Complain Of Distress Research Articles

Dexmedetomidine-treated hyperventilation syndrome triggered by the distress related with a urinary catheter after general anesthesia: a case report

BackgroundHyperventilation syndrome (HVS) sometimes occurs in patients under stressful conditions and may provoke severe complications such as myocardial infarction and death. The authors report a case of HVS following general anesthesia, where a continuous intravenous infusion of dexmedetomidine was effective for HVS.Case presentationA 23-year-old male patient with recurrent tongue cancer was scheduled to undergo partial glossectomy and neck dissection. Emergence from general anesthesia was prompt. Twenty-two minutes after extubation, the patient complained of unbearable distress caused by the urinary catheter. He began to cry, with an increased respiratory rate of over 40 breaths per minute. Intravenous infusion of flurbiprofen, droperidol, and morphine was not effective. Electrocardiography and laryngofiberscopy indicated the absence of acute coronary syndrome and airway obstruction, respectively. An arterial blood gas determination showed pH 7.63, PaCO2 18.2 mmHg, PaO2 143 mmHg on O2 mask 4 L/min, Ca2+ 4.29 mmol/L, and lactate 3.4 mmol/L. The patient was diagnosed with HVS. Dexmedetomidine infusion 2.0 μg/kg/h for 10 min followed by 0.7 μg/kg/h reduced respiratory rate, suppressed arousal, and disappeared the complaint of bladder distension. One hour after extubation, an arterial blood gas determination showed pH 7.33, PaCO2 51.3 mmHg, PaO2 196 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.5 mmol/L. After admission to the intensive care unit, dexmedetomidine infusion was maintained at the rate of 0.2 to 0.7 μg/kg/h until the following morning, and he did not complain of distress caused by the urinary catheter.ConclusionsHVS can occur after emergence from general anesthesia, and dexmedetomidine infusion was effective for HVS.

Spontaneous Ejaculations

<h3>To the Editor:—</h3> The expert's answer to the question regarding distressing spontaneous ejaculations which appeared in the Questions and Answers section ofThe Journal(<b>181</b>:69 [July 7] 1962) is open to serious objection, as the advice given is likely to result in iatrogenic aggravation of the symptom. In my experience, I have found that patients who complain of distress because of spontaneous ejaculations have displaced feelings of distress related to the anxiety which is produced as a result of a threat to their masculine identification. Further physical examination, as indicated in the answer, will probably arouse more anxiety and should be avoided until psychiatric consultation and treatment are attempted. Such psychiatric measures will, in all probability, make further physical examinations unnecessary. The "side effects" of diethylstilbestrol will further threaten the masculine identification of this patient, thus worsening his emotional condition, even if it stops the spontaneous ejaculations. These may,