Perforation on the superior side of duodenum is a risk factor of laparoscopic primary repair for duodenal ulcer perforation

Purpose@#Primary repair is the standard surgical method for treating duodenal ulcer perforations, with very good results usually anticipated because of the simplicity of the associated surgical techniques. Therefore, this study aimed to analyze the risk factors that affect laparoscopic primary repair outcomes for duodenal ulcer perforation. @*Methods@#Between June 2010 and June 2020, 124 patients who underwent laparoscopic primary repair for duodenal ulcer perforations were reviewed. Early surgical outcomes were evaluated and risk factors for postoperative complications were assessed. @*Results@#All surgeries were performed laparoscopically without open conversion. Multivariate analysis showed that the elderly (over 70 years), and perforations that needed more than 2 stitches for closure were risk factors for overall postoperative complications. Perforations that needed more than 2 stitches and perforations on the superior side of the duodenum were major risk factors for severe postoperative complications. Severe postoperative complications occurred in 6 of the patients, and 1 of them died of multiorgan failure. @*Conclusion@#Based on our results, we suggest that laparoscopic primary repair can be safely performed in duodenal ulcer perforation. However, more careful surgery and postoperative care are needed to improve the surgical outcomes of patients who need more than 2 stitches to close their perforation or who have perforations on the superior side of the duodenum.

Perforation on the superior side of duodenum is a risk factor of laparoscopic primary repair for duodenal ulcer perforation

Purpose@#Primary repair is the standard surgical method for treating duodenal ulcer perforations, with very good results usually anticipated because of the simplicity of the associated surgical techniques. Therefore, this study aimed to analyze the risk factors that affect laparoscopic primary repair outcomes for duodenal ulcer perforation. @*Methods@#Between June 2010 and June 2020, 124 patients who underwent laparoscopic primary repair for duodenal ulcer perforations were reviewed. Early surgical outcomes were evaluated and risk factors for postoperative complications were assessed. @*Results@#All surgeries were performed laparoscopically without open conversion. Multivariate analysis showed that the elderly (over 70 years), and perforations that needed more than 2 stitches for closure were risk factors for overall postoperative complications. Perforations that needed more than 2 stitches and perforations on the superior side of the duodenum were major risk factors for severe postoperative complications. Severe postoperative complications occurred in 6 of the patients, and 1 of them died of multiorgan failure. @*Conclusion@#Based on our results, we suggest that laparoscopic primary repair can be safely performed in duodenal ulcer perforation. However, more careful surgery and postoperative care are needed to improve the surgical outcomes of patients who need more than 2 stitches to close their perforation or who have perforations on the superior side of the duodenum.

Anesthesia-Related Neurally Mediated Syncope in the Perioperative Period: Two Case Reports

The following report describes the occurrence of severe hypotension and bradycardia in a healthy 50-year-old man following placement from supine to the beach chair position during general anesthesia for injured rotator cuff tendon repair, as well as the occurrence of micturition syncope in a 71-year-old man following postobstructive diuresis after combined spinal–epidural anesthesia for total knee replacement. Rapid decompression of the urinary bladder is associated with severe hypotension, bradycardia, and syncope. Neurally mediated syncope includes true vasovagal and situational syncope that can occur in association with various situations such as cough, micturition, postprandial state, and interscalene block. We report two cases of neurally mediated syncope (true vasovagal and situational) that occurred in different conditions and were controlled well with prompt and proper management without serious complications.

Surgical Outcomes and Survival Prognostic Factors for Palliative Gastrectomies in Stage IV Resectable Gastric Cancer Outlet Obstruction Patients

Purpose@#Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. @*Materials and Methods@#We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019.Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. @*Results@#There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. @*Conclusions@#We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

Surgical Outcomes and Survival Prognostic Factors for Palliative Gastrectomies in Stage IV Resectable Gastric Cancer Outlet Obstruction Patients

Purpose@#Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. @*Materials and Methods@#We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019.Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. @*Results@#There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. @*Conclusions@#We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

Ultrasound-guided greater occipital nerve block with botulinum toxin for patients with chronic headache in the occipital area: a randomized controlled trial / 대한마취과학회지

