Anesthetic experience: congenital methemoglobinemia due to hemoglobin M

Methemoglobinemia is rare. It is classified into two types: congenital methemoglobinemia and acquired methemoglobinemia. Methemoglobin is incapable of binding oxygen, leading to complications such as cyanosis, dyspnea, headache, and heart failure. In the present case, a 35-year-old man with congenital methemoglobinemia underwent general anesthesia for thyroidectomy. The patient was diagnosed with hemoglobin M at 7 years of age. Ventilation was performed with FiO2 1.0. Arterial blood gas analysis showed that the pH was 7.4, PaO 2 439 mmHg, PaCO2 40.5 mmHg, oxyhemoglobin level of 83.2%, and methemoglobin level of 15.5%. The patient had a stable course, although cyanosis was observed during surgery.

Anesthetic experience: congenital methemoglobinemia due to hemoglobin M

Methemoglobinemia is rare. It is classified into two types: congenital methemoglobinemia and acquired methemoglobinemia. Methemoglobin is incapable of binding oxygen, leading to complications such as cyanosis, dyspnea, headache, and heart failure. In the present case, a 35-year-old man with congenital methemoglobinemia underwent general anesthesia for thyroidectomy. The patient was diagnosed with hemoglobin M at 7 years of age. Ventilation was performed with FiO2 1.0. Arterial blood gas analysis showed that the pH was 7.4, PaO 2 439 mmHg, PaCO2 40.5 mmHg, oxyhemoglobin level of 83.2%, and methemoglobin level of 15.5%. The patient had a stable course, although cyanosis was observed during surgery.

Fibromyalgia: practical considerations for oral health care providers

Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia.This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.

Transient facial paralysis after myringotomy and ventilation tube insertion under sedation with sevoflurane inhalation and four-quadrant blocks with lidocaine: a case report

Myringotomy and ventilation tube insertion are widely performed in pediatric patients with chronic otitis media. This procedure is performed under general anesthesia or sedation with local anesthesia infiltration in pediatric patients. In this case report, we report a case of transient facial paralysis in a pediatric patient who underwent myringotomy and ventilation tube insertion using sevoflurane inhalation and four-quadrant blocks with lidocaine.

Junctional rhythm with severe hypotension followinginfiltration of lidocaine containing epinephrineduring dental surgery

We experienced an unusual case of accelerated junctional rhythm with severe hypotension after infiltration oflidocaine containing epinephrine during dental surgery under general anesthesia. The patient’s electrocardiogramexhibited retrograde P-waves following the QRS complex, which could be misinterpreted as ST-segment depression.As a temporary measure, administration of ephedrine restored the patient’s blood pressure to normal levels.The importance of this case lies in its demonstration of an unexpected and serious side effect of commonlyused epinephrine infiltration. This case also highlights the need for accurate interpretation of the electrocardiogramand comprehensive understanding of best practices for patient management.

Ramsay Hunt syndrome

Ramsay Hunt syndrome is a type of acute herpes zoster, which occurs by reactivation of the varicella-zoster virus at the geniculate ganglion. Clinical presentation of Ramsay Hunt syndrome includes a vesicular rash on the ear (herpes zoster oticus) or in the oral mucosa accompanied by acute peripheral facial nerve paralysis. Other cranial nerves such as V, IX, XI, and XII are often involved. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Combination treatment containing anti-viral agents and steroids is recommended for the treatment of Ramsay Hunt syndrome. Additionally, early diagnosis of Ramsay Hunt syndrome is a crucial factor to improve damaged nerves in Ramsay Hunt syndrome, which initiates treatment as soon as possible.

Dexamethasone treatment for bilateral lingual nerve injury following orotracheal intubation

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.

Cold Allodynia after C2 Root Resection in Sprague-Dawley Rats

OBJECTIVE: The purpose of this study was to evaluate pain-related behaviors after bilateral C2 root resection and change in pain patterns in the suboccipital region in rats. METHODS: Male Sprague-Dawley rats were randomly assigned to three groups (n=25/group); näive, sham, and C2 resection. Three, 7, 10, and 14 days after surgery, cold allodynia was assessed using 20 μL of 99.7% acetone. c-Fos and c-Jun were immunohistochemically stained to evaluate activation of dorsal horn gray matter in C2 segments of the spinal cord 2 hours, 1 day, 7 days, and 14 days after surgery.

