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Lack of drug effect: case report A 56-year-old man exhibited lack of effect with ephedrine and epinephrine for hypotension. The man was admitted to the emergency department for the treatment of a femoral fracture. On admission, brain CT showed subarachnoid bleeding and a laceration in the right temporal lobe of the brain. Laboratory findings revealed hypostatic pneumonia in both lungs. On admission day 3, he was scheduled for a surgery for internal fixation of the femoral fracture. Prior to the surgery, he received various anaesthetics and a muscle relaxant. Approximately 1h after the initiation of surgery, his end-tidal CO2 and oxygen saturation decreased dramatically. Additionally, his BP also decreased indicating hypotension. The anaesthesiologist immediately adjusted the mechanical ventilation to manual ventilation and auscultated the bilateral breath sounds. Subsequently, he received oxygen through the endotracheal tube along with IV ephedrine 6mg that was repeated followed by epinephrine 10µg [route not stated]. However, the treatment did not improve his haemodynamics. Subsequently, based on the laboratory findings, a diagnosis of acute pulmonary embolism was made. Author comment: "Intravenous administration of ephedrine (6mg) was repeated, and 100% oxygen was administered via the endotracheal tube; this was followed by administration of epinephrine (10 mg). However, these protocols did not improve the patient’s haemodynamics." Aiping Y, et al. Management of intraoperative acute pulmonary embolism in a patient with subarachnoid haemorrhage undergoing femoral fracture repair. Journal of International Medical Research 47: 5307-5311, No. 10, Oct 2019. Available 803434862 from: URL: http://doi.org/10.1177/0300060519874158 - China

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Reactions 23 Nov 2019 No. 1780