Anesthetic Management of a Patient with Idiopathic Hypereosinophilic Syndrome: A case report / 대한마취과학회지

Idiopathic hypereosinophilic syndrome is characterized by prolonged markedly elevated peripheral blood eosinophil count and eosinophil-related tissue damage to variable organs without an identifiable underlying cause. Eosinophilopoiesis is related with T-lymphocyte activation and cytokine cascade controlling eosinophilic production. It shows tissue infiltration in many organs including endomyocardium, lung, liver, gastrointestinal tract. Here we report a case of idiopathic hypereosinophilic syndrome presenting ruptured rectus sheath hematoma due to coagulopathy involving the liver. Severe postoperative complications were developed after general anesthesia. The patient suffered from life-threatening acute respiratory distress syndrome (ARDS). This case suggest that, in patients with marked eosinophilia requiring general anesthesia, perioperative steroid cover is advisable. This may reduce or prevent serious lung damage and other complications.

Effects of Glycopyrrolate or Atropine on Hemodynamic Responses during Anesthetic Induction with Remifentanil and Sevoflurane in Elderly Patients / 대한마취과학회지

BACKGROUND: This study was conducted to determine the effect of glycopyrrolate or atropine on attenuating hemodynamic responses such as bradycardia and hypotension during anesthetic induction with remifentanil and sevoflurane in elderly patients, in a randomized placebo-controlled double blinded manner. METHODS: 60 patients over 65 years with ASA physical status 1 or 2 were allocated to one of three groups of 20 each. Each group received saline placebo (group C) or glycopyrrolate 4microgram/kg (group G) or atropine 0.5 mg (group A) immediately after induction of anesthesia, and then remifentanil 1microgram/kg bolus was given over 30s. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthetic induction, before intubation, and during 5 minutes after intubation at 1 minute interval. RESULTS: MAP remained stable and HR increased significantly 1 min after intubation in all groups. MAP decreased significantly during 2-5 minute after intubation in all groups. HR decreased in the group C, remained stable in the group G, and increased in the group A significantly during 3-5 minute after intubation. Hypotension (systolic blood pressure < 90 mmHg checked twice) occurred in 8 patients in the group C, 1 patient in the group G, and none in the group A. CONCLUSIONS: Glycopyrrolate and atropine attenuated the hemodynamic responses to laryngoscropy and intubation during anesthetic induction with remifentanil 1microgram/kg bolus dose and sevoflurane.

Clinical Experience of Pain Management for Postlaminectomy Syndrome due to Pseudomeningocele: A case report / 대한통증학회지

Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.