Anesthesia-Related Neurally Mediated Syncope in the Perioperative Period: Two Case Reports

The following report describes the occurrence of severe hypotension and bradycardia in a healthy 50-year-old man following placement from supine to the beach chair position during general anesthesia for injured rotator cuff tendon repair, as well as the occurrence of micturition syncope in a 71-year-old man following postobstructive diuresis after combined spinal–epidural anesthesia for total knee replacement. Rapid decompression of the urinary bladder is associated with severe hypotension, bradycardia, and syncope. Neurally mediated syncope includes true vasovagal and situational syncope that can occur in association with various situations such as cough, micturition, postprandial state, and interscalene block. We report two cases of neurally mediated syncope (true vasovagal and situational) that occurred in different conditions and were controlled well with prompt and proper management without serious complications.

Increased Effect-Site Concentration of Propofol Reduces ECâ‚…â‚€ of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

OBJECTIVE@#For short-duration surgery, propofol and remifentanil are the drugs of choice for intubation without neuromuscular blockade. The Shikani Optical Stylet (SOS) is a novel semi-rigid type fiberoptic laryngoscope. In this study, we determined the clinically required effect-site concentration of remifentanil for intubation using SOS without neuromuscular blockade depending on propofol effect-site concentration.@*METHODS@#We enrolled patients scheduled for elective surgery with general anesthesia, and assigned them into two groups by a randomized, double-blind method: concentration of propofol 3.5 µg/mL (group PRO 3.5) and 7.0 µg/mL (group PRO 7.0). Anesthesia was conducted with target-controlled infusion in predetermined target effect-site concentrations of propofol. The concentration of remifentanil for successful intubation using SOS in 50% of patients (EC₅₀) was determined using a modified Dixon's up-and-down method.@*RESULTS@#The mean±standard deviation EC₅₀ of remifentanil was 5.07±0.40 ng/mL in group PRO 3.5 and 1.79±0.44 ng/mL in group PRO 7.0. From probit analysis, EC₅₀ and EC₉₅ of remifentanil in group PRO 3.5 were 4.85 ng/mL (95% confidence interval [CI], 4.44–5.16 ng/mL) and 5.42 ng/mL (95% CI, 5.13–7.47 ng/mL) respectively, and EC₅₀ and EC₉₅ of remifentanil in group PRO 7.0 were 1.68 ng/mL (95% CI, 1.22–2.01 ng/mL) and 2.29 ng/mL (95% CI, 1.98–4.05 ng/mL), respectively.@*CONCLUSION@#Increased concentration of propofol reduced EC₅₀ of remifentanil for successful intubation using SOS without neuromuscular blockade.

Anesthetic Management for an Eye Surgery in a Patient with Stevens-Johnson Syndrome

The Stevens-Johnson syndrome is a severe manifestation of erythema multiforme associated with multisystem involvement. It is extremely unusual for patients with this syndrome to present with indications for eye surgery. Respiratory tract involvement can make the management of the airway and tracheal intubation difficult. We describe herein the perioperative management of a patient with this disease who underwent surgery for amniotic membrane transplantation.

Anatomical Single-bundle Anterior Cruciate Ligament Reconstruction Using a Freehand Transtibial Technique

PURPOSE: In anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel. SURGICAL TECHNIQUE: We present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique. MATERIALS AND METHODS: Between January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery. RESULTS: The mean Lysholm score improved from 68.2+/-12.7 points preoperatively to 89.2+/-8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans. CONCLUSIONS: The three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results.

Nostril Base Augmentation Effect of Alveolar Bone Graft

BACKGROUND: The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. METHODS: Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. RESULTS: Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). CONCLUSIONS: An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Certificate Education for Geriatric Physician: Satisfaction and Feasibility / 예방의학회지

OBJECTIVES: Korea faces a number of challenges to meet demands in the area of geriatric professional medicine in a country with a rapidly ageing population. We evaluated the satisfaction and feasibility of the current education certification for geriatric physicians. METHODS: Geriatric physicians who were deemed qualified by the Korean Geriatrics Society during the period of 2001 to 2005 (n=2,200) were asked to complete structured questionnaires sent to them by mail about their satisfaction of and need for certificates of education, as well as their opinions on their geriatric specialty training. A total of 419 physicians responded. Descriptive analysis and hierarchical regression were performed to rate the respondents.satisfaction, the characteristics of the need for clarity and utility in education certification, and the characteristics of their patients. RESULTS: Although most respondents were satisfied with their education certification, those who had more elderly patients, aged 65 or older, and those who had more cognitively impaired patients, rated their education as significantly lower than did other physicians. Both groups expressed the need for more the comprehensive care and assessment concerning of their education. Multiple regression analysis indicated that satisfaction with geriatric physician qualification was associated with a physician's age, specialty, and percentage of elderly patients. CONCLSIONS: This study suggests that the current system of education certification is limited in terms of feasibility and physician satisfaction.