A Case of Pulmonary Thromboembolism during Ceaserian Section of Placenta Previa Totalis: A case report / 대한마취과학회지

The pulmonary thromboembolism (PTE) developes occasionally in trauma, surgery and pregnancy. It presents dyspnea, tachycardia, syncope, hypotension and may be fatal by right heart failure. Severe intraoperative PTE is rare. But an intraoperative PTE occurs, it is difficult to diagnose with classic diagnostic measures such as ventilation-perfusion scan, pulmonary angiography, so appropriate management may be delayed. We experienced a case of severe PTE during Ceaserian section of placenta previa totalis. The patient survived and showed complete resolution after 1-year follw-up.

Comparison of Bupivacaine and Normal Saline for Epidural Top-up on Sensory Blockade Level during Combined Spinal Epidural Anesthesia / 대한마취과학회지

BACKGROUND: An increase in the maximum level of sensory blockade by epidural 'top-up' in combined spinal epidural anesthesia may be explained by two mechanisms; a volume effect, compressing the dural sac, and a local anesthetic effect. This study was undertaken to investigate the relative importance of these factors. METHODS: Eighty patients about to undergo lower limb surgery under combined spinal epidural anesthesia were randomly assigned to four groups. Using the needle-through-needle technique, all patients received a subarachnoid injection of 8 mg of heavy bupivacaine through an epidural catheter. At 30 minutes after subarachnoid injection, an epidural top-up was given according to a randomization code. Experimental groups received 10 ml of saline, 10 ml of bupivacaine 0.25%, or 10 ml of bupivacaine 0.5%. The control group received no epidural top-up. The level of sensory blockade was checked by using the pinprick test at 5, 10, 15, 20, 25 and 30 minutes after subarachnoid injection, and at 5, 10, 15, 20, 25 and 30 minutes after epidural top-up. Blood pressure, heart rate and the incidence of side effects such as hypotension, bradycardia, nausea, and high block were analyzed. RESULTS: There was no significant difference in maximum level of sensory block among the 10 ml saline, 10 ml bupivacaine 0.25% or 10 ml bupivacaine 0.5% treated groups during epidural phase. Although blood pressure and heart rate were decreased, there were no differences among experimental groups during epidural phase. The most common side effect during combined spinal epidural anesthesia was hypotension. The incidence of bradycardia and high sensory block (above T4 dermatome level) was similar among the groups. CONCLUSIONS: After the maximum level of sensory blockade due to subarachnoid injection has been established, an epidural top-up with 10 ml of saline or 10 ml of either 0.25% or 0.5% bupivacaine did not significantly increase the level of subarachnoid block in patients with lower extremity surgery. The author concludes the there were no differences among groups with regard to the volume effect and local anesthetic effect in terms of the sensory blockade level during the epidural phase. However, blood pressure and heart rate in the epidural top-up groups reduced with operation time.

Studies of 24 Cases in Continuous Epidural Anesthesia for Cesarean Section in Preeclamptic Parturients / 대한마취과학회지

BACKGROUND: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. METHODS: All received 17.9+/-2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T12-L1 interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. RESULTS: The blood pressure of the patients started to decrease in 5 minutes and most decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3+/-2.0 and 9.2+/-1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). CONCLUSION: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.