Radial Nerve Paralysis due to Kent Retractor during Upper Abdominal Operation

After general anesthesia, peripheral nerve paralysis is a rare complication. The frequently damaged nerves including: branches of the brachial plexus, the ulnar, radial and common peroneal nerves, and sometimes the facial nerve. The radial nerve is the most infrequently damaged one, accounting for only 3% of nerve damage. We report a case of radial nerve paralysis due to self retractor during abdominal operation, its clinical findings, and review of the literature on peripheral nerve paralysis.

Radial Nerve Paralysis due to Kent Retractor during Upper Abdominal Operation

After general anesthesia, peripheral nerve paralysis is a rare complication. The frequently damaged nerves including: branches of the brachial plexus, the ulnar, radial and common peroneal nerves, and sometimes the facial nerve. The radial nerve is the most infrequently damaged one, accounting for only 3% of nerve damage. We report a case of radial nerve paralysis due to self retractor during abdominal operation, its clinical findings, and review of the literature on peripheral nerve paralysis.

How Much are Anesthesiologists Exposed to Electromagnetic Fields in Operating Rooms?

Numerous electronic devices have been introduced into the operating room. Although little is known about the relationship between exposure to electromagnetic fields (EMF) and health hazards, some authors reported its association with cancer or other diseases. We measured the amount of EMF exposure that an anesthesiologist gets in the operating room. The density of the magnetic field was checked by an extremely low frequency (ELF) field strength measurement system in the 19 operating rooms of our hospital. We measured the magnetic field intensity at a distance of 30 cm, 50 cm, and at the place where the anesthesiologist usually stands from the center of the main monitor. The average exposure quantities of magnetic fields in 19 operating rooms were 2.22 +/- 1.13 mG at 30 cm, 1.29 +/- 0.84 mG at 50 cm and 1.00 +/- 0.78 mG at the anesthesiologist's standing points respectively. Because quantities over 2 or 3 mG were accepted to be high radiation levels of EMF by many reports describing the hazards of EMF, we set 2 mG to be the cutoff value. In some of the 19 operating rooms, the measured EMF density exceeded our cutoff value. Although the health hazards related to EMF exposure are still equivocal, anesthesiologists should consider making an effort to improve their environment and reduce their exposure to EMF.

Development of Fine Time Controller of a Transtracheal Jet Ventilator and Its Experimental Application / 대한마취과학회지

BACKGROUND: Transtracheal jet ventilation (TTJV) with a large-bore angiocath that is inserted through the cricothyroid membrane can provide immediate oxygenation from a high pressure-oxygen wall outlet, as well as ventilation by means of manual triggering. However, there is widespread agreement that TTJV with a high pressure oxygen system may induce numerous complications including tracheal hemorrhage/ulceration, subcutaneous/mediastinal emphysema, and barotrauma resulting in a pneumothorax. The goal of this study was to highlight the potential effectiveness of a TTJ-ventilator with an oxygen supply pressure lower than 50 psig for proper oxygenation and ventilation avoiding the possibility of complications from a high pressure oxygen supply system. METHODS: Five mongrel dogs were intubated, paralyzed with vecuronium, and mechanically ventilated with enflurane in air maintaining the PaCO2 at 35 - 40 mmHg. A 16 G IV catheter was inserted percutaneously into the trachea below the tip of the endotracheal tube. We measured the injection volumes, entrained air volumes, and peak inflation pressures according to the changes of oxygen supply pressure (10 to 50 psig) with a fixed injection time (1 second). In addition, we evaluated the oxygenation effects of TTJV at 15 breaths per minute and an I : E 1 : 3 on 20 psig of oxygen supply pressure in hypoxic dogs. RESULTS: A 16 G angiocath provided the injected volumes from 139 ml to 595 ml according to the changes of oxygen pressure from 10 to 50 psig. The entrained air volumes were 6.7 48% of total inspirated volumes. The PaO2 was elevated over 300 mmHg and the PaCO2 was reduced to 45 mmHg within 1 minute of TTJV in hypoxic dogs. CONCLUSIONS: A TTJV system equipped with a time-controller and pressure-regulator can provide enough tidal volume to maintain oxygenation, and could minimize the volu/barotrauma of a conventional TTJV.

