Comparison of the Effects of Sufentanil and Fentanyl Intravenous Patient Controlled Analgesia after Lumbar Fusion

OBJECTIVE: Postoperative pain is one of the major complaints of patients after lumbar fusion surgery. The authors evaluated the effects of intravenous patient controlled analgesia (IV-PCA) using fentanyl or sufentanil on postoperative pain management and pain-related complications. METHODS: Forty-two patients that had undergone surgery with lumbar instrumentation and fusion at single or double levels constituted the study cohort. Patients were equally and randomly allocated to a sufentanil group (group S) or a fentanyl group (group F) for patient controlled analgesia (PCA). Group S received sufentanil at a dose of 4 μg/kg IV-PCA and group F received fentanyl 24 μg/kg IV-PCA. A numeric rating scale (NRS) of postoperative pain was applied before surgery, and immediately and at 1, 6, and 24 hours (hrs) after surgery. Oswestry disability index (ODI) scores were obtained before surgery and one month after surgery. Opioid-related side effects were also evaluated. RESULTS: No significant intergroup difference was observed in NRS or ODI scores at any of the above-mentioned time points. Side effects were more frequent in group F. More specifically, nausea, vomiting rates were significantly higher (p=0.04), but pruritus, hypotension, and headache rates were non-significantly different in the two groups. CONCLUSION: Sufentanil displayed no analgesic advantage over fentanyl postoperatively. However, sufentanil should be considerable for patients at high risk of GI issues, because it had lower postoperative nausea and vomiting rates than fentanyl.

Seborrheic dermatitis treatment with stellate ganglion block: a case report / 대한마취과학회지

Seborrheic dermatitis is a chronic recurrent inflammatory disorder presumed to be caused by increased sebaceous gland secretion, metabolic changes in the cutaneous microflora, and changes in the host immune function. Stellate ganglion block (SGB) is known to increase the blood flow rate without altering the blood pressure, heart rate, or cardiac output, to stabilize hypertonic conditions of the sympathetic nerves, and to affect the endocrine and immune systems. It is used in the differential diagnosis and treatment of autonomic nervous system disorders of the head, neck, and upper limbs. The authors report the first case of successful treatment of a patient with seborrheic dermatitis through repeated SGB trials.

Endotracheal intubation using i-gel(R) and lightwand in a patient with difficult airway: a case report / 대한마취과학회지

This case report involves tracheal intubation using i-gel(R) in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel(R) was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel(R) and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel(R) and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.

Comparison of the preventive effects of pretreatment of lidocaine with a tourniquet and a premixed injection of lidocaine on propofol-LCT/MCT injection pain / 대한마취과학회지

BACKGROUND: Lidocaine has been used widely to prevent propofol injection pain. Various methods of administration exist, such as lidocaine premixed with propofol or lidocaine pretreatment using a tourniquet, but it is unclear which method of lidocaine administration is more effective for the prevention of injection pain of propofol LCT/MCT. The purpose of this study was to compare pretreatment of lidocaine with a tourniquet and a premixed injection of lidocaine to prevent injection pain of propofol-LCT/MCT. METHODS: Patients were randomly allocated into the pretreatment group (n = 117) or the premixed group (n = 117). The pretreatment group was pretreated with 2 ml of lidocaine 2%, held with a tourniquet, before propofol-LCT/MCT injection. The premixed group was injected with a premixed solution of propofol-LCT/MCT and 2 ml of lidocaine 2%. To evaluate the incidence and severity of pain, spontaneous verbal expressions of pain, movement of hand, frowning, and moaning were recorded, and the patients were asked to recall their pain with the visual analogue score (VAS) 30 minutes after awakening from anesthesia. RESULTS: Overall, injection pain occurred in 13.7% of the pretreatment group and 15.4% of the premixed group, without any statistical difference (P = 0.71). There was no difference in spontaneous verbal expressions of pain, movement of hand, frowning, and moaning between the two groups. The pain intensity (VAS) also showed no difference between the two groups (P = 0.49). CONCLUSIONS: Pretreatment of lidocaine with a tourniquet showed no more benefit to prevent injection pain of propofol LCT/MCT compared to a premixed injection with lidocaine.

