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Acute gastric dilatation causing fatal outcome in a young female with eating disorder: a case report.

Youm SM, Kim JY, Lee JR - Korean J Anesthesiol (2015)

Bottom Line: Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started.In spite of active resuscitation for 29 min, the patient did not recover and expired.As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
A 21-year-old female with a history of bulimia nervosa came to the emergency room due to severe abdominal pain after excessive eating five hours previously. On arrival at the emergency room, extreme abdominal distension was detected and the patient's legs changed color. Computed tomography suggested severe gastric dilatation, so abdominal compartment syndrome was suspected and an emergent laparotomy was supposed to be conducted. Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started. In spite of active resuscitation for 29 min, the patient did not recover and expired. As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.

No MeSH data available.


Related in: MedlinePlus

The chart shows that the systolic pressure, diastolic pressure, pulse rate and the events of perioperative period. CPR: cardiac pulmonary resuscitation.
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Figure 3: The chart shows that the systolic pressure, diastolic pressure, pulse rate and the events of perioperative period. CPR: cardiac pulmonary resuscitation.

Mentions: We applied invasive arterial pressure monitoring with a 20 G angiocatheter on her right radial artery and inserted a 7 French central line catheter on her left internal jugular vein subsequently, prior to induction. Just as before the induction, her blood pressure dropped to 80/48 mmHg, her heart rate was 110 beats/min, and her mental status turned to a stupor. We tried to oxygenate the patient with a mask fitting and insufflations of 100% oxygen for several minutes. Anesthetic induction was conducted with midazolam 3 mg and then rocuronium 50 mg IV bolus, and 1 min after endotracheal intubation was performed without prior positive pressure ventilation with the facial mask. Just after intubation, the patient's vital signs were tolerable, with a blood pressure of 91/42 mmHg and a heart rate of 116 beats/min. For anesthetic maintenance, sevoflurane inhalation with remifentanil continuous infusion was started. A few minutes after induction, the first arterial blood sample for blood gas analysis was drawn, and the results indicated both mixed metabolic acidosis and respiratory alkalosis (Table 1). Hyperkalemia was also detected at 7.4 mmol/L, so the anesthesiologist ordered that a nurse get calcium, sodium bicarbonate, and insulin. At that time, the anesthesiologists noticed that the electrocardiogram readings seemed abnormal. Meanwhile, just after the abdominal cavity was opened and the gastric contents were sucked out through a small gastric incision, her blood pressure abruptly dropped to 36/22 mmHg (Fig. 3), and the electrocardiogram showed bizarre and wide QRS. Immediate treatment was conducted, which included the rapid infusion of 800 ml of crystalloid and 400 ml of colloid fluid, the start of a continuous infusion of norepinephrine at 0.3 µg/kg/min, the bolus administration of 300 mg of calcium, and 20 mEq of sodium bicarbonate. However, her tremendously decreased blood pressure could not be restored and her cardiac rhythm became asystolic. It only took 12 minutes from the initiation of the exploratory laparotomy to asystole. We started cardiac compressions immediately, and during the cardiac compression for resuscitation, five 1 mg doses of epinephrine bolus injection were given at a rate of one every few minutes. A bolus of 20 IU of vasopressin was also injected after the administration of the fourth dose of epinephrine. Insulin 10 IU was also administered, and both 300 mg of calcium and 300 mEq of sodium bicarbonate were injected approximately every 5 min, and so a total of 1,200 mg of calcium chloride and 1,200 mEq of sodium bicarbonate were administered to correct the hyperkalemia. Even though the procedure made for less than 50 ml of blood loss, four units of packed RBC were transfused for the decreasing tendency of hemoglobin down to 4.9 g/dl. Additional fluids as well as furosemide 40 mg IV bolus were given to correct the anuria. Consequently, as much as a total of 1,200 ml of crystalloid and 600 ml of colloid, which were loaded with 960 ml packed RBC were given during the cardiac resuscitation. The results of the arterial blood gas analysis throughout the anesthesia and resuscitation are presented in Table 1, and the change of potassium is presented in Fig. 4. All efforts for resuscitation including cardiac compressions were maintained for 29 minutes. Despite these exertion, the asystole state persisted, her blood pressure was not checked and no cardiac rhythm was restored, so the surgeon in charge pronounced her dead. The operating note illustrated that not only the stomach but also the small bowel and colon showed color change, suggesting necrosis. There was no description of the other solid abdominal organs.


