Difficult Airway and Failed Tracheal Intubation in a Patient with Mucopolaysaccharidoses Type II: A Case Report

Mucopolysaccharidoses are rare lysosomal storage diseases resulting from defects in lysosomal enzymes involved in degradation of glycosaminoglycans. Different mucopolysaccharidoses are caused by different enzyme deficiencies The anesthetic complications are related to the organs involved. Patients with mucopolysaccharidoses are rare, and few anesthetists encounter such patients. We experienced a case of mucopolysaccharidoses type II. Several endotracheal intubation attempts were tried, but we experienced failed endotracheal intubation. And we decided to proceed with surgery under bag-mask ventilation because of the short operation time. There’s no desaturation time. And the patient’s spontaneous ventilation was recovered and awakened. We have also briefly discussed the pathophysiology, clinical features, and possible airway management options for patients with mucopolysaccharidoses type II.

Anesthetic Management for Spine Surgery in a Patient with Left Internal Carotid Artery Occlusion and Penetrating Aortic Ulcer: A Case Report

A key challenge of anesthesia is to provide patients with safe and optimized anesthetic management to improve prognosis and minimize mortality and morbidity. To this end, the anesthesiologist should comprehensively understand the patient’s physical status through pre-anesthetic assessment and carefully monitor the patient during surgery. Several types of novel patient-monitoring devices may be useful to achieve this purpose. We report a case of anesthetic management in a patient with left internal carotid artery occlusion and penetrating aortic ulcer.

Regional Anesthesia for Abdominal Surgery in a Patient with Severe Chronic Respiratory Failure: A Case Report

General anesthesia is associated with a risk for postoperative pulmonary complications. The risk is even higher in patients with chronic respiratory failure, and postoperative mortality rates are high. Proper perioperative anesthetic management is important in such patients. Therefore, it is essential to optimize the patient’s physical status before anesthesia and to determine the optimal anesthesia technique based on the pre-anesthesia evaluation of the patient’s pulmonary function. We successfully performed abdominal surgery under spinal anesthesia in a patient with severe chronic respiratory failure.

Delayed Detection of Middle Turbinate Fracture after Nasotracheal Intubation: Any Tips for Prevention?

Nasotracheal intubation is valuable during intra-oral surgery. A common complication of this technique is epistaxis. We experienced a case of middle turbinate fracture which showed no immediate signs of fracture such as bleeding or avulsed particles. Two months later, it was discovered in the form of nasal obstruction with a mass-like lesion. Symptoms associated with traumatic intubation usually develop during surgery, and it is rare to be found a long time after surgery. We will review the anatomical and technical aspects for safe nasotracheal intubation.

A Case of Expiratory Limb Filter Obstruction in Heated Circuit Kit

Antimicrobial filters that prevent cross-contamination through anesthesia equipment are commonly used in operating rooms. Occlusion of this filter leads to the patient’s airway obstruction, which may lead to fatal outcomes. We report a case of the airway obstruction by antimicrobial filter occlusion during general anesthesia, and symptoms recovered immediately after removal of the filter.

Unanticipated Difficult Intubation in Patient with Undiagnosed Posterior Glottic Stenosis

Posterior glottic stenosis (PGS) is frequently caused by prolonged intubation complications, which may limit the movement of the vocal cords and obstruct airway obstruction. Despite of a life-threatening condition, it might be overlooked in asymptomatic individual. A 63-year-old female was scheduled for arthroscopic rotator cuff repair. The patient had experienced 2 times of intubation and organophosphate poisoning for suicide. Both of 7.0- and 6.5-mm inner diameter endotracheal tubes could not be passed vocal cords. After two failed attempts at intubation, adhesion of posterior part of vocal cord was revealed. We stopped the tracheal intubation and called the otolaryngologist, and adhesiolysis was performed under direct laryngosope. Thereafter, endotracheal intubation was performed successfully with 6.5-mm endotracheal tube.

