Unexpected anesthetic leakage from a damaged O-ring on the Selectatec back bar: A case report

The Selectatec mounting system was devised to provide easy and quick on-site fitting of various vaporizers for the anesthetic machine. However, a quick changing system for the vaporizer can also damage the O-ring due to friction between the vaporizer and the Selectatec back bar. We herein report a case of an unexpected anesthetic gas leakage from a damaged O-ring on the Selectatec back bar, which resulted from exchanging the vaporizers between two operations. In cases using the Datex Ohmeda machine, it is not easy to detect leakages from the vaporizers because of the location of the check valve near to the fresh gas outlet. This complicates the use of the positive pressure leakage test to detect a low pressure system leakage on the Selectatec back bar. We recommend the preanesthetic negative pressure or low-flow leakage test to detect a low pressure leakage when exchanging vaporizers on the Selectatec system.

Cerebral air embolism and subsequent transient neurologic abnormalities in a liver transplant recipient following the removal of the pulmonary artery catheter from the central venous access device: a case report / 대한마취과학회지

Cerebral air embolism is a rare but potentially life-threatening complication. We experienced a living-donor liver transplant recipient who presented with unexpected cerebral air embolism and transient neurologic abnormalities that subsequently developed just after the removal of the pulmonary artery catheter from the central venous access device. One day after the initial event, the patient's neurologic status gradually improved. The patient was discharged 30 days after liver transplantation without neurologic sequelae.

Nasogastric tube placement using a semi-rigid esophageal stethoscope in an intubated surgical patient / 대한마취과학회지

No abstract available.

Rapid identification of spontaneously resolving capnothorax using bedside M-mode ultrasonography during laparoscopic surgery: the "lung point" sign: two cases report / 대한마취과학회지

Pneumothorax during general anesthesia is more difficult to diagnose compared with that of non-anesthetized patient. Furthermore, the early diagnosis of pneumothorax is to some extent difficult due to CO2-pneumoperitoneum during laparoscopic surgery. The use of ultrasonography to diagnose pneumothorax has increased in a variety of situations, demonstrating a better diagnostic rate than conventional chest radiography. Here, we report two cases of intraoperative capnothorax that were confirmed using the M-mode "lung point" sign. However, the insertion of a chest tube could have been avoided because the spontaneous resolution of capnothorax was quickly identified using bedside lung ultrasonography.

Therapy of Pulmonary Thromboembolism under Emergency Byspass System during Anterior Cruciate Ligament Repair: A case report / 대한마취과학회지

A 56 year old female patient was transferred to the operating room for the repair of anterior cruciate ligament under general anesthesia. Initial vital sign was stable, but there was gradual decreases of the blood pressure and end-tidal CO2 after femur tourniquet application. We suspected the pulmonary thromboembolism, and started massive treatment of using ventilator with 100% O2, various invasive monitors and many vasopressors. Because the patient's vital sign was so unstable, we finally made a decision of using emergency bypass system (Capiox EBS(R), Terumo, Japan) by femoral artery and vein. After that, we transferred the patient to intensive care unit, and continued vigorous treatment. The patient was diagnosed as pulmonary thromboembolism by CT scan. We treated her with infusion of heparin and maintained ACT above 200 second. The 4th day at the intensive care unit, we removed the emergency bypass system. We transferred her to general ward without any complication after 12th day postoperatively.

Effects of Milk Consumption on Calcaneal Quantitative Ultrasound and Bone Turnover Markers of Women Living in Asan / 대한지역사회영양학회지

