Effect of intralipid administration on calcium therapy in verapamil toxicity

AIM

Lipid emulsions are promising with regard to the treatment of toxicity by agents of high lipophilic nature. Our objective is to investigate the efficacy of intralipid 20% and calcium administration at different times when symptoms of cardiac toxicity occur during verapamil infusion.

METHOD

24 adult male Spraque-Dawley rats were randomly divided into 4 different groups, the control group, calcium group, calcium following 20% intralipid group and concomitant 20% intralipid and calcium group. Following monitoring under ketamine anesthesia, all groups were administered 37.5 mg kg-1 h-1 verapamil infusion until a 50% decrease occurred in MAPb. At the end of the infusion, verapamil infusion was decreased down to 15 mg kg-1h-1 and the treatment agents predetermined for the groups were administered concomitantly.

RESULTS

There is no statistically significant difference between the administration of 20% intralipid synchronized with calcium or as a pretreatment, but both groups provided a higher survival rate when compared to the other groups.

CONCLUSIONS

The administration of calcium alone in verapamil toxicity is not sufficient; when calcium and 20% intralipid are administered together, there is no difference between the administration of lipid and calcium concomitantly and the administration of lipid prior to calcium (Tab. 1, Fig. 2, Ref. 23).

Peripheral sympathetic block with therapeutic local anesthesia for the manage-ment of upper limb digital ischemia

BACKGROUND

Thromboangiitis obliterans (TAO) is a non-arteriosclerotic segmental inflammatory occlusive vasculitis typically in the upper and lower extremities affecting small- and medium-sized arteries and veins. We present the treatment protocol for TAO involving the use of peripheral sympathetic block through an axillary catheter.

CASE REPORT

An unconscious 56-year-old female patient was transferred to the emergency service, intubated, and mechanically ventilated. The patient was provisionally diagnosed with hypertensive intracranial hematoma and admitted to the intensive care unit. Invasive arterial pressure monitoring was performed through the left radial artery cannula. Four days later, upon the observation of symptoms of a circulatory disorder in the fingers distal of the left and right hands, the cannula was removed from the left radial artery, and another was placed in the left dorsalis pedis artery. At the same time, an 18 Gauge catheter was placed in the axillary perineural sheath bilaterally, and a total of 10 ml lidocaine 0.5 % (5 ml for each side) was injected six times a day. During each injection, the temperature was measured using a surface probe on the distal of the fingers with poor perfusion and another area of the same hand with good perfusion. Lidocaine treatment protocol through the axillary perineural catheter was applied for 15 days for the right hand and 18 days for the left hand. As the treatment proceeded, a significant increase was observed in the results of the temperature measurements on the fingers with poor perfusion.  Conclusion: We believe that a peripheral sympathetic block as we report herein could be considered as an alternative in the treatment of TAO. HIPPOKRATIA 2018, 22(3): 141-144.

Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey

Florence Nightingale Hospital is a 300-bed, university-affiliated, private medical centre with a large open heart surgery programme in Istanbul, Turkey. In this study, the mortality rates, lengths of stay (LOS) and extra costs of patients with deep sternal surgical site infections (DSSSIs) and superficial sternal surgical site infections (SSSSIs) following coronary artery bypass grafting (CABG) were determined from January 1999 to December 2002. Group I included 52 patients with DSSSIs, Group II included 36 patients with SSSSIs and Group III included 88 controls. The controls were selected at random from patients operated within the same year, with the same sex and age within five years, but who had not developed infection. Mortality rates in Groups I, II and III were 19.2%, 0% and 4.5%, respectively; the mortality rate in Group I was significantly different from that in Groups II and III (P<0.005). LOS was 47, 33 and 12 days for Groups I, II and III, respectively, and LOS was statistically different for each group (P<0.005). The costs of extra LOS, antibiotics, and radiological, microbiologial and other laboratory examinations for Groups I and II were US$6850.93 and US$3740.58, respectively. Both DSSSI and SSSSI following CABG extended the LOS and increased the cost, and DSSSI was significantly associated with a high mortality rate. These results suggest the need for improved infection control measures to reduce SSSIs following CABG. As an important component of the extra cost is the extra LOS, it is essential to shorten this period. This may be particularly applicable in patients with SSSSIs.

Aetiology of convulsions due to stellate ganglion block: a review and report of two cases

Stellate ganglion block is a selective sympathetic block that affects the ipsilateral head, neck, upper extremity and upper part of the thorax. Convulsions are a recognized complication of intra-arterial injection during stellate ganglion block. As central nervous system toxicity depends ultimately on the concentration of the local anaesthetics presented to the brain, the likely causative factors are discussed as well as the types of toxic symptoms and their onset times. The paper considers the aetiological factors of such convulsions resulting from stellate ganglion block in two patients.

Cardiac operations during pregnancy: review of factors influencing fetal outcome

Women with underlying rheumatic heart disease, even if well compensated, can easily be affected by acute heart failure caused by out-of-the-ordinary cardiorespiratory requirements during pregnancy. In such cases, medical therapy is not always sufficient to drive a heart, and open heart operation might be necessary. Many factors associated with cardiac operations requiring cardiopulmonary bypass, such as hypothermia, can adversely affect both the mother and the fetus, but the morbidity and mortality rates are higher for the fetus than the mother. Because fetal heart tones were lost during cardiopulmonary bypass and were reheard in the intensive care unit in our case presentation, we have presumed that the loss of fetal heart tones should not always indicate fetal death and have discussed harmful factors in relation with the fetal morbidity and mortality in light of the literature.