71 years old , male , 65 kg ,ischaemic cardiomyopathy , post CABG 11 years . Asymptomatic since CABG.Graft study showed patent grafts.
Had traumatic cervical myelopathy 6 months after a fall,failed to recover neurologically after the first spine surgery immediately after the fall.Unable to walk , spastic paraplegia . Upper limbs weakness power 4/5. Numbness 4 limbs.Waiting to have cervical spine surgery to decompress the cord & fixation of implant .
Had recurrent ventricular fibrillation & presently in atrial fibrillation, controlled ventricular rate of 40 to 50 /minute.
Echocardiogram showed left ventricular ejection fraction 55%. Blood Pressure 140 /70 mmHg .
Planned for Implantable cardiac defibrillator insertion.
Procedure was done under monitored sedation & local anesthetics, in Cardiac catheterization Laboratory , under fluoroscopic guidance. Local anesthetic infiltration of wound 2% Lignocaine 10 ml ,( Left Subclavian vein approach ) IV Midazolam 2.5mg + IV Fentanyl 25mcg + IV Propofal infusion 50mg / hour , titrating downward to 20 mg / hour when the Blood pressure was down to 85mmHg. One dose of Ephedrine 6 mg given . Blood pressure rose back to 120/60 mmHg. Stable throughout the procedure.
Total time taken was 70 minutes.The device was not tested by inducing ventricular fibrillation because patient was not anticoagulated & was in atrial fibrillation for a long time.作者: shenxiu2 时间: 2009-11-3 19:20
敬请同路人翻译成中文. 因我懂的中文医学词汇实在有限......:D .谢了.作者: 老骥伏枥 时间: 2009-11-3 21:19
71岁男性，65kg，缺血性心脏病，CABG术后11年，自术后一直无症状，移植血管检查示血管通畅。6月前外伤性脊髓疾病，坠落伤后急诊脊髓手术未能恢复神经功能，不能行走，痉挛性瘫痪。上肢肌力4级，四肢肌无力。等待接受移植固定物取出的颈椎脊髓手术。房颤心律，反复发作性心室颤动，控制室率40——50bpm。心脏彩超示左室射血分数55%，血压140\70mmHg。。在心导管室内荧光镜监视下，手术在局麻与实施镇静监测下进行。2%利多卡因（共10ml）局麻浸润，左锁骨上静脉给于咪达唑仑2.5mg＋芬太尼25微克＋丙泊酚50mg\h，当血压降至85mmHg时减量至20mg\h，并给于麻黄素6mg，血压上升至120\60mmHg，此后一直稳定至术毕。手术耗时70min。该监测没有实施因为该患者于长期房颤中没有抗凝。