Misconceived Retropharyngeal Calcific Tendinitis during Management of Myofascial Neck Pain Syndrome

Differential diagnosis of posterior neck pain is very challenging based on symptoms and physical examination only. Retropharyngeal calcific tendinitis is a rare and frequently misdiagnosed entity in various causes of neck pain. It results from calcium hydroxyapatite deposition in the longus colli muscle which is characterized by severe neck pain, painful restriction of neck movement, dysphagia, and odynophagia. We herein report a case of a patient with acute retropharyngeal calcific tendinitis, who complained of posterior neck pain, initially diagnosed and treated as a myofascial neck pain syndrome.

Nerve injury in an undiagnosed adult tethered cord syndrome patients following spinal anesthesia: A case report

Spinal anesthesia is a safe and widely used procedure. Spinal cord injury is a rare but serious complication from spinal anesthesia occurs, unexpectedly. Risks of direct neural injury from spinal anesthesia increase in tethered cord syndrome that the spinal cord is tethered by the inelastic structure and is, also, extended to the lower lumbar vertebra. A 52-years-old female patient undergoing anti-incontinence surgery developed neurologic symptoms following spinal anesthesia. The low-lying conus (L5 body level) and tethered cord were found during the assessment of neurological symptoms.

Survey on the Treatment of Postherpetic Neuralgia in Korea; Multicenter Study of 1,414 Patients

BACKGROUND: Postherpetic neuralgia (PHN) is a serious complication resulting from herpes zoster infections, and it can impair the quality of life. In order to relieve pain from PHN, various treatments, including pharmacological and interventional methods have been used. However, little information on the recommendations for the interventional treatment of PHN, along with a lack of nation-wide surveys on the current status of PHN treatment exists. This multicenter study is the first survey on the treatment status of PHN in Korea. METHODS: Retrospective chart reviews were conducted on the entire patients who visited the pain clinics of 11 teaching hospitals from January to December of 2011. Co-morbid disease, affected site of PHN, routes to pain clinic visits, parenteral/topical medications for treatment, drugs used for nerve block, types and frequency of nerve blocks were investigated. RESULTS: A total of 1,414 patients' medical records were reviewed. The most commonly affected site was the thoracic area. The anticonvulsants and interlaminar epidural blocks were the most frequently used pharmacological and interventional methods for PHN treatment. For the interval of epidural block, intervals of 5 or more-weeks were the most popular. The proportion of PHN patients who get information from the mass media or the internet was only 0.8%.The incidence of suspected zoster sine herpete was only 0.1%. CONCLUSIONS: The treatment methods for PHN vary among hospitals. The establishment of treatment recommendation for PHN treatment is necessary. In addition, public relations activities are required in order to inform the patients of PHN treatments by pain clinicians.

Pulsed radiofrequency lesioning of the median nerve in a patient with bilateral carpal tunnel syndrome: A case report

Carpal tunnel syndrome, compression of the median nerve in the carpal tunnel at the wrist, is the most common entrapment syndrome of peripheral nerve. It is characterized by sensory and motor symptoms and signs in the distribution of the median nerve. Radiofrequency thermocoagulation is a neuroablative treatment for various chronic pain disorders, but is associated with neural injury, neuritis, and occasional neuroma. Unlike RF, pulsed radiofrequency, the use of the high current intensity and electrical fields, has been proposed for the modulation of the excited nervous system pathway of pain without neuro-destruction and other potential complications. We report a case of bilateral carpal tunnel syndrome that was relieved after PRF lesioning of both median nerves.

Acute-on-chronic subdural hematoma by spinal anesthesia in a patient with undiagnosed chronic subdural hematoma: A case report / 대한마취과학회지

Subdural hematoma is a serious but rare complication of spinal anesthesia. A 70-year-old woman patient underwent elective total knee replacement under spinal anesthesia. At 4 days postoperatively, the patient complained of headache and vomiting. Brain computed tomography revealed an acute-on-chronic subdural hematoma with midline shift. The patient recovered completely after surgical decompression. We report a patient with an undiagnosed chronic subdural hematoma, who developed acute-on-chronic subdural hematoma after spinal anesthesia.

Long QT syndrome provoked by induction of general anesthesia: A case report / 대한마취과학회지

Long QT syndrome (LQTS) is an arrhythmogenic cardiovascular disorder resulting from mutations in cardiac ion channels. LQTS is characterized by prolonged ventricular repolarization and frequently manifests itself as QT interval prolongation on the electrocardiogram (ECG). A variety of commonly prescribed anesthetic drugs possess the adverse property of prolonging cardiac repolarization and may provoke serious ventricular tachyarrhythmia called 'torsades de pointes', ventricular fibrillation, and sudden death. We experienced a case of ventricular tachycardia and ventricular fibrillation after anesthetic induction and it came out into the open that anesthetic induction provoked long QT syndrome.

