Anesthesia in a Patient with Brugada Syndrome without a Characteristic ECG Pattern: A case report / 대한마취과학회지

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in right precordial leads (V1 to V3), without structural heart disease. However, these ECG manifestations transiently normalize in up to 40% of cases. Brugada syndrome is responsible for up to one half of all sudden cardiac deaths in young adults and they may be worsened by beta blockers. We present the anesthetic management of a patient with Brugada syndrome without the characteristic ECG pattern.

Clinical Effectiveness of Laryngeal Mask Airway ProSeal(TM), Laryngeal Tube and PAxpressTM as a Supraglottic Airway / 대한마취과학회지

BACKGROUND: Supraglottic airway devices can be used to maintain stable hemodynamics during intubation, to secure a difficult airway and to administer muscle relaxants at reduced levels for brief operation. We investigated the insertion success rates, hemodynamic stabilities after insertion, intraoperative ventilatory parameters, and postoperative laryngopharyngeal discomforts of three supraglottic airway devices: the ProSealTM laryngeal mask airway (PLMA), the laryngeal tube (LT), and the PAxpressTM (PAX). METHODS: After induction with thiopental 5 mg/kg with fentanyl 1microgram/kg and rocuronuim 0.6 mg/kg as muscle relaxants, manual control ventilation was done with N2O : O2 (1 : 1) and sevoflurane 5-6 vol% for 2 minutes. The supraglottic airway devices were inserted into 94 adult ASA physical status I and II patients. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The success rates of first-attempts were similar (PLMA: 96.9%, LT: 93.1%, PAX: 96.8%). The time to achieve effective ventilation was shorten for PLMA. Peak inspiratory pressure (PIP) was significant higher for PAX than PLMA. Cuff pressure significantly increased in LT at 60 and 90 minutes after insertion. LT provided the tightest seal for positive ventilation. The incidence of blood-tinged and sore throat was highest for PAX. CONCLUSIONS: These three supraglottic airway devices can be used successfully and effectively without gastric insufflation. We suspected that the incidences of airway complications were proportional to PIP and cuff pressure and that they are dependent upon insertion skill.

The Effects of High Thoracic Epidural Patient Controlled Analgesia after Open Heart Surgery / 대한마취과학회지

BACKGROUND: Postoperative pain may be severe after open heart surgery (OHS). High thoracic epidural analgesia may reduce postoperative pain and improve the pulmonary function. We investigated the effect of epidural analgesia after median sternotomy METHODS: Fifty-six patients were randomized to epidural patient controlled analgesia (PCA) or conventional analgesia (control). Patients received OHS with standardized general anesthetic technique. The day before surgery, patients allocated to the PCA group had an epidural catheter inserted at level T4-5. Proper placement was tested with small dose of lidocaine and epinephrine. Epidural catheter was removed 3 days after surgery. Patients in control group received conventional nurse controlled analgesia. Postoperative assessment included daily visual analog scoring (VAS) and pulmonary function test 3 days after surgery. Complication and patients satisfaction were also evaluated. RESULTS: The VAS scores did not significantly differ between the groups, except 12 hours after surgery during coughing. Patients with PCA awoke and were extubated significantly earlier than patients in control group. Significantly higher forced expiratory volume in 1s and peak expiratory flow rate were seen in PCA group than in control group. No significant thoracic epidural related complications occurred. CONCLUSIONS: Thoracic epidural PCA provided better analgesia and allowed earlier extubation. Thoracic epidural PCA yields a slight, but significant, improvement in pulmonary function.