Cardiac arrests in placenta accreta patient during emergency cesarean section: A case report

We report the case of a patient who suffered two events of sudden cardiac arrests separately. Sudden onset of dyspnea and cardiac arrests occurred during cesarean section in a 35-year-old woman who delivered premature baby. Instant chest compression and epinephrine 1 mg was administered. She was diagnosed to have a placenta previa totalis with bleeding preoperatively and placenta accreta was noted intraoperatively. Cesarean hysterectomy was performed due to excessive hemorrhage associated with uterine atony. Another cardiac arrests occurred during hysterectomy. After instant successful resuscitation, she recovered her heart rhythm and transferred to tertiary hospital safely. She was discharged about two months later without any major physical or neurocognitive deficits.

Anesthetic review of emergency peripartum hysterectomy following vaginal and cesarean delivery: a retrospective study / 대한마취과학회지

BACKGROUND: The purpose of this study was to review incidence, indications, complications, and the anesthetic management of emergency obstetric hysterectomies. METHODS: This was a retrospective study of the cases of emergency obstetric hysterectomies performed at the Woman's Hospital over a 3 year period between January 2008 and December 2010. The indication for surgery, anesthetic management, operating time, estimated blood loss, pre- and postoperative hemoglobin and hematocrit values, need for blood transfusion, and perioperative complications were obtained. RESULTS: During the study period there were 46 emergency obstetric hysterectomies for 20147 deliveries, giving an incidence of 2.28/1000 deliveries. The number of emergency hysterectomies was significantly higher with the cesarean deliveries than with the vaginal deliveries. The most common indication for emergency obstetric hysterectomy was placenta accreta. Postoperatively, Dissemimated Intravascular Coagulation (DIC) was the most common complication. CONCLUSIONS: Abnormal placenta has been an main indication of emergency hysterectomy. Anesthesiologists should be eligible to aware of high risk of emergency hysterectomy and deal with massive hemorrhage.

Vertical Reduction Using Atlantoaxial Facet Spacer in Basilar Invagination with Atlantoaxial Instability

Although posterior segmental fixation technique is becoming increasingly popular, surgical treatment of craniovertebral junctional disorders is still challenging because of its complex anatomy and surrounding critical neurovascular structures. Basilar invagination is major pathology of craniovertebral junction that has been a subject of clinical interest because of its various clinical presentations and difficulty of treatment. Most authors recommend a posterior occipitocervical fixation following transoral decompression or posterior decompression and occipitocervical fixation. However, both surgical modalities inadvertently sacrifice C0-1 and C1-2 joint motion. We report two cases of basilar invagination reduced by the vertical distraction between C1-2 facet joint. We reduced the C1-2 joint in an anatomical position and fused the joint with iliac bone graft and C1-2 segmental fixation using the polyaxial screws and rods C-1 lateral mass and the C-2 pedicle.

Schwannoma of the Superficial Peroneal Nerve Presenting as Sciatica

Schwannomas are benign nerve sheath tumors that can present in various locations and they have variable symptoms. However, schwannoma of the superficial peroneal nerve is rare, and only a limited number of cases have been reported. The authors here describe a case of schwannoma of the superficial peroneal nerve, which was initially considered as a L5 radiculopathy because of its clinical similarity. In the differential diagnosis of nontraumatic and nonarthritic pain of the lower leg and foot, benign tumors, particularly schwannomas of the peroneal nerves should be considered. Treatment by excision can result in relief of the symptoms and maintenance of function.

The Effect of Metoclopramide or Lidocaine Pretreatment on Pain during Rocuronium Injection / 대한마취과학회지

BACKGROUND: Rocuronium has a high incidence of inducing pain by intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effects of lidocaine and metoclopramide pretreatments on rocuronium injection pain. METHODS: Ninety healthy patients scheduled for general anesthesia were randomly divided into three groups; a saline group (n = 30), a lidocaine group (n = 30), and a metoclopramide group (n = 30). Each patient received 2 ml of pretreatment solution (normal saline, 2% lidocaine, or 0.5% metoclopramide) via an 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, and this was followed by an intravenous injection of 0.6 mg/kg of rocuronium. General anesthesia then induced with thiopental sodium (5 mg/kg). The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, or severe by an observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine and metoclopramide groups compared with the saline group at the induction of anesthesia (P < 0.05), but no significant difference was observed between the lidocaine and metoclopramide groups. Similar results were obtained in the recovery room; one patient in each of the saline and metoclopramide groups had no recall regarding injection pain. CONCLUSIONS: Intravenous metoclopramide pretreatment is as effective as intravenous lidocaine pretreatment for alleviating rocuronium injection pain.