BACKGROUND@#Ultrasound-guided greater occipital nerve (GON) block has been frequently used to treat various types of headaches, and botulinum toxin has recently begun to be used in patients with headache. Our study presents the long-term effect of botulinum toxin on GON block using ultrasound in patients with chronic headache in occipital area.@*METHODS@#Patients with occipital headache were divided into two groups (bupivacaine: BUP group [n = 27], botulinum toxin: BTX group [n = 27]), and ultrasound-guided GON block was performed at the C2 level. GON was detected with ultrasound and distance from GON to midline, from the skin surface to GON, and size of GON were measured in both groups. Visual analogue scale (VAS) scores and Likert scale were assessed at pretreatment and at 1, 4, 8, and 24 weeks after treatment in both groups.@*RESULTS@#The distance from GON to midline was 18.9 ± 4.4 mm (right) and 17.3 ± 3.8 mm (left). The depth from the skin was 12.9 ± 1.5 mm (right) and 13.4 ± 1.6 mm (left). GON size was 3.1 mm on both sides. The VAS score and patient satisfaction score (Likert scale) in 4, 8, and 24 weeks after injection were superior for the BTX than the BUP group.@*CONCLUSIONS@#Ultrasound-guided GON block using BTX is effective in reducing short-term and long-term pain in patients with chronic headache in the occipital area.

Ultrasound-guided greater occipital nerve block with botulinum toxin for patients with chronic headache in the occipital area: a randomized controlled trial / 대한마취과학회지

BACKGROUND: Ultrasound-guided greater occipital nerve (GON) block has been frequently used to treat various types of headaches, and botulinum toxin has recently begun to be used in patients with headache. Our study presents the long-term effect of botulinum toxin on GON block using ultrasound in patients with chronic headache in occipital area. METHODS: Patients with occipital headache were divided into two groups (bupivacaine: BUP group [n = 27], botulinum toxin: BTX group [n = 27]), and ultrasound-guided GON block was performed at the C2 level. GON was detected with ultrasound and distance from GON to midline, from the skin surface to GON, and size of GON were measured in both groups. Visual analogue scale (VAS) scores and Likert scale were assessed at pretreatment and at 1, 4, 8, and 24 weeks after treatment in both groups. RESULTS: The distance from GON to midline was 18.9 ± 4.4 mm (right) and 17.3 ± 3.8 mm (left). The depth from the skin was 12.9 ± 1.5 mm (right) and 13.4 ± 1.6 mm (left). GON size was 3.1 mm on both sides. The VAS score and patient satisfaction score (Likert scale) in 4, 8, and 24 weeks after injection were superior for the BTX than the BUP group. CONCLUSIONS: Ultrasound-guided GON block using BTX is effective in reducing short-term and long-term pain in patients with chronic headache in the occipital area.

Increased Effect-Site Concentration of Propofol Reduces ECâ‚…â‚€ of Remifentanil for Successful Intubation Using the Shikani Optical Stylet without Neuromuscular Blockade

OBJECTIVE@#For short-duration surgery, propofol and remifentanil are the drugs of choice for intubation without neuromuscular blockade. The Shikani Optical Stylet (SOS) is a novel semi-rigid type fiberoptic laryngoscope. In this study, we determined the clinically required effect-site concentration of remifentanil for intubation using SOS without neuromuscular blockade depending on propofol effect-site concentration.@*METHODS@#We enrolled patients scheduled for elective surgery with general anesthesia, and assigned them into two groups by a randomized, double-blind method: concentration of propofol 3.5 µg/mL (group PRO 3.5) and 7.0 µg/mL (group PRO 7.0). Anesthesia was conducted with target-controlled infusion in predetermined target effect-site concentrations of propofol. The concentration of remifentanil for successful intubation using SOS in 50% of patients (EC₅₀) was determined using a modified Dixon's up-and-down method.@*RESULTS@#The mean±standard deviation EC₅₀ of remifentanil was 5.07±0.40 ng/mL in group PRO 3.5 and 1.79±0.44 ng/mL in group PRO 7.0. From probit analysis, EC₅₀ and EC₉₅ of remifentanil in group PRO 3.5 were 4.85 ng/mL (95% confidence interval [CI], 4.44–5.16 ng/mL) and 5.42 ng/mL (95% CI, 5.13–7.47 ng/mL) respectively, and EC₅₀ and EC₉₅ of remifentanil in group PRO 7.0 were 1.68 ng/mL (95% CI, 1.22–2.01 ng/mL) and 2.29 ng/mL (95% CI, 1.98–4.05 ng/mL), respectively.@*CONCLUSION@#Increased concentration of propofol reduced EC₅₀ of remifentanil for successful intubation using SOS without neuromuscular blockade.

