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The American Journal of Case Reports Sep 2023BACKGROUND Thoracic epidural analgesia is a commonly applied technique for perioperative pain management in major thoraco-abdominal surgery, but is complicated by high...
BACKGROUND Thoracic epidural analgesia is a commonly applied technique for perioperative pain management in major thoraco-abdominal surgery, but is complicated by high failure rates. The epidural electrical stimulation test (EEST) or "Tsui test" is a safe and effective method whereby low electrical current is used to confirm correct epidural catheter position and decrease the variability in analgesic effectiveness of the neuraxial technique. CASE REPORT We present the case of a 61-year-old woman with no prior cardiac or pulmonary comorbidities who was scheduled to undergo a ventral and parastomal hernia repair with component separation. The patient was offered a low thoracic epidural for perioperative analgesia. Technical aspects of the siting of the epidural catheter were uneventful and a confirmatory Tsui test was planned. At the initiation of electrical stimulation via the epidural catheter to confirm optimal catheter positioning, the patient experienced symptomatic bradycardia and hemodynamic instability that persisted despite terminating the electrical stimulation, and required pharmacologic intervention. CONCLUSIONS This report describes a rare case of vasovagal pre-syncope associated with the EEST or Tsui test. Although vasovagal reactions can be commonly associated with neuraxial procedures due to augmented venous return or severe emotional stress, we raise the possibility that through direct electrical stimulation in the epidural space, the EEST may have the potential to trigger such a physiologic response.
Topics: Female; Humans; Middle Aged; Herniorrhaphy; Analgesia, Epidural; Hernia, Ventral; Syncope; Electric Stimulation
PubMed: 37740480
DOI: 10.12659/AJCR.941004 -
International Archives of Allergy and... 2024Skin tests are one of the most widely used diagnostic tools for suspected drug allergies in children. Studies on systemic reactions occurring during skin testing with...
INTRODUCTION
Skin tests are one of the most widely used diagnostic tools for suspected drug allergies in children. Studies on systemic reactions occurring during skin testing with allergens have mostly been conducted in pediatric and adult patient groups together. However, data on adverse reactions including allergic reactions after drug skin tests in children are scarce. It is aimed to determine the adverse reactions after skin test in children with suspected drug allergy.
METHODS
Patients who underwent a drug skin test due to the suspicion of drug allergy between May 2017 and June 2020 were evaluated, retrospectively. Data about adverse reactions seen after skin testing at the testing area in the clinic were analyzed.
RESULTS
The study included 1,073 children (585 [54.5%] boys and 488 [45.5%] girls) with a median age of 7.5 years. A total of 12 (1.1%) reactions were detected after skin testing, and 4 (0.4%) of them were allergic reactions. Of the allergic reactions, three were anaphylaxis and one was urticaria. Two of the reactions (1 anaphylaxis and 1 urticaria) were detected after the skin prick test and the remaining 2 were detected after intradermal test. Three of the nonallergic reactions were considered as vasovagal reactions and seven were considered as nonspecific and anxiety-related reactions.
CONCLUSION
Although drug skin tests were generally well-tolerated and adverse reactions were rare, severe allergic reactions including anaphylaxis may ensue. Skin tests should be necessarily performed in clinical settings in experienced centers.
Topics: Male; Adult; Female; Humans; Child; Anaphylaxis; Retrospective Studies; Skin Tests; Drug Hypersensitivity; Urticaria
PubMed: 37729879
DOI: 10.1159/000533641 -
Cureus Aug 2023Brugada syndrome is an arrhythmogenic condition characterized by ST-segment elevation and J-point elevation in at least two precordial leads. Most ST segment elevations...
