Ultrasound-Guided Infraorbital Nerve Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: A Case Report

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.

Effects of pneumoperitoneal pressure and position changes on respiratory mechanics during laparoscopic colectomy / 대한마취과학회지

BACKGROUND: This study was designed to assess the effects of pneumoperitoneal pressure (PP) and positional changes on the respiratory mechanics during laparoscopy assisted colectomy. METHODS: Peak inspiratory pressure, plateau pressure, lung compliance, and airway resistance were recorded in PP of 10 mmHg and 15 mmHg, with the position change in 5 steps: head-down at 20degrees, head-down at 10degrees, neutral position, head-up at 10degrees and head-up at 20degrees. RESULTS: When the patient was placed head-down, the position change accentuated the effects of pneumoperitoneum on respiratory mechanics. However, when the patient was placed in a head-up position during pneumoperitoneum the results showed no pattern. In the 20degrees head-up position with the PP being 10 mmHg, the compliance increased from 30.6 to 32.6 ml/cmH2O compared with neutral position (P = 0.002). However with the PP being 15 mmHg, the compliance had not changed compared with neutral position (P = 0.989). In 20degrees head-down position with the PP of 10 mmHg, the compliance was measured as 24.2 ml/cmH2O. This was higher than that for patients in the 10degrees head-down position with a PP of 15 mmHg, which was recorded as 21.2 ml/cmH2O. Also in the airway resistance, the patient in the 20degrees head-down position with the PP of 10 mmHg showed 15.8 cmH2O/L/sec, while the patient in the 10degrees head-down position with the PP of 15 mmHg showed 16.2 cmH2O/L/sec of airway resistance. These results were not statistically significant but still suggested that the head-down position accentuated the effects of pneumoperitoneum on respiratory mechanics. CONCLUSIONS: Our results suggest that respiratory mechanics are affected by the patient position and the level of PP - the latter having greater effect.

Effects of Fluid Therapy on Serum Glucose Level in Pediatric Outpatients / 대한마취과학회지

BACKGROUND: Whether intraoperative fluid therapy should contain glucose for the pediatric outpatient surgery remains controversial. This study was designed to compare the effects of glucose and glucose-free solutions on perioperative blood glucose change. METHODS: Healthy pediatric outpatients (n = 130) for minor procedure were randomly assigned to one of two fluid therapy groups. Patients in the group H (n = 65) received lactated Ringer's solution, and patients in the group D (n = 65) received 5% dextrose perioperatively. Blood glucose was checked before infusion (a), 10 minutes after induction (b), 30 minutes after induction (c), and at the time of discharge (d). RESULTS: The preoperative fasting glucose concentrations were 97.6 +/- 12.1 mg/dl and 97.7 +/- 11.3 mg/dl for the group H and D, respectively. The patients in the group D showed significantly increased blood glucose level after induction (135.9 +/- 42.7, 150.3 +/- 36.0, 123.6 +/- 26.8 mg/dl). The patients in the group H also showed significantly increased blood glucose levels (112.2 +/- 14.0, 121.4 +/- 11.4 and 105.8 +/- 18.3 mg/dl). The glucose level of group D was significantly higher than the glucose level of group H at b, c and d. Seven patients in the group D showed hyperglycemia (> 200 mg/dl). CONCLUSIONS: Dextrose containing fluid therapy resulted dangerous hyperglycemia in the pediatric outpatient surgery. We recommend lactated Ringer's solution or other glucose-free crystalloid for the healthy outpatient pediatric population undergoing minor procedures.

The Effects of Alfentanil and a Combination of Alfentanil and Esmolol on Hemodynamic Responses after Endotracheal Intubation in Hypertensive Patients / 대한마취과학회지

