Risk of continuing planned surgery after endovascular repair of subclavian artery injury: a case report / 대한마취과학회지

Endovascular repair with covered stents has been widely used to treat subclavian and axillary artery injuries and has produced promising early results. The possibility of a thromboembolism occurring in cerebral arteries during an endovascular procedure should be a cause for concern. In the case of endovascular management of arterial traumas, a prompt and sufficient period for check-up of the patient's neurological signs is needed, even if it requires postponing elective intervention for the patient's safety. We report a rare case of liver transplantation immediately after endovascular repair of an iatrogenic subclavian arterial injury to describe the risk of continuing planned surgery without neurologic assessment.

Central Venous Catheter Misplaced in the Innominate Vein after Penetrating the Left Subclavian Vein in a Neonate: A Case Report / 대한구급학회지

In the pediatric ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and serves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.

Intraoperative low dose ketamine reduce postoperative pain after combined anesthesia with propofol and remifentanil in mastectomy patients / 대한마취과학회지

BACKGROUND: Remifentanil is a useful opioid, but it induces postoperative hyperalgesia and acute tolerance associated N-methyl-D-aspartate (NMDA) receptor. This study was aimed to investigate whether small dose ketamine, NMDA receptor antagonist, prevent remifentanil induced postoperative hyperalgesia or acute tolerance after combined anesthesia with propofol and remifentanil using target controlled infusion (TCI) in patients undergoing mastectomy. METHODS: Fourty ASA physical status 1 or 2 women, undergoing mastectomy were randomly assigned to two groups to receive intraoperative infusion of ketamine at 3microgram/kg/min rate after injection of ketamine 0.3 mg/kg as a loading dose (Group K) or saline infusion after saline loading at the same rate and dose (Group C). All the patients were anesthetized with propofol and remifentanil to maintain bispectral index (BIS) 40-60, mean arterial pressure within 20% of basal values. Remifentanil was infused with target controlled infusion (TCI) to the effect site (concentration: 2.0 ng/ml). Postoperative paine scores (visual analog scale: VAS), morphine requirements, and sedation scores were recorded for 48 hours postoperatively. RESULTS: The VAS scores and morphine requirements of the Group K were significantly lower than those of the Group C at the postanesthetic care unit and at the ward for 24 hours postoperatively. The extubation time was delayed in Group K compared with Group C. CONCLUSIONS: Intraoperative infusion of small dose ketamine reduced postoperative pain and morphine requirements after combined anesthesia with propofol and remifentanil in patients undergoing mastectomy.

Pulmonary edema and hyponatremia after hysteroscopic uterine septectomy : A case report

The hysteroscope has become a standard part of gynecologists' armamentarium, and hysteroscopy is taught routinely in residency curriculums. In recent years, its use in gynecology has changed from a diagnostic tool only to an instrument for gynecologic operations. An electrolyte-free irrigation fluid is used for hysteroscopic surgery, and it has a possibility of substantial absorption of irrigation fluid. The absorption depends on the rate, volume and nature of the irrigation fluid. Fortunately, large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Several methods have been proposed to reduce the risk but none of them is capable of preventing the complication from fluid absorption. In this case, the patient had pulmonary interstitial edema with hyponatremia after hysteroscopic uterine septectomy but that had resolved without sequelae.

Immunological abnormalities in patient with IgA nephropathy

T cell immunity and phagocytic activity were studied in the blood of patients with IgA nephropathy in order to clarify their roles in the pathogenesis of IgA nephropathy. The percentages of total T lymphocytes, helper T cell and suppressor T cells were significantly reduced in patients. A significantly elevated helper T cell/suppressor T cell ratio in patients showed a predominant reduction in suppressor T cells. There was a significant relationship between histologic findings and helper T cell/suppressor T cell ratio in patients. Natural Killer (NK) cell activity was significantly reduced but the lymphocyte response after phytohemagglutinin (PHA) stimulation was not in patients. ConA-induced suppressor cell activity was not depressed despite of a decrease in suppressor T cells in patients. Phagocytic activity of polymorphonuclear leucocytes (PMNs) ingesting yeasts was significantly reduced in patients. Also an inverse correlation was found between serum IgA levels and phagocytic activity of PMN. It is concluded that suppressor T cell defects, depressed phagocytic activity and impaired NK cell activity may play a role in the pathogenesis of IgA nephropathy.