Meningitis after a combined spinal epidural anesthesia: A case report / 대한마취과학회지

The incidence of post-dural puncture meningitis is very low. A 44-year-old patient developed a fever (38degrees C, headache, neck stiffness, nausea, and vomiting after combined spinal epidural (CSE) anesthesia and surgery for closed reduction and internal fixation (CRIF) with intramedullary (IM) nailing, tibia, Rt. With a preliminary diagnosis of bacterial meningitis, empiric broad spectrum antimicrobial treatment was immediately started after cerebrospinal fluid (CSF) sampling. The CSF was clear and revealed a white blood cell count, protein, glucose, and pressure of 146/micrometer, 225 mg/dl, 48 mg/dl (serum 151 mg/dl), and 26 cmH2O, respectively. The CSF stain and culture were negative. Considering the injection of preventive antibiotics before CSE anesthesia, partially treated bacterial meningitis was suspected. Four weeks later, clinical symptoms had improved before the patient was discharged.

Approximate entropy as the measurement of the electroencephalographic effect during sevoflurane induction / 대한마취과학회지

BACKGROUND: The processed electroencephalograms are useful surrogate measures of quantification of volatile anesthetics effect. We hypothesized that there is a certain relationship between the end-tidal concentration of sevoflurane and approximate entropy (ApEn). The aim of this study was to investigate the effect of sevoflurane on ApEn during induction. METHODS: Fourteen patients were enrolled. With recording of the electroencephalogram at the F3, F4, P3, and P4 montages, anesthesia was induced by increasing the vapor setting of sevoflurane by 1 vol% up to 8 vol% via a facemask. When the end-tidal concentration of sevoflurane did not show any further change, we increased vapor setting of sevoflurane by 1 vol%. When the end-tidal concentration of sevoflurane did not show any further change with 8 vol% of sevoflurane vapor setting, measurement of electroencephalogram was finished. The relation between end-tidal sevoflurane concentration and ApEn was tested by Spearman correlation. RESULTS: ApEn showed a significant correlation (R = -0.7551, P < 0.0001) with end-tidal sevoflurane concentration. The final pharmacodynamic parameters estimated by a sigmoid E(max) model were described as follows: E(0) = 0.91, E(max) = 0.28, C(e50) = 1.36 vol%, gamma = 1.27, kappa(e0) = 0.67 min(-1). CONCLUSIONS: Sevoflurane induction with gradual increase of end-tidal sevoflurane concentration increases the amount of regularity in approximate entropy.

Acute Pulmonary Edema following Failed Intubation: A Case Report / 대한구급학회지

Pulmonary edema that follows upper airway obstruction may occur in a variety of clinical situations. Post anesthetic laryngospasm has been implicated as the most frequent cause of this syndrome. Risk factors for development of post laryngospasm pulmonary edema include difficult intubation; nasal, oral, or pharyngeal surgical site; and obesity with obstructive apnea. We report a case that developed acute bilateral pulmonary edema after laryngospasm induced by failed intubation.

A Study on the Effect of Dosage Increase and Methods of Ondansetron Administration on the Prevention of Postoperative Nausea and Vomiting of Vaginal Total Hysterectomy Patients during IV Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting are a 'Big Little Problem' during IV-PCA after vaginal total hysterectomy. This study was designed to determine the effect of dosage and the method of ondansetron administration on the incidence of postoperative nausea and vomiting in patients that received intravenous patient-controlled analgesia (IV-PCA). METHODS: Sixty ASA I-II patients that underwent elective total vaginal hysterectomy and received postoperative IV-PCA were randomly divided into three groups according to dosage and the timing of ondansetron administration. These patients were given ondansetron; twice, (4 mg each) after induction and 5 minutes before the end of the operation (group 1); 8 mg 5 minutes before the end of the operation (group 2); and twice, (8 mg each) after induction and 5 minutes before the end of the operation (group 3). The incidences of nausea and vomiting and pain scores by visual analogue scale (VAS) were checked and recorded in recovery rooms and wards at 1, 6, 24, and 48 hours after operation, respectively. RESULTS: The three groups showed no significant differences in terms of the incidences of nausea and vomiting and had similar VAS pain scores. CONCLUSIONS: Our findings suggest that ondansetron dosage and methods of its administration are not effective at reducing the incidence of postoperative nausea and vomiting.