Retrospective anesthetic evaluation of non-obstetric surgery during pregnancy: single center experience

BACKGROUND: Laparoscopic procedures and ultrasonography are now commonly used in the obstetric field, and more non-obstetric procedures are being performed. However, little domestic data has been published on the topic. This present retrospective study investigated the clinical information and the effect on perinatal outcomes of non-obstetric surgery during pregnancy. METHODS: This retrospective study was performed using data of all adult pregnant women that underwent non-obstetric surgery at our institute between from July 2009 to December 2016. Data was collected from the institutional computerized database. The causes, types, and the gestational ages at surgery were collected as our primary outcomes. Basic characteristics of patients, operation times, anesthesia times, anesthetic methods, anesthetic agents, and adverse perinatal outcomes such as abortion or preterm delivery were evaluated as secondary outcomes. RESULTS: During the study period, there were 2,421 deliveries and 60 cases of non-obstetric surgery, an operation rate of 2.48%. The most common cause of non-obstetric surgery was abdominal surgery, followed by orthopedic surgery and neurosurgery. Most of abdominal surgeries were performed laparoscopically during the first trimester. The incidence of adverse perinatal outcomes was increased in the first trimester, was not related with anesthesia. CONCLUSIONS: The rate of non-obstetric surgery was found to be 2.48%, which was higher than those reported in previous domestic studies. This increase seems to have resulted from early diagnosis by ultrasonography and non-invasive surgery using laparoscopy. Adverse perinatal outcomes are not related with age, surgery and anesthetic-related factors but seem to be associated with surgery exposure stage, especially the first trimester.

Dislocation of the temporomandibular joint following general anesthesia / 대한마취과학회지

No abstract available.

Endotracheal intubation using a fiberoptic bronchoscope and laryngeal mask airway in ICU / 대한마취과학회지

No abstract available.

Optochiasmatic Cavernous Angioma with Rapid Progression after Biopsy Despite Radiation Therapy

We present a rare case of optochiasmatic cavernous angioma (CA) that progressed despite radiation therapy. A 31-year-old female patient presented with sudden loss of left visual acuity and right homonymous hemianopsia. Magnetic resonance imaging (MRI) revealed a suprasellar mass and findings compatible with a craniopharyngioma or an optic glioma with bleeding. An open biopsy was conducted using the transcranial approach, and histological examination revealed gliosis. During the one-year follow-up period, imaging suggested intratumoral bleeding and the mass continued to grow. We recommended re-operation, but the patient refused due to fear of surgery. Consequently, the patient received fractionated radiation therapy (3,000 cGy) to the parasellar area. Despite the radiotherapy, the mass continued to grow for the following 6 years. The final MRI before definitive treatment revealed a multilobulated, multistage hematoma with calcification in the parasellar area, extending into the third ventricle and midbrain. The patient ultimately underwent reoperation due to the growth of the tumor. The mass was completely removed with transcranial surgery, and the pathologic findings indicated a cavernous angioma (CA) without evidence of glioma. As shown in our case, patients may suffer intratumoral hemorrhage after biopsy and radiotherapy. This case places the value of biopsy and radiotherapy for a remnant lesion into question. It also shows that reaching the correct diagnosis is critical, and complete surgical removal is the treatment of choice.

Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma

A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. During conservative treatment under the diagnosis of a subdural hematoma, left cranial nerve palsies were developed (3rd and 6th), followed by scleritis and uveitis involving both eyes. Magnetic resonance imaging (MRI) revealed an unusual tentorium-falx enhancement on gadolinium-enhanced T1-weighted images. Non-specific chronic inflammation of the pachymeninges was noticed on histopathologic examination following an open biopsy. Systemic steroid treatment was initiated, resulting in dramatic improvement of symptoms. A follow-up brain MRI showed total resolution of the lesion 2 months after steroid treatment. IHCP should be included in the differential diagnosis of subtentorial-enhancing lesions.

Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin: A case report / 대한마취과학회지

Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. Enoxaparin sodium is a low molecular weight heparin (LMWH) for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty. Hemorrhage is an uncommon but documented adverse reaction when using LMWH. We report a case of epidural hematoma after lumbar epidural anesthesia in a patient who administered enoxaparin in perioperative period.

Anesthetic experience of a patient with hereditary factor XI deficiency (Hemophilia C) : A case report / 대한마취과학회지

Factor XI deficiency (also called Hemophilia C) rarely occurs among ethnicities other than Ashkenazi Jews. A boy was scheduled for frontoethmoidectomy due to bilateral chronic rhinosinusitis. He was incidentally found to have factor XI deficiency due to prolonged aPTT on preoperative laboratory finding. His medical history reveals frequent epistaxis 2 or 3 times per day and his factor XI and XII activity were 17% (normal; 60-140%) and 34% (normal; 60-140%), respectively on furthermore laboratory evaluation. He was diagnosed as hereditary factor XI deficiency. He underwent the operation with administration of the fresh frozen plasma without complication.