The objective of this study is to determine the effectiveness of 16-month milk consumption as a part of the health promotion community program for women in Asan. Subjects included 313 women belonging to the milk group (mean age = 69.1, range 47~89 y) and 66 women to the control (mean age = 43.6, range 20~69 y) group. For those in the milk group, one cup (200ml) of partially lactose-digested low-fat milk was provided everyday for 16 months. Each subject was interviewed to assess calcium intake by a 24-h recall after fasting blood was obtained for analyzing bone turnover markers, and calcaneus broadband ultrasound attenuation (BUA) was measured by quantitative ultrasound (QUS) on the left heel before and after the milk supplementation. After 16 months, the calcium intake levels changed from 55% of recommended dietary allowance (RDA) to 85% RDA in the milk group and from 73% RDA to 84% RDA in the control group. BUA were reduced from 67.9+/-8.1 to 64.7+/-17.5 dB/MHz for milk and from 90.4+/-13.0 to 87.2+/-15.2 dB/MHz for control groups. Paired ttest showed the changes of BUA for both groups (-3.24 and -3.15 dB/MHz for milk and control groups, respectively) were significant, but the two groups did not show any differences in absolute changes. When post-BUA was analyzed after age, initial BUA and menopausal status were controlled as covariates in ANCOVA model, the milk group showed significantly (p < 0.05) smaller changes than the control group (-3.50 vs -6.71 dB/MHz, respectively). According to a multiple regression analysis, milk consumption and initial BUA showed significant interaction meaning that those with lower initial BUA showed higher milk effects. We conclude that one-cup a day milk consumption for 16 month can prevent further bone loss and significantly improve calcium intake.

The Effect of Intrathecal Bupivacaine with Hypothermia on Neuronal Protection against Transient Spinal Cord Ischemia in Rats / 대한마취과학회지

BACKGROUND: Local anesthetics can reduece excitotoxic neuronal injury from ischemia. We investigated neuroprotective effects of intrathecally administered bupivacaine and hypothermia in rat model of transient spinal cord ischemia. METHODS: A PE-10 intrathecal catheter was implanted into thirty six male Sprague-Dawley rats through L4-5 interlaminar space. Animals of normothermia (N) and hypothermia (H) groups were administered 15microliter of normal saline, and 15microliter of 0.5% bupivacaine for bupivacaine (B) and bupivacaine-hypothermia (BH) groups. Transient spinal cord ischemia was induced by inflation of a 2 F Fogarty catheter placed into aortic arch for 12 minutes. During ischemia, rectal temperature was maintained to 37.0+/-0.5 degrees C for N and B groups, 34.5 +/- 0.5degrees C for H and BH groups. Motor and sensory deficit score were assessed 2 and 24 hour after reperfusion. Lumbar spinal cords were harvested for histopathology, and for immunoreactivity of heat shock protein 70 (HSP70). RESULTS: The motor and sensory deficit score of N and B group was significantly higher than H group (P < 0.05) and BH group (P < 0.05). There were also significant difference in the motor and sensory deficit score between H and BH group at 24 hr (P < 0.05). Neuronal cell death and immunoreactivity of HSP70 was frequently observed in the N and B groups, but not in the H and BH groups. CONCLUSIONS: These results suggest that intrathecal bupivacaine did not provide neuroprotection during normothermic transient spinal cord ischemia in rats, but it can enhance neuroprotective effects of hypothermia.

Increased Calcium Intake through Milk Consumption and Bone Mineral Density of Elderly Women Living in Asan

The objective of this study is to determine the effectiveness of 4-month milk consumption in the prevention of osteoporosis in elderly women living in Asan. Subjects included 277 women age over 65 years were divided into control (n=111) and milk (n=166) groups. For those in the milk group, one cup (200ml) of partially lactose-digested low-fat milk was provided everyday for 4 months. Each subject was interviewed to assess food intake by 24-h recall method before and after milk supplementation. Prevalence of osteoporosis was determined by WHO criteria with calcaneus bone mineral density (BMD) measured by quantitative ultrasound (QUS) on left heel. After 4 months, the nutrient intake levels of control did not change while intakes of energy, protein, calcium, phosphorous, riboflavin, pyridoxin, niacin and folic acid were significantly increased in milk group. No significant changes were observed in anthropometric, and BMD in both control and milk groups. T-score of milk group, however, was significantly increased after 4 month milk consumption. Prevalence of osteoporosis was increased (27% to 32%) in control group while that of milk group was decreased (32% to 30%). When BMD and t-score changes after 4 months of milk consumption were compared between those with low baseline calcium intake and high calcium intake subjects in the milk group, BMD and t-score were significantly improved in the low baseline calcium intake group. We conclude that one cup a day milk consumption for a relatively short period of 4 months can prevent further bone loss and significantly improve intakes of both macro and micro-nutrients of elderly women.