Comparison of the GlideScope and the McGrath method using vascular forceps and a tube exchanger in cases of simulated difficult airway intubation / 대한마취과학회지

BACKGROUND: A "difficult airway" can be simulated with an extrication collar, which restricts cervical motion and mouth opening. The purpose of this study is to compare the efficacy of the GlideScope and the McGrath in difficult airway simulation. METHODS: Patients were randomized using computer-generated numbers and were placed into the GlideScope group or the McGrath group. The total intubation time was defined as the time measured from when the anesthesiologist picks up the device to the time at which three successive end-tidal CO2 values are acquired after intubation. RESULTS: There was no significant difference in total intubation time between the two groups (73.0 ± 25.3 sec vs. 72.3 ± 20.9 sec, P = 0.92). The success rates of the first intubation attempt did not differ between the two groups (82.8% vs. 83.3%, P = 0.95). CONCLUSIONS: Our results suggest that there are no significant differences in the intubations with GlideScope and McGrath using vascular forceps and tube exchangers in difficult intubation scenarios.

Development of bilateral tension pneumothorax under anesthesia in a Boerhaave's syndrome patient: a case report / 대한마취과학회지

A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.

End-tidal concentration of sevoflurane for preventing rocuronium-induced withdrawal of the arm in pediatric patients / 대한마취과학회지

BACKGROUND: During induction of general anesthesia, the intravenous injection of rocuronium is often associated with withdrawal movement of the arm due to pain, and this abrupt withdrawal may result in dislodgement of the venous catheter, injury, or inadequate injection of rocuronium. We performed this study to evaluate the 50 and 95% effective end-tidal concentrations of sevoflurane (ETsev) for preventing rocuronium-induced withdrawal of the arm. METHODS: We conducted a prospective double-blind study in 31 pediatric patients. After free flow of lactated Ringer's IV fluid was confirmed, anesthesia was induced in the patients by using 2.5% thiopental sodium (4 mg/kg) and sevoflurane (4 vol%) with 6 L/min of oxygen. When the target ETsev was reached, preservative-free 1% lidocaine (1.5 mg/kg) was intravenously injected during manual venous occlusion and rocuronium (0.6 mg/kg) was injected after lidocaine injection under free-flow intravenous fluid. A nurse who was an investigator and was blinded to the ETsev injected the rocuronium. The nurse evaluated the response. RESULTS: Non-withdrawal movement was observed in 5 out of 11 patients with ETsev 3.0 vol% and in 5 out of 6 patients with ETsev 3.5 vol%. By Dixon's up-and-down method, the 50% effective concentration (EC50) of sevoflurane for non-withdrawal movement at rocuronium injection was 3.1 +/- 0.4 vol%. A logistic regression curve of the probability of non-withdrawal movements showed that the 50% effective ETsev for abolishing withdrawal movement at rocuronium injection was 2.9 vol% (95% confidence interval [CI] 2.4-3.8 vol%) and the 95% effective ETsev was 4.3 vol% (95% CI 3.6-9.8 vol%). CONCLUSIONS: This study showed that the 50 and 95% effective ETsev that prevent withdrawal movement at rocuronium injection are 2.9 and 4.3 vol%, respectively.