Effects of fentanyl and midazolam on emergence agitation following ketamine anesthesia in children

BACKGROUND: Recently, a high incidence of emergence agitation (EA) has been reported in children after sevoflurane or desflurane anesthesia. However, in case of ketamine, there are few up-to-date studies about EA in children. This study observed effects of fentanyl and midazolam on emergence agitation and the recovery profile following ketamine anesthesia for outpatient surgery in preschool children. METHODS: Seventy-five children, aged 1-7 years, undergoing brief procedure under intravenous ketamine anesthesia were randomly allocated one of three groups; saline-ketamine, fentanyl-ketamine, midazolam-ketamine. Patients were premedicated with normal saline or fentanyl 0.5microg/kg or midazolam 0.05 mg/kg 5 min before administration of ketamine. Ketamine was given in an initial dose of 1.5 mg/kg and additional dose of 0.5 mg/kg ketamine was given as needed during operative procedure. The incidence of EA and other adverse effects and stay time at recovery room and day surgery center (DSC) were noted. RESULTS: The incidence of emergence agitation was 20 % in control group, 12 % in fentanyl group, and 16 % in midazolam group. Most common adverse effects during recovery was vomiting. There were no significant differences in incidence of emergence agitation, adverse effects and stay time at recovery room and DSC among the three groups. CONCLUSIONS: In children undergoing brief outpatient surgery with ketamine anesthesia, emergence agitation was not significantly reduced by addition of fentanyl 0.5microg/kg or midazolam 0.05 mg/kg. No significant differences were observed among the three groups with respect to adverse effects and recovery profile.

Ketamine potentiates neurotoxicity in obese mice / 대한마취과학회지

BACKGROUND: Obesity exacerbates chemically-induced neurodegeneration. N-methyl-D-aspartate (NMDA) antagonists such as ketamine prevent excitotoxicity and are neuroprotective against acute brain injury, but can also be toxic. In low doses they induce reversible neuronal injury, but in higher doses they cause irreversible degeneration of cerebrocortical neurons. This study was designed to evaluate the neurotoxic effect of ketamine on obesity-induced neurotoxicity in the young mouse brain. METHODS: Five-week-old female wild and obese type (C57BL6) mice were randomly allocated into three groups (n=6 each) receiving a single intraperitoneal injection of (i) saline (control); (ii) ketamine (50 mg/kg); (iii) or ketamine (100 mg/kg). Three hours after ketamine administration, their brains were prepared histologically for quantitative assessment of the number of posterior cingulate/retrosplenial (PC/RS) neurons with vacuolation at a specific rostrocaudal level. RESULTS: Pyramidal neurons containing cytoplasmic vacuoles in layers III and IV of the PC/RS cortex were observed in all groups of mice, except wild-type mice that received saline injections. Ketamine produced a dose-dependent vacuolization in both types of mice, which was more prominent in obese mice (P < 0.05). CONCLUSIONS: Administration of ketamine in young obese mice can exacerbate neurotoxicity.

Fires and Burn Caused by Alcohol-based Disinfectants and Electrocautery: A case report / 대한마취과학회지

Operating room fires, though rare, can involve substantial morbidity and mortality. Surgical fires require an ignition source, oxidizer, and fuel. Ignition sources generally include lasers and electrocautery, oxidizer are usually oxygen, nitrous oxide, and ambient air, whereas fuels are classically surgical drapes, materials, and prepping agents. We experienced a patient who, during skin incision, sustained burns resulting from a fire in the operating room. Shortly after application of disinfectants and placement of the surgical drapes, the surgeon used the electrosurgical unit on the incision. In this case, the use of an alcohol-based disinfectant was the major contributing factor to the surgical fire. To avoid recurrence, if alcohol is used for skin prepping, it should be allowed to dry completely before draping.

Delayed Emergence from General Anesthesia Caused by Acute Subdural Hematoma: A case report / 대한마취과학회지

Emergence from anesthesia may be neurologically unsatisfactory. Delayed awakening after general anesthesia is most commonly caused by the effects of anesthetic drugs, but primary central neurologic events (hemorrhage, ischemia, and embolus, etc) that occur during surgery can cause failure to awaken. We experienced a patient whose emergence was delayed from general anesthesia for zygomatic bone savage. The patient had such unexpected focal neurologic abnormalities as left ankle clonus and anisocoria (right dilation). Brain CT revealed acute subdural hematoma as a cause of delayed emergence in the postanesthetic care unit. An emergency craniectomy was performed to evacuate the hematoma, but the patient failed to regain consciousness following surgery. The patient regained consciousness on the 28th postoperative day, and had left hemiparesis and right blindness.

Anesthetic Management of Pediatric Pancreatic Insulinoma: A case report / 대한마취과학회지

Insulinomas are the most common type of islet cell tumor. Generally, these tumors are benign (90%), intrapancreatic, solitary, and small. Moreover, hyperinsulinemia in infants and children can result in permanent damage to the central nervous system. Thus, early diagnosis and treatment are important. The principal challenge during anesthesia is the avoidance of hypoglycemia, which may occur during tumor manipulation, though hyperglycemia may follow after successful surgical removal of the tumor. Because symptoms of hypoglycemia (systemic hypertension, tachycardia, diaphoresis) may be masked during anesthesia, it is important to monitor blood glucose levels frequently during the perioperative period. Here we report up on the case of a 3 year old female with insulinoma. We monitored blood glucose levels intermittently (about every 15 minutes) using a glucometer (Medisense Optium, Abbott, USA). No hypoglycemic episode occurred during anesthesia. We report this clinical experience and review anesthetic choices and the management of this patient.

Anesthetic Management of Laparoscopic Adrenalectomy for Pheochromocytoma / 대한마취과학회지

Currently-available imaging techniques provide accurate localization of a tumor in patients with pheochromocytoma. The precision of this information allows the use of a more selective surgical approach to the tumor, such as by laparoscopy. We describe a case of a 54-year-old female who underwent resection of pheochromocytoma by a laparoscopic approach. Two events resulted in significant hemodynamic changes; the creation of the pneumoperitoneum and adrenal gland manupulation. Preoperative preparation with alpha-adrenergic blocking agents and adequate fluid loading before insufflation attenuated intraoperative cardiovascular changes, while titration of sodium nitroprusside and phentolamine allowed easy and quick control of the hemodynamic aberrances related to these processes. As a result, the operation was carried out safely, and the postoperative course was unremarkable.