Aspiration pneumonia caused by fentanyl-induced cough: a case report / 대한마취과학회지

Although fentanyl-induced cough is generally transient and benign, it can give rise to serious problems in patients to whom increasing intracranial, intraocular or intraabdominal pressures may create dangerous situations. This case demonstrates aspiration pneumonia as a complication, exhibiting severe cough induced by intravenous injection of fentanyl.

Tapia's syndrome following cervical laminoplasty: A case report / 대한마취과학회지

Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months.

Evaluation of the neurological safety of epidurally-administered pregabalin in rats / 대한마취과학회지

BACKGROUND: The primary site of action of pregabalin, i.e. the alpha-2-delta subunit of the voltage-dependent calcium channel, is located at the dorsal root ganglion and dorsal horn of the spinal cord. Therefore, the epidural administration of pregabalin could have advantages over oral administration. However, the possibility of its neurotoxicity should be excluded before any attempt at epidural administration. We evaluated the neuronal safety of epidurally-administered pregabalin by observing the sensory/motor changes and examining the histopathology of spinal cord in rats. METHODS: Sixty rats of 180-230 g were divided into three groups; 3 mg of pregabalin dissolved in 0.3 ml saline (group P, n = 20), 0.3 ml 40% alcohol (group A, n = 20), or 0.3 ml normal saline (group N, n = 20) was administered epidurally to the rats in each group. Pinch-toe test, motor function evaluation, and histopathologic examination of vacuolation, chromatolysis, meningeal inflammation, and neuritis were performed at the 1st, 3rd, 7th, and 21st day after each epidural administration. RESULTS: All rats enrolled in group P, like those in group N, showed neither sensory/motor dysfunction nor any histopathological abnormality over the 3-week observation period. In contrast, in group A, 80% of the rats showed abnormal response to the pinch-toe test and all rats showed decreased motor function during the entire evaluation period. In addition, all histopathologic findings of neurotoxicity were observed exclusively in group A. CONCLUSIONS: The epidurally administered pregabalin (about 15 mg/kg) did not cause any neurotoxic evidence, in terms of both sensory/motor function evaluation and histopathological examination in rats.

Inappropriate elevation of bispectral index values in robot assisted thyroidectomy with electromyographic endotracheal tube: A case report / 대한마취과학회지

We report a case of an erroneously elevated bispectral index (BIS) during robot assisted thyroidectomy using an electromyographic endotracheal tube (EMG tube), which is safe and useful for laryngeal electromyographic monitoring. Ten minutes after start of the operation, a sudden increase of BIS value up to 98 was noticed. The BIS values were not decreased to < 65 with supplemental anesthetics. The anesthetic method was changed from total intravenous anesthesia to balanced anesthesia. The BIS sensor and monitor were changed and other models were used. These interventions did not alter BIS values. BIS levels remained between 60 and 70 throughout the main procedure and intermittently increased to the mid-90s without any trace of poor signal quality. At the end of the surgery, the BIS values returned to normal range. The patient did not complain of intraoperative recall. Knowledge of potential interference from the use of an EMG tube must be considered when interpreting BIS.

Anesthetic management of a child with Apert syndrome : A case report

Apert syndrome involves abnormal growth of several bones such as craniofacial abnormalities, craniosynostosis and syndactyly of the feet and hands. Apert syndrome often demonstrates to the operating room for craniofacial and extremity operations. Previous reports reveal that children with Apert syndrome suffered difficulties in mask ventilation and difficult airway management during anesthetic management.We report our experience with anesthesia of a 26-month-old female patient with Apert syndrome who underwent syndactyly for separation.

Diagnostic Usefullness of Current Perception Threshold Test in Carpal Tunnel Syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. When performing routine nerve conduction studies (NCS) in clinically diagnosed CTS, we sometimes confronted with patients who have no definite electrophysiological evidence of CTS. Current perception threshold (CPT) test can evaluate the functioning of all major subpopulations of sensory nerve. The purpose of this study is to determine clinically usefulness of the CPT test in idiopathic CTS. METHODS: We prospectively studied 60 patients (90 hands) who were clinically diagnosed as CTS. Involved hands were grouped into three clinical grades (mild, moderate and severe). NCS was done using a standard technique and equipment. CPT test was measured at the distal interphalangeal joint of second, third and fifth fingers with electrical current of 5 Hz, 250 Hz and 2,000 Hz in frequency. RESULTS: Of 60 patients (90 hands), 8 (13.1%) were men and 52 (86.9%) were women. Mean age at evaluation was 56.00+/-8.94 years old. Positive rate of NCS and CPT was 0.80 (0.72, 0.88) and 0.61 (0.51, 0.71), respectively. Sensitive and specificity of CPT test was 0.49 and 0.57. As the clinical severity of CTS deteriorate, CPT test showed abnormality in low frequency stimulation. CONCLUSIONS: CPT test is an effective and relatively simple procedure for measuring perception in CTS. But CTS test is difficulty and subjectively at interpretation. We suggested that the usefullness of CPT test is lower than NCS in diagnosis of CTS.

