Inappropriate elevation of bispectral index values in robot assisted thyroidectomy with electromyographic endotracheal tube: A case report / 대한마취과학회지

We report a case of an erroneously elevated bispectral index (BIS) during robot assisted thyroidectomy using an electromyographic endotracheal tube (EMG tube), which is safe and useful for laryngeal electromyographic monitoring. Ten minutes after start of the operation, a sudden increase of BIS value up to 98 was noticed. The BIS values were not decreased to < 65 with supplemental anesthetics. The anesthetic method was changed from total intravenous anesthesia to balanced anesthesia. The BIS sensor and monitor were changed and other models were used. These interventions did not alter BIS values. BIS levels remained between 60 and 70 throughout the main procedure and intermittently increased to the mid-90s without any trace of poor signal quality. At the end of the surgery, the BIS values returned to normal range. The patient did not complain of intraoperative recall. Knowledge of potential interference from the use of an EMG tube must be considered when interpreting BIS.

Epidural Analgesia in the Parturient with Spinal Cord Injury: A case report / 대한마취과학회지

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.

The Changes of Natural Frequency and Damping Coefficient of Disposable Pressure Transducer according to the Catheter Length and Time Assigned / 대한마취과학회지

BACKGOUND: The accuracy of a disposable blood pressure transducer (DBPT) is determined by its physical properties: natural frequency (NF) and damping coefficient (DC). We planned this study to investigate whether the NF and DC of a DBPT are altered by attaching extended catheters and evaluated changes of these physical properties over time. METHODS: Fifteen DBPT sets were connected to a monitor and recorder set. These sets were divided into three groups; five sets had catheters of normal length (Group 1), five sets had 50 cm extended catheters (Group 2), and five sets had 100 cm extended catheters (Group 3). The NF and DC of each system were measured using the fast flush (FF) test. After the DBPT sets were installed, the FF test was performed for each group at five time intervals: 4, 24, 48, 72, and 96 hours. RESULTS: The NF of Groups 2 and 3 decreased and their DC increased compared to those of Group 1. Whereas the NF of Group 3 increased over time, those of Groups 1 and 2 did not. The DC of Groups 2 and 3 decreased over time, but remained unchanged over time for Group 1. When the FF test was done at intervals longer than 24 hours, it was found that the NF, but not the DC, increased for all groups. CONCLUSIONS: Attention should be paid to interpret blood pressure using DBPTs measured by extended catheters and using DBPTs for long periods of time without FFs.

Anesthetic Management of Endovascular Stent Graft Placement for Thoracic Aortic Diseases: A case report / 대한마취과학회지

Endovascular aortic repair is a new alternative to conventional surgical repair of aortic pathology. It is a less invasive technique and gives less hemodynamic stress to the patients who may have concomitant systemic diseases, compared with open aortic reconstruction. We report 2 cases of patients with thoracic aortic diseases, who underwent endovascular stent graft placement under general anesthesia. We also include a review of the literature about anesthetic management of endovascular aortic repair and present our opinions about the need to choose a suitable anesthetic technique for each patient, the method to recognize and handle the possible complications and hemodynamic changes to which we have to pay attention during procedures.