Increased amount of pleural effusion during head-down tilt position in ovarian cancer patient with ascites: A case report

Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.

Dexmedetomidine combined with midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia / 대한마취과학회지

BACKGROUND: Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation. METHODS: Ninety patients classified as American Society of Anesthesiologists physical status I–II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused. RESULTS: At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively). CONCLUSIONS: Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia.

Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after laparoscopic gynecological surgery / 대한마취과학회지

BACKGROUND: Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. METHODS: Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. RESULTS: No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 +/- 8.5 ml vs. 16.6 +/- 12.0 ml, P = 0.013). CONCLUSIONS: Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio.

A case of postoperative serotonin syndrome following the administration of fentanyl, palonosetron, and meperidine: A case report

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.

Ultrasound-guided infraorbital alcohol neurolysis for intractable trigeminal neuralgia: A case report

Trigeminal neuralgia is a severe pain disorder characterized by recurrent paroxysms of unilateral facial pain that is typically lancinating or stabbing, and is activated by cutaneous stimulation. Trigeminal alcohol neurolysis is an accepted treatment for trigeminal neuralgia. However, injections of alcohol must be placed accurately because alcohol is highly toxic. In this study, infraorbital alcohol neurolysises were performed under an ultrasound guidance. Ultrasound imaging is a safe, simple and non-invasive modality. This imaging tool allows fine adjustment of the needle tip and direct observation of the injectate. Two patients suffering from trigeminal neuralgia were treated with ultrasound-guided trigeminal alcohol neurolysis. They showed favorable pain relief without any serious complications over the 5- and 7-month follow-up, respectively.

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect / 대한마취과학회지

No abstract available.

Severe hemodynamic deterioration caused by cardiac herniation during endoscopic thoracic sympathicotomy in a patient with previously undiagnosed congenital pericardial defect / 대한마취과학회지

No abstract available.

Recurrent paroxysmal supraventricular tachycardia in the beach chair position for shoulder surgery under general anesthesia / 대한마취과학회지

No abstract available.

Successful tracheal intubation using fiberoptic bronchoscope via an I-gel(TM) supraglottic airway in a pediatric patient with Goldenhar syndrome: A case report / 대한마취과학회지

The I-gel(TM) is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel(TM) supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel(TM) supraglottic airway. The authors suggest that I-gel(TM) is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.

Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate: A case report / 대한마취과학회지

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.

Coronary artery spasm following intravenous phenylephrine on a patient under general anesthesia with previously undiagnosed variant angina and successful treatment by nitroglycerin: A case report

Coronary artery spasm under general anesthesia induces interruption of blood flow of coronary arteries and can be detected by a sudden ST elevation on electrocardiogram, which may be followed by severe cardiovascular complications. We have experienced a case of a sudden ST elevation on a 52-year-old patient with no history of coronary artery diseases undergoing spine surgery under general anesthesia. Following administration of nitroglycerin, ST elevation returned to normal. Postoperative coronary angiogram showed positive on ergonovine provocation test and the patient was diagnosed as variant angina. Correlating with the results, we concluded that the ST elevation was probably due to coronary artery spasm. Although the definite mechanism of the coronary artery spasm is unclear. A-adrenergic stimulation by phenylephrine may have acted as a solitary factor or as one of many factors. Early administration of nitroglycerin and calcium channel blocker seems to be useful in treatment and prevention of recurrence.

Aspiration pneumonitis in achalasia patient treated by per oral endoscopic myotomy: A case report

Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired lower esophagus sphincter relaxation. The exact etiology remains unclear. Stasis of ingested food in esophagus lead to clinical symptoms such as dysphagia, regurgitation, retrosternal pain and weight loss. We report a case of regurgitation during general anesthesia in thyroid cancer patient with achalasia of esophagus. Despite having per oral endoscopic myotomy 6 months ago, the patient presented regurgitation and aspiration pneumonitis. The patient recovered after a week of antibiotics therapy.