Cold Allodynia after C2 Root Resection in Sprague-Dawley Rats

OBJECTIVE: The purpose of this study was to evaluate pain-related behaviors after bilateral C2 root resection and change in pain patterns in the suboccipital region in rats.METHODS: Male Sprague-Dawley rats were randomly assigned to three groups (n=25/group); näive, sham, and C2 resection. Three, 7, 10, and 14 days after surgery, cold allodynia was assessed using 20 μL of 99.7% acetone. c-Fos and c-Jun were immunohistochemically stained to evaluate activation of dorsal horn gray matter in C2 segments of the spinal cord 2 hours, 1 day, 7 days, and 14 days after surgery.RESULTS: Three days after surgery, the response to acetone in the sham group was significantly greater than in the näive group, and this significant difference between the näive and sham groups was maintained throughout the experimental period (p < 0.05 at 3, 7, 10, and 14 days). Seven, 10, and 14 days after surgery, the C2 root resection group exhibited a significantly greater response to acetone than the näive group (p < 0.05), and both the sham and C2 resection groups exhibited significantly greater responses to acetone compared with 3 days after surgery. No significant difference in cold allodynia was observed between the sham and C2 root resection groups throughout the experimental period. Two hours after surgery, both the sham and C2 root resection groups exhibited significant increases in c-Fos- and c-Jun-positive neurons compared with the naive group (p=0.0021 and p=0.0358 for the sham group, and p=0.0135 and p=0.014 for the C2 root resection group, respectively). One day after surgery, both the sham and C2 root resection groups exhibited significant decreases in c-Fos -positive neurons compared with two hours after surgery (p=0.0169 and p=0.0123, respectively), and these significant decreases in c-Fos immunoreactivity were maintained in both the sham and C2 root resection groups 7 and 14 days after surgery. The sham and C2 root resection groups presented a tendency toward a decrease in c-Jun-positive neurons 1, 7, and 14 days after surgery, but the decrease did not reach statistical significance.CONCLUSION: We found no significant difference in cold allodynia and the early expression of c-Fos and c-Jun between the sham and C2 resection groups. Our results may support the routine resection of the C2 nerve root for posterior C1–2 fusion, but, further studies are needed.

Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

BACKGROUND: Substantial variation exists in the reported rates of postoperative venous thromboembolism (VTE) following total knee arthroplasty (TKA) in the Asian population. This retrospective study aimed to compare the early postoperative VTE incidence between patients managed with epidural anesthesia and those managed by general anesthesia at the time of TKA. METHODS: We reviewed 589 cases of unilateral primary TKA performed between January 2011 and June 2014. We selected epidural versus general anesthesia groups as the main anesthetic choices, with postoperative patient-controlled analgesia. All the patients underwent deep vein thrombosis (DVT) computed tomography angiography on postoperative day 7. The incidence of DVT and pulmonary thromboembolism (PTE) was evaluated and compared between epidural and general anesthesia. RESULTS: The overall incidence of VTE was 8.0% in the two groups together. The incidence did not differ between the groups. The odds ratio in the generalized estimation equations analysis showed a higher incidence of DVT and PTE in the epidural group; however, this result was not statistically significant. Although, the odds ratio for age showed that the risk of developing DVT and PTE increased 1.12 times per year. CONCLUSIONS: Total VTE incidence was not significantly different between patients who underwent general anesthesia and those who underwent epidural anesthesia for TKA. A prospective multicenter study is required to evaluate the nature of the Korean VTE status in major orthopedic surgeries, and to prepare guidelines and protocols for medical prophylaxis for DVT and PTE in Korea.

Therapeutic potential of stellate ganglion block in orofacial pain: a mini review

Orofacial pain is a common complaint of patients that causes distress and compromises the quality of life. It has many etiologies including trauma, interventional procedures, nerve injury, varicella-zoster (shingles), tumor, and vascular and idiopathic factors. It has been demonstrated that the sympathetic nervous system is usually involved in various orofacial pain disorders such as postherpetic neuralgia, complex regional pain syndromes, and atypical facial pain. The stellate sympathetic ganglion innervates the head, neck, and upper extremity. In this review article, the effect of stellate ganglion block and its mechanism of action in orofacial pain disorders are discussed.

