Background: Since blood pressure tends to be unstable during induction of anesthesia in patients undergoing cardiovascular surgery, an artery catheter is often inserted before induction to continuously monitor arterial pressure during induction of anesthesia. ClearSight System™ enables noninvasive continuous measurement of beatto-beat arterial pressure via a single finger cuff without pain using photoplethysmographic technology. If ClearSight System™ can replace intra-arterial pressure measurement, blood pressure could be easily and noninvasively assessed. However, the validity of ClearSight System™ during induction of anesthesia in patients undergoing cardiovascular surgery has not been evaluated. The aim of this study was to compare blood pressure measured by ClearSight System™ with intra-arterial pressure during induction of anesthesia for cardiovascular surgery. Methods: This study was registered retrospectively. Data during induction of anesthesia for elective cardiovascular surgery were obtained for patients in whom noninvasive arterial pressure was measured by ClearSight System™ (APcs) and invasive radial arterial pressure (APrad) was measured simultaneously. According to the widely used criteria formulated by international standards from the Association for the Advancement of Medical Instrumentation, the acceptable bias and precision for arterial pressure measurements were fixed at < 5 mmHg and 8 mmHg, respectively. Results: Data for 18 patients were analyzed. For 3068 analyzed paired measurements, values of APcs vs APrad bias (precision) were 13.2 (17.5), − 9.1 (7.3) and − 3.9 (7.8) mmHg for systolic, diastolic, and mean arterial pressures, respectively. Conclusions: Mean arterial pressure measured by ClearSight System™ could be considered as an alternative for mean radial arterial pressure during induction of anesthesia for elective cardiovascular surgery.
Background
Trigeminocardiac reflex (TCR) by stimulation of the sensory branch of the trigeminal nerve induces transient bradycardia and hypotension. We report a case in which light mechanical stimulation to the dura mater during brain surgery induced severe bradycardia.
Case presentation
A 77-year-old woman with bradycardia-tachycardia syndrome was scheduled for clipping of an unruptured left middle cerebral artery aneurysm. General anesthesia was performed with propofol, remifentanil, and rocuronium. Before starting surgery, the function of the pyramidal tract was examined by motor evoked potential. Transcranial electric stimulation for motor evoked potential induced atrial fibrillation and tachycardia. Continuous administration of landiolol was started and verapamil was used for tachycardia. During detachment of the dura mater from the bone, an electrocardiogram suddenly showed sinus arrest for 6 s. Immediately after the manipulation was interrupted, a junctional rhythm appeared. However, light touch to the dura mater induced severe bradycardia again, and atropine was therefore administered. In addition, the dura surface was anesthetized with topical lidocaine infiltration. After that, light touch-induced bradycardia was prevented.
Conclusions
We experienced a case of severe bradycardia during surgery due to TCR caused by light mechanical stimulation to the dura mater. Topical anesthesia of the dura surface and atropine administration were effective for preventing TCR-induced bradycardia.
Acute parotid gland swelling is a rare complication of general anesthesia and has been called 'anesthesia mumps'. However, there have been no reports of the severe swelling of the submandibular gland after general anesthesia. A 67-year-old female underwent resection of brain tumor under general anesthesia with sevoflurane and remifentanil. Surgery was performed in the supine position and lasted over 10 hours. Emergence from anesthesia and extubation were uneventful. Two hours after surgery, right mandibular swelling appeared and she progressively deteriorated. Four hours after surgery, she complained of dyspnea and a cricothyrotomy using Minitrack ® was performed to avoid complete upper airway obstruction. Computed tomography scan revealed a low-density area from right side of the glottis to the right side of the pharynx, neck and oropharynx. On the first postoperative day, she underwent a tracheotomy because the airway obstruction caused by the neck swelling had not improved. On the second postoperative day, her neck swelling gradually reduced. The rest of the postoperative course was uneventful. Prolonged intubation and stimulation by intubation or extubation can account for the swelling of the tongue and pharynx that leads to right submandibular duct obstruction.
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