Cardiac arrest caused by contralateral tension pneumothorax during one-lung ventilation - A case report –

Background@#Tension pneumothorax on the contralateral lung during one-lung ventilation (OLV) can be life-threatening if not rapidly diagnosed and managed. However, diagnosis is often delayed because the classic signs of tension pneumothorax are similar to clinical manifestations commonly observed during OLV.Case: We report a case of contralateral tension pneumothorax in a patient undergoing right upper lobectomy during OLV. The patient suffered from sudden cardiac arrest and was assisted by extra-corporeal membrane oxygenation. @*Conclusions@#Contralateral pneumothorax during OLV is rare but can occur at any time. Therefore, anesthesiologists should consider this critical complication.

Cardiac arrest due to intracranial hypotension following pseudohypoxic brain swelling induced by negative suction drainage in a cranioplasty patient: a case report / 대한마취과학회지

Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain computerized tomography (CT). We present a stuporous 22-year-old patient who underwent cranioplasty under general anesthesia. The entire course of the general anesthesia and operation progressed favorably. However, the time of scalp suture completion, sudden bradycardia and hypotension occurred, followed by cardiac arrest immediately after initiation of subgaleal and epidural suction drainage. After successful resuscitation, the comatose patient was transferred to the neurosurgical intensive care unit and PHBS was confirmed using brain CT.

Comparison of volume-controlled and pressure-controlled ventilation in the Trendelenburg position for gynecological laparoscopic surgery

BACKGROUND: Minimal invasive gynecologic surgery usually requires pneumoperitoneum and Trendelenburg positioning, which results in adverse effects on respiratory and hemodynamic parameters. The aim of this study was to investigate the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) introduced sequentially in patients who underwent gynecological laparoscopy on respiratory mechanics, cardiovascular responses, and gas exchange. METHODS: Forty patients who were scheduled for gynecologic laparoscopic surgery were enrolled. Baseline ventilation of their lungs was performed with VCV with a tidal volume (TV) of 8 ml/kg ideal body weight (IBW). Forty minutes after pneumoperitoneum and Trendelenburg positioning, the ventilation mode was changed to PCV, and airway pressure was set to provide a TV of 8 ml/kg IBW without exceeding 35 cmH2O. Respiratory mechanics and hemodynamic and gas exchange parameters were recorded at 10 minutes after induction, 30 minutes after CO2 pneumoperitoneum and Trendelenburg positioning, 30 minutes after PCV, and 30 minutes after desufflation and supine position. RESULTS: After pneumoperitoneum and Trendelenburg positioning, there were significant increases in systolic blood pressure, diastolic blood pressure, central venous pressure, peak airway pressure (PAP), mean airway pressure (Pmean), whereas lung compliance and PaO2 significantly decreased. The decrease in PAP and increases of Pmean, lung compliance and PaO2 were observed during PCV compared with VCV (P < 0.05). There were no differences in hemodynamic parameters between VCV and PCV. CONCLUSIONS: Our results demonstrated that PCV may be an effective method of ventilation during gynecologic laparoscopy in terms of improved oxygenation and minimizing adverse respiratory mechanics.

Multiple left subclavian venous catheterizations in premature infant / 대한마취과학회지

No abstract available.

Tapia's syndrome following cervical laminoplasty: A case report / 대한마취과학회지

Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months.

