The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block

BACKGROUND: Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy. METHODS: SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB. RESULTS: The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes. CONCLUSIONS: We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased.

Comparison of Continuous, Stat, and Intermittent Bolus Cardiac Output Measurements during Cardiac Surgery / 대한마취과학회지

BACKGROUND: Off-pump coronary artery bypass (OPCAB) patients often require fluid, vasopressor, or inotropic support.It is therefore important that vigilant monitoring be undertaken to guide intervention and monitor the effects of therapy.Continuous monitoring of cardiac output (CO) is advisable.The aim of this study was to compare continuous cardiac index (CCI) and stat cardiac index (SCI) with intermittent bolus cardiac index (ICI) in patients undergoing OPCAB surgery. METHODS: Matched sets of CI measurements among CCI, SCI, and ICI were collected in 35 patients undergoing elective OPCAB at specific time periods.Bland-Altman analysis was used to compare the agreement among the different methods. RESULTS: Bland-Altman analysis of CI measurements yielded a bias, precision, and percent error of 0.09 +/- 0.63 L/min/m(2) (46.2%) for CCI and 0.09 +/- 0.60 L/min/m(2) (44.0%) for SCI, compared with ICI measurements. CONCLUSIONS: We found that the agreement of CCI, SCI, and ICI was poor.This disagreement increased during periods of open thorax and open pericardium when compared to the period of closed thorax.Continuous CO measurements through pulmonary artery catheter should be interpreted with caution during OPCAB.

Relationship between Lumbar Lordosis and Asymmetry of Facet Joints / 대한마취과학회지

BACKGROUND: Facet joint is an important structure not only contributing to the stability of the lumbar motion segments but also causing low back pain. Hypothetically, the more lumbar lordosis decreases, the more corresponding facet joints orient axially and asymmetrically. Furthermore, the increased incidence of common diseases possessed of low back pain and radiologic findings such as wedging of vertebral body and spondylolisthesis were reported in the patients with asymmetric orientation of the facet joints and loss of lumbar lordosis at the same time. The purpose of our study is to define the relationship of asymmetry of the facet joints and loss of lumbar lordosis. METHODS: The asymmetry and average angle of facet joints with respect to sagittal plane were measured on the magnetic resonance images. The lumbar lordosis was measured on the lateral X-ray. The relevance of lumbar lordosis and facet orientation was analyzed through linear regression. RESULTS: There were no significant relationships between lumbar lordosis and asymmetrical orientation of facet joint. CONCLUSIONS: The loss of lumbar lordosis did not suggest asymmetrical and axial orientation of facet joints. Further investigation into pathology and consideration into individual differences of range of motion, body mass index, age, sex might be needed.