Total intravenous anesthesia in a 10-month-old patient with congenital myotonic dystrophy undergoing endoscopic third ventriculostomy: A case report / 대한마취과학회지

Myotonic dystrophy is a rare genetic disorder characterized by muscle atrophy and weakness. Surgical treatment of this condition poses various problems for the anesthesiologist. We describe the anesthetic management of a 10-month-old infant with congenital myotonic dystrophy, who was scheduled for endoscopic third ventriculostomy under general anesthesia. Anesthesia was induced with thiopental sodium, fentanyl, and vecuronium, and thereafter maintained via continuous infusion of propofol and remifentanil. The train-of-four ratio was monitored throughout the operation, and muscle relaxation was reversed with pyridostigmine and glycopyrrolate at the end of the procedure. We show that total intravenous anesthesia using propofol and remifentanil is a satisfactory anesthetic technique in very young patients with congenital myotonic dystrophy.

Comparison of the effects of propofol and pentobarbital on hydrogen peroxide-stimulated hepatic SNU761 cells / 대한마취과학회지

BACKGROUND: Propofol and barbiturates are both known to protect cells of several organs against ischemia/reperfusion injury, but there are few reports on any possible protective effects on human hepatocytes. We investigated the activities of both agents on human hepatic SNU761 cells under hydrogen peroxide (H2O2)-induced oxidative stress. METHODS: To determine whether propofol and pentobarbital protect hepatocytes from H2O2-induced toxicity, we used SNU761 cells, a human hepatocellular carcinoma (HCC) cell line. Cells were pretreated with different dosages (1, 10, 50 micrometer) of propofol or pentobarbital (1, 10, 50, 100, 400 micrometer) 30 min before H2O2 application. Lactate dehydrogenase (LDH) was measured to assess and quantify cell death. To determine the nature of cell death, treated hepatocytes were doubly stained with fluorescein isothiocyanate (FITC)-labeled Annexin V and propidium iodide (PI), and analyzed by flow cytometry. RESULTS: Pretreatment with propofol, but not pentobarbital, suppressed H2O2-induced LDH release. In Annexin V-FITC/PI binding analysis, propofol decreased the number of necrotic and late apoptotic cells, but no significant decreases in such cell numbers were seen when pentobarbital was used. CONCLUSIONS: Unlike pentobarbital, propofol, at clinical concentrations, protected SNU-761 HCC cells against oxidative stress.

Unexpected cardiac tamponade during robot-assisted permanent pacemaker insertion: A case report / 대한마취과학회지

Cardiac tamponade can result in severe hemodymanic instability, including cardiac arrest. We experienced one case of unexpected cardiac tamponade during permanent pacemaker insertion using da Vinci(TM) Surgical System (Intuitive Surgical Inc., Mountain View, USA) in 76-year-old male patient with complete atrioventricular block. Soon after the port insertion for robotic arm, sudden-onset electromechanical dissociation was developed. Prompt cardiopulmonary resuscitation was performed. Rapid left thoracotomy revealed the cardiac tamponade caused by the injury of right ventricle. Hemodynamic parameter was immediately improved after pericardiocentesis and primary repair of right ventricle. Permanent pacemaker was inserted uneventfully through the left thoracotomy. The patient was discharged 10 days after operation without any other complication.

Changes of KSR and CRP after Total Knee and Hip Arthroplasty

PURPOSE: To study the changes of ESR and CRP after total hip arthroplasty(THA) and total knee arthroplasty(TKA). MATERIALS AND METHODS: We tested the values of ESR and CRP of total 61 patients, who received THA or TKA. The levels of ESR and CRP were compared before operation, on the 2nd, 4th post-op. Day, 1st, 2nd, 3rd week after operations. RESULTS: The peak level of ESR was reached on the 4th post-op day(70.7mm/hr) in unilateral TKA group, but on the 7th day(53.2em/hr) in bilateral group. The peak level of ESR was reached on the 4th day in unilateral THA group(71.5mm/hr), as was in bilateral group(50.6em/hr). The values of ESR were declined to the normal range until the 3rd week except 9 cases(15%). The peak level of the CRP of TKA(14.0mg/dL, 15.0mg/dL) and THA(12.7mg/dL, 17.7mg/dL) in unilateral and bilateral group were reached on the 2nd day after operations. After the peak level, the values of CRP were abruptly declined to the normal and pre-op level until the 3rd week. CONCLUSION: The highest value of the CRP revealed on the 2nd post op day in bilateral group and declined to the normal range at 2nd week. The peak value of the ESR showed on the 4th post-op day, but the peak value of the bilateral group was low and the range of increase was narrow when compared with the unilateral group. The value of CRP after post-op 2 weeks could be used as the index of normal and infection in TKA or THA.