Whole lung lavage using a rapid infusion system to treat a patient with pulmonary alveolar proteinosis / 영남의대학술지

Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient’s symptoms improved without the occurrence of any complications.

Comparison of Outcomes between Intubated and Non-intubated Video-assisted Thoracoscopic Wedge Resections Applied in the Same Patient / 계명의대학술지

In video-assisted thoracoscopic surgery (VATS), general anesthesia with endotracheal intubation was considered an optimal method of anesthesia for a long time. However, complications due to general anesthesia and one-lung ventilation have become a problem. In recent years, epidural anesthesia without endotracheal intubation has been attempted in various thoracic surgical procedures with various advantages and disadvantages reported. We compared postoperative pain and prognosis when different anesthesia methods were used in a patient who underwent the same operation twice in the interval of one year. When non-intubated video-assisted thoracoscopic surgery (NIVATS) underwent under epidural anesthesia, postoperative pain score was lower, adverse events were fewer, and the hospital stay was shorter than that of VATS. The patient also expressed high subjective satisfaction. Like previous studies, the results favored NIVATS under epidural anesthesia. However, greater attention and proficiency are required from the anesthesiologist for proper analgesia and sedation.

Comparison of Outcomes between Intubated and Non-intubated Video-assisted Thoracoscopic Wedge Resections Applied in the Same Patient / 계명의대학술지

In video-assisted thoracoscopic surgery (VATS), general anesthesia with endotracheal intubation was considered an optimal method of anesthesia for a long time. However, complications due to general anesthesia and one-lung ventilation have become a problem. In recent years, epidural anesthesia without endotracheal intubation has been attempted in various thoracic surgical procedures with various advantages and disadvantages reported. We compared postoperative pain and prognosis when different anesthesia methods were used in a patient who underwent the same operation twice in the interval of one year. When non-intubated video-assisted thoracoscopic surgery (NIVATS) underwent under epidural anesthesia, postoperative pain score was lower, adverse events were fewer, and the hospital stay was shorter than that of VATS. The patient also expressed high subjective satisfaction. Like previous studies, the results favored NIVATS under epidural anesthesia. However, greater attention and proficiency are required from the anesthesiologist for proper analgesia and sedation.

Comparison of Outcomes between Intubated and Non-intubated Video-assisted Thoracoscopic Wedge Resections Applied in the Same Patient / 계명의대학술지

In video-assisted thoracoscopic surgery (VATS), general anesthesia with endotracheal intubation was considered an optimal method of anesthesia for a long time. However, complications due to general anesthesia and one-lung ventilation have become a problem. In recent years, epidural anesthesia without endotracheal intubation has been attempted in various thoracic surgical procedures with various advantages and disadvantages reported. We compared postoperative pain and prognosis when different anesthesia methods were used in a patient who underwent the same operation twice in the interval of one year. When non-intubated video-assisted thoracoscopic surgery (NIVATS) underwent under epidural anesthesia, postoperative pain score was lower, adverse events were fewer, and the hospital stay was shorter than that of VATS. The patient also expressed high subjective satisfaction. Like previous studies, the results favored NIVATS under epidural anesthesia. However, greater attention and proficiency are required from the anesthesiologist for proper analgesia and sedation.

The relationship between the surgical Apgar score and postoperative complications in patients admitted to an intensive care unit after surgery

BACKGROUND: Surgical Apgar score (SAS) is a 10-point system that measures estimated blood loss, lowest heart rate and lowest mean blood pressure during surgery, and is known to be associated with postoperative complications. The purpose of this study was to evaluate the relationship between SAS and postoperative major complications in patient admitted to intensive care unit (ICU) after surgery. METHODS: We retrospectively reviewed 543 patients who were admitted to the ICU for 8 months. SAS, patient's demographics and postoperative outcomes were collected and analyzed based on anesthetic record and several medical records in an electronic chart system built in hospital. The patients were divided into three groups based on their SAS. The postoperative major complications, duration of ICU stay and duration of hospital stay were compared among the three groups. RESULTS: In the low score group, the rate emergency, trauma and hepatobiliary operation were high. In this group, the duration of ICU and hospital stay, use of mechanical ventilation and inotropic in ICU, and postoperative complication were also increased. SAS also had a weak negative correlation with ICU stay and hospital stay. Postoperative complication and mortality rate doubled when compared to reference group (SAS 7–10) according to univariate logistic regression. CONCLUSIONS: In patients admitted to ICU after surgery, SAS, which can be measured during surgery, is closely related to postoperative parameters including major complications, mortality, and ICU stay. In other words, it is thought that the postoperative outcomes can be improved through appropriate monitoring and intervention for patients with low SAS score.

Anesthetic management of a pediatric patient with Rett syndrome: A case report

Rett syndrome is a neurodevelopmental disease that almost always affects female patients. It is caused by mutations in MeCP2 in the majority of cases. Patients diagnosed with Rett syndrome may experience serious adverse events even with smaller amounts of medication for sedation and anesthesia. The major anesthetic concerns associated with Rett syndrome are lack of cooperation, abnormal continuous limb movements, abnormal respiratory control, difficult positioning secondary to scoliosis, and altered sensitivity to painful stimuli. Because of the risks caused by these problems, anesthesiologists should be aware of the specific anesthetic concerns of patients with Rett syndrome in order to safely administer anesthesia. Here, we describe the management of a pediatric patient diagnosed with Rett syndrome.