Endotracheal intubation using i-gel(R) and lightwand in a patient with difficult airway: a case report / 대한마취과학회지

This case report involves tracheal intubation using i-gel(R) in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel(R) was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel(R) and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel(R) and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway / 대한마취과학회지

BACKGROUND: Although Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation. METHODS: Fifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects. RESULTS: There was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008). CONCLUSIONS: In a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.

Recurrence of herpes zoster in a young woman with IgG3 deficiency / 대한마취과학회지

No abstract available.

The effect-site concentration of propofol producing respiratory depression during spinal anesthesia / 대한마취과학회지

BACKGROUND: Propofol is used worldwide for its sedative effective; nonetheless, has the serious side effect of respiratory depression. An increased blood concentration of propofol is well known to be associated with increased respiratory depression. However, there are no studies of the effect site concentration inducing respiratory depression. The purpose of this study was to determine the effect site concentration inducing respiratory depression of propofol when sedating a patient after spinal anesthesia. METHODS: This study included thirty seven males who received operations with spinal anesthesia, which was performed on L3-4 and L4-5. All patients were monitored with the bispectral index and were continuously infused with propofol using target controlled infusion. Respiratory depression was diagnosed when one of the following was evident without upper respiratory obstructive signs: a greater than 20% increase of end tidal carbon dioxide from baseline pressure or pulse oximetry oxygen saturation lower than 95%. We obtained the EC5, EC10, and EC50 of the effect site propofol for respiratory depression. RESULTS: The EC5 of propofol for respiratory depression was 3.09 mcg/ml (95% CI, 2.60-3.58). The EC10 of propofol for respiratory depression was 3.18 mcg/ml (95% CI, 2.57-3.80). The EC50 of propofol for respiratory depression was 3.99 mcg/ml (95% CI, 2.36-5.61). CONCLUSIONS: The EC5, EC10, and EC50 of effect site propofol for respiratory depression during spinal anesthesia were 3.09 mcg/ml ,3.18 mcg/ml, and 3.99 mcg/ml, respectively.

Cerebellar hemorrhage after spine fixation misdiagnosed as a complication of narcotics use: A case report / 대한마취과학회지

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature.

Clinical experience in the treatment of piriformis syndrome using pulsed radiofrequency: A case report

Piriformis syndrome consists of pain, tingling sensation, and paresthesia in areas innervated by sciatic nerve and is one of the main causes of low back pain. A 43-year-old male made a visit for continuous left buttock pain and tingling sensation in lower limbs for three years. Medication, epidural block and sacroiliac joint block were performed, but without effect. Sciatic nerve block with local anesthetics and steroid, however, showed some improvement for a short period of time. The patient's symptoms, physical examination, and the fact that sciatic nerve block showed improvement for a while led to the suspicion of piriformis syndrome. Thus, pulsed radiofrequency was performed on sciatic nerve twice. Visual analog scale (VAS) was 8-9 on first visit, which decreased to 1 after treatment and lasted for more than 18 months.

Pulsatile subdural contrast image during attempted lumbar transforaminal epidural block: A case report

Transforaminal lumbar epidural block is a common procedure for the patients with back pain and radiating pain. But during the procedure, complications such as subdural or intrathecal block can occur. Because the procedure is conducted with contrast media and fluoroscopy, anesthesiologists must have deep understanding of the normal radiologic findings of epidural, subdural and intrathecal contrast images. During attempted transforaminal lumbar epidural block with fluoroscopy, we observed an unusual shaped pulsatile contrast image accidentally. Based on our experience, we report the subdural contrast image during transforaminal lumbar epidural block in radiologic aspects.

Thoracic EndoVascular Stent Graft Repair for Aortic Aneurysm

BACKGROUND: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. MATERIALS AND METHODS: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. RESULTS: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. CONCLUSION: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.

Detection of Human Papilloma Virus(HPV) in the Patients with ASCUS or LGSIL of the Cervical Cytology / 대한부인종양콜포스코피학회잡지

OBJECTIVE: This study was performed to evaluate the clinical efficacy of high-risk HPV DNA test using Hybrid Capture System in the detection of high-grade cervical intraepithelial neo- plasia(CIN II, III) from patients with atypical squamous cells of undetermined significance(ASCUS) or a low-grade squamous intraepithelial lesion(LGSIL) on referral Papanicolaou smear. STUDY DESIGN: Fifty-four patients referred to our hospital with a Papanicolaou smear report of atypical squamous cells of undetermined significance or a low-grade squamous intraepithelial lesion underwent repeat Papanicolaou smear, cervical colposcopy and directed cervical biopsy. In addition, high-risk human papillomavirus(HPV) test by Hybrid Capture System was done. A comparison of detection rate of the high-grade CIN between positive and negative results of HPV test according to repeat Papanicolaou smear report was done. Biopsy result according to HPV test result in total patients was also compared. RESULTS: HPV of high-risk type was detected in 22 of 54 women(40.7%) by Hybrid Capture System. Prevalence rate of high-risk HPV in no CIN, CIN I, and CIN II, III was 13.6%, 18.2% and 68.2% respectively. As expected, high-risk HPV was detected with greater frequency in relation to increasing severity of CIN. In 18 women, the repeat smear obtained in our clinic was reported as negative. High-risk HPV types were found in 16.7% of theses women. In the HPV-negative women, 40% had CIN II or III confirmed on cervical biopsy. In comparison, 66.7% of those with a positive result of the HPV test had CIN II or III on biopsy(P<0.05). Among the women with ASCUS or LGSIL on repeat smear, there was no significant difference in the frequency of biopsy-proved CIN II or III between positive and negative results of high-risk HPV test. In total patients, the group that had positive results for high-risk HPV showed higher incidence of CIN II or III than group with negative results(P<0.05). CONCLUSION: From these results testing women with Papanicolaou smears showing ASCUS or LGSIL for infection with high-risk HPV types would identify the patients who are at risk for HGSIL or invasive carcinoma and who require aggressive intervention. High-risk HPV DNA test using Hybrid Capture System may be a usefule method in supplement the pitfalls of cervical cytology. This test might also have prgnostic value in the management of patients with cervical intraepithelial lesions.