A suspected case of sugammadex-induced anaphylactic shock: A case report

We describe a case involving a 69-year-old woman who developed anaphylatic shock caused by a clinical dose of sugammadex (2 mg/kg, 100 mg intravenously) 5 minutes after its administration. She developed redness and welts all over her body, and complained of an oropharyngeal itching sensation with dyspnea and dizziness. Her vital signs were closely monitored. She also experienced a sudden onset of hypotension (from 110/70 to 49/40 mmHg) and tachycardia (from 75 to 120 bpm). We diagnosed anaphylactic shock on the basis of these clinical manifestations. After 20 min of traditional treatment (hydration, ephedrine, cortisol, and phenylephrine), her vital signs returned to normal. No postoperative complications were evident, and the patient was discharged from the hospital. Although the prevalence of anaphylactic reactions to sugammadex is rare, physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.

Multiple Psoas Abscess Formation after Pharmacopuncture: A Case Report

Acupuncture has been widely used in alternative medicine for pain relief but may have many complications due to lack of appropriate cares. Pharmacopuncture is a sort of acupuncture that injects a herbal ingredient through a thin tube for the purpose of combining the effects of the herb and acupuncture and it has many pitfalls. The agents used in pharmacopuncture are not refined for a desired effect and not produced by sterile standard processes under strict medical surveillance. We report a case of a 44-yr-old male patient who had multiple abscesses in the psoas region with fever, right low back and hip pain that began after the pharmacopuncture treatment. This case shows that although pharmacopuncture has been practiced widely, it is important that the appropriate aseptic technique should be used to prevent severe infections and other complications.

Cervical Spinal Cord Stimulation in a Patient with Complex Regional Pain Syndrome Type 2 at the Middle Finger: A case report / 대한마취과학회지

Complex regional pain syndrome (CRPS) is quite difficult to comprehend and manage, of which etiology and pathophysiological mechanisms have not been fully understood. CRPS is classified as either type 1 (without any known nerve injury) or type 2 (with apparent nerve or tissue injury). Spinal cord stimulation is a restorative therapy that currently offers the best chances of obtaining long-term pain relief in CRPS patients with pain that has not responded to other treatments such as physical therapy or analgesic medications. A 45 years old male patient referred to our pain clinic due to uncontrolled pain at the middle finger for 4 years after crushing injury. He was diagnosed with CRPS type 2 and treated with medication, stellate ganglion block, thoracic sympathetic block, and pulsed radiofrequency therapy, but their effects were transient and not satisfactory. A percutaneous spinal cord stimulation (SCS) with a single quadripolar electrode was tried and the patient's finger pain was improved significantly (from VAS 10 to 2). SCS is an effective treatment for CRPS type 2 which results from crushing injury when alternative therapies fail.

Inhibiting Effect of Amiodarone to Protective Action against Ischemia/Reperfusion Injury Induced by Ischemic Preconditioning / 대한마취과학회지

odarone. Isovolumetric left ventricular end systolic pressure (LVESP), left ventricular end diastolic pressure (LVEDP), dP/dtMAX and heart rate were measured. RESULTS: Group II showed more recovered LVESP, less developed ventricular stiffness, more preserved coronary effluent flow, earlier termination of arrhythmia and smaller infarct size than Group I. Group III showed preserved LVESP and dP/dtMAX, less developed ventricular stiffness, shortest arrhythmia sustaining time, smallest infarct size among all groups. These myocardial protective effects were abolished in Group IV. CONCLUSIONS: We observed that IPC and amiodarone administration, each has myocardial protective effects against myocardial ischemia, but when they are dealt at the same time, their beneficial effects diminished.

Comparison of Total Intravenous Anesthesia and Sevoflurane-Alfentanil Anesthesia for Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The aim of this prospective, double-blind randomized study was to compare the clinical properties of sevoflurane-alfentanil with propofol-remifentanil anesthesia in patients undergoing a laparoscopic cholecystectomy. METHODS: Forty patients (ASA physical status 1, 2) scheduled for elective surgery received total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-alfentanil. The TIVA group was induced with propofol 5 microgram/ml and remifentanil 4.5 ng/ml. The anesthesia was maintained with a continuous infusions of propofol 2.5 microgram/ml and remifentanil 3 ng/ml. The sevoflurane-alfentanil group was induced with alfentanil 15 microgram/kg and propofol 1.5 mg/kg IV. Maintenance was obtained with 2.0 vol% sevoflurane and a bolus of alfentanil 10microgram/kg IV where needed. RESULTS: There were no significant differences in the systolic and diastolic blood pressure and heart rate between the two groups. There were no significant differences in the time to eye opening, the time to extubation, post-anesthetic recovery room stay time and the incidence of postoperative nausea and vomiting between the two groups. CONCLUSIONS: Propofol-remifentanil (TIVA) and sevoflurane-alfentanil both provided satisfactory anesthesia for a laparoscopic cholecystectomy.

One-lung Ventilation using Wire-guided Endobronchial Blocker and Single Lumen Endotracheal Tube: A Case Report / 대한구급학회지

We had done one-lung ventilation using 9 Fr wire-guided endobronchial blocker and outer diameter 41-mm flexible fiberoptic bronchoscope in ruptured esophageal patient who expected difficult tracheal intubation and in esophageal cancer patient who was in need of mechanical ventilation during and after the operation.

The Effect of sium on the Onset Time of Rocuronium-Induced Neuromuscular Blockade in the Isolated Rat Phrenic Nerve-Hemidiaphragm / 대한마취과학회지

BACKGROUND: Magnesium sulfate (MgSO4) is widely used in the treatment of preeclamptic Hyperreflexia. Eclamptic convulsions are almost always prevented by MgSO4 in plasma concentrations of 4 to 7 mEq/L. It is well known that MgSO4 enhances the effect of nondepolarizing neuromuscular blockade. But the onset time of rocuronium is not shortened by MgSO4. METHODS: The effect of magnesium on the onset time of rocuronium-induced neuromuscular blockade was investigated in vitro rat phrenic nerve-hemidiaphragm preparation. The phrenic nerve-hemidiaphragm was dissected and suspended in an organ bath containing modified Krebs' solution and produced single twitch responses under 0.2 ms, 0.1 Hz, electrical stimulation. We added rocuronium until the twitch height decreased more than 95% of the initial level and determined a dose in 95% decrease twitch height as an effective concentration (EC95). After the administration of MgSO4, the onset time of neuromuscular blockade by rocuronium 1 x EC95, 1.5 x EC95, 2 x EC95 was compared with the onset time without MgSO4. RESULTS: EC50 and EC95 of rocuronium was 0.178 and 1.10 mg/dl. After administration of MgSO4, the concentration of Mg2 in the organ bath was 4.38 mEq/L. The onset time of the neuromuscular blockade by 1 x EC95 rocuronium was significantly shortened, but in the case of over 1.5 x EC95, it was not influenced by MgSO4. CONCLUSIONS: The concentration of Mg2 was within the therapeutic range for inhibition of uterine contraction. The onset time of rocuronium-induced neuromuscular blockade was shortened by magnesium but because a high dose of rocuronium was administered for intubation due to low potency and high plasma concentration, the effect of magnesium on the onset time of rocuronium seems to be masked. Therefore clinically, the onset time of rocuronium-induced neuromuscular blockade was not shortened by MgSO4.