The optimal concentration of remifentanil required for i-gel insertion in patients with simulated difficult airways

BACKGROUND: Because difficult airways are not commonly encountered, simulation of a difficult airway using a cervical collar has become a well-established technique of for modeling difficult laryngoscopic views and evaluating interventions for use in difficult airway scenarios. In this study, we have determined the optimal remifentanil concentrations (EC50 and EC95) required for i-gel insertion in anesthetized patients fitted with cervical collars at propofol effect-site concentrations of 4.0 and 6.0 microg/ml (group 4.0 and group 6.0). METHODS: The remifentanil dosage for each propofol effect-site concentration group was determined by the modified Dixon's up-and-down method using previous results. The experiment was started using a 4.0 ng/ml effect-site remifentanil concentration, and the dose was reduced by 0.5 ng/ml for the next attempt when tube insertion was successful; if tube insertion failed, the dose for the next attempt was increased by 0.5 ng/ml. RESULTS: EC50 and EC95 were respectively 2.11 ng/ml (95% CI, 1.78-2.26 ng/ml) and 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml) for the 4.0 group, and 0.42 ng/ml (95% CI, -1.30 to 0.77 ng/ml) and 0.75 ng/ml (0.56-14.3 ng/ml) for the 6.0 group. CONCLUSIONS: In this study, a cervical collar was attached and head fixation was performed to induce a difficult airway. The optimal concentration of remifentanil at a propofol effect-site concentration of 4.0 microg/ml was greater than 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml), and that at the propofol effect-site concentration of 6.0 microg/ml was greater than 0.75 ng/ml (0.56-14.3 ng/ml).

Reduction of propofol infusion pain using target controlled infusion of remifentanil

BACKGROUND: Propofol has a high incidence of infusion pain. We hypothesized that propofol infusion pain might be prevented by infusing remifentanil before starting the propofol infusion in a clinical setting where target controlled infusions (TCI) of both drugs were used. We compared the efficacy of remifentanil TCI administered 90 seconds before propofol TCI with remifentanil TCI and propofol TCI given immediately after a 40 mg lidocaine bolus in prevention of propofol infusion pain. METHODS: One hundred sixty five ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups. Group C: propofol TCI and remifentanil TCI was started at the same time (n = 55), group L: lidocaine 40 mg injection immediately prior to propofol TCI and remifentanil TCI (n = 55), group R: remifentanil TCI was started 90 seconds before propofol TCI (n = 55). Pain severity of propofol infusion was evaluated using a four-point scale (none, mild, moderate, severe). RESULTS: The incidence of pain in group R and group L was significantly lower than in group C. There was no significant difference between group R and group L. But the incidence of moderate and severe pain in group R was significantly lower than in group L (P < 0.05). CONCLUSIONS: Remifentanil TCI 90 seconds before propofol TCI reduces propofol infusion pain than propofol TCI and remifentanil TCI started at the same time. This protocol is considered to be more effective in alleviating moderate and severe pain than lidocaine.

Comparison of the Proseal LMA and intersurgical I-gel during gynecological laparoscopy / 대한마취과학회지

BACKGROUND: The relatively recently developed I-gel (Intersurgical Ltd., Workingham, England) is a supraglottic airway device designed for single-use that, unlike conventional LMAs, does not require an inflatable cuff. In addition, the I-gel, much like the Proseal LMA (PLMA), has a gastric drainage tube associated with an upper tube for decompression of the stomach, thereby avoiding acid reflux and decreasing the risk of pulmonary absorption. The purpose of this study was to compare PLMA and I-gel devices in patients undergoing gynecological laparoscopy based on sealing pressure before and during pneumoperitoneum, insertion time, and gas exchange. METHODS: Following Institutional Review Board approval and written informed consent, 30 adult patients were randomly allocated to one of two groups (the PLMA or I-gel group). In each case, insertion time and number of attempts were recorded. After successful insertion, airway leak pressure was measured. RESULTS: Successful insertion and mechanical ventilation with both supraglottic airway devices was achieved on the first attempt in all 30 patients, and there were no significant differences with respect to insertion time. Likewise, leak pressure did not vary significantly either between or within groups after CO2 insufflation. In addition, differences between leak volume and leak fraction between groups were not significant. CONCLUSIONS: The results of our study indicate that the I-gel is a reasonable alternative to the PLMA for controlled ventilation during laparoscopic gynecologic surgery.

