Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis / 대한마취과학회지

Background@#The costoclavicular brachial plexus block (CCB) is a recently established technique that uses the infraclavicular approach and is performed just below the clavicle. This meta-analysis aimed to determine whether CCB can reduce the incidence of hemidiaphragmatic paralysis (HDP), which is a major adverse event related to brachial plexus block (BPB), while yielding comparable block performance as other BPB techniques. @*Methods@#We searched electronic databases to identify relevant studies that compared the incidence of HDP between CCB and other BPB techniques. The primary outcome was the incidence of HDP following CCB and other BPB techniques. The secondary outcomes were pulmonary function test results, other adverse events, and block performance parameters such as onset and performance time. @*Results@#We included six randomized controlled trials that included 414 patients. Compared with the other BPB group, the CCB group had a significantly lower incidence of HDP (relative ratio: 0.21, 95% CI [0.12, 0.36], P < 0.001) and higher peak expiratory flow rate (mean difference: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015). There were no significant between-group differences with respect to other adverse events and block performance parameters. @*Conclusions@#Compared with other BPB techniques, CCB involves a lower incidence of HDP with comparable onset and performance time.

Standard digit-based versus 90° rotation technique for supraglottic airway device insertion: a meta-analysis of randomized controlled trials / 대한마취과학회지

Background@#Prompt insertion and placement of supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of insertion success rate, insertion time, and postoperative complications. @*Methods@#A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digit-based techniques for insertion of SGA devices in anesthetized patients were included. @*Results@#The first-attempt (risk ratio [RR]: 1.16, 95% CI [1.09, 1.25], P < 0.001) and overall success rates (RR: 1.06, 95% CI [1.03, 1.09], P < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference: −4.42 s, 95% CI [−6.70, −2.15 s], P < 0.001). The incidences of postoperative sore throat (RR: 0.63, 95% CI [0.49, 0.83], P < 0.001) and blood staining (RR: 0.28, 95% CI [0.20, 0.39], P < 0.001) were lower in the 90° rotation group. @*Conclusions@#The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases postoperative complications as compared with that of the standard digit-based technique in anesthetized patients.

Anesthetic considerations for urologic surgeries / 대한마취과학회지

Urologic surgeries are widely performed, and the cases have increased owing to the fact that the elderly population is growing. The narrow and limited surgical space is a challenge in performing most urologic surgeries. Additionally, the elderly population is exposed to the risk of perioperative complications; therefore, a comprehensive understanding and approach are required to provide optimized anesthesia during surgery. We have searched the literature on anesthesia for urologic surgeries and summarized the anesthetic considerations for urologic surgeries.

Anesthetic considerations for a patient with situs inversus totalis undergoing cardiac surgery: A case report

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.

Severe hypoxemia during carinal resection in the lateral position under one-lung ventilation of a non-dependent lung: a case report / 대한마취과학회지

During one-lung ventilation (OLV) in the lateral position, the dependent, ventilated lung receives more blood flow than the non-dependent, non-ventilated lung owing to gravity, improving the match of ventilation and perfusion. Conversely, in the rare clinical situations when OLV is applied to the non-dependent lung, arterial oxygenation can get worse due to considerable shunt flow to the dependent non-ventilated lung. We report a case of severe hypoxemia during carinal resection under OLV of a non-dependent lung. In this case, OLV had to be applied to the non-dependent lung in the lateral position because the bronchus of the non-dependent lung was anastomosed with the trachea, whereas the bronchus of the dependent lung had already been resected for carinal resection. The subsequent hypoxemia resulting from the shunt flow to the dependent non-ventilated lung was treated successfully by ligating the pulmonary artery of the dependent lung.

A report on the high frequency beam in hemorrhoid management based on patients' satisfaction

BACKGROUND: The most frequent disease seen in the anal area is hemorrhoid. The main therapeutic approach has been surgical treatment. However, in case of first degree and second degree hemorroids, the high frequency therapy is available. It can be applied on the OPD basis by the family pratitioners. Method: The data have been collected between Nov. 1997 and Apr. 1999, 464 cases are surveyed on the basis of sex, age, symptom duration, main symptom, location and duration of hemorrhoid, associated anal disease, therapeutic complication, and patients subjective satisfaction. Only 220 out of the 464 cases were available for the patients satisfaction study because of limited follow up study. RESULT: The sex ratio is 1.18:1 (252 in male, 212 in female). Age distribution shows a clustering pattern around the middle age(158 cases in the 30s, and 142 in the 40s respectively). Symptom duration before their first hospital visit reveals 118 cases(25.4%). under 5 years, 105 cases(22.6%) over 10 years, 102 cases(22.1%) 5 to 10 years orderly. The main symptom includes hemorrhoidal mass, bleeding, and pain. 146 cases(31.5%) had all the symptom descrived above. Patients with mass and bleeding were 122 patients(26.3%). In case of the degee of internal hemorrhoid, the second degree of hemorrhoid was the most common(386 cases: 83.2%) followed by the first degree(43 cases: 9.3%), the third degree (24 cases: 5.1%) and the forth degree(11 cases:2.4%). Total number of the patients with therapeutic complication were 99 cases. The complications were acute urinary retension (46cases: 46.5%), perianal edema (30 cases: 30.3%), bleeding (18cases: 18.2%) and anal stricture (5 cases: 5.0%). Satisfaction survey was based on the 220 follow up case study. 125 cases revealed very satisfied.(56.8%), 66 slightly satisfied (30.0%) and 29 unsatisfied.(13.2%). CONCLUSION: As shown in the study above, the high frequency therapy provided the patients with the high level of satisfaction. Based on the this fact, it is suggested to the family practitioners.