The evaluation of implementing smart patient controlled analgesic pump with a different infusion rate for different time duration on postoperative pain management

BACKGROUND: Control of postoperative pain is an important aspect of postoperative patient management. Among the methods of postoperative pain control, patient-controlled analgesia (PCA) has been the most commonly used. This study tested the convenience and safety of a PCA method in which the dose adjusted according to time. METHODS: This study included 100 patients who had previously undergone orthognathic surgery, discectomy, or total hip arthroplasty, and wished to control their postoperative pain through PCA. In the test group (n = 50), the rate of infusion was changed over time, while in the control group (n = 50), drugs were administered at a fixed rate. Patients' pain scores on the visual analogue scale, number of rescue analgesic infusions, side effects, and patients' satisfaction with analgesia were compared between the two groups. RESULTS: The patients and controls were matched for age, gender, height, weight, and body mass index. No significant difference in the mount of drug administered was found between the test and control groups at 0-24 h after the operation; however, a significant difference was observed at 24-48 h after the operation between the two groups. No difference was found in the postoperative pain score, number of side effects, and patient satisfaction between the two groups. CONCLUSIONS: Patient-controlled anesthesia administered at changing rates of infusion has similar numbers of side effects as infusion performed at a fixed rate; however, the former allows for efficient and safe management of postoperative pain even in small doses.

The effect of stellate ganglion block on the atypical facial pain

Atypical facial pain (AFP) is a type of facial pain which does not fulfill any other diagnosis. It has several features such as no objective signs, no obvious explanation of the cause and poor response to treatments. We report a case of a female patient with AFP on the left maxillary area. The pain was increased by cold innocuous stimulation and thermography showed that the temperature on the painful area was significantly decreased. The pain was successfully alleviated by stellate ganglion block (SGB). Therefore, SGB can be effectively used to treat AFP.

Treatment of herpes zoster with ultrasound-guided superficial cervical plexus block

Herpes zoster most commonly occurs in elderly patients, and usually affects sensory neurons. Therefore, its characteristic symptoms are segmental pain, itching, and sensory changes in the affected areas. A 71-yr-old woman experienced painful herpetic rash on the right cervical 2-4 dermatomes for 16 days. Two days after the onset of the rash, she was diagnosed with herpes zoster, and prescribed 250 mg famciclovir three times a day for 7 days, pregabalin 150 mg twice a day, and tramadol 150 mg once a day for 14 days, by a dermatologist. Despite medication, her pain was rated at an intensity of 6/10 on the numeric rating scale. In addition, she complained of severe itching sensation on the affected dermatomes. Superficial cervical plexus block (SCPB) was performed at the right C4 level with 15 ml 0.5% lidocaine plus triamcinolone 30 mg. Five days after the procedure, pain and itching completely disappeared. SCPB may be an effective option for the treatment of acute pain and itching arising from herpes zoster, and for the prevention of postherpetic neuralgia.

Solitary neurofibroma of the sciatic nerve which was initially misdiagnosed as herniated nucleus pulposus: A case report

Solitary peripheral nerve tumor is rare and difficult to diagnose correctly. We present an unusual case of sciatic nerve tumor in a patient with leg buttock pain. Initial lumbar magnetic resonance imaging (MRI) revealed a herniated nucleus pulposus on L5-S1. Physical examination showed a palpable mass on the left buttock and Tinel's sign was elicited with palpation of the left posterior buttock. MRI examination of the hip revealed a tumor of the sciatic nerve adjacent to the left sciatic notch. Excision of the tumor was easily performed with subsequent slight motor weakness on dorsiflexion. Histopathological examination revealed the tumor to be a neurofibroma. Solitary neurofibroma without any evidence of neurofibromatosis is a rare condition. This case emphasizes the importance of physical examination and continued investigations.

Extra cardiac tumor misdiagnosed as a left atrial myxoma / 대한마취과학회지

No abstract available.

Extra cardiac tumor misdiagnosed as a left atrial myxoma / 대한마취과학회지

No abstract available.

