Bilateral Cortical Blindness Due to Parieto-Occipital Infarction after General Anesthesia: A case report / 대한마취과학회지

Cortical blindness is characterized by visual sensation loss with retention of pupillary reaction to light, and a normal fundoscopic examination. The suggested causes are emboli, profound hypotension, anemia, and infarction of watershed areas in the parietal or occipital lobe. We experienced a case of cortical blindness with severely reduced visual acuity after penile cancer surgery under general anesthesia. In the acute stage, visual acuity was slightly improved, but over the course of several months, no further improvement in visual acuity occurred. In this case there was no severe hypotension or anemia during the operation. Two days after the operation, electroencephalography (EEG) was performed during the period of blindness and the recording obtained was abnormal, with no alpha rhythm. Biparieto-occipital lucency was found by magnetic resonance imaging (MRI). Therefore parieto-occipital infarction due to seizure, embolus, or thrombosis could be considered a possible etiology. We concluded that cortical blindness can unexpectedly develop perioperatively and postoperatively, and that close monitoring of the patient and adequate management are essential.

The Effects of Neostigmine added to Ropivacaine for Intravenous Regional Anesthesia / 대한마취과학회지

BACKGROUND: Neostigmine has been added to local anesthetic regimen for epidural or intrathecal block, and this resulted in prolonged and improved analgesia, but evidence of its benefit in intravenous regional anesthesia (IVRA) is controversial. The purpose of this study was to evaluate the effects of neostigmine added to ropivacaine for IVRA. METHODS: Forty patients undergoing hand or forearm surgery were randomly assigned to two groups to receive IVRA: Group I received 40 ml of 0.2% ropivacaine plus 1 ml of normal saline, and group II received 40 ml of 0.2% ropivacaine plus 500microgram (1 ml) of neostigmine. Sensory block onset time, postoperative visual analogue scale (VAS) scores, recovery time from motor block after deflation, mean arterial pressure (MAP), heart rate (HR), and pulse oximeter saturation (SpO2) values were measured. The incidence of side effects was recorded. RESULTS: Group II had a shorter sensory block onset time, a prolonged motor block recovery time, and lower postoperative VAS scores. No significant difference was found between the two the groups in terms of MAP, HR, SpO2 and side effects. CONCLUSIONS: The addition of neostigmine to ropivacaine in IVRA is believed to be a useful effective method for outpatient arm surgery due to a shortened sensory onset time and improved postoperative analgesia.

The Changes in Lung Mechanics before and after the Nuss Operation in Pectus Excavatum Patients / 대한마취과학회지

BACKGROUND: Nuss et al introduced a less invasive method for inserting a stainless steel bar through the small incision on the lateral chest wall into the pectus excavatum. This study was undertaken to assess the effect of the Nuss operation on lung mechanics, CT-Index and hemodynamics. METHODS: Twenty patients (age 4 to 17 years) with severe pectus excavatum underwent the Nuss operation. CT-Index (the internal transverse distance of the thorax/the vertebral-sternal distance at greatest depression) was evaluated before operation. Lung mechanics (dynamic compliance [Cdyn], static compliance [Cstat] and airway resistance [Raw]), hemodynamic changes (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]), and gas exchange (arterial oxygen tension [PaO2], arterial carbon dioxide tension [PaCO2], pulse oximeter saturation [SPO2] and end-tidal carbon dioxide tension[PETCO2]) were measured before and after the operation. RESULTS: Cdyn and Cstat decreased significantly (P < 0.05), but Raw did not change. PaCO2 and PETCO2 decreased significantly (P < 0.05), and SBP and DBP increased significantly (P < 0.05) postoperatively. CONCLUSIONS: It is concluded that decreased compliance after the Nuss operation may result from reduced thoracic elastance, not to a change of lung parenchyma.

Changes of Vital Signs, Expired Volume and Maximal Pressure by Mode of Ventilation during a Nuss Operation in Patients with Pectus Excavatum / 대한마취과학회지

BACKGROUND: This study was undertaken in order to investigate any cardiopulmonary changes caused by the surgical procedure during a Nuss operation in patients with pectus excavatum. METHODS: Thirty patients undergoing the Nuss operation were divided into two groups. The patients were randomly assigned to either Group-V (n = 15) which volume controlled ventilation was applied, or to Group-P (n = 15) where pressure controlled ventilation was applied. Mechanical ventilation provided a tidal volume to be set at approximately 10 ml/kg and a frequency set to keep ETCO2 in range, between 32 mmHg and 38 mmHg. During the surgical procedure, we recorded expired volume (VE) and inspired maximal pressure (Pmax) changes according to the ventilator mode, and then also recorded changes in vital signs. RESULTS: Heart rate and blood pressure had no significant changes in either groups. In Group-V, during rotation of the metal bar, there was a significant decrease in expired volume (P< 0.001), changes of inspired maximal pressure gradually increased with the operation (P< 0.001). In Group-P, rotation of the metal bar caused a significant decrease in expired volume (P< 0.001). CONCLUSIONS: During the Nuss operation, there should be careful observation of changes in the vital signs, expired volume and maximal pressure during insertion and rotation of the metal bar.

Surgical Repair of Inferior Sinus Venosus Defect: A Report Four Cases / 대한흉부외과학회지

Inferior sinus venosus defect is a rare lesion in which there is a large interatrial communication adjacent to the atrial connection of the inferior caval vein. The defect is located posteriorly and inferiorly, outside the confines of the true atrial septum, and partial anomalous pulmonary venous connections are the rule. We underwent surgical repair in four patients with inferior sinus venosus defect and partial anomalous pulmonary venous return. There were three males and one female with an age range from four months to 25 years. A cross-sectional echocardiogram and cardiac catheterization had been performed preoperatively in all patients, but the correct diagnosis had been made in only one case. Surgical repair was indicated due to congestive heart failure, and one patient of 4-month-old needed urgent operation. The repair was accomplished by suturing a untreated autologous pericardial patch to the right of the pulmonary veins, so that the defect was closed and all the pulmonary venous blood was directed to the left atrium. The preoperative knowledge of the unusual anatomy allows the surgeon to repair the anomaly without difficulties. For the patients in whom interatrial communication and anomalous pulmonary venous return are suggested, surgeon has to pay careful attention to the anatomical landmarks to avoid incorrect placement of the patch.