Acute Pulmonary Edema Occurred in a Patient with Hypothyroidism during Emergence from General Anesthesia: A case report / 대한마취과학회지

Anesthesia and surgery in patients with untreated or inadequately treated hypothyroidism carries the risk of potential complications such as prolonged unconsciousness, hypotension, hypoventilation, hyponatremia, precipitation of congestive heart failure, cardiopulmonary arrest and myxedema coma. In addition, these patients have an impaired ability to excrete free water. Therefore, careful attention must be devoted to fluid and electrolyte management to prevent fluid retention and edema. We experienced a case of acute pulmonary edema during emergence from anesthesia in a patient with cured hypothyroidism. The pulmonary edema was completely resolved with ICU care on the 5th postoperative day. We conclude that surgery in the patient with hypothyroidism require thyroid hormone replacement therapy, careful monitoring and management for the cardiovascular status.

The Effects of NMDA Antagonists and Sympathectomy on the c-Fos mRNA Expression in the Neuropathic Rat / 대한마취과학회지

BACKGROUND: Neuropathic pain produced by nerve injury has the characteristics of enhanced pain responses - allodynia. To understand the pathophysiology of the neuropathic pain, We evaluated the effect of NMDA antagonists and chemical sympathectomy on the c-fos mRNA expression. METHODS: We have divided rats(Sprague-Dawley, N=24) that their left L5 and L6 nerve were tightly ligated into two groups. In NMDA antagonist group(N=17), We injected 10 g MK801 and 10 g 5-amino-phosphonovalerate in three ways, intrathecally before the ligation, after ligation and subcutaneous continuously. Then behavioral tests for mechanical allodynia and cold allodynia were performed. After the test of allodynia,the expression of c-fos were assessed by Northern blot hybridization. In chemical sympathectomy group(N=7), We injected 70 mg/kg guanethidine into the peritoneum in two ways, before the ligation and after ligation. Then same methods were performed in NMDA antagonist group as well. RESULTS: Intrathecal NMDA antagonists before the ligation supressed the elevation of c-fos mRNA expression. Intrathecal NMDA antagonists on the 7 days after the ligation reduced the c-fos mRNA expression and neuropathic pain. Continuous treatment of subcutaneous NMDA antagonists supressed the development of neuropathic pain and the elevation of c-fos mRNA expression. Chemical sympathectomy before the ligation did not supress the elevation of c-fos mRNA expression. Chemical sympathectomy on the 7 days after the ligation reduced neuropathic pain and the elevation of c-fos mRNA expression. CONCLUSIONS: NMDA receptor is related to the induction and maitenance of neuropatic pain, and sympathetic nervous system has a main role in the already induced neuropathic pain.