Pneumothorax during laparoscopic totally extraperitoneal inguinal hernia repair: A case report / 대한마취과학회지

We experienced an extremely rare complication during performance of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair for a 57-year-old healthy man. About 50 minutes after CO2 insufflation, the patient developed tachycardia, hypoxemia, hypercapnia and an increased airway pressure. Right pneumothorax with subcutaneous emphysema was recognized on the emergency chest X-ray and this was successfully treated by chest tube insertion. Anesthesiologists should be aware of the possible occurrence of pneumothorax during laparoscopic TEP hernia repair.

The Effects of Intravenous Adenosine Infusion on Intraoperative Remifentanil Requirements and Postoperative Pain in Elective Tonsillectomies Are Influenced by the Time of Day the Operation Is Performed

BACKGROUND: The chronobiology of postoperative pain is an interesting topic. This study was performed to evaluate the effects of adenosine on inta-operative remifentanil requirements and on postoperative pain in patients undergoing tonsillectomies and how those effects change with changing time of day the surgery is performed. METHODS: For this study, 120 patients were randomly allocated into four groups. Patients in groups B and D received adenosine at a dose of 50microgram/kg/min, and those in group A and C received an equal volume of saline from 10 minutes after the induction of anesthesia until the end of surgery. Group A (saline) and B (adenosine) patients entered the operating room after 08:30 and finished before 11:00, Group C (saline) and D (adenosine) patients entered the operating room after 13:30 and finished before 16:00. We evaluated the intraoperative time-weighted mean remifentanil dose, and postoperative pain scores at 1, 6, 12, and 24 hours, and the analgesic dose required during the following 24 hours. RESULTS: Time-weighted mean remifentanil doses during the intraoperative period and the analgesic requirement during the following 24 hours in group D was significantly lower than in the other groups. The numeric rating scale for pain at 1, and 6 hours in group D was significantly lower (P < 0.01) than that of group A. There were no significant differences in side effects among groups. CONCLUSIONS: Use of intraoperative adenosine infusion provides perioperative analgesia. Postoperative pain is affected by the time of day the operation is performed.

The changes of skin temperature in lower extremity during spinal anesthesia and general anesthesia

BACKGROUND: Skin temperature is well known to increase after spinal anesthesia due to sympathetic blockade and vasodilation. The purpose of this study is to find the changes of skin temperature in lower extremities during spinal and general anesthesia. METHODS: Patients were divided into three groups: SA (spinal anesthesia), GA (general anesthesia) and control (N) group. Skin temperature was recorded in the ventral aspect of mid thigh before induction and 5, 15, 30 min after induction. RESULTS: In all groups, skin temperature increased after 5, 15, 30 min significantly. And temperature gradients between before induction and after 30 minutes did not differ significantly in the three groups (P < 0.05). CONCLUSIONS: The changes of skin temperature in the lower extremities are similar with spinal anesthesia and general anesthesia.