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Báo cáo y học: "Asystole following positive pressure insufflation of right pleural cavity: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Asystole following positive pressure insufflation of right pleural cavity: a case report. | Forde-Thielen and Konia Journal of Medical Case Reports 2011 5 257 http www.jmedicalcasereports.eom content 5 1 257 JOURNALOF medical case reports CASE REPORT Open Access Asystole following positive pressure insufflation of right pleural cavity a case report Kari M Forde-Thielen and Mojca R Konia Abstract Introduction Adverse hemodynamic effects with severe bradycardia have been previously reported during positive pressure insufflation of the right thoracic cavity in humans. To the best of our knowledge this is the first report of asystole during thoracoscopic surgery with positive pressure insufflation. Case presentation A 63-year-old Caucasian woman developed asystole at the onset of positive pressure insufflation of her right hemithorax during a thoracoscopic single-lung ventilation procedure. Immediate deflation of pleural cavity intravenous glycopyrrolate and atropine administration returned her heart rhythm to normal sinus rhythm. The surgery proceeded in the absence of positive pressure insufflation without any further complications. Conclusions We discuss the proposed mechanisms of hemodynamic instability with positive pressure thoracic insufflation and anesthetic and insufflation techniques that decrease the likelihood of adverse hemodynamic events. Introduction Hemodynamic consequences of pleural cavity positive pressure insufflation during thoracoscopic procedures have been described in the literature. While some of these reports show minimal clinically significant effects others show serious hemodynamic consequences. One potentially severe complication asystole has not previously been reported. We present the case of a female patient who underwent right thoracoscopic mediastinal lymph node dissection with one-lung ventilation and developed hypotension and asystole at the commencement of positive pressure insufflation of her right hemithorax. We discuss the proposed mechanisms for the development of hemodynamic changes and asystole as well as ways in .