Transient cauda equina syndrome related to a sacral schwannoma with cauda equine compression after a lumbar epidural block: A case report / 대한마취과학회지

A 53-year-old man had chronic low back and leg pain for four years without any history of trauma or neurological manifestations. There was a reduction in symptoms after a lumbar epidural block. Two hours later after the procedure, the patient complained of perineal numbness and lower extremity weakness. The neurological evaluation revealed loss of sensation in the saddle area and the posterior aspect of the leg. The deep-tendon reflexes were decreased in the leg. The patient was unable to urinate. The MRI revealed a schwannoma at the S3 level of the sacral spine with cauda equina compression. The patient's symptoms improved slightly over the next few hours. The patient had a gradual return of motor function and could feel the Foley catheter. All of the symptoms completely resolved over the next nine hours and the patient was discharged to home once completely recovered. This case illustrates the importance of clinical examination and continued vigilance for evaluation of neurological deterioration after epidural injections.

Spinal Nerve Root Swelling Mimicking Intervertebral Disc Herniation in Magnetic Resonance Imaging: A Case Report

A herniated intervertebral disc is the most common type of soft tissue mass lesion within the lumbar spinal canal. Magnetic resonance imaging (MRI) is a useful tool for the assessment of patients with lower back pain and radiating pain, especially intervertebral disc herniation. MRI findings of intervertebral disc herniation are typical. However, from time to time, despite an apparently classic history and typical MRI findings suggestive of disc herniation, surgical exploration fails to reveal any lesion of an intervertebral disc. Our patient underwent lumbar disc surgery with the preoperative diagnosis of lumbar disc herniation; however, nothing could be found during the surgical procedure, except a swollen nerve root.

Pulmonary thromboembolism occurred immediately after leg elevation under induction of general anesthesia in a patient with femur fracture : A case report

Pulmonary embolism is a fatal complication of major operation. But early detection of pulmonary thromboembolism during general anesthesia is not easy because clinical manifestations of pulmonary thromboembolism are nonspecific during general anesthesia. So the prevention of pulmonary thromboembolism is important for the high risk patients. We experienced a case of pulmonary thromboembolism which occurred in an old female patient with femur fracture immediately after leg elevation following induction of general anesthesia.

Chest Pain due to Rapidly Developed Metastatic Spinal Tumor : A case report / 한국호스피스완화의료학회지

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.

Unilateral vocal cord palsy occurred after difficult endotracheal intubation using intubating laryngeal mask airway: A case report / 대한마취과학회지

Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.

Disseminated intravascular coagulation due to placenta accreta : A case report

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.

Disseminated intravascular coagulation due to placenta accreta : A case report

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.

Acute cerebral infarction due to thrombus formation during GDC embolization for the treatment of intracranial aneurysm: A case report / 대한마취과학회지

Although Guglielmi Detachable Coil (GDC) endovascular treatment of intracranial aneurysms has become an alternative to surgery, the main complication continues to be thromboembolic events. In our patient, we found thrombus at the third branch of the right middle cerebral artery after coil embolization. We added intravenous heparin and gave abciximab, an antiplatelet agent through the catheter. We then elevated the blood pressure and administered intravenous colloid solution to maintain adequate collateral circulation. One day later, the patient presented with acute focal infartion in the right frontal lobe and we treated her with low molecular weight heparin. After seven days, the patient's symptoms disappeared, and there was no residual neurological deficit. Therefore, we believe potential clinical complications can be avoided through early recognition of thrombus and appropriate medical therapy. Furthermore, it is necessary to prevent hypotension and to maintain proper hematocrit levels during operations in patients having risk factors for thrombosis.

Anesthetic Management of a Patient with Idiopathic Hypereosinophilic Syndrome: A case report / 대한마취과학회지

Idiopathic hypereosinophilic syndrome is characterized by prolonged markedly elevated peripheral blood eosinophil count and eosinophil-related tissue damage to variable organs without an identifiable underlying cause. Eosinophilopoiesis is related with T-lymphocyte activation and cytokine cascade controlling eosinophilic production. It shows tissue infiltration in many organs including endomyocardium, lung, liver, gastrointestinal tract. Here we report a case of idiopathic hypereosinophilic syndrome presenting ruptured rectus sheath hematoma due to coagulopathy involving the liver. Severe postoperative complications were developed after general anesthesia. The patient suffered from life-threatening acute respiratory distress syndrome (ARDS). This case suggest that, in patients with marked eosinophilia requiring general anesthesia, perioperative steroid cover is advisable. This may reduce or prevent serious lung damage and other complications.

Acute Pulmonary Edema for Surgical Removal of Pheochromocytoma: A case report / 대한마취과학회지

This report describes the perioperative management of an adrenergic crisis and intraoperative pulmonary edema occurring during planned surgery for pheochromocytoma. We experienced the anesthetic management of a 45-year-old male patient with pheochromocytoma on the extra-adrenal retroperitoneum. The patient had been treated with prazosin for only 1 week before surgery. After inducing anesthesia with intravenous remifentanil, thiopental sodium, and rocuronium, anesthesia was maintained with nitrous oxide, oxygen, and isoflurane administration. The blood pressure was poorly controlled with sodium nitroprusside, esmolol, and remifentanil after manipulating the tumor. Pulmonary edema occurred intraoperatively but subsided with positive end expiratory pressure and the use of diuretics and morphine. After removing the tumor, the blood pressure was well controlled using a colloid solution, Hartman's solution, and dopamine administration. This complication occurred because of inadequate preoperative preparation. We reported this case of surgery for the removal of a pheochromocytoma with a review of the relevant literature.