The effect of type of anesthesia on intra-and postoperative blood loss at elective cesarean section / 대한마취과학회지

BACKGROUND: In cesarean section (c-sec) it is known that women receiving spinal anesthesia have decreased intraoperative blood loss compared to women receiving general anesthesia. However, we should always consider postoperative bleeding (postpartum bleeding) that may follow. The amount of postpartum bleeding can be substantial. Therefore, we sought to evaluate the effect of type of anesthesia retrospectively on intra- and postoperative blood loss by comparing the changes of postoperative Hb, Hct at c-sec. METHODS: We retrospectively compared the medical records of 287 elective c-sec patients. We excluded medical and obstetric conditions that may predispose such patients to increased blood loss. Subsequent detailed record analysis included 152 patients that received spinal anesthesia (group S), and 135 patients that received sevoflurane for general anesthesia (group G). RESULTS: In comparison with the preoperative Hb, rates of Hb in the 1st postoperative day in group S significantly decreased compared to group G, but there was no significant difference in decreasing rates of Hb in the 3rd postoperative day between groups S and G. Estimated blood loss (EBL) of the intraoperative and operative day in group S was significantly lower compared to group G, but there was no significant difference in EBL of 1st and 2nd postoperative day between groups S and G. CONCLUSIONS: We conclude that group S had a decrease in blood loss between the intraoperative and operative day and there was no significant differences in postoperative blood loss compared with group G.

Experience of severe desaturation during anesthetic induction period in an obese adult patient with Prader-Willi syndrome: A case report / 대한마취과학회지

Prader-Willi syndrome is characterized by infantile hypotonia, childhood-onset obesity, short stature, mental retardation, hyperphagia, hypogonadism. After infantile hypotonia phase, patient is prone to morbid obesity due to hyperphagia. Complications associated with morbid obesity are recognized as the main risk factors for death the lifespan of patients with Prader-Willi syndrome. We experienced desaturation and bronchospasm during arteriovenous fistula surgery in an obese adult with Prader-Willi syndrome.

Hiccups, facial flushing and hypertension after lumbar epidural steroid injection: A case report

Epidural steroid injections (ESI) are commonly used for managing radicular pain. They are generally considered to be a safe treatment with a low incidence of complications, which may be very mild and transient symptoms. We describe here one case of a delayed onset of hiccups, facial flushing and hypertension associated with a lumbar epidural steroid injection.

Hiccups, facial flushing and hypertension after lumbar epidural steroid injection: A case report

Epidural steroid injections (ESI) are commonly used for managing radicular pain. They are generally considered to be a safe treatment with a low incidence of complications, which may be very mild and transient symptoms. We describe here one case of a delayed onset of hiccups, facial flushing and hypertension associated with a lumbar epidural steroid injection.

Subcutaneous emphysema and pneumomediastinum complicating tonsillectomy: A case report

Subcutaneous emphysema and pneumomediastinum are an unusual complication following tonsillectomy. We present a 50-year-old male patient who, after receiving tonsillectomy, developed painful swelling of the cheek and neck. We experienced a case in which subcutaneous emphysema, pneumomediastinum and a deep defect in the tonsillar fossa were observed. These complications resolved 5 days later with conservative treatment, including broad-spectrum antibiotics. This case serves as a reminder that unusual and unexpected complications can occur during a routine procedure. Methods to prevent this complication are discussed.

Treatment & experience of stellate ganglion block for child herpes zoster ophthalmicus: A case report

Herpes zoster is viral infection that presents unilateral skin rash or vesicle along the sensory nerve. It is known that pediatric herpes zoster rarely occurs and usually not so severe when it developed, except in immunocompromised children. We report an uncommon case of herpes zoster ophthalmicus in a 9-year-old boy. He presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid. He was treated with oral acyclovir and stellate ganglion block, with complete resolution without sequelae. In addition, we also review the literature on herpes zoster in childhoods.

Epidural anesthesia for the patient with type IV spinal muscular atrophy: A case report / 대한마취과학회지

Spinal muscular atrophy (SMA) is a rare lower motor neurone disease in which anesthetic management is often difficult as a result of muscle weakness, hypersensitivity to non-depolarizing neuromuscular blocking agent, and succinylcholine induced hyperkalemia. We describe a 50-year-old patient with type IV SMA for synovectomy. We decided to use an epidural technique to avoid muscle relaxants and tracheal intubation. After operation, there was no exacerbation of neurologic signs and symptoms.

Combined spinal-epidural anesthesia for cesarean section in a patient with Moyamoya disease: A case report / 대한마취과학회지

Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.