Brugada syndrome is an arrhythmogenic condition characterized by ST-segment elevation and J-point elevation in at least two precordial leads. Most ST segment elevations are associated with myocardial infarction, although other conditions such as pericarditis, channelopathies, and a few genetic conditions should be considered. Brugada syndrome is an inherited cardiac condition associated with an increased risk of sudden cardiac death (SCD). The most common presentation is palpitations or syncopal events in patients presenting to the emergency department. We present the case of a young 26-year-old patient who was diagnosed with Brugada syndrome at the age of 11 following a syncopal event at school and had a transvenous implantable cardioverter defibrillator (ICD) implanted. He was found to have a high lead impedance following a collapse at his routine outpatient device clinic appointment and was transferred to our hospital. He underwent successful transvenous ICD and lead extraction and had a subcutaneous ICD implanted.
PubMed: 37719594
DOI: 10.7759/cureus.43576 -
Ochsner Journal 2023Syncope is a common complaint in clinical practice. The etiologies and mechanisms can be multiple and complex. Syncope caused by a mediastinal mass compressing the...
Syncope is a common complaint in clinical practice. The etiologies and mechanisms can be multiple and complex. Syncope caused by a mediastinal mass compressing the vagus nerve is rare. We report the case of a patient who presented to the emergency department experiencing recurrent syncope. Imaging revealed a large, calcified mass in the right paratracheal region. After intracranial lesions, cardiac arrhythmias, and orthostatic hypotension were excluded, we suspected that the syncope was related to vagus nerve compression. The patient underwent surgical resection of a mediastinal mass and had complete resolution of syncopal episodes after surgery. This case outcome suggests that recurrent syncope could be the first symptom of an intrathoracic mass.
PubMed: 37711479
DOI: 10.31486/toj.23.0032 -
Frontiers in Pediatrics 2023Orthostatic intolerance (OI) is usually mediated by the autonomic nerve and most often happens in the upright position. However, it can also occur in other positions and...
BACKGROUND
Orthostatic intolerance (OI) is usually mediated by the autonomic nerve and most often happens in the upright position. However, it can also occur in other positions and can be relieved by lying down while likely to have another attack after relief. In the current study, we aim to evaluate the predictive effect of catecholamines and electrolytes on the recurrence of OI in children.
MATERIALS AND METHODS
Children who were diagnosed with vasovagal syncope (VVS), postural tachycardia syndrome (POTS), and VVS combined with POTS were enrolled in this retrospective study and were followed up after 1-year physical treatment. Catecholamines in urine collected within 24 h, renin, angiotensin II, aldosterone in plasma, and electrolytes in both blood and urine collected in the morning were tested. A multivariate analysis and a receiver operating characteristic curve were used to validate the prediction effect.
RESULTS
In the VVS cohort, the 24 h urine adrenaline (AD) and norepinephrine (NE) levels of the non-recurrence group were lower than the 24 h urine AD and NE levels of the recurrence group, with a significant difference of < 0.05. A different content can also be witnessed in the POTS cohort that the urine of the non-recurrence group contained lower sodium and chlorine. As for the VVS + POTS cohort, the non-recurrence group has lower AD and NE levels and higher potassium and phosphorus levels in urine, the difference of which proved prominent as well.
CONCLUSION
The study provides further evidence that AD, NE, and electrolytes in urine are promising factors that are closely related to the recurrence of OI in children. The integrated evaluation system merging AD and NE may have better predictive ability.
PubMed: 37705599
DOI: 10.3389/fped.2023.1220990 -
International Journal of Molecular... Aug 2023Vasovagal syncope (VVS) refers to a heterogeneous group of conditions whereby the cardiovascular reflexes normally controlling the circulation are interrupted... (Review)
Review
Vasovagal syncope (VVS) refers to a heterogeneous group of conditions whereby the cardiovascular reflexes normally controlling the circulation are interrupted irregularly in response to a trigger, resulting in vasodilation, bradycardia, or both. VVS affects one-third of the population at least once in their lifetime or by the age of 60, reduces the quality of life, and may cause disability affecting certain routines. It poses a considerable economic burden on society, and, despite its prevalence, there is currently no proven pharmacological treatment for preventing VVS. The novel procedure of ganglionated plexus (GP) ablation has emerged rapidly in the past two decades, and has been proven successful in treating syncope. Several parameters influence the success rate of GP ablation, including specific ablation sites, localization and surgical techniques, method of access, and the integration of other interventions. This review aims to provide an overview of the existing literature on the physiological aspects and clinical effectiveness of GP ablation in the treatment of VVS. Specifically, we explore the association between GPs and VVS and examine the impact of GP ablation procedures as reported in human clinical trials. Our objective is to shed light on the therapeutic significance of GP ablation in eliminating VVS and restoring normal sinus rhythm, particularly among young adults affected by this condition.
