Perioperative management of a patient with various ECG abnormalities following subdural hematoma.
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A 51-years-old man was admitted with loss of consciousness. In the emergency room he regained consciousness. A computerized axial tomography (CT) of the head showed no abnormal shadow. Electrocardiogram (ECG) changes of the patient was suggestive of myocardial infarction and ventricular pacing was required due to complete atrio-ventricular block. However, a cardiac evaluation, including coronary angiography, echocardiogram, and cardiac isoenzyme determinations, showed no apparent evidence of acute transmural myocardial infarction. As he lost consciousness again, the second CT of the head, 6 hours after admission, revealed right subdural hematoma and right intracerebral (frontal lobular) hematoma. Because the cardiac evaluation denied myocardial infarction, he underwent general anesthesia with fentanyl and thiopental for the urgent operative treatment of his hematoma. Although his intraoperative and post operative courses were uneventful, various types of arrhythmias, including A-V block, premature ventricular cotractions, and atrial fibrillation, were observed.When ECG abnormalities are present, it is necessary to differentiate neurogenic from cardiogenic ECG changes. In case of neurogenic ECG changes, left ventricular pump function might be preserved mostly. But recent studies demonstrated focal myocytolysis occurs with subarachnoid hemorrhage. Therefore, careful monitorings of arrhythmia and hemodynamic status are mandatory in this kind of case.
- 日本臨床麻酔学会の論文
日本臨床麻酔学会 | 論文
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