Delayed recovery of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure: A case report / 대한마취과학회지

Perioperative hypothermia can occur frequently and lead to various complications. Laparoscopic procedures do not require a large incision or exposure of the viscera, but a prolonged and high pressure procedure can lead to unexpected hypothermia. Hypothermia prolongs the time-course of non-depolarizing neuromuscular blocking agents by reducing the plasma clearance significantly. Rocuronium, a new aminosteroidal neuromuscular blocking agent, can be influenced by reductions in plasma clearance and prolong the duration of action. Therefore, patients must receive ventilator care in the ICU. Aggressive measures were taken for hypothermia, and the patient was discharged without any complications. We report a case of delayed of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure with a brief review of literatures.

The therapeutic effect of interventional microadhesiolysis and nerve stimulation (IMNS) under ultrasonographic guide in frozen shoulder patient: A case report / 대한마취과학회지

Frozen shoulder is characterized by pain in the shoulder and limitation of glenohumeral movement. The underlying pathologic changes in frozen shoulder are synovial inflammation with subsequent reactive capsular fibrosis. Capsular fibrosis is the ultimate course of frozen shoulder suffering from various causes irrespectively. Therefore, adhesions that are affecting the joint movement must be released. Most important diagnostic method is thoughtful history taking and physical examination, and ultrasonography is very valuable device of diagnosis and treatment. Interventional microadhesiolysis and nerve stimulation (IMNS) is effective to manage frozen shoulder patients. IMNS for frozen shoulder is composed of three release approaches. These are (1) subacromial, (2) posterior inferior capsular, and (3) subdeltoidal & subcoracoidal release and round needle can be used for each release. We report this experiences and recommand this technique for the treatment of frozen shoulder patients.

Intravascular Migration of an Epidural Catheter Despite using Several Testing Maneuvers / 대한마취과학회지

Epidural anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration and neonatal drug depression from general anesthetics. But epidural anesthesia has the potential to produce local anesthetic systemic toxicity or inadvertent high spinal block which is due to unintentional administration of drug into an epidural vessel or subarachnoid space. There are several ways to avoid these complications. These include careful aspiration of epidural catheter, fractionation of the epidural dose, and the use of epinephrine containing epidural test dose before injection of epidural dose. We report a case of a pregnant woman who had developed a seizure after an injection of the epidural anesthetic. This occurred despite using the techniques of aspiration and epinephrine containing epidural test dose injection. So we thought that the seizure occurred probably by the migration of epidural catheter while changing positions and it should be considered in all cases of epidural anesthesia.

Pneumothorax after Interventional Muscle and Soft Tissue Stimulation Therapy : A case report

Pneumothorax is the presence of gas in the pleural space. Traumatic pneumothorax results from penetrating or nonpenetrating chest injuries and iatrogenic pneumothorax occurs as a consequence of a diagnostic or therapeutic maneuver. When interventional muscle and soft tissue stimulation (IMNS) therapy is performed, iatrogenic pneumothorax is not common, but once it has occurred, it gives suffering and pain to both the patient and physician. We experienced three cases of iatrogenic pneumothorax after IMNS therapy. Commonly, the patients with peumothorax are treated with a tube thoracostomy on admission, but these patients can be simply treated with simple observation, oxygen inhalation and simple aspiration without admission and the results are satisfactory. Although iatogenic pneumothorax after IMNS therapy appears to be an rare, IMNS procedure still must be done with care.