Anesthetic management of a patient with hemoglobinopathy: A case report

Hemoglobinopathy poses many challenges to the anesthesiologists. The central issue is the accuracy about interpretation of pulse oximetry saturation value during anesthesia. There are limited data with respect to the correlation between pulse oximetry saturation and oxygen saturation by arterial blood gas analysis in different hemoglobinopathies. We report here a case of a patient with hemoglobinopathy undergoing general anesthesia. Before the induction of anesthesia, various fractions of inspired oxygen were administered with concomitant measurement of oxygen saturation by pulse oximetry and arterial blood gas analysis. The saturation value by pulse oximetry, together with arterial blood gas analysis for oxygen tension, was used for evaluation of the patient's oxygenation status and speculation of the patient's oxygen saturation curve during the anesthesia.

Cardiac arrest with pulmonary edema in a non-parturient after ergonovine administration recovered with extracorporeal membrane oxygenation: A case report / 대한마취과학회지

Ergonovine have been used for the prevention and treatment of postpartum or postabortion hemorrhage. Although this modality has been considered relatively safe in the obstetric patients, there were a few cardiac events associated with this drug in the post-delivery or post-abortion patients, especially in patients with cardiovascular risk factors. We experienced cardiac arrest in a non-parturient with no discernible risk factors. Although resuscitated, she also suffered from pulmonary edema with unstable hemodynamics and low oxygenation. To manage the patient, extracorporeal membrane oxygenation was used and she recovered successfully without cardiopulmonary complications. Therefore, we recommend that when ergonovine is chosen as a modality, special caution should be paid to the pulmonary events, as well as cardiac, especially when administered by intravenously even in patients with no cardiovascular risk factors. If cardiac events occur, extracorporeal membrane oxygenation or other measures, such as intra-aortic balloon pump can be helpful when conventional cardiopulmonary resuscitation is not effective.

Severe Hypoxemia Following Lateral Positioning after Induction of Anesthesia in a Patient with a Diaphragmatic Hernia: A case report / 대한마취과학회지

A case of acute intraoperative hypoxemia following placement in the lateral decubitus position in a chronic diaphragmatic hernia patient undergoing general anesthesia for hip arthroplasty is presented. The patient had previously received a series of transurethral cystectomies under general anesthesia without any pulmonary complications, even though the patienthad a diaphragmatic hernia. Hypoxemia occurred after the induction of anesthesia and reposition, and surgery was subsequently postponed. The mechanisms proposed for the hypoxemia were a progressive compression atelectasis of the dependant lung caused by placement in the lateral decubitus position and the presence of the diaphragmatic hernia during anesthesia, and further reduction of the FRC of the dependent lung caused by mechanical ventilation. The patient was intubated with a left-sided endobronchial tube. After placing the patient in the lateral decubitus position, intermittent passive hyperinflation to the dependent lung and then positive pressure ventilation of both lungs was maintained to provide adequate oxygenation throughout the surgery. Therefore, differential ventilation using a double lumen tube is effective at improving hypoxemia of a patient in altered pulmonary compliance, such as in the lateral decubitus position with adiaphragmatic hernia.

General Anesthesia for Cesarean Section of a Parturient with Aplastic Anemia Refractory to Platelet Transfusion

Aplastic anemia is pancytopenia with bone marrow hypocellularity. The major risks to the pregnant women with aplastic anemia are hemorrhage and infection. Mortality during or after pregnancy is very high, especially thrombocytopenia complicated by platelet refractoriness, due to bleeding and sepsis. There is no therapeutic guideline for aplastic anemia with platelet refractoriness about cesarean section. A multidisciplinary approach to patients with aplastic anemia refractory to platelet transfusion is essential. Close consultation among the hematologist, anesthesiologist and obstetrician, and a management plan are important. We report the successful management of such a patient during cesarean section under general anesthesia.