BACKGROUND: This study was desined to determine the efficacy and clincial usefulness of alfentanil and a combined use of alfentanil and esmolol for blunting hemodynamic responses after tracheal intubation in hypertensive patients who needed a rapid sequence induction. METHODS: Group 1 received alfentanil 15microgram/kg and group 2 received alfentanil 15microgram/kg and esmolol 1 mg/kg intravenously. Thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg were used for the induction of anesthesia. Changes in blood pressure and herat rate were measured during intubation and induction of anesthesia with enflurane-N2O-O2 and vecuronium. Rate pressure products (RPP) was calculated and the frequencies of hypertension, hypotension, tachycardia, bradycardia were measured. RESULTS: In group 1, systolic blood pressure increased significantly at 1, 2 minute and decreased significantly at 4, 5, 10, 15 minute compared to base, and diastolic blood pressure increased significantly at 1 minute and decreased significantly at 4, 5, 10 minute. Heart rate increased significantly at 1, 2 minute. In group 2, systolic blood pressure decrease significantly at 3, 4, 5 minute after tracheal intubation compared to base, and diastolic blood pressure increased at 1 minute and decreased at 4, 5, 10, 15 minute. HR did not change significantly (P < 0.05). CONCLUSION: In treated hypertensive patients, the use of a combination of alfentanil 15/kg and esmolol 1 mg/kg is a useful method to attenuate hemodynamic responses after endotracheal intubation and especially for rapid sequence induction.

Hemodynamic Changes during Continuous Hyperthermic Intraperitoneal Perfusion for Gastric Cancer Patients with Peritoneal Seeding / 대한마취과학회지

BACKGREOUND: Hyperthermia is currently effective treatment against numerous cancer gastric cells' seeding on the peritoneal surface and floating in the cancerous ascites. We evaluated changes in hemodynamics during continuous hyperthermic intraperitoneal perfusion (CHPP) to determine strategies for safer general management during this procedure. METHODS: Ten patients with far-advanced gastric cancer were given surgical treatment followed by CHPP with anticancer drug. The body temperature, blood pressure, heart rate, central venous pressure, pulmonary artery pressure, cardiac output, electrolyte and blood gas were measured during pre-CHPP, CHPP and post-CHPP period. RESULTS: The blood temperature reached 39.3 +/- 0.4 degrees C(mean SD) during CHPP. Heart rate increased to 104.4 +/- 14.2 bpm and the cardiac index to 5.3 +/- 1.5 l.min 1.m 2 during CHPP. The mean arterial pressure remained stable during the study period. The systemic vascular resistance index decreased to 996.7 +/- 324.0 dynes.s.cm 5.m2. The mixed venous oxygen saturation fell during the first part of the CHPP period. CONCLUSIONS: This study suggest that the CHPP with anticancer drug may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied.

Anesthesia for Heart Transplantation / 대한마취과학회지

Cardiac transplantation has become an acceptable therapy for patients with end stage heart disease over the last decade. We experienced a case of heart transplantation to the 50 year old female patient. We used sterile technique all the time to reduce the incidence of infection. Anesthesia was induced and maintained with fentanyl 100 ug/kg. After cardiopulmonary bypass, blood products, inotropics and vasodilators were given to maintain myocardial contractility and cardiac output. The patient recovered uneventfully and discharged on 29th postoperative day.

Comparison of Right Atrium to Pulmonary Artery Oxygen Saturation During Hemorrhagic Shock , Resuscitation , and Hypoxia in Anesthetized Cats / 대한마취과학회지

Because central venous O2 saturation (superior vena cava, ScvO2) can be monitored with less risk of the patients than mixed venous O2 saturation (pulmonary artery, SvO2), there have been studies to see if ScvO2 could replace SvO2. But previous studies showed that these two measurements were correlated but "not interchangeable. Therefore the authors compared right atrial C#b saturation (SraO2) with S vO2 over a wide range of cardiorespiratory status including control, hemorrhage, resuscitation, and hypoxia in anesthetized cats. We performed thoracotomy and inserted cannulae directly into the right atrium and the pulmonary artery. Blood sampling were obtained synchronously through the cannulae and tested immediately. The correlation coefficients in control, hemorrhage, resuscitation, and hypoxia groups were 0.876, 0.794, 0.946, 0.948 respectively and the two measurements in each group showed statistically significant correlations (p<0.05). But the biases of the two measurements in each group were 0.11+/-2.9, 0.35+/-4.2, -0.55+/-3.2, 0.23+/-4.2 respectively and the limits of agreement ( 2 standard deviation) in all groups exceeded permissible (5%) to conclude that the two measurements were in agreement. Thus, we reached the conclusion that the absolute values of SraO2, though not being sufficiently identical to S vO2 to calculate O2 uptake or pulmonary shunt precisely, can reflect the S vO2 trend following the O2 supply / demand change. Further clinical studies are needed.