A case of HME obstruction by distilled water from incidentally mounted heated wire circuit kit: A case report / 대한마취과학회지

Heat-moisture exchanger (HME) is an inexpensive and effective device used to prevent respiratory complications that can be caused by endotracheal tube insertion during general anesthesia. But, HME can increase airway resistance and be occluded by the patient's secretions. Whether a HME could be occluded by clear fluids such as condensate in the airway circuit is not certain yet. In vitro, a case of HME occlusion by normal saline was reported. We report a case of HME obstruction by distilled water came from the heated wire circuit which was unintentionally connected to the HME.

Accidental intrapleural positioning of an epidural catheter in a patient undergoing a right pneumonectomy: A case report / 대한마취과학회지

Thoracic epidural analgesia is a common method of pain relief for thoracic and upper abdominal surgery. Misplacement of the epidural catheter is one of the complications associated with epidural analgesia. A 60-year-old man was scheduled for a right pneumonectomy under general anesthesia. Before inducing general anesthesia, the patient was placed in the left lateral decubitus position. A 18-gauge Tuohy needle was inserted into the T6-T7 level using the left paramedian approach 1.5 cm lateral to the midline with a loss of resistance at 7 cm, and uneventful catheter advancement was performed. Approximately 30 minutes after commencing surgery, the surgeon found the epidural catheter in the right pleural cavity. We report a case of the accidental intrapleural positioning of a thoracic epidural catheter.