Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Ann Palliat Med. 2022 May;11(5):1838-1843. doi: 10.21037/apm-22-498.
At present, the overall number of cardiac storms is small, there is a paucity of published literature describing cardiac storms in patients undergoing superficial surgery under general anesthesia (GA). In recent years, cardiac storm has attracted much clinical attention due to its high mortality, difficult management and poor prognosis.
This paper reports a 57-year-old male with cardiac electrical storm. He presented with clinical symptoms such as exudation, bad breath, restricted mouth opening, and mucous leukoplakia on local skin, without history of cardiac disease and cardiovascular disease, undergoing superficial face surgery under GA. At 2 hours after anesthesia induction, several premature ventricular beats were detected on monitoring. Hematocrit and plasma potassium were found to be markedly decreased. The patient subsequently experienced a cardiac electrical storm, with repeated episodes of polymorphic ventricular tachycardia (VT) not degenerating to ventricular fibrillation (VF). Combining these clinical symptoms and examinations, we made the diagnosis of cardiac electrical storm. At the first occurrence of bradycardia, we administered atropine, which resolved bradycardia. However, this was followed 10 minutes later by VT, which we treated with atropine and epinephrine. Epinephrine and amiodarone were given in the second episode; epinephrine and lidocaine were used to treat the third episode. Finally, he was treated successfully with pharmacologic therapy and chest compressions. No abnormal electrocardiograph events occurred in the patient after surgery.
This case highlights the possibility of anesthesia-induced autotransfusion and cardiac electrical storm occurring in patients without known cardiac disease. For this kind of case needs as soon as possible electric defibrillation and electric cardioversion, timely intravenous application effective anti-arrhythmic drugs and other treatment measures. We expect that this case report adds to the existing literature on this subject.
目前心脏风暴的总体数量较少，发表的文献也很少描述全身麻醉下接受浅表手术的患者发生心脏风暴的情况。近年来，由于心脏风暴死亡率高、管理困难、预后差，引起了临床的广泛关注。
本文报道了 1 例 57 岁男性心脏电风暴患者。患者因局部皮肤渗液、口臭、张口受限、黏膜白斑而就诊，无心脏病及心血管疾病史，在全身麻醉下行浅表面部手术。麻醉诱导后 2 小时，监测发现频发室性早搏。患者血细胞比容和血浆钾显著降低。随后患者发生心脏电风暴，反复出现多形性室性心动过速（VT），但未发展为心室颤动（VF）。结合这些临床症状和检查，我们诊断为心脏电风暴。首次发生心动过缓时，我们给予了阿托品，心动过缓得到缓解。但 10 分钟后出现 VT，我们使用了阿托品和肾上腺素。第二次发作时给予肾上腺素和胺碘酮；第三次发作时使用肾上腺素和利多卡因。最终，患者通过药物治疗和胸部按压成功得到治疗。术后患者心电图未出现异常电活动事件。
本病例提示了在无已知心脏病患者中，麻醉引起的自身输血和心脏电风暴发生的可能性。对于此类病例，需要尽快进行电除颤和电复律，及时静脉应用有效的抗心律失常药物和其他治疗措施。我们希望本病例报告能为该领域的现有文献增添新内容。