A Successful Tracheostomy under General Anesthesia with Blind Intubation via ILMA in a Sitting Position / 대한마취과학회지

The intubating laryngeal masK airway is a newly available device designed to allow for blind endotracheal intubation and treatment of patients with difficult airways. Emergency tracheostomies are required for oropharyngeal, hypopharyngeal, and laryngeal tumors acutely obstructing the airway. Patients with an airway obstructive tumor maintain their airway by a very active inspiratory effort in a sitting position. In these patients, it may be impossible to position them for a tracheostomy with shoulder extension. We report a case where a patient was tracheostomized successfully under general anesthesia with blind intubation via ILMA insertion in a sitting position.

The Development of an Inspiratory Time Adjustable Transtracheal Jet Ventilator and Evaluation in a Human Adult Trachea-Lung Model / 대한마취과학회지

BACKGROUND: Transtracheal jet ventilation (TTJV) has been used for 'Cannot Ventilate/Cannot Intubate' situation, lefe-saving situations, by simply introducing an IV catheter (angiocatheter) through the cricothyroid membrane. To decrease the occurrence of barotrauma caused by a continuous high pressure oxygen supply while applying TTJV, it would be ideal to have a TTJV system equipped with an inspiration time adjustable function which any currently commercially available TTJV does not have. METHODS: Recently, we made a prototype of an inspiration time adjustable TTJV and measured the corresponding injection volumes and peak inflation pressures according to the changes of oxygen supply pressure and inspiration time using catheters ranging from 14 to 20 G in a simulated human adult trachea-lung model. RESULTS: A 16 G angiocatheter provided 465 +/- 5 ml of injected volume with a peak inflation pressure of 25 cmH2O under a 50 psi oxygen supply at 1 second of inspiration, which would be adequate for an adult tidal volume. When a 14 G catheter was used under the same conditions as above, the injected volume was 1128 +/- 9 ml. All injected volumes were under 310 ml when 18 and 20 G angiocathers were used at variosus driving pressures (10 - 50 psi) and inspiration time (0.5, 0.75, and 1 s). CONCLUSIONS: An inspiration time adjustable TTJV can easily provide enough tidal volume to maintain oxygenation, and could be expected to prevent or reduce barotraumatic complications such as pneumothorax.

How Much are Anesthesiologists Exposed to Electromagnetic Fields in Operating Rooms? / 대한마취과학회지

BACKGROUND: So many electronic devices have been introduced in the operating room. However, little was known about the hazards of electromagnetic fields (EMF) to the human body. We have studied about how much the anesthesiologists are exposed to EMF. METHODS: In 19 operating rooms of our hospital, the intensity of magnetic fields was measured by an ELF (Extremely low frequency) field strength measurement system. The distances were 30 cm, 50 cm and the anesthesiologist's proximity to the monitoring devices. RESULTS: The average strength of 19 operating rooms were 2.22 +/- 1.13 mG at 30 cm from the monitors, 1.29 +/- 0.84 mG at 50 cm and 1.00 +/- 0.78 mG at the anesthesiologist's stand. CONCLUSIONS: We found that in some of our operating rooms the exposure to EMF was measured above Sweden's TCO limit which has been accepted as the EMF radiation rule for computer monitors. Although the hazards of EMF have not been definitely confirmed yet, the effort not to be exposed to EMF should be considered by anesthesiologists.

Intravenous Fentanyl Dose for Control of Postinguinal Herniorrhaphy Pain in Children / 대한마취과학회지

BACKGROUND: Postoperative pain control in children is a difficult problem for management. Fentanyl is one of the most commonly used narcotics in infants and children due to its rapid onset and brief duration. Infants older than 3 months had a lower incidence of apnea than adults given fentanyl; however, the dosage of fentanyl varies a great deal depending on the purpose and plan for the postoperative management. This study is designed to evaluate the effective dose of intraoperative intravenous fentanyl for pain control following inguinal herniorrhaphy in pediatric patients. METHODS: Sixty children for inguinal herniorrhaphy under general anesthesia were divided into four groups. Group I received no analgesics as a control. Group II, III and IV received intravenous fentanyl 0.5 microgram/kg, 1 microgram/kg and 1.5 microgram/kg respectively. Fentanyl was injected intravenously at the beginning of fascia closure. Extubation time and the degree of pain was evaluated. RESULTS: Our result showed that group III and IV had a lower pain score than that of the control group during the first 30 min in the recovery room (p<0.05), but no significant differences were found between the group III and group IV. The time interval from fascia closure to extubation was prolonged in the group II, III and IV compared to the control group (p<0.05). But no significant differences were found between the three groups. CONCLUSION: We suggest that intravenous administration of fentanyl 1 microgram/kg at the closure of fascia would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.