Comparison of Bone Mineral Density of Lumbar Spine in Osteoporotic Patients Treated with Percutaneous Vertebroplasty / 대한마취과학회지

BACKGROUND: Osteoporosis and its associated fractures have become increasingly common in Korea because of increasing population age. Both alendronate (ALN) and raloxifene (RLX) can treat and prevent new vertebral fractures. The purpose of this study was to compare the effects of combined alendronate and raloxifene therapy with alendronate therapy alone in osteoporotic patients that had been treated by percutaneous vertebroplasty. METHODS: We analyzed 40 patients older than 50 years, and performed percutaneous vertebroplasty due to osteoporotic compression fractures. Twenty patients received alendronate only at 70 microgram/week, and the other 20 patients received combined alendronate at 70 microgram/week and raloxifene at 60 microgram/day. At baseline and after 3 and 6 months, we measured the bone mineral density (BMD) of the lumbar spine and femoral neck. RESULTS: On average, the lumbar spine BMD increased by 7.1 and 8.7% from baseline in the ALN and in the ALN + RLX group. The increase in femoral neck BMD in the ALN + RLX group (8.0%) was greater than the 5.6% increase in the ALN group (P = 0.02). CONCLUSIONS: Combined RLX and ALN therapy is more effective than ALN therapy alone in terms of increasing the femoral neck BMD in osteoporotic vertebral compression fracture patients treated by percutaneous vertebroplasty.

Femorofemoral Cardiopulmonary Bypass in the Management of Severe Airway Obstruction by Thyroid Cancer: A Case Report / 대한마취과학회지

Severe upper airway obstruction due to thyroid cancer is often related severe hypoxia and hypercarbia during anesthesia induction. Attempts to insert an endotracheal tube or a bronchoscope may cause complete immediate airway obstruction. We anesthetized two patients. One had a large mediastinal thyroid mass which compressed trachea and caused near complete obstruction, and the other patient had a large papillary thyroid cancer, which had invaded larynx and compressed the upper trachea. Patients were sedated with fentanyl 150microgram i.v. and a target controlled infusion (TCI, 1.8microgram/ml) of propofol. A femorofemoral cardiopulmonary bypass was performed under local anesthesia. After bypass, the propofol TCI concentration was increased to 3.5microgram/ml, and fentanyl 500microgram and vecuronium 6 mg were injected. Ventilation was performed using a laryngeal mask in one patient, and a laryngeal tube in the other. After removing the tumor mass, the airway was secured, and the cardiopulmonary bypass discontinued. All patients recovered uneventfully and were discharged. We discuss the management of severe upper airway obstruction and the usefulness of cardiopulmonary bypass.