Usefulness of additional polarized light irradiation for those treated with stellate ganglion block in sudden deafness

BACKGROUND: Both stellate ganglion block (SGB) and polarized light irradiation (Superlizer) have a tendency to increase blood flow. Increases in blood flow can be estimated indirectly by changes in tympanic membrane temperature. In this study, we sought to evaluate how simultaneous SGB and Superlizer treatment affects tympanic temperature and tympanic blood flow in individuals suffering from sudden deafness. METHODS: Among patients who visited the pain clinic complaining of sudden deafness, we divided them into two groups: one receiving only SGB; the other receiving both SGB and Superlizer treatment. By comparing the tympanic membrane temperature measurements of both groups on 10, 30, and 60 minutes after treatment through a prospective study, we intended to evaluate the effect of treatment with SGB and Superlizer. RESULTS: Temperature changes measured after the injection were statistically significant in both groups. Temperature changes of the tympanic membrane were greater in the group who received both SGB and Superlizer compared to the group receiving only SGB. CONCLUSIONS: The results suggest that SGB followed by Superlizer has effects on the amount of increase in tympanic membrane temperature. This seems to be attributed to the increase in blood circulation of the inner ear compared with the group receiving only SGB. We came to the conclusion that in sudden deafness patients, the use of SGB combined with polarized light irradiation appears to be more effective in the treatment of sudden deafness.

Successful tracheal intubation using fiberoptic bronchoscope via an I-gel(TM) supraglottic airway in a pediatric patient with Goldenhar syndrome: A case report / 대한마취과학회지

The I-gel(TM) is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel(TM) supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel(TM) supraglottic airway. The authors suggest that I-gel(TM) is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.

Atropine injection followed by coronary artery spasm with ventricular tachycardia during spinal anesthesia: A case report / 대한마취과학회지

Bradycardia may occur during spinal anesthesia with atropine commonly used as a treatment. A 44-year-old female with no known history of any underlying diseases, developed a coronary spasm following ventricular tachycardia when 0.5 mg of atropine was injected intravenously to treat bradycardia during spinal anesthesia. The imbalance caused by atropine in the sympathovagal activity may predispose the coronary artery to develop spasms with ventricular tachycardia. Therefore prudent use of atropine should be accompanied by close monitoring.

Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate: A case report / 대한마취과학회지

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.

Coronary artery spasm following intravenous phenylephrine on a patient under general anesthesia with previously undiagnosed variant angina and successful treatment by nitroglycerin: A case report

Coronary artery spasm under general anesthesia induces interruption of blood flow of coronary arteries and can be detected by a sudden ST elevation on electrocardiogram, which may be followed by severe cardiovascular complications. We have experienced a case of a sudden ST elevation on a 52-year-old patient with no history of coronary artery diseases undergoing spine surgery under general anesthesia. Following administration of nitroglycerin, ST elevation returned to normal. Postoperative coronary angiogram showed positive on ergonovine provocation test and the patient was diagnosed as variant angina. Correlating with the results, we concluded that the ST elevation was probably due to coronary artery spasm. Although the definite mechanism of the coronary artery spasm is unclear. A-adrenergic stimulation by phenylephrine may have acted as a solitary factor or as one of many factors. Early administration of nitroglycerin and calcium channel blocker seems to be useful in treatment and prevention of recurrence.

One Lung Ventilation Using a Univent(R) Tube in a Patient with Permenant Tracheostomy after Total Laryngectomy: A case report / 대한마취과학회지

Which tube is the best one for the one lung ventilation? It is open to discussion of tube choice for the patient with tracheostomy after total laryngectomy. In this situation, we can use the bronchial blocker. We report the case of using a Univent(R) tube in a patient with tracheostomy after total laryngectomy for one lung ventilation. Successfully, the patient received esophagectomy, esophageal reconstruction and pyloroplasty due to esophageal cancer without any complications.

Effect of Remifentanil and Fentanyl on Bispectral Index and Hemodynamics during Propofol TCI / 대한마취과학회지

BACKGROUND: Remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short lasting pharmacokinetics. It is likely to make it a very useful opioid for clinical practice. The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to compare sedative and cardiovascular effects of remifentanil and fentanyl during target controlled infusion (TCI) of propofol by monitoring BIS and hemodynamics. METHODS: Fifty-two patients undergoing total abdominal hysterectomy were randomly assigned to remifentanil group and fentanyl group with 26 cases in each group. Anesthesia was induced with propofol (4microgram/ml) and either remifentanil (0.5microgram/kg) or fentanyl (1.5microgram/kg) and was maintained with inhalation of 50% nitrous oxide and 50% oxygen mixture and a continuous infusion of either remifentanil (0.2microgram/kg/min) or fentanyl (0.03microgram/kg/min). Depth of anesthesia, hemodynamic changes and adverse reactions were observed. RESULTS: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly lesser than that in the fentanyl group (P<0.05). During intubation, skin incision, maintenance of anesthesia and extubation, remifentanil group shows lesser fluctuation of hemodynamic value than those in the fentanyl group (P<0.05). BIS was significantly decreased both groups during infusion of propofol, but no difference was found between the two groups. There was no significant difference between the two groups in the aspect of adverse reactions. CONCLUSIONS: Remifentanil with propofol TCI based anesthetic can prevent the fluctuation of heart rate and mean arterial pressure during the operation especially, during intubation.