Comparison of dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in brachial plexus block / 대한마취과학회지

BACKGROUND: Dexmedetomidine extends the duration of nerve block when administered perineurally together with local anesthetics by central and/or peripheral action. In this study, we compared the duration of nerve block between dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in infraclavicular brachial plexus block. METHODS: Thirty patients, scheduled for upper limb surgery were assigned randomly to 3 groups of 10 patients each. We performed brachial plexus block using a nerve stimulator. In the control group (group C), patients received 40 ml of 1% mepivacaine. In group E, patients received 40 ml of 1% mepivacaine containing 200 microg of epinephrine as an adjuvant. In group D, patients received 40 ml of 1% mepivacaine containing 1 microg/kg of dexmedetomidine as an adjuvant. Sensory block duration, motor block duration, time to sense pain, and onset time were assessed. We also monitored blood pressure, heart rate, oxygen saturation and bispectral index. RESULTS: In group D and group E, sensory block duration, motor block duration and time to sense first pain were prolonged significantly compared to group C. However, there was no significant difference between group D and group E. CONCLUSIONS: Perineural 1 microg/kg of dexmedetomidine similarly prolonged nerve block duration compared to 200 microg of epinephrine, but slowed heart rate. Thus, dexmedetomidine is expected to be a good alternative as an adjuvant to local anesthesia in patients who are cautioned against epinephrine.

The effect of intravenous dexmedetomidine on the duration of brachial plexus block

BACKGROUND: Dexmedemomidine, a highly selective alpha-2 adrenoreceptor agonist has an analgesic and sedative effect without causing respiratory depression. In this study, we compared the duration of brachial plexus block (BPB), the time at which the patient first feels pain after performing BPB, the need for use of analgesics, and the occurrence rate of complications while continuous infusion with dexmedetomidine was used for sedation in patients undergoing BPB, to a control group, who were only infused with normal saline. METHODS: BPB was performed in 48 patients scheduled for upper limb surgery. Infraclavicular approach was provided with 40 ml of 1.5% mepivacaine and 200 microg of epinephrine using nerve stimulator. After verification of successful block, dexmedetomidine group received dexmedetomidine (loading dose 0.1 microg/kg/min for the first 10 minutes followed by a maintenance dose of 0.005 microg/kg/min as required to maintain bispectral index 60-80). In the control group, normal saline was infused at a rate of 10 ml/hr. The duration of BPB, the time at which the patient first feels pain after performing BPB, frequency of complication, and the use of analgesics of the both groups were checked. RESULTS: The motor and sensory block duration, and the time at which the patient first feels pain after BPB were longer in the dexmedetomidine group compared to the control group. And the need for analgesics were less in the dexmedetomidine group. CONCLUSIONS: Intravenous administration of dexmedetomidine prolongs the duration of BPB.

Hypertensive crisis during wide excision of gastrointestinal stromal cell tumor (GIST): Undiagnosed paraganglioma: A case report / 대한마취과학회지

Although paraganglioma (PGL), an extra-adrenal retroperitoneal pheochromocytoma (PHEO), is a rare catecholamine-secreting neuroendocrine tumor, it can cause severe hypertensive crisis during anesthesia or surgery if undiagnosed preoperatively. Extraluminal perigastric masses may be presumed to be gastrointestinal stromal tumors (GISTs) or soft tissue sarcomas even when histologic confirmation is not possible. Therefore, without a histologic diagnosis or symptoms of excessive catecholamine secretion, PGL may be mistaken for GIST. We report a case of preoperatively undiagnosed PGL which caused hypertensive crisis during anesthesia for retroperitoneal mass excision.

Cerebellar hemorrhage after spine fixation misdiagnosed as a complication of narcotics use: A case report / 대한마취과학회지

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature.