Therapeutic Advantages of Treatment of High-Dose Curcumin in the Ovariectomized Rat

OBJECTIVE: Although curcumin has a protective effect on bone remodeling, appropriate therapeutic concentrations of curcumin are not well known as therapeutic drugs for osteoporosis. The purpose of this study was to compare the bone sparing effect of treatment of low-dose and high-dose curcumin after ovariectomy in rats. METHODS: Forty female Sprague-Dawley rats underwent either a sham operation (the sham group) or bilateral ovariectomy (OVX). The ovariectomized animals were randomly distributed among three groups; untreated OVX group, low-dose (10 mg/kg) curcumin administered group, and high-dose (50 mg/kg) curcumin group. At 4 and 8 weeks after surgery, serum biochemical markers of bone turnover were analyzed. Bone histomorphometric parameters of the 4th lumbar vertebrae were determined by micro-computed tomography (CT). In addition, mechanical strength was determined by a three-point bending test. RESULTS: High-dose curcumin group showed significantly lower osteocalcin, alkaline phosphatase, and the telopeptide fragment of type I collagen C-terminus concentration at 4 and 8 weeks compared with the untreated OVX group as well as low-dose curcumin group. In the analyses of micro-CT scans of 4th lumbar vertebrae, the high-dose curcumin treated group showed a significant increase in bone mineral densities (p=0.028) and cortical bone mineral densities (p=0.036) compared with the low-dose curcumin treated group. Only high-dose curcumin treated group had a significant increase of mechanical strength compared with the untreated OVX group (p=0.015). CONCLUSION: The present study results demonstrat that a high-dose curcumin has therapeutic advantages over a low-dose curcumin of an antiresorptive effect on bone remodeling and improving bone mechanical strength.

Rocuronium-induced withdrawal movement: influence of ketorolac or a combination of lidocaine and ketorolac pretreatment / 대한마취과학회지

BACKGROUND: Pain on injection of rocuronium is a common clinical problem. We compared the efficacy of lidocaine, ketorolac, and the 2 in combination as pretreatment for the prevention of rocuronium-induced withdrawal movement. METHODS: For this prospective, randomized, placebo-controlled, double-blind study a total of 140 patients were randomly allocated to one of 4 treatment groups to receive intravenously placebo (saline), lidocaine (20 mg), ketorolac (10 mg), or both (n = 35 for each group), with venous occlusion. The tourniquet was released after 2 min and anesthesia was performed using 5 mg/kg thiopental sodium followed by 0.6 mg/kg rocuronium. The withdrawal response was graded on a 4-point scale in a double-blind manner. RESULTS: The overall incidence of withdrawal movements after rocuronium was 34.3% with lidocaine (P = 0.001), 40% with ketorolac (P = 0.004), and 8.6% with both (P < 0.001), compared with 74.3% with placebo. There was a significantly lower incidence of withdrawal movements in patients receiving the lidocaine/ketorolac combination than in those receiving lidocaine or ketorolac alone (P = 0.009 and 0.002, respectively). The incidence of moderate to severe withdrawal movements was 14.3% with lidocaine, 17.2% with ketorolac, and 2.9% with lidocaine/ketorolac combination, as compared to 45.7% with the placebo. There was no significant difference in withdrawal movement between the lidocaine group and the ketorolac group. CONCLUSIONS: Ketorolac pretreatment had an effect comparable to that of lidocaine in attenuating rocuronium-induced withdrawal movements and the lidocaine/ketorolac combination pretreatment, compared with lidocaine or ketorolac alone, effectively reduced withdrawal movements during rocuronium injection.

Meningioma related trigeminal neuralgia presenting as odontalgia: A case report

Classical trigeminal neuralgia is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution, and no cause of the symptoms can be identified, other than vascular compression. This type of injury may rarely be caused by identifiable conditions, including tumor in the cerebellopontine angle. If the patient is suspected for secondary trigeminal neuralgia, further evaluation is required to diagnose and treat correctly. We report a case of a 49-year-old woman with a 1-month history of facial pain, who was initially misdiagnosed as odontalgia, and even treated with the extraction of her molar teeth. This case with the review of secondary trigeminal neuralgia may highlight the difficulties of diagnosis, and the importance of early diagnostic imaging, when trigeminal neuralgia occurs with a brain tumor.