Spinal Cord Injury Occurred during the Brachial Plexus lock in a Patient with Ankylosing pondylitis: A case report / 대한마취과학회지

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.

Anesthetic Experience of a Patient with Primary Aldosteronism Complicated with Aortic Dissection: A case report / 대한마취과학회지

Primary aldosteronism is a clinical syndrome characterized by hypertension, hyperkalemia and hyporeninemia due to increased aldosterone production from the adrenal gland. It is caused by adenoma, bilateral hyperplasia or carcinoma. We experienced anesthetic management of a 49-year-old female with adrenal adenoma accompanied by aortic dissection for left adrenalectomy. To avoid undesirable hypertension which may exacerbate the aortic dissection during general anesthesia, we performed adjunctive continuous thoracic epidural anesthesia under careful hemodynamic monitoring. The patient recovered uneventfully without extension of aortic dissection.

Epidural Butorphanol Reduces the Side Effects from Epidural Morphine after Cesarean Section / 대한마취과학회지

BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.

Comparison of Tetracaine and Bupivacaine on Saddle Block / 대한마취과학회지

BACKGROUND: The effect of spinal anesthesia with hyperbaric tetracaine and bupivacaine, with and without 1:1000 epinephrine were studied in 60 patients having perianal operation in the horizontal lithotomy position. METHODS: The 60 patients were divided into four groups(n=15 in each group). Patients in group I and II received 0.5% hyperbaric tetracaine 7 mg(1.4 ml) and normal saline 0.2 ml (group I) or epinephrine 0.2 mg (0.2 ml) (group II) and patients in group III and IV received 0.5% hyperbaric bupivacaine 7 mg (1.4 ml) and normal saline 0.2 ml (group III) or epinephrine 0.2 mg (0.2 ml) (group IV). After intrathecal injection, changes and durations of sensory block, motor block and anal tone block were checked. RESULTS: The sensory block level was similar in four groups and the duration of analgesia was significantly longer in bupivacaine groups (III and IV) than in tetracaine groups (I and II) (in turn, group IV, II, III and I). Tetracaine groups were earlier onset of motor block, a larger number of patients with motor block and significantly longer duration of motor block than bupivacaine groups (in turn, group II, I, IV and III). The onset of anal tone block was earlier in tetracaine groups as the onset of motor block, but the duration of anal tone block was significantly longer in bupivacaine groups as the duration of analgesia (in turn, group IV, II, III and I). Epinephrine 0.2 mg produced significant prolongation of durations of analgesia, motor block and anal tone block of the hyperbaric tetracaine and bupivacaine. Cardiovascular change was similar in four groups and most common complication in all groups after spinal anesthesia was urinary retention. CONCLUSIONS: We conclude that the hyperbaric tetracaine and bupivacaine are appropriate anesthetic agents for perianal surgery and epinephrine produce a significant prolongation of the postoperative analgesic duration in both anesthetic agents.

Tension Pneumothorax following Subclavian Vein Cannulation in the Patient with Chronic Obstructive Pulmonary Disease: A case report / 대한마취과학회지

Subclavian vein cannulation as a central venous route is a simple and rapid beside procedure and most reliable method. The supraclavicular approach to the subclavian vein depended on a fixed entry point and accurate angulation of the needle and is particularly free from infection and phlebitis although catheters have been left in situ for long-term period. Tension pneumothorax is a complication of subclavian vein cannulation. The incidence of pneumothorax in patients with chronic obstructive pulmonary disease(COPD) is higher than in the general population and can result in serious respiratory compromise. Because pneumothorax is a serious complication in COPD, its presence must be anticipated so that close and prompt treatment, including immediate re-expansion of the lung, is offered. Authors presented one case that the patient with COPD developed tension pneumothorax in right side lung resulting from inadvertent lung injury during supraclavicular subclavian vein cannulation under general anesthesia and on trendelenberg position. The patient was treated with immediate thoraeostomy and recovered uneventfully.

