Cardiac arrest induced by the local infiltration of epinephrine during desflurane anesthesia: A case report

Topical epinephrine is useful to reduce bleeding and to give a clear operative field during general anesthesia. However, epinephrine at clinical doses has adverse cardiovascular effects, such as transient hypertension and arrhythmia. We report a case of cardiac arrest following the local infiltration of epinephrine during desflurane anesthesia. The patient recovered without sequelae after intensive care. However, it is recommended that caution is exercised when the local infiltration of epinephrine is used during general anesthesia.

Factors contributing to episodes of bradycardia hypotension during shoulder arthroscopic surgery in the sitting position after interscalene block / 대한마취과학회지

BACKGROUND: Arthroscopic shoulder surgery has been performed in the sitting position under interscalene block (ISB). Bradycardia hypotension (BH) episodes have a reported incidence of 13-29% in this setting. We performed a retrospective study to investigate contributing factors to the occurrence of BH episodes. METHODS: According to BH episodes, we divided 63 patients into two groups: BH group (n = 13) and non-BH group (n = 50). Anesthetic records and block data sheets were reviewed for demographic data, intraoperative medications, sites of ISB, use of epinephrine in local anesthetics, degree of sensory blockade, and percent change of heart rate or systolic blood pressure (SBP). Statistical analysis was done using Chi square test and Student's t-test. RESULTS: There were no significant differences in the use of epinephrine in local anesthetics between the two groups. The location of ISB site was different between the two groups in that there were relatively more right-sided ISBs in the BH group than in the non-BH group (P = 0.048). The degree of sensory blockade was lower, but not significantly, in the C8 and T1 dermatomes of the BH group than in the non-BH group (P = 0.060 and 0.077, respectively). There was a relatively higher incidence of fentanyl supplementation in the BH group than in the non-BH group (P = 0.000). CONCLUSIONS: These results suggest that right ISB and perioperative supplementation of fentanyl due to incomplete block are possible contributing factors to the occurrence of BH episodes in the sitting position during shoulder surgery using ISB.

Pulsed Radiofrequency Treatment of the Supraorbital and Supratrochlear Nerve in a Case of Trigeminal Neuralgia: A case report

Pharmacological management is the first choice for treatment of the trigeminal neuralgia patients; however, if this mode of treatment fails a minimally invasive procedure should be performed. One of the most commonly used procedures is conventional radiofrequency lesioning of the Gasserian ganglion. Despite its popularity and success rate, this technique has disadvantages such as diminished corneal reflex, masseter weakness, numbness and anesthesia dolorosa. As a result, many studies have been conducted in an attempt to find a better method of treating trigeminal neuralgia. We report here a case of a trigeminal neuralgia patient that was treated with pulsed radiofrequency lesioning of the supraorbital and supratrochlear nerve due to pain in the frontal head that was refractory to the pharmacological treatments. Following the procedure, the Visual Analogue Scale score for pain decreased to 1-2/10 and the pain relief persisted for 7 months. These results indicate that pulsed radiofrequency treatment of the peripheral nerve may be useful for trigeminal neuralgia patients that do not respond to pharmacological treatments.

Combined femoral and popliteal sciatic nerve blocks versus epidural anesthesia in great saphenous veins stripping surgery with multiple stab avulsion / 대한마취과학회지

BACKGROUND: This study was designed to test the hypothesis that a combined femoral and politeal sciatic nerve blocks (FPSNB) would have excellent clinical properties and better patient satisfaction than epidural anesthesia for the great saphenous veins stripping (GSVS) surgery with multiple stab avulsion (MSA). METHODS: Sixty patients were allocated into two groups. The epidural group received epidural anesthesia with 15 ml of 0.75% ropivacaine (n = 30), and the FPSNB group received a combined FPSNB with 25 ml of 1.5% mepivacaine with a nerve stimulator (n = 30). We assessed the anesthetic and postoperative records. A questionnaire-based study including patient satisfaction for anesthetic techniques (100 point scale) was conducted 3 days postoperatively by a blinded observer. RESULTS: The time from initial injection to the start of surgery and the duration of sensory blockade were not different between groups (P > 0.05). The percentage of patients with anesthesia-related complications in epidural anesthesia was 33.3%, 46.6%, 23.3% and 20% for shivering, hypotension, bradycardia and postoperative voiding difficulty, respectively. FPSNB did not produce these complications. Additional analgesia with 50-100 microgram of fentanyl was more frequently used in FPSNB (60% vs 6.7%, FPSNB vs Epidural group, P < 0.01), but patient satisfaction of FPSNB was higher than epidural anesthesia (88.1 +/- 13.2 vs 76.5 +/- 15.8, FPSNB vs Epidural group, P < 0.01). CONCLUSIONS: A combined FPSNB with a small amount of narcotics is an adequate anesthetic technique for unilateral GSVS surgery with MSA.

Injury to the spinal cord by a thoracic epidural catheter used to control postpneumonectomy pain : A case report / 대한마취과학회지

A thoracotomy is one of the most severe painful operations. This severe pain can usually be controlled by thoracic epidural analgesia. Epidural catheterization for analgesia has several complications, e.g., epidural hematoma, abscess, spinal stenosis, spinal infarction, direct cord trauma, and neurotoxicity by chemical contamination. These complications can cause acute paraplegia, but permanent paraplegia is extremely rare. We report a case of paresthesia and temporary paralysis in a 54-year-old patient who suffered spinal cord injury after thoracic epidural catheterization for the control of postpneumonectomy pain under general anaesthesia.