The effect of nitroglycerin on hemodynamic changes during laparoscopic low anterior resection / 대한마취과학회지

BACKGROUND: More laparoscopic low anterior resections (LAR) are being performed in recent years. There has been controversy around the hemodynamic changes affected by the Trendelenburg position and pneumoperitoneum during LAR. The goal of this study was to analyze the effect of nitroglycerin (NTG) on hemodynamic changes during LAR. METHODS: Forty ASA physical status I-II patients undergoing LAR were randomized into two groups: the NTG infused group (N group, n = 20) and the control group (C group, n = 20). Anesthesia was maintained with sevoflurane at 1-3 vol%, air/oxygen (50%/50%) and continuous infusion with remifentanil. The N group patients were given 0.5 microg/kg/min of NTG during anesthesia. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV) and systemic vascular resistance (SVR) were assessed 10 min after induction (T1), 5 min after pneumoperitoneum in the supine position (T2), 10 min after pneumoperitoneum in the Trendelenburg position (T3), 30 min after pneumoperitoneum in the Trendelenburg position (T4), 1 hr after pneumoperitoneum in the Trendelenburg position (T5) in addition to 5 (T6), 10 (T7) and 30 min (T8) after removal of the pneumoperitoneum in the supine position. RESULTS: The increases of MAP were milder in the N group (22.6-7.3%) than the C group (32.3-17.7%) during pneumoperitoneum and while in the Trendelenburg position. The significant decreases of HR were maintained in the C group, but the changes in HR were not significant in N group during the operation. The increases in CVP were less in N group than C group. The increases of SVR were milder in N group (19.4-1.4%) than C group (41.7-16.6%) during pneumoperitoneum in the Trendelenburg position. CONCLUSIONS: Intraoperative NTG infusions were effective to some degree in reducing the hemodynamic changes during pneumoperitoneum with Trendelenburg positioning for LAR.

Hypocalcemia and hypokalemia due to hyperventilation syndrome in spinal anesthesia: A case report / 대한마취과학회지

Hyperventilation syndrome (HVS) often occurs under stressful conditions, and has been reported during or after anesthesia and operation. HVS, characterized by multiple somatic symptoms and electrolyte imbalances induced by inappropriate hyperventilation, should be managed as an emergency. We report a rare case of HVS during spinal anesthesia. The patient was a previously healthy 51-year-old female without psychogenic conditions. During spinal anesthesia for lower extremity surgery, the patient complained of nausea, headache, paresthesia in the upper extremities and perioral numbness. We found carpal spasm in both hands and flattening of T wave on electrocardiogram (ECG). Emergent arterial blood gas analysis (ABGA) revealed markedly decreased PaCO2, hypocalcemia and hypokalemia. We managed the patient with verbal sedation, electrolytes replacement therapy and closed mask inhalation. HVS subsided gradually. We conclude that monitoring for possible HVS during anesthesia is very important for patient safety.

Anesthetic management in patients suspected of Creutzfeldt-Jakob disease -A case report- / 대한마취과학회지

Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder in which accumulation of the pathogenic prion protein induces neuronal damage and results in distinct pathologic features. This abnormal prion is an infectious protein and resistant to methods of sterilization currently being used. Therefore, management of definite, or suspected CJD patients requires additional precautions. We report our experience of a patient who had undergone brain biopsy for suspected of CJD. The patient was confirmed to have sporadic CJD.

Intravascular kinking of catheter during central venous catheterization in a premature infant: A case report

Central venous catheterization is of vital importance in the management of critically ill neonates and also premature infants for total parenteral nutrition, hemodynamic monitoring, anesthetic care, transfusion or the administration of a few vasoactive drugs. Various complications of this procedure have been reported, such as arterial puncture, pneumothorax, cardiac tamponade, and catheter related kinking or knotting. Due to narrow safety margins, these complications are more dangerous in extremely premature infants compared to adults. We present a case of left subclavian venous catheterization complicated by U-shaped intravascular catheter kinking in premature infant which was successfully repositioned by insertion of a new guidewire through the previous catheter without secondary skin puncture.