Outcome Evaluation with Signal Activation of Functional MRI in Spinal Cord Injury

OBJECTIVE: The authors investigated the changes of cortical sensorimotor activity in functional MRI (fMRI) and functional recovery in spinal cord injury (SCI) patients who had been treated by bone marrow cell transplantation. METHODS: Nineteen patients with SCI were included in this study; ten patients with clinical improvement and nine without. The cortical sensorimotor activations were studied using the proprioceptive stimulation during the fMRI. RESULTS: Diagnostic accuracy of fMRI with neurological improvement was 70.0% and 44.4% for sensitivity and specificity, respectively. Signal activation in the ipsilateral motor cortex in fMRI was commonly observed in the clinically neurological improved group (p-value=0.002). Signal activation in the contralateral temporal lobe and basal ganglia was more commonly found in the neurological unimproved group (p-value<0.001). Signal activation in other locations was not statistically different. CONCLUSION: In patients with SCI, activation patterns of fMRI between patients with neurologic recovery and those without varied. Such plasticity should be considered in evaluating SCI interventions based on behavioral and neurological measurements.

Sign of decreased coronary blood flow from ST depression and PVCs during a left lower lobectomy of the lung in a patient with a left internal mammary arterial bypass graft / 대한마취과학회지

No abstract available.

A clinical comparison of continuous interscalene brachial plexus block with different basal infusion rates of 0.2% ropivacaine for shoulder surgery / 대한마취과학회지

BACKGROUND: A continuous interscalene brachial plexus block is a highly effective postoperative analgesic modality after shoulder surgery. However, there is no consensus regarding the optimal basal infusion rate of ropivacaine for a continuous interscalene brachial plexus block. A prospective, double blind study was performed to compare two different basal rates of 0.2% ropivacaine for a continuous interscalene brachial plexus block after shoulder surgery. METHODS: Sixty-two patients receiving shoulder surgery under an interscalene brachial plexus block were included. The continuous interscalene brachial plexus block was performed using a modified lateral technique with 30 ml of 0.5% ropivacaine. Surgery was carried out under an interscalene brachial plexus block or general anesthesia. After surgery, the patients were divided randomly into two groups containing 32 each. During the first 48 h after surgery, groups R8 and R6 received a continuous infusion of 0.2% ropivacaine at 8 ml/h and 6 ml/h, respectively. The pain scores at rest and on movement, supplemental analgesia, motor block, adverse events and patient's satisfaction were recorded. RESULTS: The pain scores, supplemental analgesia, motor block, adverse events and patient's satisfaction were similar in the two groups. CONCLUSIONS: When providing continuous interscalene brachial plexus block after shoulder surgery, 0.2% ropivacaine at a basal rate of 8 ml/h or 6 ml/h produces similar clinical efficacy. Therefore, decreasing the basal rate of CISB is more appropriate considering the toxicity of local anesthetics.

Right hydrothorax misconceived as atelectasis after left internal jugular vein catheterization: A case report / 대한마취과학회지

Central vein catheterization is a common procedure for monitoring the central venous pressure, securing vascular access, administrating vasoactive drugs and removing air embolisms. However, many complications can occur, such as vessel injury, pneumothorax, hydrothorax, nerve injury, arrhythmia and infection at the insertion site. We encountered an unusual complication of a localized right hydrothorax that was initially misinterpreted as an atelectasis after left internal jugular vein catheterization and right lateral positioning for a left lower lobectomy.

Assessment of the Quality of Postherpetic Neuralgia Related Korean Internet Sites

BACKGROUND: There is no assessment of internet sites that carry information on chronic pain disease. So we assessed the quality of information about postherpetic neuralgia available on Korean internet sites. METHODS: The keywords 'postherpetic neuralgia', 'herpes zoster, neuropathic pain', 'herpes zoster, pain', 'herpes zoster' were searched in Korean on four search engines in Korea between the 1st to the 15th of May, 2009. We evaluated the outcome on two factors; the aspect of the contents which is subdivided into two categories, the content and authorship, and the technical aspect including web design, and efficiency. RESULTS: A total of 26 internet sites were found. Among these sites, 6 (23%) informed by anesthesiologist. The average score of the 26 internet sites was only 37.4 +/- 20.1 out of a total of 100. A mean score of the contents was 13.3 +/- 8.3 out of 40 points, the authorship was 10.0 +/- 6.7 out of 20 points, the design was 9.2 +/- 5.3 out of 20 points, the efficiency was 6.8 +/- 4.3 out of 20 points. When comparing the score between anesthesiologist and non-anesthesiologist, the contents was 18.7 +/- 7.4 vs. 11.7 +/- 7.9, the authorship was 13.4 +/- 4.7 vs. 9.0 +/- 6.8, the design was 12.5 +/- 4.2 vs. 8.3 +/- 5.2 and the efficiency was 6.8 +/- 4.5 vs. 4.3 +/- 4.0 (P < 0.05). CONCLUSIONS: There is a need for more accurate information about postherpetic neuralgia on the Korean internet by anesthesiologists.

