Acute and Critical Care

Case Report

Cardiology
Successful neural modulation of bedside modified thoracic epidural anesthesia for ventricular tachycardia electrical storm: Ki-Woon Kang; Acute Crit Care. 2024;39(4):643-646. Published online May 31, 2022; DOI: https://doi.org/10.4266/acc.2021.01683

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Ventricular tachycardia (VT)/ventricular fibrillation (VF) storm can be hemodynamically compromising and life-threatening. Management of medically refractory VT/VF storm is challenging in the intensive care unit. A 38-year-old male patient was diagnosed with non-ischemic heart failure and acute kidney injury with documented frequent premature ventricular contraction with QT prolongation after recurrent VT/VF. Even though the patient was intubated with sedatives and had taken more than two anti-arrhythmic drugs with external recurrent defibrillation at bedside, the electrical storm persisted for several hours. However, medically refractory VT/VF storm can be successfully and rapidly terminated with a modified thoracic epidural anesthesia at bedside. This case demonstrates that a bedside thoracic epidural anesthesia can be an effective non-pharmacological option to treat medically refractory VT/VF storm in the intensive care unit.

Citations

Citations to this article as recorded by

Stellate Ganglia: A Key Therapeutic Target for Malignant Ventricular Arrhythmia in Heart Disease
Yu-Long Li, Yu Li, Huiyin Tu, Anthony J. Evans, Tapan A. Patel, Hong Zheng, Kaushik P. Patel
Circulation Research.2025; 136(9): 1049. CrossRef
Neuromodulation of the Cardiac Autonomic Nervous System for Arrhythmia Treatment
Benjamin Wong, Yuki Kuwabara, Siamak Salavatian
Biomedicines.2025; 13(7): 1776. CrossRef
Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia
Veronica Dusi, Filippo Angelini, Enrico Baldi, Antonio Toscano, Carol Gravinese, Simone Frea, Sara Compagnoni, Arianna Morena, Andrea Saglietto, Eleonora Balzani, Matteo Giunta, Andrea Costamagna, Mauro Rinaldi, Anna Chiara Trompeo, Roberto Rordorf, Matte
Europace.2024;[Epub] CrossRef
Antiarrhythmic Mechanisms of Epidural Blockade After Myocardial Infarction
Jonathan D. Hoang, Valerie Y.H. van Weperen, Ki-Woon Kang, Neil R. Jani, Mohammed A. Swid, Christopher A. Chan, Zulfiqar Ali Lokhandwala, Robert L. Lux, Marmar Vaseghi
Circulation Research.2024;[Epub] CrossRef

Randomized Controlled Trial

Post-thoracotomy Analgesia & ICU Length of Stay: Comparison of Thoracic Epidrual Morphine Infusion and Lumbar Epidural Plus Intravenous Morphine Infusion: Seok Hwa Yoon, Jung Hyun Lee, Hee Suk Yoon, Yoon Hee Kim, Myung Hoon Na, Seung Pyung Lim; Korean J Crit Care Med. 2007;22(2):77-82.

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Abstract PDF: BACKGROUND
Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group).
METHODS
Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed.
RESULTS
There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital.
CONCLUSIONS
Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.

Case Report

A Case of Spontaneous Intracranial Hypotension with Headache and Tinnitus Treated with Epidural Blood Patch : A Case Report: Bong Jae Lee; Korean J Crit Care Med. 2006;21(2):126-130.

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Abstract PDF: Spontaneous intracranial hypotension (SIH) is a syndrome of low cerebrospinal fluid pressure characterized by postural headaches in patients without any history of dural puncture, back trauma, operative procedure, or medical illness. The clinical spectrum of SIH is quite variable and includes headache, neck stiffness, nausea, horizontal diplopia, dizziness, tinnitus, visual blurring, radicular arm pain. When the headache persists or more incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is used in the management of SIH and highly effective. I experienced a case of 39 year old female with postural headache and tinnitus who was diagnosed as having SIH and successfully treated with epidural blood patch.

Original Article

The Effect of Epidural Block on Renal Function in Patients Undergoing Subtotal Gastrectomy with General Anesthesia: Moon Seok Chang; Korean J Crit Care Med. 2005;20(1):44-48.

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Abstract PDF: BACKGROUND
Epidural block is widly used for anesthesia or analgesia, so many researches has been done in the field of cardiovascular system. And we reported the effects of epidural block on renal function in patients undergoing total abdominal hysterectomy with general anesthesia. In this research I evaluated the effect of epidural anesthesia on renal function in patients undergoing subtotal gastrectomy with general anesthesia. The earlier was in lumbar level and the later was in thoracic level. METHODS: We studied 15 patient who were in ASA 1 or 2. The epidural catheter was inserted via 17 gauge Tuohy needle through the T10-T11 intervertebral space of the patients before general anesthesia. Anesthesia for all the patients were maintained with isoflurane, nitrous oxide and oxygen. We measured urine output and hemodynamic profiles such as mean arterial pressure, pulse, CVP, cardiac output during 2 hours of general anesthesia period. And then we injected 10ml of 0.15% bupivacaine to the epidural space and measured the same parameters as those of general anesthesia period during another 2 hours of epidural anesthesia combined with general anesthesia. We also compared urine output and renal function (creatinine clearance, Na clearance, fractional excretion of Na and free water clearance) between each of the two periods. RESULTS: Mean arterial pressure and pulse were lower after epidural injection than before (p<0.05), but Cardiac output and CVP were not significantly different between two periods. Renal function data were not significantly different between the two periods.
CONCLUSIONS
Renal function was maintained during sympathetic block by thoracic epidural anesthesia combined with general anesthesia.

Case Report

Labor Analgesia with Epidural Blockade in Parturient with Peripartum Cardiomyopathy: A Case Report: Tae Ha Ryu, Jae Hoon Jeong, Dong Gun Lim, Si Oh Kim; Korean J Crit Care Med. 2004;19(2):143-147.

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Abstract PDF: Peripartum cardiomyopathy (PPCM) is an unusual and uncommon causes of antepartum and postpartum heart failure, which may result in severe cardiac failure and death. PPCM is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure but can rapidly progress to cardiac failure. We presented a case of elective labor induction in a patient with peripartum cardiomyopathy. A epidural analgesia technique was performed without difficulty for labor analgesia in parturient with peripartum cardiomyopathy. Her post-delivery course was uncomplicated but her baby has died due to respiratory failure. We suggest that vaginal delivery with careful incremental epidural alnalgesia in patient with PPCM is acceptable methods and close peripartum monitoring is essential in the management of PPCM.

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