Sustained erroneous near-infrared cerebral oxygen saturation in alert icteric patient with vanishing bile duct syndrome during and after liver transplantation: A case report

Monitoring cerebral oxygenation using a near infrared spectroscopy (NIRS) device is useful for estimating cerebral hypoperfusion and is available during liver transplantation (LT). However, high serum bilirubin concentration can interfere with NIRS because bilirubin absorbs near infrared light. We report a patient who underwent LT with a diagnosis of vanishing bile duct syndrome, whose regional cerebral oxygen saturation (rSO₂) remained below 15% even with alert mental status and SpO2₂ value of 99%. The rSO₂ values were almost fixed at the lowest measurable level throughout the intra- and postoperative period. We report a case of erroneously low rSO₂ values during the perioperative period in a liver transplant recipient which might be attributable to skin pigmentation rather than higher serum bilirubin concentration.

A suspected sugammadex-induced anaphylactic shock: A case report

BACKGROUND: The reversal of a neuromuscular blockade has typically been achieved with a cholinesterase inhibitor and the concomitant use of an anticholinergic agent, and this remains a popular method. Since the introduction of sugammadex in the market, its use has been increasing because of the rapid recovery from a neuromuscular blockade achieved by rocuronium. The occurrence of anaphylaxis or an anaphylactic reaction resulting from sugammadex is rare and has been reported sparsely. Thus, one may not recognize the possibility of sugammadex-induced hypersensitivity when sudden life-threatening hypotension occurs, especially without skin manifestations during the emergence of anesthesia. This may delay treatment and increase morbidity. CASE: We report a case of a sugammadex-related hypersensitivity reaction which manifested as pure cardiovascular collapse during the emergence of anesthesia. CONCLUSIONS: We emphasize that vigilance should be paid for at least five minutes following sugammadex administration in daily clinical practice.

Anesthetic Experience of Unexpected Change to One-Lung Ventilation with Bronchial Blocker

One-lung ventilation is an anesthesiological technique to accomplish surgical visualization during thoracic surgical procedures, and is often required unexpectedly during surgery. Traditionally the double lumen tube is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker to establish one-lung ventilation. We have experienced unexpected change to one-lung ventilation with bronchial blocker. A 40-year-old (158 cm, 48 kg) woman was scheduled for emergency exploratory laparotomy due to panperitonitis. A sudden diaphragmatic perforation occurred during the operation. Since oxygen saturation was reduced, intraoperative tube change was not available. Therefore, one-lung ventilation was done with bronchial blockers. After the bronchial blocker was placed, one-lung ventilation was well maintained and the operation was terminated successfully.

Perioperative Anesthetic Management of a Patient with Dermatomyositis

Dermatomyositis is a relatively rare myopathy which is characterized by muscle weakness and chronic inflammatory changes in muscle and skin. Dermatomyositis typically presents with subacute, progressive proximal muscle weakness, a skin rash, or both. Other common extramuscular manifestations include various cardiac abnormality, interstitial lung disease, and malignancy. In dermatomyositis patients, various clinical features might be present depending on the severity of the disease, the presence and extent of the accompanying disease, and the response to muscle relaxants. There are not enough data about anesthetic management of patients with dermatomyositis. Therefore, dermatomyositis may be special problems for anesthesiologists in the preoperative, intraoperative, and postoperative period. The author reports a case of perioperative management of a patient with dermatomyositis.

Epinephrine-Induced Acute Pulmonary Edema during Septoplasty

Epinephrine is used with lidocaine to provide bloodless surgical field and to prolong the action of local anesthetics. But epinephrine also has many adverse reactions, such as agitation, restlessness, headache, tachycardia, hypertension, and some significantly more dangerous conditions including myocardial ischemia, ventricular arrhythmia, cerebral hemorrhage and pulmonary edema, cardiac arrest, etc. We have experienced epinephrine-induced acute pulmonary edema due to submucosal intranasal application of epinephrine soaked gauze during septoplasty. The patient was successfully treated in intensive care unit with positive pressure ventilation, diuretics, and inotropic support. He was extubated after 5 hours and discharged after 7 days without any complications.

