Anesthetic Management for Elective Total Hip Replacement Arthoroplasty in a Patient with Eisenmenger's Syndrome

Eisenmenger's syndrome describes the elevation of pulmonary arterial pressure to the systemic level caused by an increased pulmonary vascular resistance with reversed or bi-directional shunt through an intracardiac or aortopulmonary communication. We report the case of 48-year-old woman with an elective total hip replacement arthroplasty for right femur neck fracture with Eisenmenger's syndrome secondary to large atrial septal defect. Anesthesia was induced with etomidate and rocuronium, maintained with desflurane 5 vol% and O₂ 3 L/min. Mirinone and norepinephrine were infused continuously to decrease right to left shunt. The patient was extubated after spontaneous breathing recovery and transferred to the intensive care unit. She was treated with mirinone, norepinephrine, dopamine, and dobutamine for hypoxemia and hypotension. After 3 hours of admission to intensive care unit, the patient had a cardiac arrest and died 30 minutes later.

Morphologic changes in the spinal cord following intrathecal palonosetron-HCl injection in rats

BACKGROUND: Intravenous palonosetron-HCl, a second-generation antagonist of selective serotonin type 3 (5-HT3) receptors, can prevent chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV). 5-HT3 receptors are abundant in the lower brainstem and the substantia gelatinosa of the spinal cord, which provides a theoretical rationale for neuraxial administration of 5-HT3 receptor antagonists for CINV, PONV, and opioid-induced nausea and vomiting. However, there are no reports of neuraxial administration of palonosetron-HCl. Before neuraxial administration of a drug is accepted for clinical use, its safety must be proven. This study was conducted to determine whether neuraxial administration of palonosetron-HCl produces neurologic injury. METHODS: Male Sprague-Dawley rats under general anesthesia were catheterized intrathecally and the catheter tip was advanced caudally to the L1 vertebra. After 7 days, 20 µl of normal saline (N group, n = 6) or 20 µl (1 µg) of palonosetron-HCl (P group, n = 6) were injected intrathecally once per day for 2 weeks. Neurotoxic changes were evaluated by light microscopy (LM) and electron microscopy (EM) of the spinal cord. Behavioral changes were also evaluated in both groups. RESULTS: One of the N group rats and three of the P group rats demonstrated abnormal behavior during intrathecal drug injection, but otherwise their behavior was normal. The spinal cords of the N group did not have any abnormal findings by LM or EM. The spinal cords of the P group had multiple vacuoles in the white matter by LM, especially in the dorsal funiculus, and EM revealed myelin, axonal, and mitochondrial swelling. CONCLUSIONS: Results suggest that chronic intrathecal administration of palonosetron-HCl produced microscopic morphologic changes in the spinal cords of rats.

The Effect of Different Oxygen Flow Rates via Nasal Cannula in Recovery Room after Pectus Excavatum by the Nuss Procedure

OBJECTIVE: In pectus excavatum patients, Nuss procedure provides excellent cosmetic results, but it cause hypoxemia and hypercarbia by the reduction of alveolar ventilation due to severe thorax expansion and pain after operation. This study was designed to evaluate the effect of different oxygen flow rates via a nasal cannula in recovery room after correction of pectus excavatum by Nuss procedure. METHODS: Forty patients (3–12 years old) undergoing pectus excavatum repair were randomly assigned and divided into two groups. Patients were given 200 mL/kg/min flow of 100% oxygen (group 1) and 100 mL/kg/min flow of oxygen (group 2) via nasal cannula in the recovery room. Arterial blood gas analysis and peripheral oxygen saturation were measured at arrival and after 5, 10, 15, and 30 minutes in the recovery room. RESULTS: In group 1 compared with group 2, decrease of PaCO2 (partial pressure of CO2 in arterial blood) accumulation was observed in 5, 10, and 15 minutes. Arterial oxygen pressure (PaO2) difference was not significant between the group. But, in comparison within groups, PaO2 level was significantly higher at 5, 10, 15, and 30 minutes than just after arrival at the recovery room. In both group, heart rate and systolic blood pressure were no significant difference. CONCLUSION: We recommend that 200 mL/kg/min flow of 100% oxygen should be administered to patients who were taken Nuss procedure for prevention of hypoxemia and hypercarbia in recovery rooms.

A comparison of oxycodone and fentanyl in intravenous patient-controlled analgesia after laparoscopic hysterectomy / 대한마취과학회지

BACKGROUND: We planned to compare the effect of intravenous oxycodone and fentanyl on post-operative pain after laparoscopic hysterectomy. METHODS: We examined 60 patients were randomized to postoperative pain treatment with either oxycodone (n = 30, Group O) or fentanyl (n = 30, Group F). The patients received 10 mg oxycodone/100 microg fentanyl with ketorolac 30 mg before the end of anesthesia and then continued with patient-controlled analgesia for 48 h postoperatively. RESULTS: The accumulated oxycodone consumption was less than fentanyl during 8, 24 and 48 h postoperatively. Numeric rating score of Group O showed significantly lower than that of Group F during 30 min, 2, 4, 8 and 24 h postoperatively. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea was higher in the Group O during the 24 and 48 h postoperative period. CONCLUSIONS: Oxycodone IV-PCA was more advantageous than fentanyl IV-PCA for laparoscopic hysterectomy in view of accumulated oxycodone consumption, pain control and cost beneficial effect. However, patient satisfaction was not good in the group O compared to group F.