Two Cases of Hypnic Headache

Hypnic headache is a unique headache disorder that occurs exclusively during sleep and often with "alarm-clock" consistency. It is a rare, benign, moderately severe, enduring headache syndrome that occurs in middle-aged to elderly adults and affects both sexes. The pathophysiology of hypnic headache is unknown, but its circardian periodicity and responsiveness to lithium suggest chronobiologic sleep disturbance contributing to the genesis of hypnic headache. We have recently experienced 2 cases of hypnic headache. They showed the characteristic signs of hypnic headache. We present our cases and discuss the pathophysiology of hypnic headache.

The Appropriate Inflow Rates of Oxygen and Nitrous Oxide in Adult General Anesthesia / 대한마취과학회지

BACKGROUND: During adult general anesthesia, we used 3~5 L/min of fresh gas flow(FGF) but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to determine the minimal appropriate inflow rate of oxygen and nitrous oxide during semiclosed circle technique. METHODS: We selected 40 patients, ASA group 1 or 2, scheduled for elective, nonabdominal surgery under general anesthesia with semiclosed circle system. Anesthesia was maintained with 50% oxygen, nitrous oxide and enflurane, controlled ventilation was used; rate of 10/min, tidal volume of 10 ml/kg. After induction and vital signs stabilized, FGF was changed to 4 L, 3 L, 2 L and 1L/min at interval of 30 minutes. We observed mean airway pressure and arterial blood gas tensions. RESULTS: The changes of mean airway pressure did not correlated with fresh gas inflow rate. In arterial blood gas analysis, PaO2 showed a decreasing tendency significantly according to decreasing fresh gas inflow rate(p<0.01) but there were no clinical hypoxemia in all patients. There were no significant changes in pH, PaCO2 and base excess. CONCLUSIONS: We consider that FGF of 1~2 L/min is appropriate during adult general anesthesia because of economic and ecological advantages. Also, we consider low flow technique with below 1L/min can be used safely and effectively under proper gas monitoring such as oxygen analyzer, capnometer.