The perioperative management of a patient with lowe syndrome for general anesthesia: A case report / 대한마취과학회지

Lowe syndrome (the oculo-cerebro-renal syndrome of Lowe, OCRL) is a multi-system disorder that affects the eyes, nervous system, and kidney. OCRL is a rare X-linked recessive disease with a prevalence of approximately 1 : 500,000. The clinical features of OCRL include congenital cataracts, growth and mental retardation, areflexia, hypotonia, and renal tubular dysfunction (Fanconi-type). Chronic metabolic acidosis and hypotonia may be the most important component affecting management of the peri-anesthetic period during general anesthesia. However, problems such as electrolyte imbalance, seizure, fragility of the bone structures, and increased intraocular pressure should also be considered during the perioperative period. We report here the perioperative management of a patient with Lowe syndrome during the removal of multiple scalp cysts under general anesthesia.

Perforation of the superior vena cava during liver transplantation: A case report / 대한마취과학회지

Placement of a pulmonary artery catheter for hemodynamic monitoring in the operating room or intensive care unit is very useful, but this is associated with various complications. They are rupture of the pulmonary artery, pneumothorax, hemothorax, thromboembolism, hemoptysis, arrythmia, valvular damage, sepsis, rupture of the balloon, entrapment or knotting of the catheter and so on. We experienced a case of perforation of the superior vena cava that was caused by a pulmonary artery catheter during liver transplantation. We diagnosed hemothorax during the operation, and we recognized the perforation by performing thoracoscopy. The perforation site was sutured successfully and there were no more problems.

Anesthetic management of a patient with antiphospholipid syndrome and who underwent thrombectomy of the inferior vena cava with cardiopulmonary bypass: A case report / 대한마취과학회지

Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with recurrent arterial and venous thrombotic events. The hemostatic aspects of antiphospholipid syndrome (APS) in patients requiring thrombectomy along with cardiopulmonary bypass present unique challenges to anesthesiologists.We present the case of a 36-year-old woman with thrombosis of the inferior vena cava as a result of APS with particular reference to the precautions that are necessary during the perioperative care.The particularly important things are the prevention of thrombotic or hemorrhagic complications, management of the associated thrombocytopenia and the laboratory methods of monitoring the perioperative anticoagulation in the setting of a prolonged clotting time.

Hyperkalemic cardiac arrest triggered by intravenous lidocaine following axillary brachial plexus block for the creation of an arteriovenous fistula: A case report / 대한마취과학회지

Axillary brachial plexus blockade (BPB) is commonly used as an anesthetic method for patients undergoing the creation of an arteriovenous fistula (AVF) during end-stage renal disease (ESRD). Several studies have shown that the combination of intravenous lidocaine and hyperkalemia in ESRD can produce severe conduction disturbance and asystole. Here, we report a case of cardiac arrest in a 41 year old male patient who manifested severe cardiac conduction disturbance during creation of an AVF. Sixty-five minutes after BPB, the intravenous therapeutic doses of lidocaine administered to treat frequent premature ventricular contractions aggravated his heart rhythm and produced a sine wave and ventricular fibrillation. It was assumed that ventricular fibrillation was induced by a combination of local anesthetics administered during BPB and systemic hyperkalemia as a result of the ESRD [ED highlight-please ensure my changes do not alter your intended meaning]. The patient was completely resuscitated 45 minutes after the cardiopulmonary resuscitation and correction of the hyperkalemia.

Intrathecal Catheter and Subcutaneous Access Port Implantation in Pain Management for Terminal Cancer Patient: A case report / 대한통증학회지

It is important to treat cancer-related pain in cancer patients to ensure the life quality of the patient, as well as to improve their life span. It has been estimated that at least 5% of cancer patients have pain refractory to medical treatment. Therefore, the need for epidural or intrathecal analgesia with opioids and local anesthetics is indicated if systemic treatment has failed. Intrathecal catheter placement and implantation of the injection port for administration of opioids and local anesthetics may improve pain relief in patients who are unresponsive to epidural routes. Although intrathecal implantation has several complications, similar infection rates have been reported between intrathecal and epidural administration. In addition, intrathecal administration showed better outcomes, including improved pain control, lowered daily doses, and an improvement in the level of drowsiness experienced when compared to epidural administration. We report here a case in which a terminal cancer patient was treated using an intrathecal catheter and subcutaneous port. The patient had cancer-related pain that could not be controlled by epidural opioid administration. Based on the results presented here, we suggest that intrathecal implantation is a feasible long term pain management method for intractable cancer pain patients.

Laryngeal Mask Airway in Patient with T-Tube Tracheal Stent who are Undergoing Non-Airway Related Surgery -A case report- / 대한마취과학회지

Some patient with T-tube tracheal stent may need to be anesthetized to be performed the non-airway related surgery. Without removal of the stent, general anesthesia with endotracheal intubation in these patents may cause serious complications, such as stent dislodgement, bleeding and breakage of stent. We describe a 43-year-old woman with a T-tube stent in situ, who was anesthetized using Laryngeal Mask Airway (LMA) for her ventriculo-peritoneal shunt operation. We occluded the top end of the LMA, thus employed it as a means of upper airway occlusion, while ventilation continued via the extratracheal portion of the T-tube stent, without any complications.