Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：目前，心脏风暴的总数很少，关于在全身麻醉(GA)下进行浅表手术的患者的心脏风暴的公开文献很少.近年来,心脏风暴因其高死亡率而备受临床关注，管理困难，预后不良。
方法：本文报道了一名57岁男性心脏电风暴患者。他出现了临床症状，如渗出，口臭,限制张口,和局部皮肤上的粘液白斑，没有心脏病和心血管疾病史，在GA下进行浅表面部手术。麻醉诱导后2小时,在监测中发现了几个室性早搏。发现血细胞比容和血浆钾明显减少。患者随后经历了心脏电风暴，多形性室性心动过速（VT）反复发作，不会退化为心室纤颤（VF）。结合这些临床症状和检查，我们做出了心脏电风暴的诊断.在第一次出现心动过缓时，我们服用了阿托品,解决了心动过缓.然而,十分钟后是VT，我们用阿托品和肾上腺素治疗。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。最后,他通过药物治疗和胸部按压成功治疗。术后患者未发生异常心电图事件。
结论：该病例强调了在没有已知心脏病的患者中发生麻醉诱导的自体输血和心脏电风暴的可能性。对于这种情况需要尽快电除颤和电复律，及时静脉应用有效的抗心律失常药物等治疗措施。我们希望此病例报告增加了有关此主题的现有文献。
方法：本文报道了一名57岁男性心脏电风暴患者。他出现了临床症状，如渗出，口臭,限制张口,和局部皮肤上的粘液白斑，没有心脏病和心血管疾病史，在GA下进行浅表面部手术。麻醉诱导后2小时,在监测中发现了几个室性早搏。发现血细胞比容和血浆钾明显减少。患者随后经历了心脏电风暴，多形性室性心动过速（VT）反复发作，不会退化为心室纤颤（VF）。结合这些临床症状和检查，我们做出了心脏电风暴的诊断.在第一次出现心动过缓时，我们服用了阿托品,解决了心动过缓.然而,十分钟后是VT，我们用阿托品和肾上腺素治疗。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。最后,他通过药物治疗和胸部按压成功治疗。术后患者未发生异常心电图事件。
结论：该病例强调了在没有已知心脏病的患者中发生麻醉诱导的自体输血和心脏电风暴的可能性。对于这种情况需要尽快电除颤和电复律，及时静脉应用有效的抗心律失常药物等治疗措施。我们希望此病例报告增加了有关此主题的现有文献。
