Mitral valve repair in infective endocarditis during pregnancy

Infective endocarditis (IE) during pregnancy and subsequent cardiac surgery are rare and associated with a high risk of mortality for the mother and fetus. It is difficult to determine the right time for cardiac intervention when IE is diagnosed early in pregnancy. A 33-year-old previously healthy woman in the 11th week of pregnancy was diagnosed with IE and underwent surgical intervention. The cardiopulmonary bypass settings and the anesthetic drugs were carefully chosen. Although she was in good health, while being discharged, the fetus did not survive. Anesthesiologists prioritizing the mother's survival should aim to improve fetal outcomes in such cases.

Effects of Enhanced Recovery Surgery Concept on Anesthetic Agents Costs during Perioperative Period in Our Hospital / 中国药师

Objective:To analyze the effects of enhanced recovery after surgery(ERAS) concept on anesthetic agents in our hos-pital in order to provide evidence for rational drug use. Methods:The patients received ERAS care and surgery from departments of o-torhinolaryngology,gynecology and urology during June and December in 2016 were selected into ERAS group. Meanwhile, the pa-tients received usual care and routine operation were selected into the traditional group. Anesthetic agents of the two groups were then analyzed. Results:The anesthetic agents costs, the usage rate and expenses of patient controlled analgesia pump and the total drug costs of ERAS groups were significantly lower than those of the traditional groups(P<0.05 or P<0.01). Conclusion:With the de-velopment of ERAS concept, the patients can receive good diagnosis and treatment. Meanwhile, anesthetic agents costs, total drug costs and drug proportion decrease as well.

Rare postoperative delayed malignant hyperthermia after off‑pump coronary bypass surgery and brief review of literature.

Postoperative malignant hyperthermia (MH) is a very rare phenomena. It is generally observed within less than an hour after discontinuation of the anesthetic trigger. Present case describes rare delayed postoperative presentation of MH after off‑pump coronary bypass surgery. Prompt recognition and immediate treatment with dantrolene can effectively treat the fatal syndrome. Family education and genetic counseling should be encouraged.

Anestesia regional subaracnoidea para cesárea y pomeroy postparto: aplicación de anestésico local a una velocidad de inyección menor o mayor a 60 segundos / Regional spinal anesthesia for c-section and postpartum pomeroy: administering a local anesthetic at a <60 or >60 seconds injection rate

Objetivo. Describir si existe o no relación entre la velocidad de aplicación del anestésico en anestesia subaracnoidea y la presentación de hipotensión y efectos colaterales en las pacientes programadas para cesárea y Pomeroy postparto. Métodos. Estudio observacional de serie de casos, en el Instituto Materno Infantil-Hospital La Victoria. Se incluyó a 60 pacientes intervenidas por cesárea o Pomeroy postparto, y en quienes se midieron dos variables: la velocidad de aplicación de la anestesia subaracnoidea (menor o mayor a 60 segundos) y los efectos de dos mezclas anestésicas (bupivacaína hiperbárica al 0,5 % 7,5 mg, más morfina 100 mcg, y bupivacaína hiperbárica al 0,5 % 12 mg, más fentanil 20 mcg). Se registraron las cifras de presión arterial media y los efectos colaterales al aplicar el anestésico, en los minutos 1, 5, 10 y 15, y al final de la cirugía. Resultados. La evidencia obtenida sugiere que no hay diferencias entre los efectos hemodinámicos de las mezclas o entre las técnicas anestésicas, así como tampoco las hay en cuanto a la presentación de efectos secundarios.

Objective. To identify any potential relationship between the rate of administration of the anesthetic agent in the subarachnoid space and thedevelopment of hypotension and side effects in patients scheduled for C-section and postpartumPomeroy. Methods. Observational case series study at the Instituto Materno Infantil-Hospital La Victoria. 60patients who underwent a C-section procedure or a postpartum Pomeroy were included and two variables were measured: the rate of administrationof the anesthetic agent in the subarachnoid space (<60 or >60 seconds) and the effects of two anesthetics combined (0.5 % hyperbaricbupivacaine 7.5 mg, plus morphine 100 mcg, and 0.5 % hyperbaric bupivacaine 12 mg, plus fentanyl 20 mcg). The mean blood pressure values were recorded, together with any side effectsfollowing the administration of the anesthetic agent at 1, 5, 10 and 15 minutes and at the end of surgery.Results. The evidence obtained suggests that there are no differences in the hemodynamic effects of the combination or the anesthetic technique used, nor with regards to the occurrence of side effects.

