Acute Bacterial Meningitis after Percutaneous Radiofrequency Trigeminal Rhinzotomy of the Maxillary Cancer Patient : A case report / 대한마취과학회지

Since 1920, when Harvey Cushing first used radiofrequency in electrosurgery, the procedural technique has developed rapidly. Even though this procedure is minimally invasive and safer than other neurodestructive procedures, it is still not free of complications. A 72-year-old female patient had constant facial pain, despite several operations and radiotherapies for her maxillary cancer. The region innervated ophthalmic branch and maxillary branch of the trigeminal nerve was involved, with radiofrequency procedure of the gasserian ganglion for pain control also performed at the area. After the procedure, her blood pressure became elevated and she complained of a headache, and six hours later, she became irritable and distracted. Bacterial meningitis was diagnosed by a spinal tap, with third-generation cephalosporin administered as the treatment. The following day, her symptoms had improved and the pain was also reduced. She was discharged from hospital after 14 days, without any sequelae.

The Comparison of Magnesium Sulfate and Remifentanil in Attenuating Hemodynamic Response to Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Laryngoscopy and endotracheal intubation may cause tachycardia and hypertension. Magnesium directly inhibits the release of catecholamine from the adrenal medulla, with has a vasodilating effect. Remifentanil indirectly decreases the release of catecholamine by increasing the depth of anesthetic. The effects of magnesium sulfate and remifentanil at attenuating the sympathetic responses were compared during laryngoscopy and endotracheal intubation. METHODS: Eighty ASA class 1 or 2 patients, scheduled for elective surgery under general anesthesia, and requiring endotracheal intubation, were divided into four groups. The patient received either normal saline, 50 mg/kg magnesium sulfate, 1.0microgram/kg remifentanil or 25 mg/kg magnesium sulfate and 0.5microgram/kg remifentanil Groups C, M, R and MR, respectively, according to their assigned group. The specific drugs for each group were administered over a 30 second period prior to the induction of anesthesia with 2 mg/kg propofol and 1.5 mg/kg succinylcholine. The Systolic blood pressure, diastolic blood pressure and heart rate were recorded prior to induction (T1), immediately prior to intubation (T2), immediately after intubation (T3), and 1 and 3 minutes after intubation (T4 and T5, respectively). RESULTS: The percentage changes in the systolic blood pressure of groups M, R and MR were lower immediately after intubation than that of group C. The systolic blood pressures of groups M and MR increased from those at the baseline, but the systolic blood pressure of group R decreased from that at the baseline immediately after intubation. The heart rate of group M increased from that at the baseline, but the heart rate of group R decreased from that at the baseline immediately prior to intubation. CONCLUSIONS: The blood pressure immediately after endotracheal intubation was increased by the administration of magnesium sulfate, but the induced change was less than that of group C. The blood pressure was decreased by the administration of remifentanil immediately after endotracheal intubation. Magnesium sulfate caused tachycardia, but remifentanil caused bradycardia.