Evaluation of Spinal Fusion Using Bone Marrow Derived Mesenchymal Stem Cells with or without Fibroblast Growth Factor-4

OBJECTIVE: In this study, the authors assessed the ability of rat bone marrow derived mesenchymal stem cells (BMDMSCs), in the presence of a growth factor, fibroblast growth factor-4 (FGF-4) and hydroxyapatite, to act as a scaffold for posterolateral spinal fusion in a rat model. METHODS: Using a rat posterolateral spine fusion model, the experimental study comprised 3 groups. Group 1 was composed of 6 animals that were implanted with 0.08 gram hydroxyapatite only. Group 2 was composed of 6 animals that were implanted with 0.08 gram hydroxyapatite containing 1 x 10(6)/ 60 microliter rat of BMDMSCs. Group 3 was composed of 6 animals that were implanted with 0.08 gram hydroxyapatite containing 1 x 10(6)/ 60 microliter of rat BMDMSCs and FGF-4 1 microgram to induce the bony differentiation of the BMDMSCs. Rats were assessed using radiographs obtained at 4, 6, and 8 weeks postoperatively. After sacrifice, spines were explanted and assessed by manual palpation, high-resolution microcomputerized tomography, and histological analysis. RESULTS: Radiographic, high-resolution microcomputerized tomographic, and manual palpation revealed spinal fusion in five rats (83%) in Group 2 at 8 weeks. However, in Group 1, three (60%) rats developed fusion at L4-L5 by radiography and two (40%) by manual palpation in radiographic examination. In addition, in Group 3, bone fusion was observed in only 50% of rats by manual palpation and radiographic examination at this time. CONCLUSION: The present study demonstrates that 0.08 gram of hydroxyapatite with 1 x 10(6)/ 60 microliter rat of BMDMSCs induced bone fusion. FGF-4, added to differentiate primitive 1 x 10(6)/ 60 microliter rat of BMDMSCs did not induce fusion. Based on histologic data, FGF-4 appears to induce fibrotic change rather than differentiation to bone by 1 x 10(6)/ 60 microliter rat of BMDMSCs.

Rhabdomyolysis following posterior lumbar interbody fusion in prone position: report 2 cases: Two cases report / 대한마취과학회지

The spine surgery performed in the prone position could cause severe complications such as visual acuity impairment, spinal infarct and rhabdomyolysis. When treating rhabdomyolysis, it is important to prevent acute renal failure from accompanying rhabdomyolysis due to the poor prognosis. We have experienced two cases of rhabdomyolysis after spine surgery where dark urine was present during spine surgery under general anesthesia. Anesthesiologists should pay attention for early diagnosis and treatment of the rhabdomyolysis developing during the spine surgery.

Usefulness of ultrasound-guided infraclavicular brachial plexus block: a comparison with nerve stimulation method / 대한마취과학회지

