Rationale:Angiotensin-converting enzyme (ACE) inhibitors are one of the most used medication among patients with arterial hypertension. In most cases, ACE inhibitors caused side effects are mild; however, from 0.1% to 0.7% of patients can develop life threatening adverse effect, angioedema. Unlike histamine mediated, ACE inhibitor-related angioedema can develop at any time during the treatment course.Patient concerns:An 89-year-old woman with a medical history for arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation developed ACE inhibitor-induced angioedema after 5 years of daily ramipril administration.Diagnoses:Arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation and late onset ACE inhibitor-induced angioedema.Interventions:The ACE inhibitor was used for arterial hypertension on a daily basis for the past 5 years. Patient developed airway obstruction requiring intubation. Standard therapy with epinephrine, methylprednisolone and clemastine was administered. Treatment was ineffective, considering that angioedema persisted.Outcomes:Angioedema resolved after 13 days from the discontinuation of ramipril. Death due to cardiopulmonary insufficiency occurred 24 days after the admission to intensive care unit, despite full clinical resolution of ACE inhibitor-induced angioedema.Lessons:Our case highlight the importance of educating clinicians about ACE inhibitor-induced angioedema, as potentially fatal adverse drug reaction. Considering the fact, that no laboratory or confirmatory test exist to diagnose ACE inhibitor-induced angioedema, clinicians’ knowledge is the key element in recognition of ACE inhibitor-related angioedema.
Background. The aim of the study was to identify the accuracy of and agreement between two non-invasive haemodynamic monitoring techniques in the perioperative setting – thoracic electrical bioimpedance (TEB) and Edwards Lifesciences ClearSight system (CS). Materials and methods. The study included ten patients. Parametric quantitative data were expressed as mean ± SD. The ShapiroWilk test was used to test the normality of the distributions. A linear regression model was used to measure the strength of the linear relationship between TEB and CS. Bland-Altman analysis was performed to assess the mean difference, precision, and the limits of agreements (LOA). The Critchley and Critchley method was used to calculate the percentage error (PE), and if
Introduction. Deliberate hypotension (DH) is a widely used anaesthesia technique for decreasing intraoperative bleeding and improving the visibility of the operating field. Orofacial region has rich blood supply, therefore adequate bleeding management is needed. Methods. A literature search was performed using the search terms and was limited to English language. We used specific databases for our literature search. Discussion. The positive effect of DH is associated with mechanism of action leading to reduction of blood loss and reduced blood transfusion rate, accompanied by proper pain management. However, adverse effects are distinguishable, although the presentation completely depends on the hypotensive anaesthetic used for induction of DH. Conclusion. The application of controlled hypotension in maxillofacial surgery is highly advisable. Despite the positive effects, constant monitoring of the vital signs and drug induced side effects in perioperative period is needed.
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