Residual Epidual and Subural Hematoma in the Occipital Area / 대한마취과학회지

In a 8 year-old boy who had epidural hematoma in the occipital area, had an episode of dislodgement of the endotracheal tube due to improper position. After operation, there were drowsy consciousness, irregular respiration, apnea, absence of cough reflex and swallowing reflex. Then these was no improvement in spite of treatment, and because of this hypoxic encephalopathy was diagnosed. WE suspected there might be some pathologic lesion volving the respiratory center and lower cranial nerves. CT scanning was performed and the result was diagnosed with epidural hematoma and subdural hematoma in the posterior fossa. The patient was reoperated.

Anesthetic Management for the Palient with Insuliaoma / 대한마취과학회지

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.