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Persistent electrocardiogram changes during excision of craniopharyngioma

Saudi Journal of Anaesthesia
Medknow Publications
Publication Date
DOI: 10.4103/1658-354x.93069
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Sir, Neurosurgical patients show a variety of cardiac disturbances[12] but majority of them are transient in nature. Here we have reported a case of cardiac ischemic after craniopharyngioma excision that persisted even in the postoperative period. A 15-year-old male patient weighing 30 kg was admitted to the neurosurgery department with complaints of progressive, painless loss of vision in both eyes, and headache since the previous 5 years. After clinical and radiologic examination, the patient was diagnosed as a case of craniopharyngioma. The magnetic resonance imaging (MRI) revealed a large sellar suprasellar cystic mass compressing optic chiasma. There was edema surrounding the tumor and moderate hydrocephalus was present. The patient was scheduled for elective craniotomy and excision of tumor after undergoing routine laboratory investigations. All the preoperative investigations, including electrocardiogram (ECG) and X-ray chest were normal. On the day of surgery the patient was premedicated with 0.2 mg glycopyrrolate intramuscularly an hour before the surgery. In the operating room routine monitors, namely, ECG, pulse oximeter (SpO2), noninvasive blood pressure (NIBP), and Bispectral index (BIS) were attached and the basal recording were noted. The ECG wave form appeared normal over the monitor. General anesthesia was induced with fentanyl 2 μg/kg, propofol 2 mg/kg, and tracheal intubation facilitated with rocuronium 1 mg/kg. Trachea was intubated using 6.0 mm cuffed portex endotracheal tube. Anesthesia was maintained with isoflurane in oxygen nitrous oxide mixture (40:60) and intermittent boluses of fentanyl and vecuronium as and when required. Intraoperative invasive monitoring, that is, central venous pressure and arterial blood pressure, was done using right internal jugular vein and left posterior tibial artery, respectively. Esophageal temperature (35.5°C–37°C) and depth of anesthesia (BIS 40–60) was maintained during anesthesia. During the intraoperative course while the tumor was being e

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