Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

A comparison of the influence of 2.7% sorbitol-0.54% mannitol and 5% glucose irrigating fluids on plasma serum physiology during hysteroscopic procedures / 대한마취과학회지

BACKGROUND: 2.7% sorbitol-0.54% mannitol has been selected as an alternative irrigating fluid during endoscopic surgery for its theoretical advantages. We compared the influence of 2.7% sorbitol-0.54% mannitol (Urosol(TM), CJ Pharma, Seoul, Korea) and 5% glucose as an irrigating solution for hysteroscopic myomectomy & polypectomy in the occurrence of associated complications. METHODS: Thirty patients scheduled for a hysteroscopic operation were included in a prospective randomized trial comparing 2.7% sorbitol-0.54% mannitol solution (Group S, n = 15) and 5% glucose (Group G, n = 15) as an irrigating fluid. We recorded the amount of the irrigating fluids, the amount of fluid intake, and the duration of the procedure. Serum sodium, chloride, potassium, glucose values, and serum osmolality were measured before (just after the induction, T1), during (when 2 L of irrigation fluid was infused, T2), and after (1 h after the end of the operation, T3) the hysteroscopic procedure. RESULTS: The mean volume of absorbed irrigating fluid was 185.0 +/- 73.5 ml in Group G and 175.4 +/- 50.5 ml in Group S. Transient hyperglycemia occurred in one patient of Group G. No differences were found in the intraoperative and postoperative levels of serum sodium, potassium, chloride, glucose and osmolality in both groups. CONCLUSIONS: There was no clinical evidence of hyponatremic hypoosmolality in any of the patients. We found no difference between 2.7% sorbitol-0.54% mannitol and 5% glucose as an irrigating fluid for hysteroscopic procedures with mild to moderate irrigant absorption.

Successful anesthetic management of two myasthenic patients using total intravenous anesthesia without muscle relaxants: A report of two cases

Myasthenia gravis (MG) is an autoimmune-mediated disease characterized by weakness and fatigability due to dysfunction of the neuromuscular junction from antibodies directed against the acetylcholine receptor (AchR). The main considerations for the anesthesiologist are the underlying muscle weakness and interactions with various anesthetic drugs. This includes sensitivity to neuromuscular blocking agents and volatile agents, and the risk of postoperative respiratory failure. We report two cases of transsternal thymectomy for MG under general anesthesia with the use of a bispectral index-monitored total intravenous technique using propofol and remifentanil without muscle relaxants.

Pulmonary embolism developing during recovery period of total abdominal hysterectomy: A case report

Pulmonary embolism is a not uncommon perioperative complication that results in substantial morbidity and mortality. However prompt diagnosis is difficult because clinical symptoms and signs of pulmonary embolism are not completely obvious. We report a case of severe pulmonary embolism on the first postoperative day of total abdominal hysterectomy in a patient transfused preoperatively for iron deficiency anemia caused by menorrhagia. We diagnosed pulmonary embolism by echocardiogram and chest spiral computerized tomography and the patient was moved to the intensive care unit. Tissue plasminogen activator was given and followed by continuous heparin infusion but the patient did not improve. He developed multiple organ dysfunction syndrome and died on the seventh postoperative day.