Dyspnea due to Residual Neuromuscular Blockade in Elderly Patient with Unrecognized Pre-existing Unilateral Vocal Cord Paralysis / 이화의대지

Muscle relaxation using neuromuscular blocking agent is an essential process for endotracheal intubation and surgery, and requires adequate recovery of muscle function after surgery. Residual neuromuscular blockade is defined as an insufficient neuromuscular recovery that can be prevented by confirming train-of-four ratio >0.9 using objective neuromuscular monitoring. Sugammadex, a novel selective relaxant-binding agent, produces rapid and effective reversal of rocuronium-induced neuromuscular blockade. We report a case of the residual neuromuscular blockade accompanying dyspnea and stridor after general anesthesia in an unrecognized pre-existing symptomless unilateral vocal cord paralysis patient, who had experienced the disappearance of dyspnea and stridor after administration of sugammadex.

Retrospective Analysis of Difficult Intubation / 이화의대지

OBJECTIVES: We analyzed retrospectively incidence, management, and predictors of difficult intubation, which have been known through practical cases. METHODS: A total of 217 cases of difficult intubation (DI) between 2010 and 2014 were investigated. Risk factors such as age, body mass index, Mallampati score, thyromental distance, degree of mouth opening and range of neck motion, Cormack-Lehane grade, intubation and airway management techniques were investigated. The cases of each department were analyzed and the airway management techniques according to simplified risk scores (SRS) were also investigated. RESULTS: The average incidence of DI was 0.49%. Patients undergoing surgery in the departments of oro-maxillo-facial surgery (1.35%), ophthalmologic surgery (0.96%), urologic surgery (0.80%), and head and neck surgery of ear-nose-throat (0.62%) showed the higher incidence of DI. Difficult mask ventilation (10 of 217, 4.6%) was occurred with DI. Higher SRS were related to high rates of video laryngoscope use and fiberoptic guided intubation. There was a decrease in the use of McCoy blades after 2013, an increase in the use of video laryngoscope, and a consistent rate of fiberoptic intubation. CONCLUSION: It is not easy to check all the predictors of DI in a preanesthetic evaluation and the predictors are not accurate. The role of clinical preparation and practical management is important, and the most important thing is to establish a planned induction strategy. Multiple factors system, such as simplified risk factors should be used to evaluate patients to prepare for appropriate airway management techniques in case of DI.

The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome / 대한마취과학회지

BACKGROUND: The increased pain at the latent phase can be associated with dysfunctional labor as well as increases in cesarean delivery frequency. We aimed to research the effect of the degree of pain at the time of epidural analgesia on the entire labor process including the mode of delivery. METHODS: We performed epidural analgesia to 102 nulliparous women on patients' request. We divided the group into three based on NRS (numeric rating scale) at the moment of epidural analgesia; mild pain, NRS 1-4; moderate pain, NRS 5-7; severe pain, NRS 8-10. The primary outcome was the mode of delivery (normal labor or cesarean delivery). RESULTS: There were significant differences in the mode of delivery among groups. Patients with severe labor pain had a significantly higher cesarean delivery compared to patients with moderate labor pain (P = 0.006). The duration of the first and second stage of labor, fetal heart rate, use of oxytocin and premature rupture of membranes had no differences in the three groups. CONCLUSIONS: Our research showed that the degree of pain at the time of epidural analgesia request might influence the rate of cesarean delivery. Further research would be necessary for clarifying the mechanism that the augmentation of pain affects the mode of delivery.