Peri-operative ketamine with the ambulatory elastometric infusion pump as an adjuvant to manage acute postoperative pain after spinal fusion in adults: a prospective randomized trial / 대한마취과학회지

BACKGROUND: In this study, we assessed the effectiveness of ketamine as an alternative to non-steroidal anti-inflammatory drugs (NSAID), to manage acute postoperative pain after spinal fusion when given intravenously via a patient-controlled analgesia (PCA) pump in which the dose was proportional to that of fentanyl. METHODS: Forty patients undergoing 1-2 level spinal fusion were enrolled in this study. Patients were intraoperatively randomized into two groups to receive intravenous PCA consisting either of fentanyl 0.4 microg/ml/kg (control group) or fentanyl 0.4 microg/ml/kg with ketamine 30 microg/ml/kg (ketamine group) after intravenous injection of a loading dose. The loading dose in the control group was fentanyl 1 microg/kg with normal saline equal to ketamine volume and in the ketamine group it was fentanyl 1 microg/kg with ketamine 0.2 mg/kg. The verbal numerical rating scale (NRS), fentanyl and ketamine infusion rate, and side effects were evaluated at 1, 24, and 48 hours after surgery. RESULTS: There were no significant differences in patient demographics, duration of surgery and anesthesia or intra-operative opioids administration. We did not find any significant differences in the mean infusion rate of intraoperative remifentanil or postoperative fentanyl or in the side effects between the groups, but we did find a significant difference in the NRS between the groups. CONCLUSIONS: Based on our results, we conclude that a small dose of ketamine (0.5-2.5 microg/kg/min) proportional to fentanyl is not only safe, but also lowers postoperative pain intensity in patients undergoing spinal fusion, although the opioid-sparing effects of ketamine were not demonstrated.

Comparison of volume-controlled and pressure-controlled ventilation using a laryngeal mask airway during gynecological laparoscopy / 대한마취과학회지

BACKGROUND: Several publications have reported the successful, safe use of Laryngeal Mask Airway (LMA)-Classic devices in patients undergoing laparoscopic surgery. However, there have been no studies that have examined the application of volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) using a LMA during gynecological laparoscopy. The aim of this study is to compare how the VCV and PCV modes and using a LMA affect the pulmonary mechanics, the gas exchange and the cardiovascular responses in patients who are undergoing gynecological laparoscopy. METHODS: Sixty female patients were randomly allocated to one of two groups, (the VCV or PCV groups). In the VCV group, baseline ventilation of the lung was performed with volume-controlled ventilation and a tidal volume of 10 ml/kg ideal body weight (IBW). In the PCV group, baseline ventilation of the lung using pressure-controlled ventilation was initiated with a peak airway pressure that provided a tidal volume of 10 ml/kg IBW and an upper limit of 35 cmH2O. The end-tidal CO2, the peak airway pressures (Ppeak), the compliance, the airway resistance and the arterial oxygen saturation were recorded at T1: 5 minutes after insertion of the laryngeal airway, and at T2 and T3: 5 and 15 minutes, respectively, after CO2 insufflation. RESULTS: The Ppeak at 5 minutes and 15 minutes after CO2 insufflation were significantly increased compared to the baseline values in both groups. Also, at 5 minutes and 15 minutes after CO2 insufflation, there were significant differences of the Ppeak between the two groups. The compliance decreased in both groups after creating the pneumopertoneim (P < 0.05). CONCLUSIONS: Our results demonstrate that PCV may be an effective method of ventilation during gynecological laparoscopy, and it ensures oxygenation while minimizing the increases of the peak airway pressure after CO2 insufflation.

A comparison of the Glidescope(R) to the McGrath(R) videolaryngoscope in patients / 대한마취과학회지

BACKGROUND: The Glidescope(R) videolaryngoscope is a new device for tracheal intubation that provides an improved view of the larynx. This study was performed to compare the Glidescope with the McGrath videolaryngoscope in terms of time to intubation (TTI) and number of attempts. METHODS: Patients were randomly allocated to one of two groups, Glidescope or McGrath group, by using computer-generated numbers. Tracheal intubation was attempted by an anesthesiologist with extensive experience using these two devices. The operator recorded ease of visualization of glottic structures based on the classification described by Cormack and Lehane. Number of failures, number of attempts and their duration, total intubation time, and events during the whole procedure were recorded. The duration of one attempt was defined as the time elapsed between picking up the endotracheal tube and verification of tracheal intubation with visualization of three expiratory carbon dioxide waveforms. TTI was defined as the sum of the duration of all intubation attempts (as many as three), excluding preoxygenation procedures. RESULTS: TTI was significantly shorter for the Glidescope(R) compared to the McGrath(R) laryngoscope (40.5 vs. 53.3 s, respectively, P < 0.05). However, glottic views obtained at intubation were similar between the two groups. Number of intubation attempts was not significantly different between the two groups (1.03 +/- 0.19 vs 1.10 +/- 0.32, respectively) (mean +/- SD). CONCLUSIONS: Study results demonstrated that the Glidescope reduced total intubation time in comparison with the McGrath, in terms of TTI in patients with normal airways.

