Abstract | PURPOSE: CLINICAL FEATURES: Initiation of an iv labetalol infusion resulted in good blood pressure control in a patient suffering from a Fisher grade 3 subarachnoid hemorrhage with an initial Glascow coma scale of 14/15 and mild hydrocephalus. Progressive deterioration of neurological symptoms and evidence of worsening hydrocephalus preceded the sudden development of profound hypotension (60/35 mmHg) and bradycardia with a minimum heart rate of 40 beats.min(-1). Initial resuscitative efforts included administration of intravascular fluid, hypertonic saline, atropine, adrenalin (more than 10 mg in divided doses) and noradrenalin. These measures restored the blood pressure to 80/45 with a HR of 98 beats.min(-1). Intraoperative placement of an intraventricular drain released cerebrospinal fluid under pressure with an initial intracranial pressure of 15 cm H(2)O. A combination of adrenalin, noradrenalin, dopamine and vasopressin infusions were required to restore the blood pressure to 130/65 mmHg after an additional two hours. All inotropic and vasopressor support was weaned off after the 14th hr (about two drug half-lives). The patient was awake and responsive the following day, with no obvious neurological consequences. No evidence of neurological injury, drug administration error or myocardial dysfunction was documented. CONCLUSION:
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Authors | Sana Jivraj, C David Mazer, Andrew J Baker, Mabel Choi, Gregory M T Hare |
Journal | Canadian journal of anaesthesia = Journal canadien d'anesthesie
(Can J Anaesth)
Vol. 53
Issue 7
Pg. 678-83
(Jul 2006)
ISSN: 0832-610X [Print] United States |
PMID | 16803915
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antihypertensive Agents
- Cardiotonic Agents
- Vasoconstrictor Agents
- Vasopressins
- Labetalol
- Dopamine
- Norepinephrine
- Epinephrine
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Topics |
- Antihypertensive Agents
(adverse effects)
- Bradycardia
(chemically induced, drug therapy)
- Cardiotonic Agents
(administration & dosage)
- Dopamine
(administration & dosage)
- Epinephrine
(administration & dosage)
- Female
- Humans
- Hypotension
(chemically induced, diagnosis, drug therapy)
- Intracranial Aneurysm
(complications)
- Labetalol
(adverse effects)
- Middle Aged
- Norepinephrine
(administration & dosage)
- Subarachnoid Hemorrhage
(complications)
- Time Factors
- Vasoconstrictor Agents
(administration & dosage)
- Vasopressins
(administration & dosage)
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