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Jeong-min Hwang - One of the best experts on this subject based on the ideXlab platform.

  • Adjustment in patients with Asystole during strabismus surgery
    Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
    Co-Authors: Jeong-min Hwang
    Abstract:

    Purpose To investigate whether patients who developed Asystole during strabismus surgery under general anesthesia also develop Asystole during adjustment, and whether adjustment can safely be performed under topical anesthesia in these patients. Design Retrospective, noncomparative interventional case series. Methods Adjustment was performed with topical anesthesia in four patients aged 28, 32, 50, and 53 years who exhibited Asystole during strabismus surgery under general anesthesia. Blood pressure and electrocardiogram were monitored during the adjustment. Results Adjustment was successfully completed in all patients without Asystole. Two patients showed oculocardiac reflex (OCR), with a reduction in heart rate (HR) >20% of the baseline value. One of these patients exhibited severe OCR that developed when the patient’s posture was changed from the supine to the sitting position for measurement of the angle of strabismus after adjustment, and again during conjunctival manipulation after conjunctival closure. No patient required atropine. Conclusions Adjustment can safely be performed under topical anesthesia in patients who developed Asystole during strabismus surgery under general anesthesia.

  • Adjustment in patients with Asystole during strabismus surgery
    Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2011
    Co-Authors: Seong-won Min, Jeong-min Hwang
    Abstract:

    Purpose To investigate whether patients who developed Asystole during strabismus surgery under general anesthesia also develop Asystole during adjustment, and whether adjustment can safely be performed under topical anesthesia in these patients.

  • The incidence of Asystole in patients undergoing strabismus surgery
    Eye, 2009
    Co-Authors: Jeong-min Hwang
    Abstract:

    Purpose To investigate the incidence of Asystole during strabismus surgery. Design Retrospective, noncomparative interventional case series. Methods Six months to 80 years of age of 3628 consecutive patients who underwent strabismus surgery from October 1994 to May 2007 were enrolled. Results Four patients (0.11%) under general anaesthesia showed Asystole during strabismus surgery. All four were adults of 28, 32, 50, and 53 years of age. Two patients had hypertension and three had preoperative electrocardiographic abnormalities. Three patients had previously undergone uneventful strabismus surgery. Conclusions Asystole is likely to be encountered during strabismus surgery with an incidence of ca. 0.11%.

James T. Niemann - One of the best experts on this subject based on the ideXlab platform.

  • outcome of out of hospital postcountershock Asystole and pulseless electrical activity versus primary Asystole and pulseless electrical activity
    Critical Care Medicine, 2001
    Co-Authors: James T. Niemann, Samuel J. Stratton, Brian Cruz, Roger J. Lewis
    Abstract:

    Objective: In the prehospital setting, countershock terminates ventricular fibrillation (VF) in about 80% of cases. However, countershock is most commonly followed by Asystole or pulseless electrical activity (PEA). The consequences of such a countershock outcome have not been well studied. The purpose of this investigation was to compare the outcome of prehospital VF victims shocked into Asystole or PEA with that of patients whose first documented rhythm was Asystole or PEA (primary Asystole or PEA). Design: Observational, retrospective study conducted over 5 yrs (1995-1999). Setting: A municipal hospital with a catchment area of >200,000. Patients: Consecutive adult patients with out-of-hospital non-traumatic cardiopulmonary arrest of cardiac origin. Patients found in VF who developed Asystole or PEA after countershocks (group 1) and patients found in Asystole or PEA (primary Asystole or PEA) (group 2) were included if the reported downtime was <10 min. Interventions: None. Measurements and Results: Study end points included restoration of circulation (defined as a pulse for any duration), survival to hospital admission, and survival to hospital discharge. Ratios were determined, 95% confidence intervals were calculated, and observed differences were compared. For group 1 patients (n = 101), 61% of patients had a bystander-witnessed collapse and 34% received bystander cardiopulmonary resuscitation. For group 2 patients (n = 140), collapse was bystander witnessed in 71% and 45% received bystander cardiopulmonary resuscitation. These differences were not statistically significant. Restoration of circulation was significantly more frequent in group 2 than group 1 (42% vs. 16%, p <.001) as was survival to hospital admission (36% vs. 11%, p =.001). Survival to hospital discharge was greater in group 2 patients, but the difference failed to achieve statistical significance (10% vs. 3%, p =.062). Conclusions: Countershock of prolonged VF followed by a nonperfusing rhythm has a worse prognosis than primary Asystole or PEA and may be related to myocardial electrical injury.