Recurred pneumocephalus in a head trauma patient following positive pressure mask ventilation during induction of anesthesia: A case report / 대한마취과학회지

Pneumocephalus is a condition which usually results from head trauma. It has been known that iatrogenic pneumocephalus can occur as a complication of positive pressure mask ventilation during induction of anesthesia or ventilatory care for head trauma patients. We report a case of mask ventilation during anesthesia induction in a 50-year-old male patient with head trauma. Initial pneumocephalus associated with cerebrospinal fluid leakage was diagnosed immediate following head injury involving facial sinuses. He was managed with emergent lumbar drainage and supportive care. Pneumocephalus recurred following positive pressure mask ventilation (PPMV) during anesthesia induction for surgery on the right arm. Recurred pneumocephalus was managed with high flow oxygen and supportive care. Anesthesiologists should be aware of pneumocephalus as a potential complication of PPMV in head trauma patients, even after resolution of previous pneumocephalus.

During the treatment for thoracic postherpetic neuralgia, penetrating atherosclerotic ulcerations occurred: A case report

Treatment for thoracic postherpetic neuralgia can cause penetrating atherosclerotic ulcerations Postherpetic neuralgia is a frequent complication of herpes zoster.It is more common in the elderly population.If the pattern of pain changes especially in the older patients, differential diagnosis is important because the symptoms of some diseases which may be life threatening is similar with that of postherpetic neuralgia.An 83-year-old woman was admitted presenting aggravated pain, dyspnea and poor oral intake during treatment for postherpetic neuralgia involving the left T3 dermatome. She had a previous history of hypertension, congestive heart failure, and pulmonary embolism.Penetrating atherosclerotic ulceration involving the thoracic aorta was diagnosed by CT angiography and her clinical outcome improved through medical treatment.

An anesthetic experience during open heart surgery in a patient with Budd-Chiari syndrome combined with superior vena cava syndrome: A case report / 대한마취과학회지

Budd-Chiari syndrome (BCS) is a rare disorder that arises from obstruction of the hepatic venous outflow tract. BCS causes various clinical status from liver cirrhosis and other systemic diseases that are usually fatal. BCS is caused by hypercoagulability, e.g, arising from malignancy, oral contraceptives, and deficiency of protein S or C. It is not rare that BCS often shows venous thrombosis, including in superior vena cava. We performed a cardiac anesthesia for a 44 year old male with BCS and total superior vena cava syndrome (SVCS) due to the hereditary protein S and C deficiency. Surgical relief of the hepatic outflow stenosis was performed during deep hypothermic circulatory arrest. The patient was managed successfully without conventional intraoperative hemodynamic monitoring such as central venous catheterization, pulmonary artery catheterization, or transesophageal echocardiography due to underlying SVCS and the risk of varix bleeding. After weaning of cardiopulmonary bypass, mild acidosis and hypoxia improved slowly in an intensive care unit. Hypercoagulability was controlled by warfarin during the first postoperative day.

Pulmonary hemorrhage accompanied with pulmonary edema induced by endotracheal tube occlusion in a child: A case report / 대한마취과학회지

Negative pressure induced pulmonary edema due to upper airway obstruction is a well-recognized problem. However, negative pressure pulmonary hemorrhage is extremely uncommon. We report a child who developed negative pressure pulmonary hemorrhage following acute airway obstruction caused by clench of endotracheal tube during emergence of anesthesia. The patient was treated with positive pressure ventilation and frequent tracheal suction. Hemorrhage from endotracheal tube was gradually decreased after 4 hours. The patient was extubated after 7 hours.

Perioperative Management for the Patient with May-Thurner Syndrome: A Case Report / 대한구급학회지

May-Thurner syndrome is an anatomic variant in which the left common iliac vein is compressed by the right common iliac artery. The most frequent clinical presentation is deep vein thrombosis of the left lower extremity. We report the perioperative management in a patient with May-Thurner syndrome undergoing an open reduction of a tibia fracture. The patient developed deep vein thrombosis of the left lower extremity and had an endovascular stent placed approximately 1 year earlier. An important aspect of the perioperative management in a patient with May-Thurner syndrome is to prevent deep vein thrombosis. We monitored the activated clotting time during the intraoperative period.

