Anesthetic Management of Carotid Endarterectomy under Cervical Plexus Block / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.

Paraplegia Following Percutaneous Nephrolithotomy under General Anesthesia: A case report / 대한마취과학회지

We present a case of paraplegia, compatible with spinal cord ischemia, following percutaneous nephrolithotomy in a 58-year-old male under the diagnosis of left renal stone. After retroperitoneal operative procedures in the prone position, sensory loss below the level of T4, paraplegia and transient loss of visual acuity were developed. These clinical findings reflect ischemia of the anterior spinal cord with complete motor paralysis and sensory loss to T4 dermatomal level resulting from an anterior spinal artery syndrome. The initial treatment was started with intravenous heparin and corticosteroid. At present, sensory loss is almost recovered and motor deficit is remarkably improved to a level of ambulation with cane. The patient is still treated with oral coumadine and neuromotor rehabilitation. The cause of spinal cord ischemia is unknown, but we speculate ischemia of the spinal cord was associated with embolism and spasm or trauma of feeding artery (ies) of Adamkiewicz.

The Phantom Limb Sensation Expressed by Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Phantom limb sensation is an unusual position sense of the extremity during nerve block that the position of extremity is misinterpreted as being flexed, or elevated, when actually they are in neutral position. Whether it is from the fixation of proprioceptive input at the time of motor blockade or from unmasking of the pattern which has been already present in the CNS is still controversial. We perfomed this study under the assumption that phantom limb sensation can still be reproduced without the influence of position at the time of nerve blockade. METHODS: Thirty-six patients scheduled for elective orthopedic surgery were randomly assigned. For 26 patients, spinal anesthesia was performed with hyperbaric 0.5% tetracaine or bupivacaine at lateral decubitus position and the position was changed to supine immediately. Existence of phantom limb sensation and the level of anesthesia was recorded at 10 and 20 minutes after injection of local anesthetics. For 10 patients, same local anesthetics were injected after patient's legs were straightened in lateral decubitus position. RESULTS: Forteen out of 26 patients whose position were changed to supine immediately after the injection of local anesthetics experienced phantom limb sensations. Five out of 10 patients whose legs were kept straight before the injection of local anesthetics experienced phantom limb sensations. Previous history of trauma was positively related to the expression of phantom limb sensation. CONCLUSION: Our data showed that the expression of phantom limb sensation is reproducible. And this was not related to the position at the time of spinal anesthesia. Trauma seems to be an important factor related to the expression of phantom limb sensation.