Anesthetic Experience of Unexpected Change to One-Lung Ventilation with Bronchial Blocker

One-lung ventilation is an anesthesiological technique to accomplish surgical visualization during thoracic surgical procedures, and is often required unexpectedly during surgery. Traditionally the double lumen tube is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker to establish one-lung ventilation. We have experienced unexpected change to one-lung ventilation with bronchial blocker. A 40-year-old (158 cm, 48 kg) woman was scheduled for emergency exploratory laparotomy due to panperitonitis. A sudden diaphragmatic perforation occurred during the operation. Since oxygen saturation was reduced, intraoperative tube change was not available. Therefore, one-lung ventilation was done with bronchial blockers. After the bronchial blocker was placed, one-lung ventilation was well maintained and the operation was terminated successfully.

Epinephrine-Induced Acute Pulmonary Edema during Septoplasty

Epinephrine is used with lidocaine to provide bloodless surgical field and to prolong the action of local anesthetics. But epinephrine also has many adverse reactions, such as agitation, restlessness, headache, tachycardia, hypertension, and some significantly more dangerous conditions including myocardial ischemia, ventricular arrhythmia, cerebral hemorrhage and pulmonary edema, cardiac arrest, etc. We have experienced epinephrine-induced acute pulmonary edema due to submucosal intranasal application of epinephrine soaked gauze during septoplasty. The patient was successfully treated in intensive care unit with positive pressure ventilation, diuretics, and inotropic support. He was extubated after 5 hours and discharged after 7 days without any complications.

A Single-Center Experience of Transfusion Free Surgical Treatment over 13 Years in Korea

OBJECTIVE: Patient' desire of transfusion free surgery has been increasing due to blood transfusion risks. We analyzed the perioperative parameters and perioperative management of transfusion free surgical treatment in Soonchunhyang University Seoul Hospital. METHODS: Operation quantity and blood unstoring count from blood bank between 2000 and 2012 were collected from chronological records. Perioperative parameters including preoperative hemoglobin level, postoperative hemoglobin level, and lowest hemoglobin level were collected from medical records. Perioperative blood management such as acute normovolemic hemodilution, intraoperative blood cell salvage, or hematinic agents and complication were assessed. RESULTS: A total of 3,088 patients underwent transfusion free surgery at Soonchunhyang University Seoul Hospital between 2000 and 2012. Postoperative hemoglobin level <5.0 g/dL were 33 patients. Four patients expired at postoperative period with serious perioperative complications. Average of expired patient's hemoglobin was 3.22 g/dL and overall mortality was 0.12%. Operation was increased as years go by. The amount of blood use bank wasn't increased in general patients with transfusion. CONCLUSION: Careful perioperative blood management for transfusion free surgical treatment was responsible for safety and results in good clinical outcomes. Overall transfusion rate was decreased in spite of increasing operation quantity.

Awake during General Anesthesia with BispectralIndex Value of 35

Awareness of intraoperative events in patients under general anesthesia is rare, but awareness during anesthesia is a serious complication that leads to anxiety and post-traumatic stress disorder. The Bispectral Index (BIS) has generally been accepted as a measurement of hypnosis under anesthesia. It is derived from a processed electroencephalogram and computer algorithm that assigns a numerical value based on the probability of consciousness. A 46-year-old, 65-kg male without underlying disease underwent elective surgery for ventral hernia. The patient in this case was administered an anesthetic that we frequently use and then average BIS value are 35. But he experienced awake during general anesthesia. We describe the first case of intraoperation awake under BIS 40 using desflurane.