tailieunhanh - Báo cáo y học: "Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation. | Samuels et al. Journal of Cardiothoracic Surgery 2010 5 126 http content 5 1 126 JOTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation Louis E Samuels1 Elena Casanova-Ghosh1 Christopher Droogan2 Abstract A healthy 53 year old man developed profound cardiogenic shock following instillation of bupivacaine-lidocaine-epinephrine solution as a locoregional anesthetic for elective outpatient shoulder surgery. Intubation resuscitation and transfer to the nearby hospital were done echocardiography showed profound biventricular dysfunction cardiac catheterization showed normal coronary arteries. Despite placement of an intra-aortic balloon pump and intravenous vasoactive drugs the patient remained in shock. Stabilization was achieved with emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device LVAD . Twenty-four hours later cardiac function normalized and the LVAD was removed. The patient was discharged five days later and remained with normal heart function in three-year follow-up. Introduction Interscalene nerve blockade for shoulder surgery is a common practice among anesthesiologists and orthopedic surgeons 1 . Although major complications are uncommon the most life-threatening ones are cardiotoxic in nature 2 . Depending upon which agents are utilized the effects may be transient and rapidly resolve or prolonged and require advanced resuscitative measures 3 . The case of a 53 year old man who developed acute cardiogenic shock during administration of a loco-regional anesthetic for outpatient elective shoulder surgery is presented. Emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device LVAD were necessary as a rescue therapy and bridge to myocardial recovery. Clinical Summary A 53 year old healthy man presented with