Clinical Observation of 1,067 Cases of Epidural Anesthesia / 대한마취과학회지

From January l, l990 to June 30, l992, tota1 1,067 epidural anesthesia were evaluated retrospectively for physical status, level of anesthesia, agents of 1ocal anesthetics, complication and poatoperative pain control. The reaults were as follows: 1) Annual numbers of epidural aneathesia were 272 cases in 1990. 392 cases in 1991 and 403 cases in 1992 respectively. The number of epidural anesthesia was increaeing with years. 2) The most common site of epidural puncture level wae L(3-4) intervertebral space and mean depth from skin to epidural space was 4.88 cm. 3) The local anesthetics that used during epidural anesthesia were lidocaine(1%, 1.5%, 2%) and bupivacaine(0.25%, 0.375%. 0.5%). 4) The most common sensory level which were blocked by epidural anesthesia waa T(10) and most common complication was hypotension. 5) Postoperative pain control with epidural anestheaia was managed with continuous drug infusor after 1991, and it was managed with single bolus injection before 1991. In conclusion, epidural anesthesia is a safe regional anesthesia that will reduce the incidence of hypotension provided that careful control of the aensory level to be anesthetiaed is taken under consideration along with the age, physical status, site of operation, volume of local anesthetics and it is effective for the postoperative pain control with continuous infusion of morphine sulfate and local anesthetic through catheter.

Anesthesia Experience for Open Heart Surgery - Report of 40 cases / 대한마취과학회지

This report is concerned with our clinical experience of 40 cases of anesthesia for open heart surgery at the Department of Anesthesiology, Seoul Adventist hospital during the period between July, 1988 and May, 1990. The results were as follows: 1) Among the 40 cases, 16 cases were congenital heart disease and 24 cases were acguired heart disease. 13 cases were male and 27 were female, Age was varied from 4 years to 71 years and mean was 33.2 years. 2) Morphine and glycopyrrolate were used as premedicants. 3) Thiopental, morphine and fentanly were used as induction agents, were injected singly or in combination. 4) Morphine, fentanyl and N2O were used as anesthetic agents in conjunction with halothane or enflurane. 5) Succinylcholine, vecuronium and pancuronium were used for intubation and maintenance of muscle relaxation. 6) The duration of eardiopulmonary bypass, aortic cross clamp, surgery and anesthesia in acquired heart disease were longer than in congenital heart disease, 7) Overall the mortality rate was 5% and the cause of death were air embolism and respiratory failue.

Anesthesia for Pediatic Minor Surgical Patient with Lung Sareoma / 대한마취과학회지

A 2 year 9 month old boy was treated for a long time with a diagnosis of pneumonis. A biopsy of the neck mass performed under endotracheal anesthesia for 70 minutes. He was moved to the recovery room with an endotracheal tube, 50 min. later, cardiac arrest suddenly developed and was not resuscitated. Autopsy findings showed lymphosarcoma of the left lung with metastasis to the neck, liver and splsen, and a bilateral atypical pneunomia with left pleural malignant efficusion producing about 500ml. possible causes of death and the prevention are discussed.

Clinical Observation of 6,048 Cases of Anesthesia - The past 7 years / 대한마취과학회지

A total of 6043 surgical cases were performed at S.D.A. Hospital from 1973 to 1979. These were analyzed statistically according to yearly numbers and emergency states, age, sex, anesthetic methods, anesthetic technique, duration of anesthesia, anesthetic agents and mortality. These were all inpatients operated under general anesthesia, and the results are as follows. Results. 1) Yearly numbers and emergency numbers were steadily increasing. 2) Sex ratio was 65%: 35% 2887 male cases(47.7%) and 5156 female cases(52.23%). 3) More than half of the age group was adult(21 to 60 years) 4) Halothane, nitrous oxide and neuromuscular blocker were used with increasing tendency. 5) The anesthetic technique was, in more than 90% of cases, was circle absorption system. 6) General surgery cases were 40% of the total of all departments. 7) In 66.95% of anesthesias the duration was 1 to 3 hours. 8) General anesthesia group was 98.63%. 9) Deathe occurred in 6 cases our of a total of 6043 cases.