  • Outcome of out-of-hospital postcountershock Asystole and pulseless electrical activity versus primary Asystole and pulseless electrical activity.
    Critical care medicine, 2001
    Co-Authors: James T. Niemann, Samuel J. Stratton, Brian Cruz, Roger J. Lewis
    Abstract:

    Objective: In the prehospital setting, countershock terminates ventricular fibrillation (VF) in about 80% of cases. However, countershock is most commonly followed by Asystole or pulseless electrical activity (PEA). The consequences of such a countershock outcome have not been well studied. The purpose of this investigation was to compare the outcome of prehospital VF victims shocked into Asystole or PEA with that of patients whose first documented rhythm was Asystole or PEA (primary Asystole or PEA). Design: Observational, retrospective study conducted over 5 yrs (1995-1999). Setting: A municipal hospital with a catchment area of >200,000. Patients: Consecutive adult patients with out-of-hospital non-traumatic cardiopulmonary arrest of cardiac origin. Patients found in VF who developed Asystole or PEA after countershocks (group 1) and patients found in Asystole or PEA (primary Asystole or PEA) (group 2) were included if the reported downtime was

  • Endotracheal versus intravenous epinephrine and atropine in out-of-hospital "primary" and postcountershock Asystole.
    Critical care medicine, 2000
    Co-Authors: James T. Niemann, Samuel J. Stratton
    Abstract:

    STUDY OBJECTIVE Pulmonary blood flow during cardiac arrest and cardiopulmonary resuscitation (CPR) is 18 yrs in atraumatic cardiac arrest whose first documented field rhythm was Asystole with time-to-definitive care of < or =10 mins (primary Asystole) and patients found in ventricular fibrillation who developed postcountershock Asystole (secondary Asystole) were included. Patients were grouped according to route of drug administration (i.v., ET, or no drug therapy) as well as rhythm (primary or secondary Asystole). A positive response to drug therapy was defined as any subsequent rhythm other than Asystole during continued prehospital resuscitation. MEASUREMENTS AND MAIN RESULTS A total of 136 patients met inclusion criteria. The following groups were defined: group 1, primary Asystole/i.v. drugs (n = 39); group 2, postcountershock Asystole/i.v. drugs (n = 39); group 3, primary Asystole/ET drugs (n = 25); group 4, postcountershock Asystole/ET drugs (n = 18); and group 5, primary or secondary Asystole/no drug therapy (n = 15). Significant differences were not observed between groups with respect to age, gender, witnessed arrest, frequency of bystander CPR, or time-to-definitive care. The positive rhythm response rate was significantly greater in group 1 (64%) and group 2 (69%) (both p < .01) than in Group 3 (12%) or group 4 (11%). The response rate in the control group was 20% and not significantly different from either ET group. The intravenous groups also had a significantly greater rate of return of spontaneous circulation (17%) when compared with the ET groups (0%) (p = .005). CONCLUSION We conclude that the currently recommended doses of epinephrine and atropine administered endotracheally are rarely effective in the setting of cardiac arrest and CPR.

Samuel J. Stratton - One of the best experts on this subject based on the ideXlab platform.

  • outcome of out of hospital postcountershock Asystole and pulseless electrical activity versus primary Asystole and pulseless electrical activity
    Critical Care Medicine, 2001
    Co-Authors: James T. Niemann, Samuel J. Stratton, Brian Cruz, Roger J. Lewis
    Abstract:

    Objective: In the prehospital setting, countershock terminates ventricular fibrillation (VF) in about 80% of cases. However, countershock is most commonly followed by Asystole or pulseless electrical activity (PEA). The consequences of such a countershock outcome have not been well studied. The purpose of this investigation was to compare the outcome of prehospital VF victims shocked into Asystole or PEA with that of patients whose first documented rhythm was Asystole or PEA (primary Asystole or PEA). Design: Observational, retrospective study conducted over 5 yrs (1995-1999). Setting: A municipal hospital with a catchment area of >200,000. Patients: Consecutive adult patients with out-of-hospital non-traumatic cardiopulmonary arrest of cardiac origin. Patients found in VF who developed Asystole or PEA after countershocks (group 1) and patients found in Asystole or PEA (primary Asystole or PEA) (group 2) were included if the reported downtime was <10 min. Interventions: None. Measurements and Results: Study end points included restoration of circulation (defined as a pulse for any duration), survival to hospital admission, and survival to hospital discharge. Ratios were determined, 95% confidence intervals were calculated, and observed differences were compared. For group 1 patients (n = 101), 61% of patients had a bystander-witnessed collapse and 34% received bystander cardiopulmonary resuscitation. For group 2 patients (n = 140), collapse was bystander witnessed in 71% and 45% received bystander cardiopulmonary resuscitation. These differences were not statistically significant. Restoration of circulation was significantly more frequent in group 2 than group 1 (42% vs. 16%, p <.001) as was survival to hospital admission (36% vs. 11%, p =.001). Survival to hospital discharge was greater in group 2 patients, but the difference failed to achieve statistical significance (10% vs. 3%, p =.062). Conclusions: Countershock of prolonged VF followed by a nonperfusing rhythm has a worse prognosis than primary Asystole or PEA and may be related to myocardial electrical injury.

