Combined third occipital and C3 deep medial branch neurotomy in a patient with C2-3 facet joint osteoarthritis associated cervicogenic headaches: A case report

Cervicogenic headache is pain from the head due to various sources in the cervical spine. The C2-3 zygapophysial joints are the most commonly involved structure, and this type of headache could be relieved by blocks or neurotomy of the third occipital nerve. A 59-years-old female patient suffered from cervicogenic headaches due to severe C2-3 zygapophysial joint hypertrophy. Her pain was partially relieved by the third occipital radiofrequency neurotomy, and was almost completely removed by C3 deep medial branch neurotomy. Herein, we report a case of osteoarthritis associated cervicogenic headaches at the C2-3 zygapophysial joints and proposed a treatment option.

Symptomatic epidural gas cyst treated with epidural block and percutaneous needle aspiration: A case report / 대한마취과학회지

A 68-year-old woman suffered from lower back and radiating pain on her right buttock and posterior calf. Axial magnetic resonance imaging showed a 7 x 7 mm nodular lesion (T1 and, T2 low signal intensity) at the epidural space between the L5-S1 level and computed tomography revealed it was an epidural gas cyst. The authors performed an epidural block and percutaneous needle aspiration of the epidural gas cyst. The patient showed almost complete resolution of symptoms one year later. The authors suggest that an epidural nerve block with needle aspiration of a gas cyst could be an alternative treatment option for patients with a symptomatic epidural gas cyst before surgery.

Percutaneous bipolar radiofrequency T3 sympathicotomy in Raynaud's disease: A case report / 대한마취과학회지

A 54-year-old female was suffering from cold-induced Raynaud's attacks in her both hands with symptoms most severe in her left hand. As the patient did not respond to previous medical treatments and endoscopic thoracic sympathectomy, we performed percutaneous bipolar radiofrequency thoracic sympathicotomy at the left T3 vertebral level. After the procedure, the patient obtained a long duration of symptom relief over 3 years. Percutaneous bipolar radiofrequency T3 sympathicotomy is minimally invasive and effective technique by creating large continuous strip lesion.

Morphologic Analysis of Water-Cooled Bipolar Radiofrequency lesions on Egg White in Vitro

BACKGROUND: The aim of this study was to document the optimal spacing of two cannulae to form continuous strip lesions and maximal surface area by using water-cooled bipolar radiofrequency technology. METHODS: Two water-cooled needle probes (15 cm length, 18-gauge probe with 6 mm electrode tip) were placed in a parallel position 10, 20, 24, 26, and 28 mm apart and submerged in egg white. Temperatures of the probes were raised from 35degrees C to 90degrees C and the progress of lesion formation was photographed every 1 minute with the increase of the tip temperature. Approximately 30 photographs were taken. The resultant surface areas of the lesions were measured with the digital image program. RESULTS: Continuous strip lesions were formed when the cannulae were spaced 24 mm or less apart; monopolar lesions around each cannula resulted if they were spaced more than 26 mm apart. Maximal surface areas through the formation of continuous strip lesion were 221 mm2, 375 mm2, and 476 mm2 in 10, 20, and 24 mm, respectively. Summations of maximal surface area of each monopolar lesions were 394 mm2 and 103 mm2 in 26 and 28 mm, respectively. CONCLUSIONS: Water-cooled bipolar Radiofrequency technology creates continuous "strip" lesions proportional in size to the distance between the probes till the distance between cannulae is 24 mm or less. Spacing the cannulae 24 mm apart and treating about 80degrees C for 24 minutes maximizes the surface area of the lesion.

A New Anterior Approach for Fluoroscopy-guided Suprascapular Nerve Block: A Preliminary Report

BACKGROUND: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). METHODS: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. RESULTS: The average NRS was decreased from 4.8 +/- 0.6 to 0.6 +/- 0.5 after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of 15.1 +/- 2.2 (11-19degrees) and a caudal angle of 15.4 +/- 1.7degrees (12-18degrees). The average distance from the skin to the scapular notch was 5.8 +/- 0.6 cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. CONCLUSIONS: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

Kinked J-tip guidewire within the tracheal lumen during retrograde intubation: A case report

Retrograde intubation is an alternative option for gaining airway access for patients with a difficult airway.We report a successful management of a kinked J-tip guidewire within a tracheal lumen with flexible fiberoptic laryngoscope in a patient with type II odontoid fracture.It is helpful to adjusting the depth of angiocatheter and handling of J-tip guidewire if J-tip guidewire does not come out into the oral cavity at the expected length during retrograde intubation.

Spontaneous Retropharyngeal Hematoma: A Case Report

Spontaneous retropharyngeal hematoma is rare and difficult to diagnosis early. A 23-year-old male spontaneously developed acute onset of neck pain, limitation of neck motion, and mild dysphagia. Magnetic resonance imaging demonstrated blood products in prevertebral space from C2 to C4, suggesting a diagnosis of retropharyngeal hematoma. We report a rare case of spontaneous retropharyngeal hematoma causing neck pain.

One-Lung Ventilation Using a Fogarty Catheter in a Patient with Tracheostomy after Pharyngectomy and Laryngectomy: A case report / 대한마취과학회지

One lung ventilation with a double-lumen endotracheal tube or Univent tube may be achieved difficultly or dangerously in some patient such as young age, anatomic anomaly, low body weight and tracheostomy patient. Bronchial blocker with a Fogarty catheter has been used successfully for such situations. Here, we reported the clinical experience in using a Fogarty embolectomy catheter as a bronchial blocker in patient with tracheostomy after pharyngectomy and laryngectomy. The patient was received left upper lobectomy with thoracotomy due to metastatic lung cancer.

Comparison of Bispectral Index at Each Thiopental Sodium Induction Dose / 대한마취과학회지

BACKGROUND: Thiopental sodium is one of the most commonly used intravenous anesthetics, but there exists no reliable report of BIS that can predict the hypnotic state. Our purpose was to compare BIS values after administering different doses of thiopental sodium. METHODS: With institutional review board approval and informed consent, sixty adult patients scheduled for elective surgery were studied. The patients were divided into three groups according to induction doses as follows: group 1: 3 mg/kg, group 2: 4 mg/kg, group 3: 5 mg/kg. After induction the BIS was monitored at 15 second intervals to 90 seconds. The number of patients with a BIS of less than 55 was recorded. RESULTS: The BIS at baseline and 15 seconds after administration were not statistically different in the three groups. The BIS at 30 seconds in group 1 differed from those of groups 2 and 3, but all of the mean BIS values were more than 55. The BIS values at 45 and 90 seconds were statistically different for three groups, and the mean BIS values of groups 2 and 3 were less than 55. The number of patients with a BIS of less than 55 at any point was eight in group 1, and twenty in groups 2 and 3. CONCLUSIONS: BIS monitoring suggests that a dosage above 4 mg/kg of thiopental sodium is sufficient for the reliable induction of anesthesia.