Cardiac arrest due to baclofen withdrawal syndrome.

A 41-year-old man presented with postcervical traumatic complete quadriparesis under intrathecal baclofen therapy (ITB) for refractory spasticity. Less than 24 h after having his baclofen pump substituted, he develops hyperthermia, seizures, cognitive depression, acute hypoxaemic respiratory failure and cardiovascular instability leading to mechanical ventilation and vasopressor support. He was transferred to an intensive care unit with diagnosis of community-acquired pneumonia leading to septic shock. He evolved with progressive clinical worsening and multisystem organ failure and cardiac arrest in non-shockable rhythm (pulseless electrical activity)--4 min resuscitation with return of spontaneous circulation. Considering the possible diagnosis of baclofen withdrawal syndrome and, in suspicion of ITB delivery disruption, the catheter system was surgically explored and a leaking tubule attachment was found. Despite aggressive cardiovascular, respiratory and renal support therapy, clinical improvement occurred only after restoration of intrathecal drug delivery. He was discharged from the hospital after 56 days, having returned to baseline status.

[Influence of processed EEG monitoring in the anesthetic management and its cost in off-pump coronary surgery: a research protocol]. / Influência da Monitorização com EEG processado na Conduta Anestésica e seu Custo em Cirurgia Coronária Off-PuMP: Protocolo de Investigação.

BACKGROUD: Although in some studies intraoperative processed EEG monitoring has shown advantages such as less use of hypnotic drugs and decrease duration of both anesthetic emergency and recovery times, there is controversy on the incidence of awareness. It has not been demonstrated that this type of monitoring interferes with length of hospital stay, morbidity and mortality. Processed EEG monitoring, such as the bispectral index (BIS) has been widely accepted in assessing anesthetic depth, yet its usage is not part of the standard monitoring of the American Society of Anesthesiologiy (ASA). Other forms of monitoring anesthetic depth widely used are clinical monitoring associated with monitoring expiratory fraction of halogenated anesthetic agents. METHODOLOGY: Prospective randomized study comparing two groups of patients undergoing coronary artery bypass surgery without cardiopulmonary bypass (CPB): group A - BIS visible (BIS value is shown throughout the procedure) and group B - BIS not visible (BIS is hidden and monitoring of anesthetic depth is based on clinical signs associated with the monitoring of expiratory fraction of halogenated anesthetic agent). The aim of this study is to verify the existence of differences in anesthetic depth and associated costs in the two group study's and also to add evidence to anesthetic depth monitoring in an area where few studies have been done - cardiac surgery.