Topics: Young Adult; Animals; Humans; Syncope, Vasovagal; Quality of Life; Ablation Techniques; Anura; Bradycardia
PubMed: 37686062
DOI: 10.3390/ijms241713264 -
Hellenic Journal of Cardiology : HJC =... 2023Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of...
Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of cardioneuroablation performed in young patients who suffered from recurrent neurally-mediated syncope with asystole and functional atrioventricular block. The patients remain syncope-free during follow-ups.
Topics: Humans; Syncope; Syncope, Vasovagal; Heart Arrest
PubMed: 37647986
DOI: 10.1016/j.hjc.2023.08.012 -
Biology Aug 2023To systematically summarize the evidence of head-up tilt sleeping (HUTS) on orthostatic tolerance, we conducted a systematic, predefined search in PubMed, OVID Embase,...
To systematically summarize the evidence of head-up tilt sleeping (HUTS) on orthostatic tolerance, we conducted a systematic, predefined search in PubMed, OVID Embase, Cochrane and Web of Science. We included studies assessing the effect of HUTS on orthostatic tolerance and other cardiovascular measures and rated the quality with the American Academy of Neurology risk of bias tool. We included 10 studies ( = 185) in four groups: orthostatic hypotension (OH; 6 studies, = 103), vasovagal syncope (1 study, = 12), nocturnal angina pectoris (1 study, = 10) and healthy subjects (2 studies, = 58). HUTS duration varied (1 day-4 months) with variable inclinations (5°-15°). In two of six OH studies, HUTS significantly improved standing systolic blood pressure. Orthostatic tolerance was consistently enhanced in OH studies with higher angles (≥12°), in 2 out of 3 with smaller angles (5°) but also in one studying horizontal sleeping. In vasovagal syncope, HUTS significantly augmented resilience to extreme orthostatic stress. One study was rated as a class II risk of bias, one of Class II/III and eight of Class IV. The evidence favouring HUTS to improve orthostatic tolerance is weak due to variable interventions, populations, small samples and a high risk of bias. Despite this, we found some physiological signs suggesting a beneficial effect.
PubMed: 37626994
DOI: 10.3390/biology12081108 -
Europace : European Pacing,... Aug 2023Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have...
Over the last 25 years, the Europace journal has greatly contributed to dissemination of research and knowledge in the field of syncope. More than 400 manuscripts have been published in the journal. They undoubtedly improved our understanding of syncope. This symptom is now clearly differentiated from other forms of transient loss of consciousness. The critical role of vasodepression and/or cardioinhibition as final mechanisms of reflex syncope is emphasized. Current diagnostic approach sharply separates between cardiac and autonomic pathways. Physiologic insights have been translated, through rigorously designed clinical trials, into non-pharmacological or pharmacological interventions and interventional therapies. The following manuscript is intended to give the reader the current state of the art of knowledge of syncope by highlighting landmark contributions of the Europace journal.
Topics: Humans; Syncope; Syncope, Vasovagal; Heart
PubMed: 37622579
DOI: 10.1093/europace/euad163 -
Saudi Journal of Anaesthesia 2023[This corrects the article on p. 161 in vol. 15, PMID: 34188635.].
[This corrects the article on p. 161 in vol. 15, PMID: 34188635.].
PubMed: 37601494
DOI: 10.4103/1658-354X.374015