Anesthetic experience for patients with malignant hyperthermia susceptibility determined by molecular genetic test: A report of 2 cases / 대한마취과학회지

Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder manifested as a life threatening hypermetabolic crisis in susceptible individuals following exposure to inhalation anesthetics and to depolarizing muscle relaxants. The preoperative diagnosis of MH susceptibility is difficult. The gold standard for determination of MH susceptibility is the in vitro contracture test. However, it is invasive, requiring skeletal muscle biopsy and is not widely available. Recent advances in genetic testing for mutations that result in MH during anesthesia have helped some genetic test have limitations in clinical application due to the diversity of mutations. In Korea, we found the RYR1 genetic mutation by molecular genetic testing for MH susceptibility in a family for which MH had occurred. Based on the results of genetic testing, we could known MH susceptibility of 2 patients. We believe that the genetic testing for MH can be developed and used with some limitations in clinical settings in Korea.

Comparison between the index finger insertion and catheter-guided insertion techniques for airway placement of a ProSeal(TM) laryngeal mask by inexperienced personnel / 대한마취과학회지

BACKGROUND: Insertion of a ProSeal(TM) laryngeal mask airway (PLMA(TM)) by experienced users was more successful with using a catheter-guided (CG) technique than a digital technique. The purpose of this study is to assess the efficacy of the CG insertion technique for a PLMA(TM) by inexperienced personnel. METHODS: Forty patients aged 18-65 yr and who were undergoing general anesthesia were randomly allocated to the index finger (IF) or CG insertion techniques for PLMA(TM) insertion. The IF technique was performed with the routine insertion technique. The CG technique was performed using a catheter inserted PLMA(TM), which was primed into the drain tube of the PLMA(TM) with using a soft flexible catheter. Successful insertion was primarily judged by the clinical function of the airway. The number of insertion attempts and the insertion time were recorded. Postoperative airway morbidity (sore throat, dysphonia, dysphagia) was assessed at 24 hr postoperatively. RESULTS: The success rate was similar between the groups (IF, 18/20; CG, 15/20). The successful insertion time (the time to provide an effective airway) was similar between the groups but the insertion time at the first attempt was shorter for the IF technique (IF, 21.6 +/- 5.3 s; CG, 27.4 +/- 10.3 s). There were no differences between the groups for the postoperative airway morbidity. CONCLUSIONS: This study suggests that the CG insertion technique is not a useful alternative technique for inexperienced personnel.

The malfunction of self-inflating bag resuscitator due to mis-assembly: A case report / 대한마취과학회지

A self-inflating bag resuscitator is universally used to ventilate patients during cardiopulmonary resuscitation and transfer. This device can be reused after sterilization and reassembly, and the mis-assembly of a resuscitator can possibly happen. We report here on a case of mis-assembly of a resuscitator valve that resulted to barotrauma and instability of a patient.