Epidural anesthesia for permanent spinal cord stimulation with a cylindrical type lead: a case series / 대한마취과학회지

Spinal cord stimulation (SCS) in trials involving external stimulation are easily conducted under local anesthesia. However, implantation of a permanent SCS system is painful, and can be intolerable in some patients. Epidural anesthesia can be used to perform the SCS implantation without discomfort if the patient can localize the area of paresthesia. However, little is known about epidural anesthesia for SCS. This paper reports 23 cases of permanent SCS with a cylindrical type lead implanted under the epidural anesthesia. Epidural anesthesia was sufficient in 22 patients without discomfort and significant complications. The remaining patient experienced incomplete epidural anesthesia and required additional analgesics to blunt the pain. All the leads were placed consistent with the patient's report of paresthesia area under epidural anesthesia. Thus, epidural anesthesia is an effective and safe method for the optimal placement of SCS to minimize the discomfort for patients without impairing patients' response to the intraoperative stimulation test.

Treatment of digit ulcers in a patient with Buerger's disease by using cervical spinal cord stimulation: a case report / 대한마취과학회지

Buerger's disease (thromboangiitis obliterans) is known as a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. Most effective treatment for Buerger's disease is smoking cessation. Except for the cessation of tobacco use, surgical revascularization is available in severe ischemia and a distal target vessel. Amputation has been used as the last treatment option of the disease up to the present. Increasing limb survival and decreasing amputation rate is important. This case describes the use of spinal cord stimulation (SCS) in patient with Buerger's disease and its effect is not only the complete healing of ulcers but also amputation is not performed.

Airway obstruction by extrinsic tracheal compression during spinal surgery under prone position: A case report / 대한마취과학회지

Tracheal compression by vascular anomalies in adults is uncommon and most related reports are of children. A 79-year-old woman without any respiratory history underwent a lumbar spine surgery under general anesthesia. She suddenly developed airway obstruction after a position change from supine to prone. A fiberoptic bronchoscopy showed the obstruction of endotracheal tube. The obstruction was relieved after we changed the depth of endotracheal tube and supported the patient's neck with a cotton roll. The surgery ended without any other event and the patient recovered safely. A computed tomography revealed the rightward tracheal deviation and tortuous innominate artery contact with trachea. The patient didn't manifest any respiratory related symptoms during postoperative period, and she was discharged without any treatment.

Suspicious stress induced cardiomyopathy following hemorrhoidectomy under spinal anesthesia: A case report / 대한마취과학회지

A 48-year-old healthy woman was admitted in our hospital for elective hemorrhoidectomy. She developed sudden headache and chest pain, and showed sinus bradycardia, arrhythmia and hypotension forty minutes after spinal anesthesia with 0.5% hyperbaric bupivacaine. An EKG showed ST depression and an transthoracic echocardiogram performed in PACU demonstrated mild LV dysfunction with hypokinesia of LV inferolateral wall. An coronary angiography on postoperative day 1 revealed normal coronary vessel and akinesia of LV inferior wall. Levels of CK-MB and Troponin I were mildly elevated. With medical therapy, the patient's symptoms improved and recovered without any complication.

Bilateral vocal cord palsy in a post-anesthesia care unit after total thyroidectomy: A case report / 대한마취과학회지

A patient had respiratory difficulty and hoarseness following total thyroidectomy due to bilateral vocal cord palsy. The patient was a 60-year-old man who underwent total thyroidectomy for papillary carcinoma of the thyroid. He had no laryngeal symptoms prior to the operation. Anesthesia lasted 3.5 hours and was uneventful. Spontaneous respiration resumed after reversal of the neuromuscular blockade. After arriving at the post-anesthesia care unit, he complained of respiratory difficulty and hoarseness. We confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. It is necessary to perform a complete and thorough search for the underlying cause of vocal cord palsy.

Needle Depth to Lumbar Plexus in Lumbar Plexus Block by Posterior Approach and Its Relation with Body Indices in Korean / 대한마취과학회지

BACKGROUND: Lumbar plexus block by posterior approach has been used for thigh and hip surgery and unilateral low back pain and/or low extremity pain control. We measured the needle depth from the skin to the lumbar plexus and its relation with body indices in Korean. METHODS: Forty-eight (male 35, female 13) patients with unilateral low back pain and/or low extremity pain received lumbar plexus block by the posterior approach known as "psoas compartment block". We measured the distance from the skin to the lumbar plexus with the aid of a nerve stimulator and evaluated its relation to body mass indices such as weight, height, abdominal circumference and body mass index (BMI; kg/m2). RESULTS: The distance described above was 7.42 +/- 0.82 cm (range 6.0-9.5 cm) in males and 7.18 +/- 1.24 cm (range 5.3-10.0 cm) in females. Its relation to body weight was greater than with other body indices. The Pearson's coefficient between the distance and body weight was 0.745 in males and 0.842 in females. The predicted distance (cm) was 4.23 + 0.0471 x weight (kg) in males (adjusted R2 = 0.532) and 1.25 + 0.0975 x weight in females (adjusted R2 = 0.682). CONCLUSIONS: Body weight is the most important factor for prediction of the distance from the skin to the lumbar plexus. The distance was about 6-10 cm in korean patients.

Anatomical Review and Clinical Effect of Psoas Compartment Block

OBJECTIVE: The purposes of this study were to evaluate the relation of the lumbar plexus with the psoas compartment, to measure the distance from skin to psoas compartment, and to determine the efficacy of psoas compartment block for the unilateral leg pain and/or low back pain. METHOD: Six cadavers were dissected and the computed tomography of the lumbar region were performed in 22 subjects. The psoas compartment block of 10 ml of 0.5 percent lidocaine were performed in 31 patients with unilateral leg pain and/or low back pain. Visual Analog Scale (VAS) and sensory, motor functions were assessed before the block and 5, 30 minutes, and 1, 2, 3 hours and 1 week after the block. The distance from skin to psoas compartment were measured during the procedure. The questionnaires on the procedure were completed after 1 week. RESULTS: Cadaver dissections demonstrated that the 3 main nerves of lumbar plexus were within the psoas compartment between the level of L4 and L5. Computed tomography provided that the average distances of anterior and posterior borders of psoas major from the low back skin were 10.8 & 6.3 cm and that of medial & lateral borders from the median sagital plane were 2.9 & 7.1 cm respectively. There were statistically significant correlations between distance from skin to psoas compartment and body weight, abdominal circumference as well as body mass index (p<0.0001). The VAS was 7.7 before the block and 5.4 1 week after the block (p<0.05) and satisfactory outcomes were shown in 71 percent of the subjects. CONCLUSION: Psoas compartment block was effective for the patients with unilateral leg pain and/or low back pain without major side effects and complications.

Effect of Deep Hypothermia and Total Circulatory Arrest During Open Heart Surgery on Arterial Blood Gas Analysis / 대한마취과학회지

Eight infants or children with congenital heart disease underwent coorrective cardiac surgery suing hypothemia, cardioulmminary bypass, and total circulatory arrest. Threr were no signisifants change in pH, PaiP2, and arterial bicarbonate ion concentraion between pre-arrest and post-arrest times.

Effect of Deep Hypothermia and Total Circulatory Arrest During Open Heart Surgery on Arterial Blood Gas Analysis / 대한마취과학회지

Eight infants or children with congenital heart disease underwent coorrective cardiac surgery suing hypothemia, cardioulmminary bypass, and total circulatory arrest. Threr were no signisifants change in pH, PaiP2, and arterial bicarbonate ion concentraion between pre-arrest and post-arrest times.