Delayed Tension Pneumothorax Detected 4 Days after Central Venous Catheterization: A case report / 대한마취과학회지

Pneumothorax is one of the most frequent complications of percutaneous central venous catheterization.Most significant pneumothoraces are easily detected on postcatheterization chest radiograph.However, we report a rare case of delayed tension pneumothorax detected 4 days after unsuccessful central venous catheterization via the infraclavicular subclavian vein, although initial postcatheterization and postoperative supine chest radiographs showed no active lesion.

Residual Dizziness after Successful Repositioning Treatment in Patients with Benign Paroxysmal Positional Vertigo

BACKGROUND AND PURPOSE: Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Although the repositioning maneuver dramatically improves the vertigo, some patients complain of residual dizziness. We evaluated the incidence and characteristics of persistent dizziness after successful particle repositioning and the clinical factors associated with the residual dizziness. METHODS: We performed a prospective investigation in 49 consecutive patients with confirmed BPPV. The patients were treated with a repositioning maneuver appropriate for the type of BPPV. Success was defined by the resolution of nystagmus and positional vertigo. All patients were followed up until complete resolution of all dizziness, for a maximum of 3 months. We collected data on the characteristics and duration of any residual dizziness and analyzed the clinical factors associated with the residual dizziness. RESULTS: Of the 49 patients, 11 were men and 38 were women aged 60.4+/-13.0 years (mean +/-SD), and 30 (61%) of them complained of residual dizziness after successful repositioning treatment. There were two types of residual dizziness: continuous lightheadedness and short-lasting unsteadiness occurring during head movement, standing, or walking. The dizziness lasted for 16.4+/-17.6 days (range=2-80 days, median=10 days). A longer duration of BPPV before treatment was significantly associated with residual dizziness (p=0.04). CONCLUSIONS: Residual dizziness after successful repositioning was observed in two-thirds of the patients with BPPV and disappeared within 3 months without specific treatment in all cases. The results indicate that early successful repositioning can reduce the incidence of residual dizziness.

Epidemiology of Complex Regional Pain Syndrome: A Retrospective Chart Review of 150 Korean Patients

Complex regional pain syndrome (CRPS) is a chronically painful and disabling disorder. However, no data are available even on the epidemiology of CRPS in Korea. This study was undertaken to retrospectively assess the epidemiologic characteristics of CRPS in 150 consecutive patients at a tertiary chronic pain center from March 2002 to February 2006. Information was obtained regarding patients' demographics, nature of injury, and treatment modalities. Seventy-one percent of patients had CRPS type I. The mean 11-point verbal numerical rating scale score at initial examinations and at the time of study were 8.0 and 5.7, respectively. Thirty-two percent of patients showed no change or increase in pain intensity during follow-up at our pain center. The mean duration of CRPS symptoms prior to our pain center evaluation and prior to the time of study were 27 months and 50 months, respectively. These patients had seen on average 5 different physicians before being referred to our center. This study shows that the majority of CRPS patients were referred to our center after more than 2 yr of symptoms. The clinical implication of such delayed transfer and strategies to avoid this problem are discussed.

The effect of propofol on myocardial protection after regional ischemia-reperfusion injury in an in vivo rat heart model / 대한마취과학회지

BACKGROUND: It is known that propofol protects myocardium against a global ischemia-reperfusion injury in the isolated rat heart model. The aim of this study was to investigate whether propofol, at a clinically relevant concentration infused during the peri-ischemic period, also provides a protective effect against a regional myocardial ischemia-reperfusion injury in vivo. METHODS: Rats were subjected to 25 minutes of coronary artery occlusion followed by 24 hours of reperfusion. Propofol or intralipid was administrated during 35 minutes starting 5 minutes before the onset of ischemia until 5 minutes after the onset of reperfusion. A micromanometer catheter was advanced into the left ventricle and the hemodynamic function was evaluated. The infarct size was determined by triphenyltetrazolium staining after 24 hours of reperfusion. RESULTS: Propofol administration during the peri-ischemic period demonstrated protective effects on hemodynamic function and infarct size reduction. In the control group, the peak rate of the ventricular pressure increase (+dP/dt(max))(P = 0.0001) and the peak rate of the intraventricular pressure decline (-dP/dt(max))(P = 0.0001) were significantly decreased compared to the sham group. In the propofol group, the +dP/dt(max) (P = 0.003) and -dP/dt(max) (P = 0.002) were significantly improved compared to the control group. The infarct size was 47.6% of the area at risks in the control group, and was reduced markedly by administration of propofol during the peri-ischemic period to 26.2% in the propofol group (P = 0.004). CONCLUSIONS: Propofol, at a clinically relevant concentration infused during the peri-ischemic period, have protective effect after regional myocardial ischemia-reperfusion injury in an in vivo rat heart model.

