CT Guided Cervical Transforaminal Steroid Injection: 2 Months Follow-up / 대한통증학회지

BACKGROUND: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. METHODS: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. RESULTS: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. CONCLUSIONS: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.

CT Guided Cervical Transforaminal Steroid Injection for the Elderly Patient with Enlarged Internal Jugular Vein and Vertebral Artery: A case report / 대한마취과학회지

Seventy nine-year old female patient visited our department presenting radicular pain on her neck, left shoulder and arm. She had a history of hypertension and underwent coronary angiography and angioplasty 4 years ago. Cervical MRI showed central disc herniation with osteophyte and left foraminal stenosis at C5-6 level and bulging disc with osteophyte and foraminal stenosis (left > right) at C6-7. First plan was transforaminal steroid injection under C-arm fluoroscopy at C5-6 level. Unexpectedly, we could find enlarged internal jugular vein and vertebral artery on MRI scan, which is due to cardiovascular disease. These important vascular structures were expected to be injured by needle during the procedure if done under C-arm fluoroscopy. We decided to give transforaminal steroid injection under CT fluoroscopy to avoid injury to the large vessels and inadvertent complication. The procedure was successfully done using CT fluoroscopy (Brilliance 10(TM), Philips(R), USA) without any complication associated with vascular injury or intravascular injection.

The Effect of Continuous Infusion of Ondansetron on Nausea and Vomiting during Intravenous Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to determine the effectiveness of the continuous infusion of ondansetron for the prevention of postoperative nausea and vomiting (PONV) in intravenous patient-controlled analgesia (PCA). METHODS: One hundred and sixty patients undergoing spinal surgery were randomized into four groups according to the method of ondansetron administration, placebo (n = 40, group 1), ondansetron 8 mg mixed to IV PCA (n = 40, group 2), ondansetron 4 mg IV before induction or after surgery in addition to 8 mg mixed to IV PCA (n = 40, group 3 or n = 40, group 4). The incidences of nausea, vomiting, and side effects were recorded for 48 hr postoperatively. RESULTS: The incidence of nausea in group 1 (43 %) was significantly higher than in the other groups (group 2; 18%, group 3; 15%, group 4; 18%) (P < 0.05), and vomiting was one in group 1. CONCLUSIONS: Continuous ondansetron infusion is effective at preventing PONV, but the effects of additional bolus injections to continuous infusion of ondansetron were not different from continuous infusion only.

Antagonistic Effect of Flumazenil on the Prolonged Oversedation after Sevoflurane Based Anesthesia: A case report / 대한마취과학회지

Prolonged oversedation occurs frequently in postoperative care units, and sometimes delays transfer to normal units. Flumazenil is a known reversal drug for benzodiazepines, and is used to reverse the oversedation caused by benzodiazepines. However, we found that flumazenil was effective in a case of sevoflurane induced oversedation. A prolonged oversedation of 90 minutes occurred after sevoflurane anesthesia without benzodiazepine at a postoperative care unit. Immediately after an intravenous injection of flumazenil, the patient fully awoke and was oriented.