Spinal cord stimulation for neuropathic pain following idiopathic transverse myelitis: A case report / 대한마취과학회지

We present a patient with intractable neuropathic pain because of idiopathic transverse myelitis unresponsive to medical treatment. After a successful trial of spinal cord stimulation, a permanent stimulator was implanted. Improvement was noted in visual analogue scale, medication usage and daily function. Spinal cord stimulation may offer a therapeutic option for patients with neuropathic pain resulting from transverse myelitis and should be considered when other treatments are failed.

Anesthesia for a 10-year-old boy with Duchenne muscular dystrophy syndrome: A case report / 대한마취과학회지

Duchenne muscular dystrophy (DMD) is an eventually fatal disorder that is characterized by rapidly progressive muscle weakness and atrophy of muscle tissue. The clinical manifestations of DMD vary depending on the stages of the disease. Succinylcholine-induced hyperkalemia and the administration of volatile anesthetic agents, - particularly halothane, - during acute rhabdomyolysis are more likely to result in cardiac arrest and unsuccessful resuscitation in DMD patients than in the general public. This is a case report of a 10-year-old boy who underwent elective strabismus revision under general anesthesia. Anesthesia was induced and maintained with intravenous propofol and remifentanil, which was started at the targeted effect concentration of 3.0micrometer/ml and 3.5 ng/ml respectively via target controlled infusion (TCI). No inhaled anesthetic was used. In addition, an initial dose 0.4 mg/kg of atracurium was injected intravenously over 15s. The results of this case report found intravenous infusion of propofol, remifentanil and atracurium to be safe because the malignant hyperthermia did not occur.

The Effect of Hemodynamic Changes on the Regression of Sensory Analgesia after Epidural Block / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the difference in regression of sensory analgesia on hemodynamic changes between bupivacaine and lidocaine in epidural blockade. METHODS: The thirty-six patients (ASA physical status Ior II) scheduled for elective cesarean section, we performed lumbar epidural blockade using 2% lidocaine (group I, II) or 0.5% bupivacaine (group III, IV). Eighty minutes after surgery, we divided the patients into 4 groups: The group I, III received normal saline, 20 ml, for 30 min; the group II, IV received normal saline, 20 ml, containing ephedrine, 2 mg ml, for 30 min. We compared the regression of sensory analgesia at 80 min with that at 140 min. RESULTS: The proximal extent of sensory analgesia at 140 min was significantly lower than that at 80 min in group II. However, no such significant changes occurred in group I, III, IV. CONCLUSIONS: The ephedrine-induced blood pressure increase accelerates regression of epidural blockade using lidocaine. We thought that even moderate and clinically insignificant cardiovascular activation by anxiety or pain can be a cause of reduction in the efficacy and duration of epidural blockade.

Anesthetic Management using Laryngeal Mask Airway during Reconstructive Surgery of Trachea Cancer: A case report / 대한마취과학회지

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.

The Effects of Fentanyl and Isoflurane on the Cerebrovascular CO2 Reactivity / 대한마취과학회지

The changes of arterial carbon dioxide partial pressure considerably influence cerebral blood flow and different anesthetic agents have different effects on cerebrovascular physiology. However the importance of these differences in neuroanesthetic practice are unclear. Transcranial Doppler ultrasonography allows the noninvasive direct measurements of cerebral blood flow velocity and direction in the basal brain arteries. The authors performed transcranial Doppler ultrasonography to measure the blood flow velocity of middle cerebral artery in 12 patients who were anesthetized with 10 mcg/kg of fentanyl and 66 % nitrous oxide in oxygen(fentanyl group) and 12 patients with 1.0 vo1% isoflurane and 66 % nitrous oxide in oxygen(isoflurane group) during normocapnia(P(ET)CO(2)=38 mmHg) and hypocapnia(P(ET)CO(2)=28 mmHg)state. The carbon dioxide reactivity was expressed as the changes in mean blood flow velocity per unit changes in endtidal carbon dioxide partial pressure(P(ET)CO(2)). Mean blood flow velocity of middle cerebral artery decreased from 46.6+/-8.9 cm/s to 30.0+/-5.3 cm/s in the fentanyl group and 42.7+/-5.6 cm/s to 32.5+/-4.6 cm/s in the isoflurane group as the P(ET)CO(2) decreased from 38 mmHg to 28 mmHg. There was a significant difference between the CO2 reactivity of fentanyl group(1.7+/-0.7 cm/s/mmHg) and isoflurane group(1,0+/-0,2 cm/s/mmHg) (p<0.05). It is concluded that hyperventilation is more likely to affect cerebral blood flow during fentanyl-nitrous oxide anesthesia than during isoflurane-nitrous oxide anesthesia.