Unanticipated Difficult Intubation in a Preeclamptic Parturient with Asymptomatic Subglottic Stenosis Caused by Unknown Origin : A case report

Subglottic stenosis can be caused by various etiology such as idiopathic, infectious disease, trauma from previous prolonged intubation, airway surgery, external blunt trauma, radiaton, or inhalation burn. Although extremely rare, subglottic stenosis may be present in pregnancy and engender a complex and technically challenging dilemma for anesthesiologist as how to evaluate and best manage these patients. A 36-year-old parturient was scheduled for Cesarean section. When most of the vocal cords were exposed clearly by laryngoscopy after injection of thiopental sodium & succinylcholine, the 7.0 mm internal diameter (ID) endotracheal tube could not be advanced below the level of the vocal cords because of resistance. So, intubation was re-attempted several times after oxygenation by mask with smaller tubes. Finally, a 6.0 mm ID cuffed tube was passed successfully through the vocal cords, and secured in place. because of the unexpected difficulties in intubation, an otolaryngologist was consulted to examine the larynx with a microscope. We present an unexpected case of the difficult endotracheal intubation caused by a unrecognized subglottic stenosis in a preeclamptic who underwent the induction of general anesthesia for Cesarean section.

Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Referred Shoulder Pain due to Metastatic Liver Cancer: A case report / 대한통증학회지

A diagnosis of shoulder pain is varied and difficult to make. The initial onset of liver cancer is difficult to detect and patients typically do not complain of symptoms as most tumors are asymptomatic. If the symptoms of the patients develop, the first symptom is usually pain that extends from the abdomen to the back and shoulder. A suprascapular nerve block is used in the treatment of the referred shoulder pain due to a metastatic hepatoma, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 66-year-old male patient complaining of referred right shoulder pain due to metastatic liver cancer, which was relieved after PRF lesioning of the suprascapular nerve.

Effects of Fentanyl and Remifentanil on Hemodynamic Responses to Endotracheal Intubation during the Induction of Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: Laryngoscopy and endotracheal intubation cause hemodynamic changes such as hypertension and tachycardia. Adjuvant fentanyl administration have been used to reduce the hemodynamic changes. Remifentanil, a newly developed ultra short acting opioid, has recently been used to reduce the hemodynamic changes. This study investigated the effects of fentanyl and remifentanil on hemodynamic responses to laryngoscopy and endotracheal intubation. METHODS: Sixth ASA class I or II patients who scheduled for elective surgery were divided randomly into 3 groups. Each patient received normal saline, fentanyl 1.5microgram/kg or remifentanil 1.5microgram/kg, respectively. Predetermined drugs for each group were administered over 30 seconds after induction of anesthesia with TCI of propofol effect site target concentration 4.0microgram/ml and rocuronium 1.0 mg/kg. Laryngoscopy and endotracheal intubation was carried out and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured baseline (initial), before intubation (BI) and during 5 minutes after intubation (I1 to I5). RESULTS: In the fentanyl group, I1 HR value was significantly higher than baseline. In the remifentanil group, SBP and MAP were significantly lower than baseline during post-intubation period. Fentanyl and remifentanil groups show lesser hemodynamic changes than those in the control group. There were no significant differences of hemodynamic changes between fentanyl and remifentanil group. CONCLUSIONS: Fentanyl and remifentanil can attenuate hemodynamic responses after laryngoscopy and endotracheal intubation.

Effects of Glycopyrrolate or Atropine on Hemodynamic Responses during Anesthetic Induction with Remifentanil and Sevoflurane in Elderly Patients / 대한마취과학회지

BACKGROUND: This study was conducted to determine the effect of glycopyrrolate or atropine on attenuating hemodynamic responses such as bradycardia and hypotension during anesthetic induction with remifentanil and sevoflurane in elderly patients, in a randomized placebo-controlled double blinded manner. METHODS: 60 patients over 65 years with ASA physical status 1 or 2 were allocated to one of three groups of 20 each. Each group received saline placebo (group C) or glycopyrrolate 4microgram/kg (group G) or atropine 0.5 mg (group A) immediately after induction of anesthesia, and then remifentanil 1microgram/kg bolus was given over 30s. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthetic induction, before intubation, and during 5 minutes after intubation at 1 minute interval. RESULTS: MAP remained stable and HR increased significantly 1 min after intubation in all groups. MAP decreased significantly during 2-5 minute after intubation in all groups. HR decreased in the group C, remained stable in the group G, and increased in the group A significantly during 3-5 minute after intubation. Hypotension (systolic blood pressure < 90 mmHg checked twice) occurred in 8 patients in the group C, 1 patient in the group G, and none in the group A. CONCLUSIONS: Glycopyrrolate and atropine attenuated the hemodynamic responses to laryngoscropy and intubation during anesthetic induction with remifentanil 1microgram/kg bolus dose and sevoflurane.