  • Outcome of out-of-hospital postcountershock Asystole and pulseless electrical activity versus primary Asystole and pulseless electrical activity.
    Critical care medicine, 2001
    Co-Authors: James T. Niemann, Samuel J. Stratton, Brian Cruz, Roger J. Lewis
    Abstract:

    Objective: In the prehospital setting, countershock terminates ventricular fibrillation (VF) in about 80% of cases. However, countershock is most commonly followed by Asystole or pulseless electrical activity (PEA). The consequences of such a countershock outcome have not been well studied. The purpose of this investigation was to compare the outcome of prehospital VF victims shocked into Asystole or PEA with that of patients whose first documented rhythm was Asystole or PEA (primary Asystole or PEA). Design: Observational, retrospective study conducted over 5 yrs (1995-1999). Setting: A municipal hospital with a catchment area of >200,000. Patients: Consecutive adult patients with out-of-hospital non-traumatic cardiopulmonary arrest of cardiac origin. Patients found in VF who developed Asystole or PEA after countershocks (group 1) and patients found in Asystole or PEA (primary Asystole or PEA) (group 2) were included if the reported downtime was

  • Endotracheal versus intravenous epinephrine and atropine in out-of-hospital "primary" and postcountershock Asystole.
    Critical care medicine, 2000
    Co-Authors: James T. Niemann, Samuel J. Stratton
    Abstract:

    STUDY OBJECTIVE Pulmonary blood flow during cardiac arrest and cardiopulmonary resuscitation (CPR) is 18 yrs in atraumatic cardiac arrest whose first documented field rhythm was Asystole with time-to-definitive care of < or =10 mins (primary Asystole) and patients found in ventricular fibrillation who developed postcountershock Asystole (secondary Asystole) were included. Patients were grouped according to route of drug administration (i.v., ET, or no drug therapy) as well as rhythm (primary or secondary Asystole). A positive response to drug therapy was defined as any subsequent rhythm other than Asystole during continued prehospital resuscitation. MEASUREMENTS AND MAIN RESULTS A total of 136 patients met inclusion criteria. The following groups were defined: group 1, primary Asystole/i.v. drugs (n = 39); group 2, postcountershock Asystole/i.v. drugs (n = 39); group 3, primary Asystole/ET drugs (n = 25); group 4, postcountershock Asystole/ET drugs (n = 18); and group 5, primary or secondary Asystole/no drug therapy (n = 15). Significant differences were not observed between groups with respect to age, gender, witnessed arrest, frequency of bystander CPR, or time-to-definitive care. The positive rhythm response rate was significantly greater in group 1 (64%) and group 2 (69%) (both p < .01) than in Group 3 (12%) or group 4 (11%). The response rate in the control group was 20% and not significantly different from either ET group. The intravenous groups also had a significantly greater rate of return of spontaneous circulation (17%) when compared with the ET groups (0%) (p = .005). CONCLUSION We conclude that the currently recommended doses of epinephrine and atropine administered endotracheally are rarely effective in the setting of cardiac arrest and CPR.

Evgeny Tsimerinov - One of the best experts on this subject based on the ideXlab platform.

  • Prolonged Asystole: Neurogenic vs. Cardiac Origin? (Ictal Cardiac Asystole Captured during Invasive Video EEG Monitoring with Successful Surgical Outcome) (P03.140)
    Neurology, 2013
    Co-Authors: Anishee K. Shah, Dawn Eliashiv, Jeffrey M. Chung, John Jefferson, Evgeny Tsimerinov
    Abstract:

    OBJECTIVE: To present for the first time a case of ictal Asystole captured during invasive EEG monitoring. BACKGROUND: Bradycardia and cardiac Asystole as ictal phenomena are under recognized but previously described features in patients with medically refractory partial epilepsy. However, previous documentation of ictal bradyarrhythmia and ictal Asystole emanating concurrently from the right frontal and temporal lobe seizures are infrequent. There are no reports of patients with ictal Asystole that have successfully undergone invasive EEG monitoring followed by resective epilepsy surgery with resolution of seizures and bradyarrhythmia. DESIGN/METHODS: We present a patient with medically refractory partial epilepsy who was diagnosed with seizure related ictal bradyarrhythmia and Asystole during invasive depth electrode EEG monitoring, and subsequently underwent successful resective epilepsy surgery. A 36 year old male with medically refractory partial seizures presented with a history of sudden falls and generalized seizures. Synchronized video EEG monitoring with EKG recordings on an implanted cardiac loop recorder suggested that the seizures were emanating simultaneously from the right orbitofrontal and right temporal lobes and were associated with ictal bradycardia and an episode of prolonged ictal Asystole for 25 seconds. RESULTS: The patient underwent right fronto-orbital lobe and the right hippocampal temporal resection. The patient has not had seizure spells during the following 3 year period of observation after the resective epilepsy surgery. CONCLUSIONS: In conclusion, the incidence of life-threatening cardiac symptoms such as ictal bradyarrhythmia and ictal Asystole are perhaps more frequent than documented and its awareness should be increased. Also, the presence of the ictal bradyarrhythmia and Asystole are not a contraindications the resective epilepsy surgery. Disclosure: Dr. Shah has nothing to disclose. Dr. Eliashiv has received personal compensation for activities with Pfizer Inc, UCB Pharma, Lundbeck, and GlaxoSmithKline, Inc. as a speaker. Dr. Chung has nothing to disclose. Dr. Jefferson has nothing to disclose. Dr. Tsimerinov has nothing to disclose.

Roger J. Lewis - One of the best experts on this subject based on the ideXlab platform.

  • outcome of out of hospital postcountershock Asystole and pulseless electrical activity versus primary Asystole and pulseless electrical activity
    Critical Care Medicine, 2001
    Co-Authors: James T. Niemann, Samuel J. Stratton, Brian Cruz, Roger J. Lewis
    Abstract:

    Objective: In the prehospital setting, countershock terminates ventricular fibrillation (VF) in about 80% of cases. However, countershock is most commonly followed by Asystole or pulseless electrical activity (PEA). The consequences of such a countershock outcome have not been well studied. The purpose of this investigation was to compare the outcome of prehospital VF victims shocked into Asystole or PEA with that of patients whose first documented rhythm was Asystole or PEA (primary Asystole or PEA). Design: Observational, retrospective study conducted over 5 yrs (1995-1999). Setting: A municipal hospital with a catchment area of >200,000. Patients: Consecutive adult patients with out-of-hospital non-traumatic cardiopulmonary arrest of cardiac origin. Patients found in VF who developed Asystole or PEA after countershocks (group 1) and patients found in Asystole or PEA (primary Asystole or PEA) (group 2) were included if the reported downtime was <10 min. Interventions: None. Measurements and Results: Study end points included restoration of circulation (defined as a pulse for any duration), survival to hospital admission, and survival to hospital discharge. Ratios were determined, 95% confidence intervals were calculated, and observed differences were compared. For group 1 patients (n = 101), 61% of patients had a bystander-witnessed collapse and 34% received bystander cardiopulmonary resuscitation. For group 2 patients (n = 140), collapse was bystander witnessed in 71% and 45% received bystander cardiopulmonary resuscitation. These differences were not statistically significant. Restoration of circulation was significantly more frequent in group 2 than group 1 (42% vs. 16%, p <.001) as was survival to hospital admission (36% vs. 11%, p =.001). Survival to hospital discharge was greater in group 2 patients, but the difference failed to achieve statistical significance (10% vs. 3%, p =.062). Conclusions: Countershock of prolonged VF followed by a nonperfusing rhythm has a worse prognosis than primary Asystole or PEA and may be related to myocardial electrical injury.

  • Outcome of out-of-hospital postcountershock Asystole and pulseless electrical activity versus primary Asystole and pulseless electrical activity.
    Critical care medicine, 2001
    Co-Authors: James T. Niemann, Samuel J. Stratton, Brian Cruz, Roger J. Lewis
    Abstract:

    Objective: In the prehospital setting, countershock terminates ventricular fibrillation (VF) in about 80% of cases. However, countershock is most commonly followed by Asystole or pulseless electrical activity (PEA). The consequences of such a countershock outcome have not been well studied. The purpose of this investigation was to compare the outcome of prehospital VF victims shocked into Asystole or PEA with that of patients whose first documented rhythm was Asystole or PEA (primary Asystole or PEA). Design: Observational, retrospective study conducted over 5 yrs (1995-1999). Setting: A municipal hospital with a catchment area of >200,000. Patients: Consecutive adult patients with out-of-hospital non-traumatic cardiopulmonary arrest of cardiac origin. Patients found in VF who developed Asystole or PEA after countershocks (group 1) and patients found in Asystole or PEA (primary Asystole or PEA) (group 2) were included if the reported downtime was