Acute gastric dilatation causing fatal outcome in a young female with eating disorder: a case report.

Youm SM, Kim JY, Lee JR - Korean J Anesthesiol (2015)

The chart shows that the systolic pressure, diastolic pressure, pulse rate and the events of perioperative period. CPR: cardiac pulmonary resuscitation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384409&req=5

Figure 3: The chart shows that the systolic pressure, diastolic pressure, pulse rate and the events of perioperative period. CPR: cardiac pulmonary resuscitation.
Mentions: We applied invasive arterial pressure monitoring with a 20 G angiocatheter on her right radial artery and inserted a 7 French central line catheter on her left internal jugular vein subsequently, prior to induction. Just as before the induction, her blood pressure dropped to 80/48 mmHg, her heart rate was 110 beats/min, and her mental status turned to a stupor. We tried to oxygenate the patient with a mask fitting and insufflations of 100% oxygen for several minutes. Anesthetic induction was conducted with midazolam 3 mg and then rocuronium 50 mg IV bolus, and 1 min after endotracheal intubation was performed without prior positive pressure ventilation with the facial mask. Just after intubation, the patient's vital signs were tolerable, with a blood pressure of 91/42 mmHg and a heart rate of 116 beats/min. For anesthetic maintenance, sevoflurane inhalation with remifentanil continuous infusion was started. A few minutes after induction, the first arterial blood sample for blood gas analysis was drawn, and the results indicated both mixed metabolic acidosis and respiratory alkalosis (Table 1). Hyperkalemia was also detected at 7.4 mmol/L, so the anesthesiologist ordered that a nurse get calcium, sodium bicarbonate, and insulin. At that time, the anesthesiologists noticed that the electrocardiogram readings seemed abnormal. Meanwhile, just after the abdominal cavity was opened and the gastric contents were sucked out through a small gastric incision, her blood pressure abruptly dropped to 36/22 mmHg (Fig. 3), and the electrocardiogram showed bizarre and wide QRS. Immediate treatment was conducted, which included the rapid infusion of 800 ml of crystalloid and 400 ml of colloid fluid, the start of a continuous infusion of norepinephrine at 0.3 µg/kg/min, the bolus administration of 300 mg of calcium, and 20 mEq of sodium bicarbonate. However, her tremendously decreased blood pressure could not be restored and her cardiac rhythm became asystolic. It only took 12 minutes from the initiation of the exploratory laparotomy to asystole. We started cardiac compressions immediately, and during the cardiac compression for resuscitation, five 1 mg doses of epinephrine bolus injection were given at a rate of one every few minutes. A bolus of 20 IU of vasopressin was also injected after the administration of the fourth dose of epinephrine. Insulin 10 IU was also administered, and both 300 mg of calcium and 300 mEq of sodium bicarbonate were injected approximately every 5 min, and so a total of 1,200 mg of calcium chloride and 1,200 mEq of sodium bicarbonate were administered to correct the hyperkalemia. Even though the procedure made for less than 50 ml of blood loss, four units of packed RBC were transfused for the decreasing tendency of hemoglobin down to 4.9 g/dl. Additional fluids as well as furosemide 40 mg IV bolus were given to correct the anuria. Consequently, as much as a total of 1,200 ml of crystalloid and 600 ml of colloid, which were loaded with 960 ml packed RBC were given during the cardiac resuscitation. The results of the arterial blood gas analysis throughout the anesthesia and resuscitation are presented in Table 1, and the change of potassium is presented in Fig. 4. All efforts for resuscitation including cardiac compressions were maintained for 29 minutes. Despite these exertion, the asystole state persisted, her blood pressure was not checked and no cardiac rhythm was restored, so the surgeon in charge pronounced her dead. The operating note illustrated that not only the stomach but also the small bowel and colon showed color change, suggesting necrosis. There was no description of the other solid abdominal organs.

Bottom Line: Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started.In spite of active resuscitation for 29 min, the patient did not recover and expired.As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
A 21-year-old female with a history of bulimia nervosa came to the emergency room due to severe abdominal pain after excessive eating five hours previously. On arrival at the emergency room, extreme abdominal distension was detected and the patient's legs changed color. Computed tomography suggested severe gastric dilatation, so abdominal compartment syndrome was suspected and an emergent laparotomy was supposed to be conducted. Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started. In spite of active resuscitation for 29 min, the patient did not recover and expired. As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.

No MeSH data available.


Related in: MedlinePlus