Experience of the Pediatric Patients Consulted to Pain Center

BACKGROUND: The aim of this study was to investigate the management of pediatric patients who were referred to the pain center. METHODS: The data was collected based on 32 pediatric patients referred to the pain center from March 2002 to August 2006. The number of patients each year, gender distribution, age, requested departments, clinical causes of consultation, and the pain management before and after the consultation were analyzed retrospectively. RESULTS: 32 pediatric patients (19 males and 13 females), aged 3- 17 years, were enrolled in this study. Fifty-six percent of patients were in adolescence. The major need for the consultation was cancer pain (50.0%), myofascial pain syndrome (10.0%) and central pain (10.0%). Before the consultation, 62.1% of the patients were managed by opioid-based medications of which 26.1% were managed by only partial agonists and 29.6% were managed by only PRN. At the pain center, opioid-based medication was also the main treatment. CONCLUSIONS: The number of pediatric patients referred to the pain center has increased. Under this condition, the pain physician should be concerned about pediatric pain patients and their management.

An Analysis of Paresthesia Areas Evoked by Spinal Cord Stimulation in Relation to the Position of Electrode Tip / 대한통증학회지

BACKGROUND: Spinal cord stimulation is a well-established method for the management of several types of chronic and intractable pain. This form of stimulation elicits a tingling sensation (paresthesia) in the corresponding dermatomes. The goal of this study was to establish a correlation between the spinal levels of the implanted epidural electrodes and the paresthesia elicited due to stimulation of the neural structures. METHODS: Thirty five patients, who received trial spinal cord stimulation, were evaluated. After the insertion of the lead to the selected position, the areas of paresthesia evoked by stimulation were evaluated. RESULTS: Seventy-one percent of cases showed paresthesia in the shoulder area when the tip of the electrode was located between the C2 C4 levels. At the upper extremities, paresthesia was evoked in 86 93% of cases, regardless of the location of the electrode tip within the cervical spinal segments. The most common tip placement of the leads eliciting hand stimulation was at the C5 level. The most common level of electrode tip placement eliciting paresthesia of the anterior and posterior thigh and the foot were at the T7 T12, T10 L1 and T11 L1 vertebral segments, respectively. CONCLUSIONS: Detailed knowledge of the patterns of stimulation induced paresthesia in relation to the spine level of the implanted electrodes has allowed the more consistent and successful placement of epidural electrodes at the desired spine level.

Hyponatremia-Induced Seizure Following Polydipsia in a Schizophrenic Patient / 대한간질학회지

A 29-year-old man with schizophrenia was admitted to the emergency department in a stupor following the first generalized tonicclonic seizure. He had drunk about 1.5 L of Coke and 2 L of water each day for 1 week without eating any other food. A laboratory evaluation revealed severe hyponatremia (110 mEq/L), and we diagnosed a hyponatremia-induced seizure. As polydipsia and hyponatremia are not uncommon in schizophrenics, hyponatremia-induced seizure should be included in the causes of seizure in schizophrenics.

Perioperative Pain Management in the Patient with Complex Regional Pain Syndrome: A case report / 대한통증학회지

Complex regional pain syndrome (CRPS) is a syndrome of pain and sudomotor or vasomotor instabilities. The perioperative pain management in CRPS patients is very important, as surgery can aggravate preexisting symptoms, especially when performed around the lesion site. Despite the increasing interest in CRPS research, little is known about the optimal perioperative treatment strategy for CRPS patients. Herein, the case of a female CRPS patient, who underwent elective surgery at the lesion site, is reported. As a preemptive analgesia, the patient was satisfactorily managed with two weeks of patient-controlled epidural analgesia, initiated 2 days prior to surgery. The techniques for the prevention of perioperative pain, including preemptive analgesia, as well as its importance, are discussed.

A Case of Balloon Kyphoplasty in High Risk under Cement Leakage: A case report / 대한통증학회지

A vertebral compression fracture can cause chronic back pain, and may also result in progressive kyphosis. The traditional treatments of a vertebral compression fracture include bed rest, analgesics and bracing. Balloon kyphoplasty can restore the vertebral height and allow safe bone cement injection into the cavity made by the balloon, which significantly reduces the risk of cement leakage compared to vertebroplasty. An 82-year-old female patient suffered from severe low back pain. Due to the intractable pain and immobility, which could not be relieved by conventional care, as well as the empty vertebral body associated with communicated fractures of the vertebral surfaces, balloon kyphoplasty, with a thicker bone cement injection than usual with balloon kyphoplasty, was chosen. The preoperative intractable pain and immobility were dramatically relieved soon after the procedure, without any complications.

