Surgical Treatment of Bilateral Coronary to Pulmonary Artery Fistulae with a Saccular Aneurysm: A case report / 대한흉부외과학회지

A 76-year-old woman with a history of chest pain and palpitation, was diagnosed with bilateral coronary to pulmonary artery fistulae with a concomitant saccular aneurysm, which is quite rare. Suture closure of the fistular vessels around the pulmonary artery root, the removal of a saccular aneurysm, and the transpulmonary closure of coronary to pulmonary artery fistulae were performed. The patient was well at 4 months after surgery.

Combined Repair of Coronary Artery Disease and Left Subclavian Artery Occlusion / 대한흉부외과학회지

A 47-year-old male with hypertension, diabetes mellitus and heavy smoking, but no anginal symptoms, presented with claudication of the lower extremities. Extremity angiography with coronary angiography revealed peripheral arterial lesions including a left subclavian artery occlusion with coronary artery disease. The patient underwent an initial off-pump coronary artery bypass with an ascending aorto-axillary bypass. The right internal mammary artery was anastomosed to the left anterior descending coronary artery. The greater saphenous vein graft was connected from the ascending aorto-axillary bypass graft to the diagonal branch. At postoperative day 18, femorofemoral and bilateral femoropopliteal bypasses were performed. We report a case of the combined repair of coronary artery disease and a left subclavian artery occlusion.

Effects of Ondansetron or Naloxone Patient-Controlled Analgesia on Postoperative Analgesia and Side Effects / 대한마취과학회지

BACKGROUND: Opioid delivered by PCA (patient-controlled analgesia) is effective at relieving pain after surgery, but it is associated with side effects, such as nausea, vomiting, pruritus, respiratory depression, and urinary retention. The purpose of this study was to compare fentanyl-related side effects and the quality of analgesia when naloxone or ondansetron was added to IV PCA regimen. METHODS: Ninety patients undergoing lumbar laminectomy were enrolled in this study. General anesthesia was maintained with 50% N2O and enflurane. In the recovery room patients received a 1microgram/kg bolus of fentanyl, and addition normal saline 2 ml (group C), ondansetron 4 mg (group O), or naloxone 0.04 mg (group N). Simultaneously intravenous fentanyl PCA with normal saline (group C), ondansetron 4 mg (group O), or naloxone 0.36 mg (group N) was commenced. Pain scores and side effects were assessed on postoperative days (PODs) 0, 1, and 2 using a VAS (visual analogue scale). RESULTS: The incidences of vomiting in the groups C, O, and N were 13.2%, 13.2%, and 3.3%, respectively. The VAS scores for nausea on PODs 0 and 1 in group N were significantly lower than in group C. The VAS scores for sedation on POD 0 in group N was lower than in group C, and on POD 2 lower than in group O. No differences in the VAS for pain and urinary retention were observed between the three groups. CONCLUSIONS: Low-dose naloxone with IV fentanyl PCA is effective at reducing opioid-related nausea and sedation without attenuating the quality of analgesia.

Comparison between a Fentanyl and Clonidine Admixture to Lidocaine in a Brachial Plexus Block / 대한마취과학회지

BACKGORUND: The admixture of clonidine or fentanyl to 1.5% lidocaine for brachial plexus block was studied with regard to onset and duration of anesthesia and postoperative analgesia after a brachial plexus blockade. METHODS: Thirty patients (ASA i-ii) undergoing surgery of the forearm and hand under an interscalene brachial plexus blockade (BPB) were included in this study. Patients were randomly divided into 3 groups. BPB was performed using 40 ml of 1.5% lidocaine added epinephrine 1:200,000 in group E, 1mug/kg of fentanyl in group F, and 2mug/kg of clonidine in group C, respectively. The onset times of blockade in the radial, ulnar, median and musculocutaneous nerve were recorded. Hemodynamic data and sedation scores were monitored. Finally, the duration of the sensory block was assessed. A value of P<0.05 was considered as statistically significant. RESULTS: The clonidine group was shorter in onset time, decreased need for postoperative analgesia and increased analgesic duration than other groups but more sedated than group E. With the admixture of fentanyl, pain scores were lower at 180 and 210 min after the block (VAS:mean 2, 8) than with epinephrine (VAS:mean 27, 30 respectively). Hemodynamic changes were not significantly different in all groups. CONCLUSiONS: The addition of clonidine to 1.5% lidocaine causes a rapid onset of analgesia and prolonged duration of sensory blockade in the brachial plexus blockade when compared to the addition of epinephrine or fentanyl to 1.5% lidocaine.