title: [Anesthetic management using esmolol for arthroscopic synovectomy in a patient with thyroid storm].
abstract: We report a case of a 47-year-old woman with past medical history of Graves disease who presented with thyroid storm, a state of physiologic decompensation due to severe thyrotoxicosis, and arthritis purulenta. Antithyroid therapy ameliorated thyrotoxicosis in 4 days, and arthroscopic synovectomy of the right knee was performed. Anesthesia was induced with intravenous propofol. Esmolol, an ultra-short-acting beta blocker listed in national drug tariff of Japan for intraoperative continuous iv infusion in March 2008, was also administered to control heart rate. Then, laryngeal mask airway was inserted and echo-guided femoral nerve block was done with ropivacaine. Anesthesia was maintained with i.v. infusion of propofol and fentanyl. Short episode of supraventricular tachycardia occurred twice, but each tachycardia disappered in about a half minute. The postoperative course was uneventful. Esmolol probably acted to prevent intraoperative tachycardia due to increased beta-adrenergic tone.
authors.affiliation: Anesthesia and Analgesia Service, Chiba Aoba Municipal Hospital, Chiba 260-0852.
authors.forename: Kei
authors.initials: K
authors.lastname: Torigoe
authors.forename: Hiroto
authors.initials: H
authors.lastname: Suzuki
authors.forename: Waka
authors.initials: W
authors.lastname: Nakajima
authors.forename: Minori
authors.initials: M
authors.lastname: Takahashi
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Aoyagi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000771:Anesthesia, Intravenous; D013956:Antithyroid Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D005283:Fentanyl; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000517:prevention & control*; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D015742:Propofol; D000074402:Synovectomy; D013585:Synovitis / Q000150:complications / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000517:prevention & control*; D013958:Thyroid Crisis / Q000150:complications* / Q000188:drug therapy; D013971:Thyrotoxicosis / Q000150:complications* / Q000188:drug therapy; D018487:Ventricular Dysfunction, Left / Q000150:complications
chemical_list: D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D011412:Propanolamines; C036604:esmolol; D005283:Fentanyl; D015742:Propofol