Analysis for Climate Factors in Onset of Spontaneous Subarachnoid Hemorrhage: A Seasonal Variation Study

PURPOSE: The aim of this study was to determine whether there are monthly and seasonal variations of incidence of subarachnoid hemorrhage (SAH) in Seoul. METHODS: We conducted a cross-sectional, retrospective study on the incidence of SAH using the National Emergency Department Information System (NEDIS) of Korea, a nationwide electronic emergency medical care database. Meteorological data (daily and monthly mean sea level air pressure, daily and monthly mean air temperature, daily temperature range) between January 2010 and December 2010 in Seoul were acquired from the Korea Meteorological Administration. The incidence of SAH in patients visiting the ED was defined as those assigned the following codes of the Korea Standard Classification of Disease, 6th Revision (KCD-6codes): I600-I609. RESULTS: The diurnal variation of the onset of SAH showed two broad peak times from 10 a.m. to 2 p.m. and from 4 p.m. to 7 p.m. There was a clear seasonal variation in the occurrence rate of SAH, which was higher in winter than in any other season. Daily temperature (mean, maximum, and minimum) and mean sea-level barometric pressure were not associated with the occurrence rates of SAH. Univariate analysis showed no significant difference between bleeding days and non-bleeding days for the number of SAH patients. In multivariate analysis, the monthly mean temperature showed significant correlation with the occurrence of SAH. CONCLUSION: This study showed seasonal variation in the onset of SAH. Conduct of further population-based study would be required in order to obtain more precise and valuable information.

Cerebral air embolism after removal of internal jugular venous catheter: A case report / 대한마취과학회지

Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler's position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV).

The effects of remifentanil and lidocaine on the cardiovascular responses to tracheal intubation in hypertensive patients / 대한마취과학회지

BACKGROUND: Hypertensive patients are more prone to exhibit an exaggerated hemodynamic responses to laryngoscopy and tracheal intubation. We compared the effects of remifentanil and lidocaine on the cardiovascular responses during intubation in hypertensive patients. METHODS: Fifty adult hypertensive patients (>140/90 mmHg) were divided into 2 groups (remifentanil group; 1.0 microgram/kg, n = 25, lidocaine group; 1.5 mg/kg, n = 25). After 3 minutes'oxygenation, anesthesia was induced using 0.2 mg glycopyrrolate, 1.5 mg/kg propofol, and 1 of experimental drugs (30 seconds) bolus administration. Tracheal intubation was facilitated 90 seconds after administration of rocuronium; anesthesia was maintained with 2% sevoflurane and air in oxygen. Arterial blood pressure and heart rate were measured at the following times: resting state (baseline), after oxygenation; before intubation; just after intubation; and at 1, 3, and 5 minutes after intubation. RESULTS: There was significant attenuation of mean systolic and diastolic arterial blood pressures, after intubation of the remifentanil group compared to the lidocaine group at just after intubation and at 1 minute after intubation (P < .05). The difference in heart rate was not significant between both groups. CONCLUSIONS: Bolus administration of remifentanil was found to be superior to lidocaine in the attenuation of the blood pressure during intubation in hypertensive patients.