Isolated Unilateral Hypoglossal Nerve Palsy Following Transoral Endotracheal Intubation for Endoscopic Sinus Surgery

Hypoglossal nerve palsy is a rare complication of endotracheal intubation. The mechanism of nerve palsy is mainly attributed to stretching or compression of the nerve during airway manipulation. The cuff pressure can also contribute to the occurrence of hypoglossal nerve palsy. Since it is often accompanied by other cranial nerve palsies, meticulous overall cranial nerve examination is necessary. The main treatment is supportive with respiratory monitoring. The prognosis is favorable. Majority of patients achieve nearly full recovery of nerve function. Here, we report a case of unilateral hypoglossal nerve palsy following usual, uneventful endotracheal intubation and review the literature.

Liver transplantation in Jehovah's Witnesses: two cases report / 대한마취과학회지

Liver transplantation is especially challenging in patients who are Jehovah's Witnesses because their religious beliefs prohibit the receipt of blood products. We present two cases of living donor liver transplantation performed in adult Jehovah's Witnesses in South Korea without the use of blood products. In the first case, preoperative erythropoiesisstimulation therapy increased hemoglobin levels from 8.1 to 13.1 g/dl after 9 weeks. In the second case, hemoglobin levels increased from 7.4 to 10.8 g/dl after 6 months of erythropoiesis-stimulation therapy. With the combination of acute normovolemic hemodilution, intraoperative cell salvage, and use of transfusion alternatives, liver transplantation was successfully performed without transfusion of blood products.

Development of the Geop-Pain questionnaire for multidisciplinary assessment of pain sensitivity / 대한마취과학회지

BACKGROUND: To assess the multidisciplinary aspects of pain, various self-rating questionnaires have been developed, but there have not been sufficient relevant studies on this topic in South Korea. The aim of this study was to develop a new pain sensitivity-related questionnaire in the Korean language that would be simple and would well reflect Koreans' senses. METHODS: A new pain assessment questionnaire was developed through a pre-survey on "geop", which is the Korean word expressing fear, anxiety, or catastrophizing. We named the new assessment questionnaire the Geop-Pain Questionnaire (GPQ). The GPQ was composed of 15 items divided into three categories and rated on a 5-point scale. As a preliminary study, internal consistency and test-retest reliability analyses were conducted. Subsequently, 109 individuals completed the GPQ along with three pain-related questionnaires translated into Korean (Pain Sensitivity Questionnaire [PSQ], Pain Anxiety Symptoms Scale [PASS], and Pain Catastrophizing Scale [PCS]), and the correlations were analyzed. RESULTS: All items in the GPQ showed appropriate internal consistency, and the test-retest reliability analysis showed no statistically significant differences. The correlations between the GPQ and the existing questionnaires revealed that the GPQ scores had mid-positive correlations with the PSQ scores and strong positive correlations with the PASS and PCS scores. CONCLUSIONS: This study attempted to develop a questionnaire assessing pain sensitivity multidimensionally using the Korean word geop for the first time. The self-rating GPQ showed high correlations with the existing questionnaires and demonstrated potential to be utilized as a pain prediction index in clinical practice.

Anesthetic Experience of Spinal Anesthesia after Sedation in Un-cooperated Elderly Patients

Regional anesthesia is mostly used in operations on the lower abdomen or lower extremities in elderly patients. It shows nearly no difference in long-term outcomes compared to general anesthesia, but it is used more often because of the several advantages. However, during the regional anesthetic procedures, the patient must cooperate and has to be lateral decubitus position without physical movement. Therefore, in the case of the patients who are not cooperated, it may be not easy to perform regional anesthesia. In this study, we present 3 case reports that regional anesthesia after sedation is performed in un-cooperated patients. Regional anesthesia after sedation may be a good method to improve outcomes in un-cooperated elderly patients.

