Stellate ganglion block for the treatment of intractable hiccups: A case report

Hiccups are an involuntary contraction of the diaphragm that may repeat several times per minute. In general, hiccups are very common, transient, and self-limited. However, if the condition persists longer than days or months, it impacts a patient's quality of life. Pharmacologic and non-pharmacologic methods are used for the treatment of persistent or intractable hiccups. Nerve block and stimulation have been shown to be effective through neural pathway interruption or stimulation of the hiccup reflex arc. Stellate ganglion block (SGB) is an injection of local anesthetic adjacent to a group of nerves in the neck known as the stellate ganglion. The authors report a case of SGB as an effective treatment for a patient with intractable hiccups resulting from right lateral medullary syndrome.

Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

General anesthesia in a patient with multicentric Castleman's disease: a case report / 대한마취과학회지

Castleman's disease (CD) is a rare lymphoproliferative disorder of undetermined etiology. Unicentric Castleman's disease is confined to a single lymph node; it is usually asymptomatic though sometimes has local manifestations related to mass effects. In contrast, multicentric Castleman's disease (MCD) typically presents with lymphoid hyperplasia at multiple sites; it is associated with systemic symptoms and abnormal laboratory findings, with a less favorable prognosis. In case of anesthesia in CD, an exhaustive preanesthetic evaluation is essential to identify associated clinical manifestations which may influence the management of the anesthesia. Perioperative careful monitoring and proper anesthetic management are both important. We report a case of general anesthesia with anesthetic management in a patient with MCD that has not been documented in the literature.

Transient left bundle branch block associated with hypoxia during monitored anesthesia care: A case report

Transient left bundle branch block (LBBB) is uncommon during anesthesia. It is mainly related to the changes in blood pressure or heart rate. Its occurrence can be confused with acute myocardial ischemia or ventricular tachycardia, therefore differential diagnosis is important. We report a case of transient LBBB which developed with hypoxia during monitored anesthesia care. LBBB is reversed to sinus rhythm after recovery from hypoxia.

Intraoperative very late stent thrombosis in patient undergoing arthroscopic shoulder surgery / 대한마취과학회지

No abstract available.

Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report / 대한마취과학회지

Neurogenic pulmonary edema (NPE) in brain dead organ donors occurring after an acute central nervous system insult threatens organ preservation of potential organ donors and the outcome of organ donation. Hence the active and immediate management of NPE is critical. In this case, a 50-year-old male was admitted to the intensive care unit (ICU) for organ donation. He was hypoxic due to NPE induced by spontaneous intracerebral hemorrhage and intraventricular hemorrhage. Protective ventilatory management, intermittent recruitment maneuvers, and supportive treatment were maintained in the ICU and the operating room (OR). Despite this management, the hypoxemia worsened after the OR admission. So inhaled nitric oxide (NO) therapy was performed during the operation, and the hypoxic phenomena showed remarkable improvement. The organ retrieval was successfully completed. Therefore, NO inhalation can be helpful in the improvement of hypoxemia caused by NPE in brain dead organ donors during anesthesia for the organ donation.

Anaphylaxis induced by priming dose of rocuronium during induction of anesthesia: Report of two cases

We experienced 2 cases of anaphylaxis during induction of anesthesia. Anesthesia was induced with a priming dose of rocuronium and followed by thiopental sodium two minutes later. Immediately after injection of thiopental sodium, they showed a sudden active coughing, urticaria around neck, and difficult ventilation. The residual intubating dose of rocuronium was injected to do endotracheal intubation. Subsequently, patients showed severe hypotension, hypoxia, and erythema. Rapid treatment was applied and they were recovered without any complications. The first patient had rejected skin test for drugs, but the second patient had a positive skin test for rocuronium two weeks after event.

Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer: A case report / 대한마취과학회지

The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.

The effect of knee flexion with the patient in the supine position and under general anesthesia for reducing postoperative low back pain

BACKGROUND: Postoperative low back pain is common. Some studies have indicated that the use of a lumbosacral wedge is effective in reducing the incidence of postoperative low back pain. This study aimed to evaluate the effect of knee flexion with the patient in the supine position and under general anesthesia for reducing postoperative low back pain. METHODS: 261 patients who were undergoing surgery under general anesthesia were randomized to the supine position (Group I) or the supine position with both knees in flexion (Group II). The incidence of low back pain and the pain score (VAS) were measured at the following time points: postoperatively 6 hours, 1 day, 2 days, 3 days and 4 days. RESULTS: The incidence of low back pain in group II was significantly lower than that in Group I at postoperative 6 hours, 1 day and, 2 days (P < 0.05). But, no significant differences of their pain scores were observed between the groups. CONCLUSIONS: We conclude that the intraoperative supine position with both knees in flexion can reduced the incidence of postoperative low back pain in a fashion like using a lumbosacral wedge to support the lumbosacral area.

