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      Atypical cardioversion in unstable arrhythmia caused by clavicle surgery

      case-report
      Author(s): a , * , b
      Publication date (Electronic):
      Journal: Trauma Case Reports
      Publisher: Elsevier

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          Abstract

          We report on a 54-year old male with traumatic brain injury, flail chest and floating shoulder undergoing intramedullary stabilization of a midshaft clavicle fracture in beach chair position. Intraoperatively the patient developed instable atrial fibrillation triggered by implantation of intramedullary nail. Secondary this case shows feasibility of cardioversion in latero-lateral electrode-position due to inaccessible standard positions and patient fixation between the operation table and the X-ray apparatus.

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          Incidental conversion to sinus rhythm from atrial fibrillation during external jugular venous catheterization.

          H.Thomas Lee, Kathryn Cozine (1997)
          External jugular venous (EJV) catheterization is a frequent method of gaining central venous access because of its low complication rate. We describe a unique experience during EJV in which a patient with chronic atrial fibrillation converted suddenly to a sustained sinus rhythm without perioperative complication from this event. Our experience depicts a rare consequence of the central catheter placement and we, as anesthesiologists, should be aware of its potential occurrence in the operating room.
          Article 0 comments Cited 2 times – based on 0 reviews     Review now
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            Arrhythmia during extracorporeal shock wave lithotripsy.

            Z Zeng, E Lindstedt, A Roijer … (1993)
            A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.
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              [Extrasystoles during extracorporeal biliary shockwave lithotripsy. Their incidence and clinical significance].

              A Rambow, M Staritz, A. Grosse … (1991)
              Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (VPS) (6-81 per 23 hours) in the 24-hour ECG the number of VPS increased during the one-hour ESWL procedure significantly to 6-55 (P less than 0.05). 14 of these patients had an unremarkable cardiac history. Changing the lithotriptor coupling angle failed to suppress the VPS in only two patients. In these two it was necessary to trigger the shock wave with the ECG. Blood pressure rose markedly (up to 220 mm Hg systolic) during ESWL in only three patients, known hypertensives. But this rise was easily controlled with nifedipine, 10 mg sublingually. These data demonstrate that ESWL is a safe alternative to operative treatment, even in the presence of existing cardiac disease. Nonetheless, precautions should be taken in case there are complications.
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                Author and article information

                Contributors
                Stefan Bushuven
                Journal
                Journal ID (nlm-ta): Trauma Case Rep
                Journal ID (iso-abbrev): Trauma Case Rep
                Title: Trauma Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2352-6440
                Publication date PMC-release: 31 October 2017
                Publication date Collection: December 2017
                Publication date (Electronic): 31 October 2017
                Volume: 12
                Pages: 28-30
                Affiliations
                [a ]Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital Singen, Virchowstrasse 10, 78224 Singen, Germany
                [b ]Department of Orthopedics, Traumatology and Hand Surgery, Hegau Bodensee Hospital Singen, Virchowstrasse 10, 78224 Singen, Germany
                Author notes
                [* ]Corresponding author at: Virchowstrasse 10, 78224 Singen, Germany.Virchowstrasse 10Singen78224Germany S.Bushuven@ 123456gmx.de
                Article
                Publisher ID: S2352-6440(17)30058-4
                DOI: 10.1016/j.tcr.2017.10.012
                PMC ID: 5887088
                SO-VID: 051a177f-e76d-45df-a3d5-ab3d7d5c850a
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date accepted : 25 October 2017
                Categories
                Subject: Article

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