The Internet Journal of Anesthesiology™ ISSN: 1092-406X

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Letter To The Editor: Autopeep Due To Cardiac Pulsations

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Awtarjit Singh Dr.
Consultant Anesthetist
Sarawak General Hospital

Citation: A. Singh : Letter To The Editor: Autopeep Due To Cardiac Pulsations . The Internet Journal of Anesthesiology. 1998 Volume 2 Number 3

Case Report
Anesthesia
Conclusion

Case Report

37 year old Malay lady undergoing operation for uterine fibroid: Total abdominal hysterectomy with salphingo-oopherectomy as an elective procedure. She has history of chronic rheumatic heart disease with atrial fibrillation with moderate tricuspid regurgitation, mitral stenosis and aortic regurgitation. Mitral valvotomy was performed in 1990 for severe MS /MR. Presently not in heart failure. Current medications are :

digoxin 0.125 mg daily
furosemide 40 mg daily
slow K 1 gm b.d
penicillin V 250 mg b.d
warfarin 2 mg daily

On Examination:

Comfortable weight: 70 kg
Able to lie flat
Jugular venous pressure :not raised
Blood pressure: 110/80
Pulse: 82/min irregularly irregular
Apex beat displaced on 6th ICL outside MCL.
Gross parasternal heave noted
Chest x-ray : gross cardiomegaly

Anesthesia

General anesthesia, premedication: diazepam 5 mg on-call to OR, Boyles machine checked

Induction:

Thiopentone 250 mg
Fentanyl 50 mg
Vecuronium :6 mg

Uneventful intubation, connected to ventilator :OHMEDA 7900, volume control, circle system

Settings:

Tidal volume :500 ml
Rate:12/min
O2/N2O :2:4
Isoflurane 0.75%
I:E ratio 1:2
PEEP=0
PIP :25-28 cmH2O

It was noted that the pressure gauge was showing autoPEEP =5 cmH2O with a fluctuating baseline. On ventilator disconnection pressure gauge needle returned to zero. On auscultation air entry was equal bilaterally with no sign of bronchospasm. The patient was adequately paralyzed with vecuronium. Unidirectional valves were rechecked and found to be functioning.

The cause of the autoPEEP was the result of the transmitted cardiac pulsations from the grossly dilated heart.

Conclusion

Unexplained autoPEEP on ventilator especially with a fluctuating baseline should lead one to think of a cardiac origin as a cause.

Sincerely yours,

Dr. Awtarjit Singh

This article was last modified on Fri, 13 Feb 09 13:12:07 -0600

This page was generated on Sat, 20 Mar 10 07:12:21 -0500, and may be cached.

The Internet Journal of Anesthesiology™ ISSN: 1092-406X

Letter To The Editor: Autopeep Due To Cardiac Pulsations

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Case Report

Anesthesia

Conclusion


	The Internet Journal of Anesthesiology™ ISSN: 1092-406X \| Home \| Editors \| Current Issue \| Archives \| Instructions for Authors \| Disclaimer \| Share with others \| Letter To The Editor: Autopeep Due To Cardiac Pulsations Read printer friendly Subscribe in a reader Share with others Related Articles Editorial: Anesthesia and Cyberspace DA-1 Agonist Fenoldopam: Pharmacology and Physiology Monitoring of Stimulus-Induced 40Hz Brain Oscillations Mini-dose Combined Spinal-epidural Anaesthesia In A Parturient With Univentricular Heart And Severe Pulmonary Hypertension Hemodilution Decreases Critical Closing Pressure But Does Not Increase The Aortic To Distal Pressure Gradient In Dogs Awtarjit Singh Dr. Consultant Anesthetist Sarawak General Hospital Citation: A. Singh : Letter To The Editor: Autopeep Due To Cardiac Pulsations . The Internet Journal of Anesthesiology. 1998 Volume 2 Number 3 Keywords: anesthesiology \| anesthesia \| intensive care medicine \| critical care medicine \| trauma \| regional anesthesia \| education \| multimedia \| internet \| online \| electronic publication \| peer-review Table of Contents Case Report Anesthesia Conclusion Case Report 37 year old Malay lady undergoing operation for uterine fibroid: Total abdominal hysterectomy with salphingo-oopherectomy as an elective procedure. She has history of chronic rheumatic heart disease with atrial fibrillation with moderate tricuspid regurgitation, mitral stenosis and aortic regurgitation. Mitral valvotomy was performed in 1990 for severe MS /MR. Presently not in heart failure. Current medications are : digoxin 0.125 mg daily furosemide 40 mg daily slow K 1 gm b.d penicillin V 250 mg b.d warfarin 2 mg daily On Examination: Comfortable weight: 70 kg Able to lie flat Jugular venous pressure :not raised Blood pressure: 110/80 Pulse: 82/min irregularly irregular Apex beat displaced on 6th ICL outside MCL. Gross parasternal heave noted Chest x-ray : gross cardiomegaly Anesthesia General anesthesia, premedication: diazepam 5 mg on-call to OR, Boyles machine checked Induction: Thiopentone 250 mg Fentanyl 50 mg Vecuronium :6 mg Uneventful intubation, connected to ventilator :OHMEDA 7900, volume control, circle system Settings: Tidal volume :500 ml Rate:12/min O2/N2O :2:4 Isoflurane 0.75% I:E ratio 1:2 PEEP=0 PIP :25-28 cmH2O It was noted that the pressure gauge was showing autoPEEP =5 cmH2O with a fluctuating baseline. On ventilator disconnection pressure gauge needle returned to zero. On auscultation air entry was equal bilaterally with no sign of bronchospasm. The patient was adequately paralyzed with vecuronium. Unidirectional valves were rechecked and found to be functioning. The cause of the autoPEEP was the result of the transmitted cardiac pulsations from the grossly dilated heart. Conclusion Unexplained autoPEEP on ventilator especially with a fluctuating baseline should lead one to think of a cardiac origin as a cause. Sincerely yours, Dr. Awtarjit Singh This article was last modified on Fri, 13 Feb 09 13:12:07 -0600 This page was generated on Sat, 20 Mar 10 07:12:21 -0500, and may be cached.
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