Various drugs

Abstract

Cardiac arrest and lack of efficacy: case report A 2-month-old male infant experienced cardiac arrest following administration of sevoflurane and propofol to induce anesthesia; and he exhibited lack of efficacy for epinephrine, calcium gluconate, magnesium sulfate and sodium bicarbonate while undergoing treatment for cardiac arrest [not all routes and dosages stated]. The boy presented for elective repair of inguinal hernia. Prior to the procedure, anaesthesia was given with sevoflurane 8% and IV propofol 2 mg/kg. Following the intubation, concentration of sevoflurane was decreased to 3%. However, after 5 minutes of intubation, an ECG showed wide QRS complex tachycardia. His BP dropped to 58/26mm Hg. A diagnosis of cardiac arrest was made [time to reaction onset not stated]. The boy’s resuscitation was started with repeated doses of sodium bicarbonate and epinephrine. A bolus dose of epinephrine showed a transient increase in BP, but it subsequent decreased. Over a period of 20 minutes, he was given 9 doses of epinephrine (2–10 μg/kg) and four doses of sodium bicarbonate (2–5 mEq/kg), a single dose of magnesium sulfate 30 mg/kg and one dose of calcium gluconate 5 mg/kg along with an electrical counter shock. This was followed by an infusion of epinephrine 50 μg/kg/min. The change in the QRS patter was considered secondary to a significant elevation of the ST segment. Despite resuscitation efforts, spontaneous circulation was not achieved. He was provided extracorporeal membrane oxygenation and was transferred to the ICU. A transthoracic echocardiogram demonstrated a diffusely hypoplastic and thickened ascending aorta and moderate to severe decrease in the left ventricular function. In the ICU, while on ECMO, he additionally developed seizures. The serial ECGs did not show improvement of cardiac function. A cranial CT revealed diffuse hypoxic-ischaemic injury. Subsequently, his life support was withdrawn. Later, investigations revealed that he had Williams syndrome, that increased the risk of anaesthetic associated cardiac arrest. Author comment: The risk of an adverse cardiac event during anesthesia may be as high as 11%. . .We report a case of cardiac arrest in a 2-month-old infant with undiagnosed Williams syndrome. During induction of anesthesia, the infant sustained an adverse cardiac event. Despite vigorous resuscitation, spontaneous hemodynamic stability could not be achieved and extracorporeal membrane oxygenation was required.