The Perioperative Management of Diabetic Patients: A Retrospective Study / 대한마취과학회지

BACKGROUND: Diabetic patients have more chance of requiring surgery than non-diabetic population. Glycemic and metabolic controls are key points in the perioperative diabetic management. A variety of methods have been proposed for the management of diabetics perioperatively, but their effectiveness is still controversial. This study was done to investigate whether diabetic patients are managed appropriately in perioperative period. METHODS: Among diabetic patients referred to anesthesiologic outpatient clinic from August 1997 to September 2002, 85 patients were randomly selected Diabetic duration, medication for diabetic control, concurrent illness and referral surgical department was recorded. In preoperative routine laboratory findings, HbA1c, fasting glucose and postprandial glucose were checked Perioperative glucose control protocols applied to patients were investigated RESULTS: Patients received 1.32 operation per person. Diabetic duration was 12.2 +/- 7.2 years, thirty nine patients had take oral hypoglycemic agent and thirty one patients had received insulin. Mean HbA1c was 8.0 +/- 1.6%, thirty four patients showed above 8.0%. Alberti's regimen was used in fifty five patients and insulin was omitted in fifty six patients. Two patients received insulin of half of usual dose in the morning. Alberti's regimen in major surgery and no insulin in minor surgery were preferred. The composition of Alberti's regimen and target blood glucose level varied. During operation, blood glucose was checked only in fourty four cases. Five of seven postoperative hypoglycemic patients were not checked glucose level during operation. Mortality rate was 7% and major cause of death was sepsis. All of the mortality cases had diabetic cardiovascular and nephrologic complications. CONCLUSIONS: We concluded there is a pitfall in managing diabetic patients requiring surgery. There must be a consensus between surgeon and anesthesiologist about perioperative management of diabetics. Perioperative glucose level should be checked as often as feasible, and insulin supply be continued during operation.

Health Risk Assessment and Analysis on the Volatile Organic Compounds in Some Workplace / 예방의학회지

This study was conducted to assess the health risk on the volatile organic compounds such as toluene, xylene, and styrene in painting workplace. It was monitored through personal air sampling during working time in selected 5 workplaces and analysed using gas chromatography. For the settlement of exposure situation, there were regarded working conditions such as working hours, yearly working days, and working years. Also, Monte-Carlo simulation was used for the induction of hazard index using toxicity value from IRIS(Integrated risk information system) database. The results of risk assessment were summarized as follows : 1. The air concentration of toluene was 7.096+/-15.6 ppm, 2.586+/-4.2 ppm for xylene, 1.914+/-5.3 ppm for styrene in blast painting workplaces. The level of toluene was different significantly compared with the level of xylene and styrene. 2. Computated chronic daily intake value of 95th percentile on toluene, xylene and styrene treated by Monte-Carlo simulation were 9.616, 3.567, 2.782 mg/kg/day, respectively. 3. Computated hazard index value of 75th percentile on toluene, xylene and styrene treated by Monte-Carlo simulation were 3.5, 1.0 and 1.6, respectively. Adverse health effects on the toluene, xylene and styrene would be expected by working exposure in blast painting workplace since the hazard indices of three compounds were exceeded 1 in the surroundings of percenitile 75 through having the low emerged frequency

Effect of Sodium Selenite on Metallothionem Induction by the Treatment of Mercuric Chloride to Rats / 대한산업의학회지

This study was conducted to investigate the metallothionein induction by sodium selenite in mercuric Chloride intoxication. Mercuric chloride of 3.0 mg/kg of body weight was administered simultaneously with sodium selenite of either a high dosage of 2.5 mg/kg or low dosage of 1mg/kg via intraperitioneal injecion to rats. After the treatment, 6, 12, 24 and 72 hours later, mercury and selenium content in liver and kidney tissues, serum transaminase activities(SGOT, SGPT), metallothionein, glutathione, glutathione peroxidase sotivity and histological changes were determined. The results were summarized as follows on: 1. The combined administration of mercury and selenium significantly more decreased mercury concentrations in liver and kidney compared to the administration of mercury only. 2. The combined administration of mercury and selenium significantly more increased renal metallothionein compared to administration of mercury only. This phenomenon was more remarkable when a large dose(2.5 mg/kg) of selenium was administered with mercuric chloride. 3. Glutathione concentration, glutathione peroxidase activity in liver and kidney and serum transaininase activity(SGOT, SGPT) were less suppressed in the combined administration group than the mercury only group. 4. Histological damage in renal tissue was not revealed in rats treated with mercury and selenium. From the above results, selenium administered simultaneously with mercury decreased mercury concentration in liver and kidney, increased renal metallothionein concentration and decreased the toxicity of mercury. The hypothetic mechanism suggested is that selenium induces the metallothionein combined with Hg and redistributes Hg in tissues.