BACKGROUND: Recently, ultrasound guidance in clinical procedures including brachial plexus block has gained popularity. This method has been considered to be an efficient and a useful method with real-time visualization. Many reports have showed the usefulness of ultrasound-guided brachial plexus block. We evaluated the usefulness of ultrasound guidance in infraclavicular brachial plexus block compared with nerve stimulation. METHODS: Thirty patients were randomized into two groups of US group (ultrasound-guided block) and NS group (nerve stimulation). Blocks were performed with mepivacaine 2% and bupivacaine 0.5% with epinephrine 1:200,000 (total volume 40 ml). Block execution time, onset time, success rate, patient's discomfort and complications were measured and statistically evaluated for the comparison. RESULTS: Block execution time were 88.3 +/- 48.1 sec in US group and 172.7 +/- 103.1 sec in group NS, respectively (P = 0.017). Onset time were 16.0 +/- 6.9 min and 17.7 +/- 7.8 min (P = 0.434). Success rates were 93.3% and 80.0% (P = 0.283). Patient's discomfort was not significantly different. Pain in patients with fractured arm was significantly lower in US group (P = 0.004). CONCLUSIONS: An ultrasound-guided infraclavicular brachial plexus block is useful with less time consumption and less discomfort in patients with fracture of arm. Success rate and onset time were acceptable.

Anesthetic Management of Early Ligation of Patent Ductus Arteriosus for Premature Infants in the Neonatal Intensive Care Unit / 대한마취과학회지

BACKGROUND: Left-to-right shunt through patent ductus arteriosus (PDA) produces significant hemodynamic and respiratory derangements in premature infants. Combined diseases in these patients often preclude attempts to close the PDA medically with indomethacin. Recently, the efficacy of early surgical closure performed in neonatal intensive care unit (NICU) rather than in operating room (OR) has been emphasized to reduce the risks of transferring unstable infants. Therefore, we reviewed the anesthetic management and clinical status of premature infants who underwent early surgical closure of PDA in NICU. METHODS: Between 2001 and 2007, we reviewed retrospectively 17 premature infants with extremely low birth weight below 1,500 g and 33 weeks gestational age who underwent early ligation of PDA in NICU with left axillary minithoracotomy. RESULTS: The mean gestational age and weight of infants were 29.4 +/- 1.8 (26(+3) - 32) weeks and 849 +/- 165 (450 - 1,080) g. Most of the infants had complications related to PDA and prematurity. Diastolic blood pressure and pulse oxymetry saturation changed with ligation of PDA from 27.4 +/- 5.3 mmHg and 96.3 +/- 2.9% to 38.1 +/- 10.0 mmHg and 93.8 +/- 2.6%, respectively. The body temperature didn't show significant alterations. There was no direct procedure-related death although threeinfants died from pneumonia and sepsis at 29, 30 and 34 days postoperatively. CONCLUSIONS: Performing early PDA ligation in NICU was demonstrated to be safe and effective, especially in terms of providing continuous care and avoiding the risk of hypothermia.

Internal jugular vein thrombosis detection by ultrasound scan after failure of internal jugular vein catheterization: A case report / 대한마취과학회지

Right internal jugular vein catheterization is performed frequently as central venous catheterization by the landmark method. This procedure, however, might prove difficulty due to anatomic variations or thrombosis of internal jugular vein. We failed to catheterize right internal jugular vein by the landmark method in 70-year-old female patient. And then, we detected right internal jugular vein thrombosis by ultrasound scan. Left internal jugular vein catheterization was performed by the ultrasound guided technique. Central venous catheterization has possibility to fail despite several attempts by the landmark method. Then, ultrasound guided approach is a good choice to aid central venous catheterization when difficulties or complications have been encountered.

Treatment of spontaneous intracranial hypotension with multiple leakage sites of cerebrospinal fluid : A case report

Spontaneous intracranial hypotension (SIH) is an uncommon disease that's caused by cerebrospinal fluid (CSF) leakage and this disease is considered to be an important cause of persistent headache. It is characterized by a postural headache in patients who are without any history of dural puncture or trauma. Conservative management, including bed rest analgesics and intravenous fluid administration, are the first-line treatment of SIH, and an autologous epidural blood patch (EBP) is generally indicated for those who fail the conservative management. We report here on a case of SIH with confirmed CSF leakage at the cervical, thoracic and lumbar levels, and this was successfully managed with a single autologous EBP at the lumbar level. We believe that an EBP at the leakage site with the highest pressure level should be considered as a primary treatment for SIH with multiple sites of leakage.

Anaphylaxis by vecuronium during induction of general anesthesia: A case report / 대한마취과학회지

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immediate proper intensive care. The operation was delayed and a skin test was performed on the 7th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction.