Search

Patients with intermittent Wolff-Parkinson-White (WPW) syndrome, defined as intermittent loss of the delta waves, can show occasional conduction through the accessory pathway. WPW syndrome often causes paroxysmal supraventricular tachycardia or atrial fibrillation. However, it may be difficult to identify the abnormalities preoperatively because of their only intermittent occurrence. We report a case in which exogenously administered epinephrine and an autonomic imbalance may have precipitated the abrupt occurrence and disappearance of the delta waves.

A 28-month-old boy (height, 76 cm; weight, 9.4 kg) diagnosed as having Williams syndrome presented for dental care. We report a case of postoperatively suspected malignant hyperthermia after the administration of general anesthesia for dental treatment in this patient with severe supravalvular aortic stenosis and pulmonary artery hypoplasia. Anesthesia was maintained through the inhalation of nitrous oxide and sevoflurane with oxygen. The patient was hemodynamically stable and no other abnormalities were observed. After the completion of the dental treatment, he was transferred to the pediatric ward. On arrival at the ward, the patient's core temperature increased to 39.5 degrees C and tachypnea (RR, 30 breaths/min) was observed. The SPO2 during inhalation was slightly low (92%-93%). Serum biochemistry revealed an elevated CK level (1345 U/L) but no other abnormal findings. Twelve hours after the dental treatment, the patient's core temperature fell to 37.4 degrees C. After hospitalization for 4 days, the patient was discharged in good condition. In the present case, general anesthesia was employed for dental treatment despite severe supravalvular aortic stenosis and peripheral pulmonary artery hypoplasia, because conventional dental therapy was very difficult as a result of the patient's mental retardation and hyperkinesia. The present case suggests that the use of volatile agents that could trigger malignant hyperthermia should be avoided wherever possible.

Two cases of vasovagal syncope (VVS) during venous access are reported. Both patients had a history of fainting episodes and experienced bradycardia with asystole, hypotension, and fainting. Pain and phobic stress during venous access triggered an increase in parasympathetic tone, resulting in bradycardia with asystole and hypotension in both cases. Hypotension and bradycardia likely caused cerebral hypoperfusion, leading to fainting. The intense parasympathetic tone triggered by somatic or emotional stress was likely responsible for directly depressing the sinus node, leading to asystole and bradycardia. Bradycardia with asystole progressing to syncope is a potentially fatal dysrhythmia in patients with cardiovascular disease or older patients with decreased cardiac function. Appropriate treatment for VVS includes the administration of intravenous fluids, vagolytics, ephedrine, and the rapid use of the Trendelenburg position. Intravenous fluids and atropine were used to treat the present patients.

We report two cases who exhibited a decrease in their bispectral index (BIS) score, associated with syncope during venipuncture in patients with suspected needle phobia. In case 1, the reduction in BIS score occurred during the development of hypotension and bradycardia and may well have been caused by cerebral hypoperfusion. In case 2, the patient lost consciousness with decreasing BIS score before hypotension and bradycardia; this patient's condition could not be completely explained by cerebral hypoperfusion as a result of a vasovagal reflex because the patient's blood pressure and heart rate remained normal during the syncopal episode.

Objective: We describe continuous maxillary nerve block at the pterygopalatine fossa and investigate the efficacy of this technique for perioperative pain control in oral surgery., Study Design: Sixteen patients undergoing radical maxillary sinusotomy were enrolled; group I (n = 8) received general anesthesia without maxillary nerve block, and group II (n = 8) received maxillary nerve block before general anesthesia. The intraoperative concentration of sevoflurane, the extent of blockade, and total analgesics (diclofenac sodium) needed after surgery were recorded., Results: The mean sevoflurane concentration was significantly lower in group II. Diclofenac sodium consumption was significantly reduced in group II., Conclusion: Indwelling maxillary nerve catheter methods decrease anesthetic consumption and provide good postoperative analgesia.