Emergency exploratory laparotomy in a COVID-19 patient - A case report -

Background@#Surgeries in patients with coronavirus disease 2019 (COVID-19) put medical staff at a high risk of infection. We report the anesthetic management and infection control of a mechanically ventilated COVID-19 patient who underwent exploratory laparotomy for suspected duodenal ulcer perforation.Case: A 73-year-old man, mechanically ventilated for confirmed COVID-19, showed clinical and radiographic signs of a perforated duodenal ulcer, and he was transferred under sedation and intubation to a negative-pressure operating room. The operating and assistant staff wore personal protective equipment. High-efficiency particulate absorbing (HEPA) filters were inserted into the expiratory circuits of the anesthesia machine and portable ventilator. No participating staff contracted COVID-19, although the patient later died due to pneumonia. @*Conclusions@#This report can contribute to establishing clinical guidelines for the surgical management and operation room setting of COVID-19 patients.

Assessment of successful epidural steroid injection using photoplethysmogram

BACKGROUND:One of effective treatment methods for back pain and radiculopathy is epidural steroid injection (ESI). However, its effectiveness is hard to judge.So, it is strongly urged to develop a method to evaluate the proper injection of ESI. Photoplethysmogram (PPG) is known as a technique to measure blood oxygen saturation. We were intended to study the PPG for the evaluation of the ESI instantaneously. METHODS:All patients were explained for the study protocol to get informed consent.Twenty volunteers were recruited for this study and four of them were allocated in one of 5 ESI levels; L2-3, L3-4, L4-5, L5-S1 and caudal.They were in the lateral position with 4 PPG probes in their both 2nd fingers and 2nd toes.The PPG signals were collected to a device and converted digitally.PPG signal has two components, total absorbance (TA) and oscillating pulse component (OPC).We compared the both toe PPG signals before and after ESI based on the finger PPG. RESULTS:TA changed in 60% of ESI volunteers and L4-L5 and L5-S1 groups had high change rate compared to L2-L3 group.Also, the symptom relief rate of TA and OPC change volunteers of L4-L5 and L5-S1 were 100% but other level had variable relief rate. CONCLUSIONS:It is possible to use the PPG signal to predict ESI success based appropriate signal change.It is also needed to develop other level signal detection method and to modify appropriate guideline for the decision of change of PPG.

Anesthesia for Heart Transplantation in Dilated Cardiomyopathy Patient with Delirium: A case report / 대한마취과학회지

Heart transplantation is the last method for the patients who are suffering from heart failure refractory to conventional medical treatment. Traditional contraindications of heart transplantation are irreversible pulmonary arterial hypertension, active infection, irreversible renal, hepatic dysfunction, coexisting neoplasm, psychosocial instability, substance abuse and so on. But these days, traditional contraindications have been changed because increased clinical experience allowed liberalization of patients who were previously considered contraindication. We experienced a case of successful heart transplantation in dilated cardiomyopathy patient with preoperative delirium.

Unexpected Massive Bleeding during Liver Transplantation in Patients with Budd-Chiari Syndrome: A case report / 대한마취과학회지

Budd-Chiari syndrome (BCS) is a heterogenous group of disorders characterized by obstruction of hepatic venous outflow. Severe liver cirrhosis and limited cardiac reserve in patients with BCS makes them less tolerant to liver transplantation. We experienced two cases of massive bleeding during living donor liver transplantation in patients with BCS. Blood products and fluids were rapidly infused with a rapid infusion system, final infusion volume in these two patients were 177 L and 193 L, and the use of Cell Savers allowed for the patient's blood products to be saved. The patients were managed successfully and recovered uneventfully with advanced monitoring, including monitoring of their jugular venous oxygen saturation and continuous cardiac output. Therefore, rapid infusion systems and Cell Savers, along with advanced monitoring, are necessary in the event of massive bleeding during liver transplantation.

Pulmonary Embolism in a Patient of Renal Cell Carcinoma with Inferior Vena Cava Thrombus : A case report

Renal cell carcinoma (RCC) involves frequently the inferior vena cava (IVC). As effective treatment of RCC with IVC thrombus is currently lacking, aggressive surgical treatment may be considered. However, this procedure can result in fatal complications such as pulmonary embolism. We experienced a case of pulmonary embolism diagnosed, not by intraoperative transesophageal echocardiography, but by a computed tomography scan taken just after radical nephrectomy with IVC thrombectomy in a 63-year-old patient with RCC extending to the IVC.

Airway Management of a Patient with Esophago-tracheal Perforation by Endotracheal Tube: A case report / 대한마취과학회지

Although uncommon and rarely reported, tracheo-esophageal perforation during traumatic intubation is life threatening and associated with a high mortality rate. It may result in severe airway complications such as a pneumothorax, pneumomediastium, pneumonia, and mediastinitis. The mortality rate of esophageal perforation has been reported to range from 6 to 34%, and up to 56% if the diagnosis is delayed by more than 12 hours after the event. In our case, the patient had been intubated for 3 weeks with an esophago-tracheal perforation. The perforation was not found by the physician because he had no signs of esophageal perforation, the tip of endotracheal tube was well in the trachea and balloon of the tube was sufficient to prevent air leakage. After the failure of extubation for three times, the diagnosis was carried out by gastrofibroscopy, bronchoscopy and chest 3-dimensional computed tomography. His tracheal and esophageal walls were injured with severe inflammation. Therefore, primary repair could not be done and only a tracheostomy was performed.