Usefulness of 3-Dimensional Body Surface Scanning in the Evaluation of Patients with Pectus Carinatum

Background@#Radiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC. @*Methods@#The medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed. @*Results@#Based on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60). @*Conclusion@#Based on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.

Acute Heart Failure Induced by a beta-blocker after the Local Infiltration of Epinephrine: A case report / 대한마취과학회지

Topical epinephrine can cause severe hypertension, ventricular tachycardia, myocardial ischemia, cardiac arrest or pulmonary edema. The increased blood pressure and left ventricular afterload, as well as decreased left ventricular compliance caused by epinephrine may also decrease the cardiac output. If a beta blocker is used in these situations, the resulting decreased contractility and inability to increase the heart rate may further compromise the cardiopulmonary function. A 26 year-old man developed tachycardia and hypertension following the local infiltration of epinephrine 2 ml (1:10,000) around the nasal mucosa and an intramucosal injection of epinephrine 7.2 ml (1:100,000). He was treated with intravenous esmolol 10 mg. He showed a decreasing heart rate and blood pressure, depressed ST segments and inverted T waves. At the same time, the pulsation of the femoral arteries was not palpable. Cardiac massage was started. He was treated with intravenous atropine 0.5 mg and epinephrine 5microgram. He recovered from circulatory failure after this treatment and his ECG showed a normal sinus rhythm.

Intravenous Lidocaine Prior to Extubation Reduces Emergence Agitation and Cough in Pediatric Adenotonsillectomy under Sevoflurane Anesthesia / 대한마취과학회지

BACKGROUND: Sevoflurane is widely used to ambulatory pediatric anesthesia. But, sevoflurane is associated with a high incidence of emergence agitation in children. In this study, we examined the effect of single intravenous lidocaine prior to extubation on emergence agitation and cough in children undergoing adenotonsillectomy. METHODS: All patients received a standardized anesthetic regimen with 2~3% sevoflurane in 50% O2/N2O after anesthetic induction with intravenous glycopyrrolate 0.004 mg/kg, thiopental 5 mg/kg and vecuronium 0.1 mg/kg. In a double-blinded trial, 120 children (3~9 years) were randomly assigned to receive normal saline 0.1 ml/kg (Group C), 1% lidocaine 1 mg/kg (Group L1) or 2% lidocaine 2 mg/kg (Group L2), at 1 min after beginning of spontaneous respiration. After extubation, the sedation score and the incidence of agitation and cough were recorded. RESULTS: The incidence of agitation and cough in Group L1 and L2 were significantly less than Group C (P or = 2) than Group C. More patients in Group L1 were in deeper sedation than Group L2 and C at 10 min after arrival at PACU. CONCLUSIONS: We conclude that intravenous lidocaine prior to extubation reduces emergence agitation and cough after sevoflurane anesthesia in children undergoing adenotonsillectomy.

Electrophysiologic Mechanisms of Sevoflurane on Prolongation of the QT Interval: K+ Currents in Rat Ventricular Myocytes / 대한마취과학회지

BACKGROUND: Whereas sevoflurane (SEVO) has been reported to prolong the QT interval, little has been known on the electrophysiologic effects of SEVO which contributes to the prolongation of action potential (AP) duration. METHODS: The ventricular myocytes were obtained from enzymatically treated rat hearts. The standard whole cell voltage-clamp methods were used. The AP was measured using current clamp technique. As a repolarizing K+ current, the transient outward K+ current (I(to)), the sustained outward K+ current (I(sus)), and the inwardly rectifying K+ current (I(kI)) were measured. The L-type Ca2+ current (I(Ca), L) was also obtained. After the baseline measurements, the myocytes were exposed to 1.7 and 3.4% SEVO. SEVO concentrations in Tyrode superfusate at room temperature were 0.35 and 0.7 mM for 1.7 and 3.4% SEVO, respectively. Results are mean +/- SEM. RESULTS: SEVO prolonged the AP duration, while the amplitude and the resting membrane potential remained unchanged. At membrane potential of +60 mV, peak I(to) was significantly reduced by 18 +/- 2 and 24 +/- 2% by 0.35 and 0.7 mM SEVO, respectively. 0.7 mM SEVO did not shift the steady-state inactivation curve. Isus was unaffected by 0.7 mM SEVO. The I(kI) at -130 mV was little altered by 0.7 mM SEVO. I(Ca), L was significantly reduced by 28 +/- 3 and 33 +/- 1% by 0.35 and 0.7 mM SEVO, respectively. CONCLUSIONS: Prolongation of AP duration by SEVO in rat ventricular myocytes is likely to be caused by a reduction of I(to). Resting membrane potential was unaffected by SEVO, which seems to be related to no alteration of I(kI).

Early Detection of Intrathecal Migration of Epidural Catheter for Postoperative Pain Control: A case report / 대한마취과학회지

A 68 years old male patient was scheduled for open cholecystectomy and common bile duct exploration for gallstone and common bile duct stones with cholecystitis. With the patient in lateral decubitus position, a 17 G Tuohy needle was inserted into the epidural space via midline approach at the T10-11 interspace by using the loss of resistance technique. Then, an 18 G epidural catheter was inserted into the epidural space upward 5 cm for postoperative pain control without complications such as bleeding, paresthesia or CSF leakage. After the epidural catheterization, general anesthesia was induced. During the surgery, the aspiration test via the epidural catheter was done once more before connection of PCA device to the epidural catheter, and some clear fluid was found to be aspirated. Intrathecal migration of the epidural catheter was doubted and confirmed by a measurement of glucose level and the thiopental precipitation test. After the end of surgery, the epidural catheter was removed and the patient was discharged from the PACU 1 hour later without any complication or sequelae. We report a case of early detection of intrathecal migration of an epidural catheter by a measurement of glucose level and the thiopental precipitation test of the aspirated fluid.

Electrophysiologic Effect of Desflurane on the Prolongation of Action Potential Duration in Ventricular Myocytes / 대한마취과학회지

BACKGROUND: Desflurane has been reported to prolong the QTc. Several ionic currents that contribute to the prolongation of the action potential (AP) duration were investigated using guinea pig (GP) and rat ventricular myocytes. METHODS: The normal APs were measured in isolated GP papillary muscles at 37 degrees C. Ventricular myocytes were obtained from GP and rat hearts. Both the delayed outward K+ current (I(K)) and the inward rectifier K+ current (I(KI)) were assessed using a voltage ramp protocol. A more detailed study on the I(K) was performed. The ICa, L was measured. In the rat ventricular myocytes, the transient outward K+ current (I(to)) was obtained. All the patch clamp experiments were carried out at room temperature. The values are presented as mean +/- SD. RESULTS: 0.91 mM desflurane significantly prolonged the APD in the GP ventricular myocytes. Using a linear voltage ramp protocol, the I(KI) at -130 mV and the peak outward I(KI) at -60 to -50 mV were not found to be significantly reduced by 0.78 and 1.23 mM desflurane, respectively. However, the peak outward I(K) at +60 mV was significantly reduced to 63 +/- 19% and 58 +/- 12% of the baseline by 0.78 and 1.23 mM desflurane, respectively. At a membrane potential of +60 mV, 0.78 and 1.23 mM desflurane reduced the Ito to 80 +/- 8% and 68 +/- 7%, respectively. A concentration-dependent reduction in the ICa, L was observed. CONCLUSIONS: The prolongation of the APD induced by clinically relevant concentrations of desflurane in GP and rat ventricular myocytes is most likely the result of I(K) and I(to) suppression.