• PDF / 171,086 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 46 Downloads / 130 Views

DOWNLOAD

REPORT

---

1 S

Dizziness and lack of efficacy: case report A 74-year-old man developed dizziness during treatment with carbamazepine for trigeminocardiac reflex (TCR). Additionally, he exhibited lack of efficacy to atropine and lidocaine while receiving treatment for TCR [not all routes stated; duration of treatment to reaction onset and outcome not stated]. The man, who had a 2-year history of left trigeminal neuralgia (TN) had been receiving regular carbamazepine 200mg twice daily. However, his symptoms were found to be aggravated as over the past year. During treatment, he developed dizziness as a side effect. It was difficult for him to tolerate the large doses of carbamazepine. He presented to seek percutaneous balloon compression (PBC treatment). He had a history of hypertension and his blood pressure was controlled around 140/90mm Hg on an unspecified medications. Pre-operative examination did not show any abnormalities. An MRI of head revealed bilateral trigeminal vascular compression with a more obvious compression on the left side. At operating room, a 12-lead ECG, oxygen saturation, bispectral index and continuous arterial pressure monitoring were performed. He was anaesthetised with midazolam, propofol, sufentanil and vecuronium bromide. He was placed on mechanical ventilation following intubation. Following anaesthesia, he his vital signs were noted to be stable. At the beginning of the operation, he was started on IV atropine 0.5mg injection. During puncture, he developed sudden sinus arrest for 5 seconds. Immediately, his operation was stopped and his heart rate quickly returned to the normal. It was observed that puncture needle entered the foramen ovale. Considering his safety, another dose of atropine 0.5mg was given. At this time, when the needle was re-operated, he developed bradycardia. His HR reduced to 47 bpm from 80 bpm. His HR retuned to the normal after immediate cessation. However, the bradycardia recurred as the puncture needle moved slightly. Thereafter, IV lidocaine 2% 1mL was injected in to the puncture site via puncture needle. However, sinus arrest recurred for 4 seconds. As a result, his operation suspended again. An improvement was not noted after another 2 minutes of waiting, but he developed bradycardia again. Thereafter, he was started on isoproterenol via continuous pump and the speed was adjusted dynamically to maintain the heart rate at 90 bpm. When his blood pressure was found to be below 90/60mm Hg, he received norepinephrine. Thereafter, an operation was completed. His all medications were stopped after cessation of the balloon compression. His intra-operative blood pressure was found to be stable. His condition recovered quickly following operation and was clearly conscious with facial numbness, which was an indication of effectiveness of the operation. The postoperative ECG was normal. Eventually, he was discharged satisfactorily. During follow-up period, a significant pain relief was noted and there was no discomfort. Eventually, it was concluded that atropine and lidocaine fail