Asunto(s)
Anestésicos/farmacología , Enfermedades del Sistema Nervioso/fisiopatología , Sistema Nervioso/efectos de los fármacos , Enfermedades Neuromusculares/fisiopatología , Esclerosis Amiotrófica Lateral/fisiopatología , Esclerosis Amiotrófica Lateral/cirugía , Anestésicos/administración & dosificación , Sistema Nervioso Autónomo/efectos de los fármacos , Sistema Nervioso Autónomo/fisiología , Sistema Nervioso Autónomo/fisiopatología , Corea/fisiopatología , Corea/cirugía , Humanos , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/cirugía , Sistema Nervioso/fisiopatología , Fenómenos Fisiológicos del Sistema Nervioso , Síndrome de Shy-Drager/fisiopatología , Síndrome de Shy-Drager/cirugíaRESUMEN
BACKGROUND: Chiari I malformation (CM1) is characterized by impaired CSF flow through the foramen magnum. Dysfunctional autonomic cardiovascular regulation may result in syncope. Syncope may be the primary presenting symptom of CM1: a syndrome termed Chiari drop attack. It has been postulated that Chiari drop attack is secondary to dysautonomia caused by hindbrain compression. There has been recent debate regarding the association between CM1, dysautonomia and Chiari drop attack. METHODS: We selected patients with Chiari drop attacks who had negative workups for cardiac syncope, followed by tilt table testing and subsequent surgical decompression. We report test results and clinical outcomes following CM1 decompression. RESULTS: Ten patients met the inclusion criteria: 5 patients had positive and 5 negative tilt table tests. Following decompression, 7 had symptomatic improvement or resolution and 3 failed to improve. The sensitivity and specificity of the tilt table test for detecting clinical improvement with surgical decompression was 43 and 33%, respectively. Tilt table testing had 40% accuracy in predicting clinical response to decompression. CONCLUSIONS: In this short series, surgical decompression of CM1 has a high success rate (70%) for patients with Chiari drop attacks. Tilt table testing has poor predictive value in judging the clinical response to surgical decompression and is not a useful test to guide surgical decision- making.
Asunto(s)
Malformación de Arnold-Chiari , Descompresión Quirúrgica , Síndrome de Shy-Drager , Síncope , Pruebas de Mesa Inclinada , Adolescente , Adulto , Malformación de Arnold-Chiari/complicaciones , Malformación de Arnold-Chiari/diagnóstico , Malformación de Arnold-Chiari/cirugía , Niño , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Síndrome de Shy-Drager/diagnóstico , Síndrome de Shy-Drager/etiología , Síndrome de Shy-Drager/cirugía , Síncope/diagnóstico , Síncope/etiología , Síncope/cirugía , Adulto JovenRESUMEN
A 61-year-old man with Shy-Drager Syndrome underwent partial pulmonary lobectomy under general anesthesia combined with thoracic epidural anesthesia. The blood pressure decreased from 140/ 100 mmHg to 80/50 mmHg after thoracic epidural anesthesia. It increased after intravenous ephedrine. The blood pressure decreased when he was returned to the supine position postoperatively. It did not increase as expected with intravenous ephedrine. Intravenous etilefrine promptly raised the blood pressure. There was no postoperative cardiorespiratory complications.
Asunto(s)
Anestesia Epidural , Anestesia General , Síndrome de Shy-Drager/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 53-year-old man with Shy-Drager syndrome underwent emergency surgery for the resection of the larynx under general anesthesia. Anesthesia was induced with fentanyl 0.1 mg and thiopental 100 mg, and endotracheal intubation was facilitated with vecuronium 8 mg. The onset of action of vecuronium was very slow. Anesthesia was maintained with about 1% of sevoflurane, with nitrous oxide 3 l.min-1 in oxygen 3 l.min-1. Norepinephrine was effective for hypotension while dopamine was not. He was extubated on the first postoperative day without any complications. The effects of vecuronium, norepinephrine, and dopamine might be changed in the patient with Shy-Drager syndrome.
