Modified electroconvulsive therapy (mECT) with the use of hypnotics and muscle relaxants is an optional and prevailing treatment for depression in patients who have failed on antidepressant regimens. We describe a patient who developed ventricular tachycardia (VT) immediately after mECT. A 64-year-old man with no remarkable past history underwent a course of mECT for drug-resistant depression. Anesthesia was induced with intravenous thiopental (150 mg) followed by rocuronium (50 mg). Three minutes after the administration of rocuronium, the brain was electrically stimulated using a pulse wave. The first mECT session was performed uneventfully. However, the second session 2 days later elicited acute hypertension (182/134 mmHg) and tachycardia (130 bpm), resulting in the appearance of single and couplets of premature ventricular contractions on the electrocardiogram followed by VT lasting about 10 s. The chest was immediately compressed several times, then normal sinus rhythm was spontaneously restored without administering antiarrhythmic agents. The patient recovered from anesthesia without complications. Postoperatively, close examination was unable to definitively determine the cause of VT, resulting in the cancellation of subsequent mECT sessions. It is important to bear in mind that mECT can induce life-threatening arrhythmias such as VT.
The goal of primary debulking surgery (PDS) in ovarian cancer is to achieve complete resection of the tumors. There are, however, many complications after this surgery, because of its invasiveness. Small bowel obstruction is one of the major complications of PDS. The rate of incidence of small bowel obstruction after PDS has been reported as 30%. While adhesive small bowel obstruction has traditionally been managed via the open approach, it often induces another adhesive small bowel obstruction after surgery. Therefore, patients with small bowel obstruction may benefit from the laparoscopic approach due to its low invasiveness. We report a case of laparoscopically assisted surgery performed for adhesive small bowel obstruction following PDS. A 48-year old woman had small bowel obstruction 10 days post-PDS.Twenty days after the surgery, she developed septic shock and disseminated intravascular coagulation (DIC) due to bacterial translocation from the small bowel obstruction. After recovering from the septic shock and DIC, we performed a laparoscopically assisted surgery to relieve the adhesions of the small bowel obstruction. Surgery was performed using the GelPOINT Ⓡ advanced platform as the main platform. There were many severe adhesions between the small bowel, pelvic wall and the sigmoid colon. We successfully relieved most of the adhesions by laparoscopic surgery, and directly repaired the defective parts of the serosa of the small bowel, accessing them from the small incision part of the main platform. The patient recovered well without recurrence of either the small bowel obstruction or the ovarian cancer.Due to its decreased degree of invasiveness, laparoscopic surgery, rather than open surgery, might be more appropriate when treating adhesive small bowel obstruction.
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