Overlapped multiple distal entrapment neuropathies hindering diagnosis of thoracic outlet syndrome: A case report

Thoracic outlet syndrome is caused by the compression of neurovascular structures at the thoracic outlet region. Diagnosis is difficult since thoracic outlet syndrome is often accompanied by distal entrapment neuropathies such as carpal tunnel syndrome or ulnar and radial neuropathies. In this article, the authors report a case regarding a patient with thoracic outlet syndrome whose diagnosis was delayed due to the overlapping of multiple distal entrapment neuropathies.

The Comparison of Suceess Rates of Lightwand Facilitated Tracheal Intubation in Different Head Positions (Neutral Position versus Sniffing Position) / 대한마취과학회지

BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.

The Comparison of Suceess Rates of Lightwand Facilitated Tracheal Intubation in Different Head Positions (Neutral Position versus Sniffing Position) / 대한마취과학회지

BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.

Comparative First Intubation Success Rates of Blind Orotracheal Intubation Using Intubating Laryngeal Mask Airway with or without Handle Elevation / 대한마취과학회지

BACKGROUND: Elevation of intubating laryngeal mask airway (ILMA) handle increase the efficacy of the seal by pressing the cuff more firmly into the periglottic tissues and many clinicians apply an upward force to ILMA handle during blind intubation. In this study, we compared the first intubation success rate through ILMA during intubation with or without handle elevation. METHODS: With informed consent, fifty adult patients of ASA physical status I or II were selected. After insertion of ILMA size 4, optimal ventilation was established by slightly rotating the device in the sagittal plane, using the metal handle, until the least resistance to bag ventilation is achieved. Ventilation grade and fiberoptic bronchoscopic view were evaluated at the proper position. Intubation using ILMA was limited to first attempt regardless of successful tracheal intubation. After intubated tube was removed, ILMA was slightly elevated away from the posterior pharyngeal wall using the metal handle, and ventilation grade with fiberoptic bronchoscopic view were evaluated, then intubation was proceeded. Success rates of both methods on the first attempt were calculated. RESULTS: Ventilation grade and fiberoptic bronchoscopic view had no significant differences under the intubation using ILMA with or without handle elevation. Success rates of intubation on the first attempt with and without handle elevation were 78% and 82%. Therefore both methods had no significant differences. CONCLUSIONS: Blind tracheal intubation using ILMA with handle elevation is not necessary to get higher intubation success rates on the first attempt. Finding proper ventilation position and technical experience are required for successful blind tracheal intubation using ILMA.

One-Lung Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is an arrhythmogenic disease that is manifested by specific patterns of right bundle branch block with ST elevation in right precordial (V1-V3) ECG leads causing ventricular fibrillation, leads to a sudden death without organic heart problems. It is an incomplete penetrating autosomal dominant disease that is due to mutation in SCN5A gene, coding for Na+ channel of cardiac muscles. This syndrome is more common and may be endemic in southeast Asia. Although it is a highly risky disease, it's preventive treatment for arrhythmia has not been established yet. We experienced a case of 28 year old man who had wedge resection of lung because of spontaneous pneumothorax under general anesthesia and who was suspected Brugada syndrome based on specific ECG patterns and a family history of his father's sudden death after syncope.

The Effect of Alfentanil on the Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Inguinal Herniorraphy / 대한마취과학회지

BACKGROUND: Sevoflurane anesthesia is associated with emergence agitation in children. In this study, we compared the emergence and recovery profiles of children who received sevoflurane with fentanyl or alfentanil for inguinal herniorrhaphy. METHODS: Forty-five children receiving sevoflurane anesthesia for inguinal herniorraphy were assigned to three groups. Saline 0.1 ml/kg (group S), alfentanil 10microgram//kg (group A) or fentanyl 1microgram//kg (group F) was administered intravenously at the beginning of fascia closure. Duration of operation and anesthesia and emergence time were evaluated at the operating room. Agitation score, a degree of pain, the time of stay in PACU (postanesthetic care unit) and postoperative side effects were evaluated by a blinded observer at the PACU. RESULTS: The emergence time was prolonged in the group F compared to the other groups. The time of stay in PACU was prolonged in the group F compared to the group S. Group A and F had lower agitation score and pain score in comparison with that of the group S at the 0, 5, 10, 15 min in the PACU. Agitation score was also significantly lower in the group F compared to the group A at 30 min. CONCLUSIONS: We suggest that intravenous administration of alfentanil 10microgram//kg or fentanyl 1microgram//kg at the closure of fascia could effectively reduce the agitation score. Alfentanil also does not delay from emergence and the time of stay in the PACU.

A Sudden Cardiac Arrest before Spinal Anesthesia of a Diabetic Patient: A case report / 대한마취과학회지

Vasovagal syncope is elicited by the Bezold-Jarisch reflex, triggered by anxiety, emotional stress or pain. It is the result of reflexively increasing parasympathetic tone and decreasing sympathetic tone sensed by chemoreceptor in vagus nerve and mechanoreceptor of ventricle, which causes bradycardia, systemic vasodilatation and profound hypotension. Although it is a transient episode in many cases, it could give rise to cardiac arrest. Diabetic autonomic neuropathy can lead to significant change in blood pressure and pulse rate, bradycardia, hypotension, and even cardiac arrest by increasing the risk of hemodynamic instability under general or regional anesthesia. We have experienced a patient who had once cardiac arrest following after positional change and recovered in a few minutes. The patient was supposed to have diabetic autonomic neuropathy under the emotional stress and anxiety before spinal anesthesia was done. We believe that this is the result of combination between paradoxical Bezold-Jarisch reflex caused by overactivation of parasympathetic nerve system and autonomic nervous system instability precipitated by diabetic autonomic neuropathy.

Pain Management for Low Bsck Pain and Lumbosacral Raliculopathy / 대한마취과학회지

Since the introduction of epidural corticoateroid injections for the management of sciaticall, luintosacral radiculopathy has become one of the most common pain problems enco-untered by anesthesiologists. In order to function effectively, anesthesiologiats should be able to: 1) recognize those syndromes which may respond to nerve block: 2) understand the pathophysiology of the conditions being treated and 3) be familiar with alternate ther-apeutic pathways for patientg not responding to merre b1ock. There are many etiologic factors of low back pain and lumbosacral radiculopathy. Particularly, Nerve root compression caused by a protruding disc, a osteophyte or tumors are usually responsible for pain. Neural inflammation, therefore, is considered to play a major role in pain production.The use of local anesthetics in mixture with steroids is believed to break down neural inflammation. Steroids and local anesthetics were injected lumbar or caudal epidmal to 106 patients for the purpose of relieving low back pain and lumbosacral radiculopathy. The resu1ts are as follows : Excellent Pain relieved group : 27 Patients (25.5%) Good Pain relieved group: 49 Patients(46.1%) Fair pain relieved group : IS patients(14.2%) Not effective group : 15 Patients (14.2%).