Ultrasound-guided greater occipital nerve block for patients with occipital headache and short term follow up / 대한마취과학회지

BACKGROUND: The greater occipital nerve (GON) block has been frequently used for different types of headache, but performed with rough estimates of anatomic landmarks. Our study presents the values of the anatomic parameters and estimates the effectiveness of the ultrasound-guided GON blockade. METHODS: The GON was detected using ultrasound technique and distance from external occipital protuberance (EOP) to GON, from GON to occipital artery and depth from skin to GON was measured in volunteers. Patients with occipital headache were divided into two groups (ultrasound-guided block: group S, conventional blind block: group B) and GON block was performed. The same parameters were measured on group S and VAS scores were assessed at pretreatment, 1 week and 4 weeks after treatment on both groups. RESULTS: The GON had distance of 23.1 +/- 3.4 mm (right) and 20.5 +/- 2.8 mm (left) from EOP to GON. Its depth below the skin was 6.8 +/- 1.5 mm (right) and 7.0 +/- 1.3 mm (left). The distance from GON to occipital artery was 1.5 +/- 0.6 mm (right) and 1.2 +/- 0.6 mm (left) in volunteers. Initial VAS score of group S and group B patients were 6.4 +/- 0.2 and 6.5 +/- 0.2. VAS score of 4 weeks after injection were 2.3 +/- 0.2 on group S and 3.8 +/- 0.3 on group B (P = 0.0003). CONCLUSIONS: The parameters measured in this study should be useful for GON block and ultrasound-guided blockade is likely to be a more effective technique than blind blockade in occipital headache treatment.

Cost analysis of sevoflurane anesthesia compared with propofol and remifentanil infusion

BACKGROUND: Cost control in general anesthesia is no longer an option; it is a necessity. New anesthetics have entered the market, but economic differences in comparison to standard anesthetic regimens are not exactly known. The purpose of this study was to compare the cost of a sevoflurane-based strategy with a propofol-based general anesthetic technique. METHODS: Eighty patients undergoing elective surgery were randomly divided into two groups, with 40 patients each. The propofol group received propofol with remifentanil infusion, and the sevoflurane group received sevoflurane with N2O 50%, O2 50% for anesthesia. Sevoflurane consumption was measured by weighing the vaporizer using a precision weighing machine. We recorded the use of all drugs for the induction and maintenance of anesthesia, and postoperative pain control in the postoperative anesthesia care unit. RESULTS: The recovery characteristics were not significantly different in the two groups. Total (intra and postoperative) cost were significantly higher in the propofol group than in the sevoflurane group. CONCLUSIONS: We conclude that in today's climate of cost savings, a comprehensive pharmacoeconomic approach is needed.

Ipsilateral Reexpansion Pulmonary Edema Developed after Decortication: A Case Report / 대한구급학회지

Reexpansion pulmonary edema (RPE) is a rare but sometimes fatal complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. We experienced a case of RPE that developed following decortication. A 46 year-old female had a decortication for pyothorax under one-lung anesthesia. There was no event during the operation and results of arterial blood gas analysis were within normal limits. After the operation, tracheal extubation was performed and 100% oxygen saturation on a pulse oximeter (SpO2) was maintained with 100% O2, (8 L/min) via mask ventilation with self-respiration. The patient, with 50% Venturi mask, was transported to the intensive care unit (ICU). On arrival at the ICU, a SpO2 of 80% was detected and arterial blood gas analysis revealed hypoxemia with acute hypercapnic respiratory acidosis. Fortunately, reexpansion pulmonary edema was detected early and intensive treatment was performed using mechanical ventilation with positive end-expiratory pressure. Tracheal extubation was performed after 1 day of mechanical ventilation. The reexpansion pulmonary edema was successfully treated and the patient recovered without any complications.