Successful Intubation of a Double-Lumen Endobronchial Tube Using the Modified Seldinger Technique Following Intubation of a Single-Lumen Endotracheal Tube in a Case of Difficult DLT Intubation -A case report- / 대한마취과학회지

Intubation of an double-lumen endotracheal tube (DLT) in either a normal or a difficult airway may be more difficult than the intubation of a single-lumen endotracheal tube (ETT). A 72-year-old man undergoing right upper lobectomy could not be intubated with either a 37 Fr or a 35 Fr DLT after induction of anesthesia due to an inability to visualize the glottis. Difficult intubation had not been foreseen, but inspection through the laryngoscope revealed a Cormack grade III condition. Following two attempts to place the DLT, fibroptic bronchoscopy also proved unsuccessful. We intubated a 8.0 mm ETT with OELM (optimal external laryngeal manipulation) and followed this by inserting an infusion set catheter into the ETT as a guiding stylet. The ETT was then withdrawn with the catheter in situ in the trachea, and a 35 Fr DLT successfully introduced. After removing the catheter, the position of the DLT was corrected by fibroptic bronchoscopy. No further complication occurred and surgery was finished satisfactory. We achieved successful DLT intubation using the modified Seldinger technique with an infusion set catheter through an intubated ETT in a patient with an unanticipated difficult airway.

Excessively Abrupt Increase of ETCO2 Following the Subcutaneous Infiltration of a High Dose of Epinephrine for Intraoperative Hemostasis: A Case Report / 대한마취과학회지

End tidal carbon dioxide tension (ETCO2), the partial pressure of exhaled CO2 obtained at the end of tidal breath measured by capnometer, can enable PaCO2 estimation and the monitoring of adequate ventilation. However, there are many factors that may affect ETCO2. Recently, we experienced a patient that developed an abrupt increase of ETCO2 of over 10 mmHg following the subcutaneous infiltration of a high dose of epinephrine for intraoperative hemostasis. This increase in ETCO2 may have been caused by an increased cardiac output and an increase in CO2 production due to increased tissue metabolism. Therefore, when we use ETCO2 to monitor a patient's ventilation, we should bear in mind that three factors - ventilation, hemodynamics and metabolism, may affect the the determined ETCO2 level.

Analysis of Postoperative Nausea and Vomiting after Pediatric Strabismus Surgery with Sevoflurane-N2O/O2 Anesthesia / 대한마취과학회지

BACKGROUND: Children undergoing strabismus surgery have a high incidence of postoperative nausea and vomiting (PONV). Previous reports have proposed PONV risk factors with conflicting results. We reevaluated the risk factors following pediatric strabismus surgery. METHODS: After obtaining informed consent, we conducted a prospective study of 58 ASA I children (aged 3-15 years) who had undergone elective strabismus surgery performed by the same ophthalmologist to investigate PONV risk factors. Anesthesia was induced with thiopental and rocuronium and maintained by inhalation anesthesia with 2 vol.% sevoflurane in 50% N2O/O2. Premedicants, anticholinergics, analgesics, or subtenon lidocaine injection were not used perioperatively. PONV was recorded by patients' parents during the first 24 hours after surgery. We analyzed the influence on PONV of age, sex, preoperative anxiety, oculocardiac reflex (OCR), and procedure duration. RESULTS: The incidence of PONV was 25.9%. Age was found to be associated with PONV (P or = 8 year of age, 4.2, with 95% Cl 1.2-15.4). Sex, OCR, preoperative anxiety, and procedure duration did not affect PONV. CONCLUSIONS: We found that only age is associated with PONV, and that the incidence of PONV is higher in school children than in preschoolers after pediatric strabismus surgery. These results suggest that much more attention should be paid to preventing PONV during strabismus surgery in school children.