Factors Associated Postoperative Hydrocephalus in Patients with Traumatic Acute Subdural Hemorrhage

OBJECTIVE: Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients’ long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH). METHODS: Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period. RESULTS: Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus. CONCLUSION: In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.

Bronchospasm during Minimally Invasive Cardiac Surgery in a Patient with a Mosaic Attenuation Pattern on Lung Computed Tomography: A Case Report / 대한구급학회지

Severe bronchospasm during cardiac surgery is an uncommon, but serious problem. A 52-year-old woman with a mosaic attenuation pattern on the whole lung field was scheduled for repair of an atrial septal defect under minimally invasive cardiac surgery. Bronchospasm developed intraoperatively, but the underlying ventilatory impairment, poor performance of one-lung ventilation and initiation of cardiopulmonary bypass delayed diagnosing and treating the bronchospasm. The bronchospasm induced severe pulmonary edema that required postoperative ventilatory care.

The effect of infusion rate and catheter length on the temperature of warming fluid / 대한마취과학회지

BACKGROUND: We used warming fluid for maintenance of body temperature in operating room or intensive care unit. This study was aimed to investigate the effect of infusion rate and catheter length on the temperature of warming fluid. METHODS: Normal saline was used for testing infusion and temperature of infusion was maintained by a warmer as 40degrees C. The temperatures of solution in infusion line were measured at 0, 25, 50, 75, and 100 cm apart from warmer at six different flow rates (100, 200, 300, 700, 1,400, and 2,100 ml/h). We also measured the temperature changes at room temperature (RT) and 5degrees C, 10degrees C, and 15degrees C above RT. RESULTS: The time to maintain solution temperature as 40degrees C was 165, 122, 37, 37, 21, and 19 s at flow rate 100, 200, 300, 700, 1,400, and 2,100 ml/h. The peak temperature was 43.58 +/- 0.58, 44.43 +/- 1.18, 44.37 +/- 0.70, 43.79 +/- 0.61, 42.82 +/- 0.97, and 42.11 +/- 0.92degrees C according to increasing flow rate. The temperature at 100 cm apart from warmer was 23.96 +/- 1.53, 25.46 +/- 2.76, 29.32 +/- 3.47, 31.40 +/- 5.38, 31.39 +/- 6.75, and 38.14 +/- 0.96degrees C according to increasing flow rate. CONCLUSIONS: These results suggested that the decreasing rate of temperature was related inversely to the flow rate and directly to the catheter length. There may be needed a rapid infusion pump with adequate heating system at a high flow rate and to locate the warmer close to patient for reserving a heating effect.

Anesthetic management of a patient with Kasabach-Merritt syndrome: A case report

Kasabach-Merritt syndrome presents various problems for anesthetic management, which include thrombocytopenia, bleeding tendency, and problems arising from the hemangioma mass itself. A 1-month-old male was given sclerotherapies, platelet transfusions, steroid, interferon alpha, vincristine because of the bleeding from the right lower leg hemangioma, but platelet numbers were decreased and seizures occurred due to frontal lobe focal hemorrhage. After all, he was scheduled for his right lower leg amputation when he was 7 months old. Anesthesia was carefully induced with thiopental, rocuronium, fentanyl, and flexible bronchoscope. It was maintained with sevoflurane and air/oxygen with fentanyl injection. Although excessive bleeding was expected during anesthesia and surgery, the operation was performed without correction of platelet number. Two days later, postoperative course was improved almost normal.

Intraoperative awareness during sevoflurane-remifentanil anesthesia for minimal invasive mitral valvuloplasty: A case report / 대한마취과학회지

We report a case of unintentional intraoperative awareness during sevoflurane-remifentanil anesthesia in a 26 years old woman undergoing elective minimal invasive mitral valvuloplasty. Cardioprotective effects of sevoflurane were clinically most apparent when administered throughout the surgical procedure. Also use of sevoflurane during cardiopulmonary bypass decreases incidence of awareness. Although awareness during cardiac anesthesia has been previously described with sevoflurane, the implication of this case is that unexpected awareness can occur in patients with sevoflurane during cardiopulmonary bypass on cardiac surgery. Therefore, more attention is needed to use sevoflurane during cardiopulmonary bypass.

Relationship between carotid intima-media thickness and hemodynamic changes during anesthetic induction / 대한마취과학회지

BACKGROUND: The carotid intima-media thickness (IMT) have been known to be related to the degree of atherosclerosis and cardiovascular risk factors. The aim of this study was to elucidate the relationship of IMT and the hemodynamic changes during anesthetic induction. METHODS: Two hundred fourteen patients scheduled for general anesthesia were studied. The blood pressures and heart rates during anesthetic induction and endotracheal intubation were measured. IMT was measured at right common carotid artery using M-mode ultrasonography after anesthesia, RESULTS: Mean IMT of the patients was 0.611 +/- 0.146 (0.34-0.96) mm. IMT was significantly related with age, systolic blood pressure, the changes of blood pressure after induction, and the changes of blood pressure after intubation. IMT was not related for basal heart rate and the changes of heart rate during anesthetic induction and intubation. CONCLUSIONS: IMT is related with the magnitude of blood pressure decreasing during anesthetic induction and increasing during intubation. The further study is needed to evaluate the relationship of IMT and hemodynamic changes during other anesthetic practice.

The Effects of Milnacipran on Rat Pain Model / 대한마취과학회지

BACKGROUND: Serotonin and norepinephrine are known as agents of the nonopiate endogenous descending pain control system. Recently, selective serotonin norepinephrine receptor inhibitors (SNRIs) have been developed as antidepressants. We studied the effects of milnacipran, a SNRI in a spinal nerve ligation (SNL) model and formalin test. METHODS: Male Sprague-Dawley rats weighing 200-250 gm were used for this study. In the SNL model, under an anesthetic state, the 5th lumbar spinal nerve was ligated and a PE-10 catheter was inserted into the subarachnoid space. Milnacipran was injected intraperitoneally or intrathecally and the threshold of tactile allodynia was measured. In the formalin test, milnacipran was administered intraperitoneally or intrathecally. 30 minutes after intraperitoneal injection or 60 minutes after intrathecal injection the formalin test was performed and flinching was counted for 60 minutes. RESULTS: In the spinal nerve ligation model, pain response decreased significantly (P <0.05). But, after intraperitoneal milnacipran administration in the spinal nerve ligation model, no difference in mechanical allodynia was observed between among groups. In formalin test, intraperitoneal and intrathecal milnacipran administration decreased phase I response, but there was no change in phase II response. CONCLUSIONS: Milnacipran reduced neuropathic pain after intrathecal administration. But there was no difference after intraperitoneal administration. Intraperitoneal and intrathecal milnacipran administration in formalin test reduced only the acute phase, but no difference in chronic chemical induced centralization pain was observed.