Anesthetic Management of a Patient with Congenital Long QT Syndrome

Long QT syndrome is characterized by syncope and fatal ventricular arrhythmia or fibrillation at an young age. A 25-year-old female patient with congenital Long QU syndrome (Jervell and Lange-Nielsen syndrome) was scheduled for cochlea implantation due to congenital deafness. During anesthetic induction, maintenance, and emergence of these patients, cardiac arrests have been reported, which may be due to asymmetrical adrenergic stimuli in the heart, especially in unrecognized cases. Beta blocker is the first-line therapeutic drug for long QT syndrome. However, there is a controversy with regard to which anesthetics are safe for the management of patients with long QT syndrome. This case report describes an anesthetic management of a patient with congenital long QT syndrome who was treated with beta blocker.ope

Comparison Between a Fentanyl and Clonidine Admixture to Lidocaine in a Brachial Plexus Block

Background: The admixture of clonidine or fentanyl to 1.5% lidocaine for brachial plexus block was studied with regard to onset and duration of anesthesia and postoperative analgesia after a brachial plexus blockade. Methods: Thirty patients (ASA I-II) undergoing surgery of the forearm and hand under an interscalene brachial plexus blockade (BPB) were included in this study. Patients were randomly divided into 3 groups. BPB was performed using 40 ml of 1.5% lidocaine added epinephrine 1：200,000 in group E, 1μg/kg of fentanyl in group F, and 2μg/kg of clonidine in group C, respectively. The onset times of blockade in the radial, ulnar, median and musculocutaneous nerve were recorded. Hemodynamic data and sedation scores were monitored. Finally, the duration of the sensory block was assessed. A value of P ＜ 0.05 was considered as statistically significant. Results: The clonidine group was shorter in onset time, decreased need for postoperative analgesia and increased analgesic duration than other groups but more sedated than group E. With the admixture of fentanyl, pain scores were lower at 180 and 210 min after the block (VAS: mean 2, 8) than with epinephrine (VAS: mean 27, 30 respectively). Hemodynamic changes were not significantly different in all groups. Conclusions: The addition of clonidine to 1.5% lidocaine causes a rapid onset of analgesia and prolonged duration of sensory blockade in the brachial plexus blockade when compared to the addition of epinephrine or fentanyl to 1.5% lidocaine.ope

Discharge decision-making by intensivists on readmission to the intensive care unit

Patients readmitted to the intensive care unit (ICU) have a significantly higher mortality rate. The role of intensivists in judging when to discharge patients from the ICU is very important. We undertook this study to evaluate the effect of the intensivists' discharge decision-making on readmission to ICU. The intensivists actively participated in the discharge decision-making, with the discharge guideline taken into consideration, in respect of group 1 patients, but not in respect of group 2. The readmission rate in group 1 was lower than that in group 2. The readmission in patients in each group was associated with higher mortality rates and longer lengths of stay at the ICU. Respiratory failure was the major cause of readmission. In the non-survivors out of the readmitted patients, the Acute Physiology and Chronic Health Evaluation (APACHE) scores on the initial discharge and readmission, the multiple organ dysfunction syndrome (MODS) scores on the initial admission, discharge and readmission were higher than the corresponding indices in the survivors. We conclude that the readmission rate was lower when intensivists participated in the discharge decision-making, and that APACHE and MODS scores on the first discharge and readmission were significant prognostic factors in respect of the readmitted patients.ope