Unilateral phrenic nerve block guided by ultrasonography and nerve stimulator for the treatment of hiccup developed after tongue cancer operation: A case report / 대한마취과학회지

Hiccups are common benign and usually transient phenomenon that occur in nearly everyone. However, persistent or intractable hiccups can cause multiple problems including malnutrition, weight loss, fatigue, dehydration, insomnia, and wound dehiscence. We have experienced a case of postoperative persistent hiccup. The patient was formerly diagnosed tongue cancer and developed persistent hiccup after partial glossectomy with modified radical neck dissection and a radial forearm free-flap operation. He was unsuccessfully managed using pharmacologic methods, and then we tried phrenic nerve block guided by ultrasonography and a nerve stimulator because the surface anatomy of neck was deformed by the previous operation. Thirty minutes after the block, the hiccups disappeared.

Cervical Transforaminal Axis Measured by MRI and Its Relation to the Internal Jugular Vein, Internal Carotid Artery and Vertebral Artery / 대한통증학회지

BACKGROUND: The safety of cervical transforaminal epidural block has been the subject of debate, therefore, this study was conducted to measure the angle of the cervical transforaminal axis and to investigate its relationship to the internal jugular vein, internal carotid artery and vertebral artery. METHODS: One hundred cases of cervical MRI were reviewed. The angle between a line passing through the center of the vertebral body and spinous process and a line passing through the center of the lamina in C3-4, C4-5 and C5-6 was measured and designated as A-degree. Additionally, we drew a line at the back of the vertebral artery that ran parallel to a line passing through the center of the lamina, which was presented as A-line. We then examined the distribution of the area in which the internal jugular vein and the internal carotid artery were located. RESULTS: The mean values of the A-degree in C3-4, C4-5 and C5-6 were 53.5 +/- 4.3, 54.2 +/- 4.6 and 54.3 +/- 4.8, respectively. There were no statistically significant differences among age groups or vertebral levels (ANOVA test, P > 0.05). The A-line was distributed primarily throughout zone 3, 4, and 5 in C3-4 and zone 5 in C4-5 and C5-6. CONCLUSIONS: The results of this study indicate that the mean values of A-degree were not statistically different among each age group and each vertebral level. However, the A-line may be located in the zone in which the internal jugular vein and the internal carotid artery lie and individual differences in the A-degree remain.

Plasma Lidocaine Concentration and Hemodynamic Effect after 10% Lidocaine Spray on Laryngopharyngeal and Intratracheal Site during the Endotracheal Intubation / 대한마취과학회지

BACKGROUND: To minimize hemodynamic responses to laryngoscopy and endotracheal intubation, 10% lidocaine spray to laryngopharyngeal area seems to be favorable. The aim of this study was to evaluate plasma concentration and hemodynamic responses following different dose of 10% lidocaine spray before laryngoscopic intubation. METHODS: Fifteen patients (ASA I, II) were randomly allocated. Group I (n = 5) patients were received saline spray for control, group II (n = 5) patients were received 1 mg/kg 10% lidocaine spray on laryngopharynx before induction of anesthesia and received 1 mg/kg 10% lidocaine topical spray to trachea under direct laryngoscopic view one minute before intubation, group III (n = 5) patients were received 1.5 mg/kg lidocaine spray. Hemodynamic response were measured at baseline, postspray 1 min, postintubation, postspray 2, 4, 6, 8, 10 min. Arterial blood samples for lidocaine concentration analysis were obtained at baseline and 2, 4, 6, 8, 10, 20, 30, 60, 120 minutes after larygopharyngeal and intratracheal administration of lidocaine. RESULTS: The highest lidocaine concentrations in arterial blood were 1.76 +/- 0.52microgram/ml for group II, 2.86 +/- 0.40microgram/ml for group III (mean +/- SD) 2 to 10 minutes after laryngopharyngeal and intratracheal administration. There weren't any definitive toxic symptoms observed during the study. Hemodynamic responses of group II and III were not satisfactory but remarkably stable compared with group I. There were no differences between group II and III. CONCLUSION: Sympathetic responses after 2-3 mg/kg lidocaine spray on laryngopharynx are favorably but not sufficiently attenuated during endotracheal intubation.

Changes of Serum Histamine Concentration during General Anesthesia with Propofol-N2O in Korean / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effect of propofol on the histamine release during general anesthesia. METHODS: Ten premedicated adult patients, ASA physical status I or II, 20-55 yrs scheduled for elective surgery were included. Venous blood samples (3 ml each) were obtained from median cubital vein before induction as a control and at 1, 3, 5, 10, 30, 60, 120 minutes after the administration of propofol and postoperative one hour to measure the plasma histamine concentrations. After intubation with vecuronium, anesthesia was maintained with propofol in combination with 60% N2O and 40% O2. Mean arterial pressure, heart rate were measured and the development of skin wheal, facial flushing, bronchospasm were monitored. RESULTS: The changes of the serum histamine concentration did not show any significant differences, and hypersensitivity reactions were not observed. Hemodynamic changes at 1, 3 minutes may be due to the effect of propofol on mean arterial pressure and heart rate, so these changes did not correlate with plasma histamine concentration. CONCLUSIONS: Propofol was found to be a useful anesthetic agent without histamine release for patients with allergy or asthma.