ; Hypotension ; Male ; Muscle Relaxation ; Neuromuscular Blockade ; Phenylephrine ; Postoperative Complications

PURPOSE: During carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque. MATERIALS AND METHODS: Thirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque. RESULTS: Nineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively). CONCLUSION: The calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.
Aged ; Angioplasty/*adverse effects ; Bradycardia/complications ; Carotid Arteries/*surgery ; Carotid Stenosis/*physiopathology ; Female ; *Hemodynamics ; Humans ; Hypotension/complications ; Intraoperative Complications/*etiology/radiography ; Intraoperative Period ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Stents ; Tomography, X-Ray Computed

OBJECTIVES: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common operative neurocognitive disorders, which places a heavy burden on patients, families and society. Therefore, it is very important to search for preventive drugs. Previous studies have demonstrated that perioperative use of dexmedetomidine resulted in a decrease the incidence of POD and POCD. But the specific effect of dexmedetomidine on elderly patients undergoing hepatic lobectomy and its potential mechanism are not clear. This study aims to evaluate the efficacy of intraoperative use of dexmedetomidine on preventing POD and POCD in elderly patients undergoing hepatic lobectomy and the influence on the balance between proinflammation and anti-inflammation. METHODS: This trial was designed as a single-center, prospective, randomized, controlled study. One hundred and twenty hospitalized patients from January 2019 to December 2020, aged 60-80 years old with American Society of Anesthesiologists (ASA) II-III and scheduled for hepatic lobectomy, were randomly allocated into 3 groups (n=40) using a random number table: A C group, a Dex1 group, and a Dex2 group. After anesthesia induction, saline in the C group, dexmedetomidine [0.3 μg/(kg·h)] in the Dex1 group, and dexmedetomidine [0.6 μg/(kg·h)] in the Dex2 group were infused until the end of operation. The incidences of hypotension and bradycardia were compared among the 3 groups. Confusion Assessment Method (CAM) for assessing POD and Mini Mental State Examination (MMSE) for evaluating POCD were recorded and venous blood samples were obtained for the determination of neuron specific enolase (NSE), TNF-α, IL-1β, and IL-10 at the different time below: the time before anesthesia (T0), and the first day (T1), the third day (T2), the fifth day (T3), and the seventh day (T4) after operation. RESULTS: Compared with the C group, the incidences of bradycardia in the Dex1 group or the Dex2 group increased (both P<0.05) and there was no difference in hypotension in the Dex1 group or the Dex2 group (both P>0.05). The incidences of POD in the C group, the Dex1 group, and the Dex2 group were 22.5%, 5.0%, and 7.5%, respectively. The incidences of POD in the Dex1 group or the Dex2 group declined significantly as compared to the C group (both P<0.05). However, there is no difference in the incidence of POD between the Dex1 group and the Dex2 group (P>0.05). The incidences of POCD in the C group, the Dex1 group, and the Dex2 group were 30.0%, 12.5%, and 10.0%, respectively. The incidences of POCD in the Dex1 group and the Dex2 group declined significantly as compared to the C group (both P<0.05). And no obvious difference was seen in the incidence of POCD in the Dex1 group and the Dex2 group (P>0.05). Compared with the C group, the level of TNF-α and IL-1β decreased and the level of IL-10 increased at each time points (from T1 to T4) in the Dex1 group and the Dex2 group (all P<0.05). Compared with the Dex1 group, the level of IL-1β at T2 and IL-10 from T1 to T3 elevated in the Dex2 group (all P<0.05). Compared with the T0, the concentrations of NSE in C group at each time points (from T1 to T4) and in the Dex1 group and the Dex2 group from T1 to T3 increased (all P<0.05). Compared with the C group, the level of NSE decreased from T1 to T4 in the Dex1 group and the Dex2 group (all P<0.05). CONCLUSIONS Intraoperative dexmedetomidine infusion can reduce the incidence of POCD and POD in elderly patients undergoing hepatic lobectomy, and the protective mechanism appears to involve the down-regulation of TNF-α and IL-1β and upregulation of IL-10 expression, which lead to rebalance between proinflammation and anti-inflammation.
Aged ; Aged, 80 and over ; Bradycardia ; Cognitive Dysfunction/prevention & control* ; Delirium/prevention & control* ; Dexmedetomidine/therapeutic use* ; Humans ; Hypotension/drug therapy* ; Interleukin-10 ; Middle Aged ; Postoperative Cognitive Complications/prevention & control* ; Postoperative Complications/epidemiology* ; Prospective Studies ; Tumor Necrosis Factor-alpha

Fundoplication is accepted as an effective treatment of gastroesophageal reflux disease. The recent results of laparoscopic fundoplication demonstrated safety and less morbidity, shorter hospital stay and less pulmonary complication compared to the open operation. Laparoscopic fundoplication has been our first choice of operation for gastroesophageal reflux disease since 2003. Among 29 cases, there were 2 conversion cases because of severe distension of transverse colon and hepatomegaly. We studied 27 consecutive patients operated upon from January 2003 through December 2004. There were 15 boys and 12 girls, ages from 1.5 months to 12 years (median 25.3 months). Body weight ranged from 2.9 kg to 37 kg (median 9.8 kg). Neurological abnormalities were present in 23 patients. Indications for surgery included medically refractory reflux associated with vomiting, pneumopathy, otorhinolaryngologic pathology, failure to thrive, esophagitis, apnea and bradycardia. We used 4-5 trocars of 5 mm or 12 mm with 30degrees telescope and performed the Nissen technique in all patients. In neurological impaired patients, gastrostomy tube was placed at the time of fundoplication. Median operative time was 130 minutes (70 . 300 minutes). There was no mortality nor intraoperative complication. Twenty-six patients were followed for median of 19 months (8 . 31 months). Four patients (15.4 %), who were all neurological impaired, developed recurrent symptoms of gastroesophageal reflux disease. Two of these patients had reoperation (1 laparoscopic approach, 1 open method). There were significant increases in body weight in 11 patients after fundoplication. Laparoscopic fundoplication is acceptable as a safe and effective method for gastroesophageal reflux disease.
Apnea ; Body Weight ; Bradycardia ; Child* ; Colon, Transverse ; Esophagitis ; Failure to Thrive ; Female ; Fundoplication* ; Gastroesophageal Reflux* ; Gastrostomy ; Hepatomegaly ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Mortality ; Operative Time ; Pathology ; Reoperation ; Surgical Instruments ; Telescopes ; Vomiting