The Effects of Anesthetic Agents on Emergence Delirium in Pediatric Strabismus Surgery / 대한마취과학회지

BACKGROUND: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. METHODS: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5microgram/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. RESULTS: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. CONCLUSIONS: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery.

Double-Blind Study of Intrarectal Administration of Anesthetic Agent for Pain Control during Transrectal Prostatic Biopsy / 대한남성과학회지

PURPOSE: We evaluated the safety and efficacy of intrarectal administration of anesthetic agent for transrectal prostate biopsy. MATERIALS AND METHODS: For a double-blind prospective trial, 100 men undergoing transrectal prostate biopsy were randomized into three groups using an established list. In the control group (n=36), 40mL of normal saline was administered transrectally 10 min before the procedure. The lidocaine group (n=31) and the benzocaine group (n=33) were give 40 mL of 1% lidocaine and 0.3% benzocaine, respectively. Patients were asked to score the severity of the pain expected before and after the biopsy procedure using a self-administered verbal rating scale. Pain was assessed using a 10-point linear visual analog scale. RESULTS: The median pain score expected before the transrectal prostate biopsy was 6.7+/-0.3, 7.1+/-0.2, and 6.7+/-0.3 in the control, lidocaine, and benzocaine group, respectively. The median pain score during the biopsy was 6.1+/-0.3, 5.8+/-0.3 (P<0.05), and 5.9+/-0.4 in the control, lidocaine, and benzocaine group, respectively. Ninety seven percent of the control group, 100% of the lidocaine group, and 91% of the benzocaine group complained of severe and bothersome pain, with a score of 5 or greater during the biopsy. No adverse events were noted. CONCLUSIONS: Intrarectal administration of anesthetic agent is a simple, safe, and efficacious method of providing satisfactory anesthesia in patients undergoing transrectal prostate biopsy. We recommend 1% lidocaine solution in the patients to perform transrectal prostatic biopsy.

The Clinical Efficacy of Topical Agents for Premature Ejaculation / 대한남성과학회지

PURPOSE: The penile hypersensitivity is one of the complicated causes of premature ejaculation so that it has been applied to the local anesthesia or the penile dorsal neurectomy in the cases of treatment. The authors had compared the clinical efficacy of various kinds of OTC topical agents which were designed for premature ejaculation and were approved of selling in Korean market. MATERIALS AND METHODS: 10 normal adult male with ages from 29 to 24 years (ave. 33.4) were enrolled in this study. 8 topical agents of cream-type such as SS-cream(R), gel-type such as Power gel(R), B.M. gel(R), BIGTO gel(R) and Control gel(R), solution-type such as E.L.T soln(R), and spray type such as Sanova(R), Tstone(R) were applicated. With exception of SS-cream(R) which was natural medicine, the rest of them were made from lidocane 9.6%. We evaluated characteristics, efficacy, satisfaction and adverse reactions in treatment of premature ejaculation with 8 topical agents. RESULTS: In concerning of their odor, SS-sream(R) was the strongest (p<0.05). The viscosity was the highest in cream-type agent as SS-cream(R). However washing after sexual intercourse is relatively easy in every cases with the lowest necessity of washing in solution-type E.L.T soln(R) (p<0.05). The main causes of feeling the usage of drugs by partners were delay of ejaculation time, feeling of foreign bodies in genital organ, and the odor of drugs itself. Except SS-cream(R) with 60 minutes, the interval time of drug effect was about 15 to 20 minutes in every cases without any significant difference as well as adequate duration of drug efficacy. The times of usage per one pack was more in both E.L.T(R). soln which was make-up compact-type, and Sanova(R), Tstone(R) which was spray-type than the rest of drugs which were contained in disposal pack or tube. Also E.L.T soln(R), Sanova(R) and Tstone(R) had showed the convenience of usage (p<0.05). With overall satisfaction, there was excellent convenience of usage in E.L.T. soln which was packed in make-up compact (p<0.05). CONCLUSIONS: Topical anesthetic agents designed for premature ejaculation are safe and effective medical treatment with no significant difference in their characteristics, efficacy, and occurrence of adverse reaction among the various topical agents. Therefore, we suggest that the most important factors which influence the satisfaction and selectivity to topical anesthetic agents for premature ejaculations are the preserving container and method of application.