Cardiac catheterization laboratory to cardiac operating room

Raymond Cooper, Adam Sewell

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The case An 87-year-old female with severe and symptomatic aortic stenosis was to undergo a percutaneous aortic valve replacement in the cath lab under general anesthesia. Workup included a “tight” AS by transthoracic echo, with an aortic valve area of 0.4 cm2and a transvalvular gradient of 85 mmHg. She had a history of HTN, on metoprolol, and NIDDM, controlled with Glucophage, although she had forgotten to refill her prescription after her last doctor's appointment. She was short of breath and had episodes of syncope. Her EKG showed NSR with a HR of 68 bpm. Her labs were all within normal limits, with a HCT of 30 g/dL and a glucose level of 283. General anesthesia was induced with etomidate and fentany1. Muscle relaxation was achieved with rocuronium. Anesthesia was maintained with sevoflurane in oxygen. Twenty units of intravenous (IV) insulin were given to treat the elevated glucose level. Two hours into the procedure, just prior to deployment of the valve, a wire passed across the valve inadvertently transected the wall of the proximal aorta. The patient rapidly decompensated and the blood pressure dropped to 70mmHg systolic, with a pulsus paradoxus noted with each ventilator breath. Rapid administration of crystalloid solution was initiated, and the blood bank was notified to send 4 units of packed red blood cells. Cardiac surgeons responded, and the sternum was rapidly opened. In spite of rapid fluid administration, blood pressure continued to fall.

Original languageEnglish (US)
Title of host publicationCore Clinical Competencies in Anesthesiology
Subtitle of host publicationA Case-Based Approach
PublisherCambridge University Press
Pages252-259
Number of pages8
ISBN (Electronic)9780511730092
ISBN (Print)9780521144131
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

Fingerprint

Operating Rooms
Cardiac Catheterization
Aortic Valve
General Anesthesia
Blood Pressure
Etomidate
Glucose
Blood Banks
Sternum
Metoprolol
Muscle Relaxation
Metformin
Aortic Valve Stenosis
Syncope
Mechanical Ventilators
Type 2 Diabetes Mellitus
Prescriptions
Pulse
Aorta
Appointments and Schedules

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Cooper, R., & Sewell, A. (2010). Cardiac catheterization laboratory to cardiac operating room. In Core Clinical Competencies in Anesthesiology: A Case-Based Approach (pp. 252-259). Cambridge University Press. https://doi.org/10.1017/CBO9780511730092.051

Cardiac catheterization laboratory to cardiac operating room. / Cooper, Raymond; Sewell, Adam.

Core Clinical Competencies in Anesthesiology: A Case-Based Approach. Cambridge University Press, 2010. p. 252-259.

Research output: Chapter in Book/Report/Conference proceedingChapter

Cooper, R & Sewell, A 2010, Cardiac catheterization laboratory to cardiac operating room. in Core Clinical Competencies in Anesthesiology: A Case-Based Approach. Cambridge University Press, pp. 252-259. https://doi.org/10.1017/CBO9780511730092.051
Cooper R, Sewell A. Cardiac catheterization laboratory to cardiac operating room. In Core Clinical Competencies in Anesthesiology: A Case-Based Approach. Cambridge University Press. 2010. p. 252-259 https://doi.org/10.1017/CBO9780511730092.051
Cooper, Raymond ; Sewell, Adam. / Cardiac catheterization laboratory to cardiac operating room. Core Clinical Competencies in Anesthesiology: A Case-Based Approach. Cambridge University Press, 2010. pp. 252-259
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