A Pilot Study of the Correlation between the Numeric Rating Scale used to Evaluate "Geop" and Questionnaires on Pain Perception

BACKGROUND: The word "geop" is a unique Korean term commonly used to describe fright, fear and anxiety, and similar concepts. The purpose of this pilot study is to examine the correlation between the Numeric Rating Scale (NRS) score of geop and three different questionnaires on pain perception. METHODS: Patients aged 20 to 70 years who visited our outpatient pain clinics were evaluated. They were requested to rate the NRS score (range: 0-100) if they felt geop. Next, they completed questionnaires on pain perception, in this case the Korean version of the Pain Sensitivity Questionnaire (PSQ), the Pain Catastrophizing Scale (PCS), and the Pain Anxiety Symptoms Scale (PASS). The correlations among each variable were evaluated by statistical analyses. RESULTS: There was no statistically significant correlation between the NRS score of geop and the PSQ score (r = 0.075, P = 0.5605). The NRS score of geop showed a significant correlation with the PCS total score (r = 0.346, P = 0.0063). Among the sub-scales, Rumination (r = 0.338, P = 0.0077) and Magnification (r = 0.343, P = 0.0069) were correlated with the NRS score of geop. In addition, the NRS score of geop showed a significant correlation with the PASS total score (r = 0.475, P = 0.0001). The cognitive (r = 0.473, P = 0.0002) and fear factors (r = 0.349, P = 0.0063) also showed significant correlations with the NRS score of geop. CONCLUSIONS: This study marks the first attempt to introduce the concept of "geop." The NRS score of geop showed a moderate positive correlation with the total PCS and PASS score. However, further investigations are required before the "geop" concept can be used practically in clinical fields.

A suspected malignant hyperthermia managed without dantrolene sodium / 대한마취과학회지

No abstract available.

Intraoperative Detection of Rate Dependent Left Bundle Branch Block

Rate dependent left bundle branch block (RDLBBB) is an uncommon case. RDLBBB is defined as an intraventricular conduction defect that may return, if only temporarily, to sinus rhythm at lower heart rates. It appears when the heart rate exceeds a certain critical value. Although RDLBBB is usually benign, its diagnosis and treatment have clinical importance for association of RDLBBB and myocardial ischemia and infarction. Therefore, in the case of detection of intraoperative RDLBBB, a clear differentiation should be done as soon as possible. Also it is important to start appropriate treatment and to do clinical follow-up examination. We report a case of intraoperative RDLBBB during general anesthesia for laparoscopic cholecystectomy in 82 years old female patient who has a history of hypertension.

Anesthetic Management of a Patient with Mitochondrial Myopathy Undergoing Orthopedic Surgery

Mitochondria myopathies consist of large heterogeneous groups of disorders resulting from primary dysfunction of the mitochondrial respiratory chain and causing muscle disease. These disorders involve the multiple organ system and appear to be extensive variability in clinical presentation. Therefore anesthetic management of patients with mitochondrial myopathies should begin with careful preoperative investigation and preparation. We report successful general anesthesia in a 22-year-old man with mitochondrial myopathy undergoing orthopedic surgery.

Male Chronic Pelvic Pain Syndrome

Male chronic pelvic pain syndrome (MCPPS) is defined as chronic pain, pressure, or discomfort localized to the pelvis, perineum, or genitalia of males lasting more than 3 months that is not due to readily explainable causes. Other names for the disorder include prostatodynia and chronic nonbacterial (abacterial) prostatitis, although it is unclear how the symptoms relate to the prostate. And it appears to be extensive variability in clinical presentation and may result in chronic neuropathic pain and neuromuscular pain. Therefore patients with MCPPS should be cared by multimodal treatment including antihyperalgesics, antidepressants and pain intervention procedures such as caudal block. We report successful care in two men with MCPPS.