The effect of knee flexion with the patient in the supine position and under general anesthesia for reducing postoperative low back pain

BACKGROUND: Postoperative low back pain is common. Some studies have indicated that the use of a lumbosacral wedge is effective in reducing the incidence of postoperative low back pain. This study aimed to evaluate the effect of knee flexion with the patient in the supine position and under general anesthesia for reducing postoperative low back pain. METHODS: 261 patients who were undergoing surgery under general anesthesia were randomized to the supine position (Group I) or the supine position with both knees in flexion (Group II). The incidence of low back pain and the pain score (VAS) were measured at the following time points: postoperatively 6 hours, 1 day, 2 days, 3 days and 4 days. RESULTS: The incidence of low back pain in group II was significantly lower than that in Group I at postoperative 6 hours, 1 day and, 2 days (P < 0.05). But, no significant differences of their pain scores were observed between the groups. CONCLUSIONS: We conclude that the intraoperative supine position with both knees in flexion can reduced the incidence of postoperative low back pain in a fashion like using a lumbosacral wedge to support the lumbosacral area.

Pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery: A case report / 대한마취과학회지

Arthroscopic shoulder surgery has become a common and routine procedure because it provides several advantages for the diagnosis and therapy of shoulder injuries. However, shoulder arthroscopy is not a technique that's void of complications. We describe here a unique case of a patient who experienced pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery, and this surgery was done under general anesthesia.

Hemodynamic Responses of Pretreatments Designed to Reduce Withdrawal Movements Following Rocuronium Injection: A Comparison of Alfentanil with Lidocaine / 대한마취과학회지

BACKGROUND: This study was conducted to compare the efficacy of intravenous alfentanil and lidocaine as a pretreatment for the prevention of withdrawal movements following a rocuronium injection and hemodynamic change following tracheal intubation. METHODS: This study evaluated 180 patients that were divided into the following 3 pretreatment groups: group C: normal saline, group L: lidocaine 1 mg/kg, group A: alfentanil 10microgram/kg. Anesthesia was induced using 5 mg/kg thiopental sodium, after which the test drug was injected. Rocuronium (1 mg/kg) was then administered 1 minute after the test drug was injected over 5 seconds and the response was characterized as one of the following: no movement, movement limited to the wrist, to the elbow or to the shoulder. Intubation was performed 1 minute later. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were then recorded at each of the following points: T1: preinduction, T2: immediately prior to rocuronium injection, T3: immediately after rocuronium injection, T4: immediately prior to intubation, T5: immediately after intubation, T6: 1 minute after intubation, T7: 5 minutes after intubation. RESULTS: The incidence of withdrawal movement was significantly lower in group A than groups C and L (P < 0.05). In addition, SBP, DBP and HR following intubation were significantly lower in group A than group C and group L (P < 0.05). CONCLUSIONS: Pretreatment with 10microgram/kg of alfentanil effectively reduced the incidence of withdrawal movement in response of rocuronium injection and caused minimal hemodynamic changes following intubation.

Hemothorax after Central Venous Catherization Failure through the Subclavian Vein / 영남의대학술지

Central venous catheterization via an internal jugular vein or subclavian vein has become a common procedure in monitoring CVP and managing severely ill patients. However, there have beennumerous reports of complications associated with central venous catheterization. These include vessel injury, pneumothorax, hemothorax, nerve injury, arrhythmias, arteriovenous thrombosis, pulmonary embolism, and infection at the insertion site. We report a case of hemothorax after subclavian vein catheterization failure, along with successful treatment.

Severe bradycardia and transient asystole during epidural anesthesia: A case report / 대한마취과학회지

The severe bradycardia and asystole are uncommon complications of epidural anesthesia but can be life threatening if not managed properly. A 73-year-old, ASA class 3, male patient was admitted for a total knee replacement under epidural anesthesia. Approximately 10 minutes after epidural anesthesia, the heart rate decreased significantly to 20 beats/min with asystole. The heart rate returned to 80 beats/min after administering atropine, ephedrine, and external cardiac compression. Severe bradycardia and asystole may be induced by vagal activation as a result of the low venous return and sympathetic blockade.

Effect of Intraarticular Ketamine after Knee Arthroscopy / 대한통증학회지

BACKGROUND: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. METHODS: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. RESULTS: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. CONCLUSIONS: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.