Myoclonus following Spinal Anesthesia with Hyperbaric Bupivacaine: A case report / 대한마취과학회지

Myoclonus is a rare neurologic complication of spinal anesthesia.We describe here a case of spinal segmental myoclonus that we encountered in a 45-year-old woman following spinal anesthesia. Spinal anesthesia was performed using 2.4 section sign cent of 0.5% hyperbaric bupivacaine without any complications and surgery was uneventful.However, myoclonic movements were observed in her lower extremities 2 hours after the intrathecal injection. These movements were ameliorated by intravenous injection of diazepam. The patient fully recovered without any neurologic sequelae.

Severe Hypercapnia during Cardiopulmonary Bypass due to Carbon Dioxide Insufflation: A case report / 대한마취과학회지

Air embolization is a potential danger during open heart surgery. To prevent air embolization in incompletely deaired cardiac chambers, flooding of the surgical fields with carbon dioxide (CO2) is used during cardiopulmonary bypass. CO2 flooding may be more useful in de-airing for patients undergoing minimally invasive cardiac surgery. We experienced an episode of sudden, severe hypercapnia and respiratory acidosis in a 51-year-old female patient during hypothermic cardiopulmonary bypass for minimally invasive mitral valve replacement. During hypercapnia, hemodynamic and BIS data were stable except for a slight increase in mean arterial pressure. After ruling out other causes of hypercapnia such as oxygenator failure and malignant hyperthermia, severe hypercapnia disappeared gradually after the cessation of CO2 flooding in the surgical field. No neurologic or cardiopulmonary complications were noted after the operation. We concluded that frequent or continuous CO2 monitoring may be required during CO2 insufflation at surgical fields to prevent hypercapnic complications in minimally invasive cardiac surgery.

Hemodynamic and Arterial Blood Gas Changes following Tourniquet Use under General Anesthesia with Sevoflurane or Propofol for Total Knee Replacement (TKR) in Geriatric Patients

BACKGROUND: Tourniquets are widely used to provide a clean surgical field but can induce variable hemodynamic and metabolic changes. Sevoflurane is one of anesthetic agents used for unstable or elderly patients, and propofol can be used for smooth induction and early recovery with few side effects. This study evaluated the differences in the hemodynamic and metabolic changes after the application of a tourniquet under general anesthesia with sevoflurane or propofol for total knee replacement (TKR). METHODS: Thirty elderly female patients scheduled to undergo TKR were allocated into two groups, the general anesthesia with sevoflurane group (S group, n = 15) or the propofol group (P group, n = 15). The hemodynamic parameters such as the mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), and arterial blood analysis were checked immediately before (control, T1), at 5 (T2), 30 (T3) and 60 minute (T4) after inflation, and at 5 (T5) and 30 minutes after (T6) deflation. RESULTS: Compared with T1, the MAP increased significantly at T2, T3, and T4 in both groups. The increase in the SVR after inflating the tourniquet and the decrease in the SVR after deflation were lower in the P group than in the S group. The metabolic changes after deflating the tourniquet were similar in both groups. CONCLUSIONS: Compared with sevoflurane, propofol did not significantly decrease the hemodynamic and metabolic changes after placing a tourniquet during TKR for elderly patients. therefore, both sevoflurane and propofol are acceptable anesthetics for TKR in geriatric patients.

Total Atelectasis after Intubation of a Double Lumen Tube: A case report / 대한마취과학회지

The intubation of a double lumen endotracheal tube (DLT) has become the technique of choice for most procedures requiring one lung ventilation (OLV). The potential complications of the use of DLT are airway ruptures and malpositions of the DLT which can induce an increase of airway pressure, hypercapnia, severe hypoxemia, and other effects during the induction of general anesthesia. The intractable hypoxia due to total lung atelectasis is one of the very rare complications during and after intubation of the DLT. We experienced a 16 year-old male patient with severe hypoxia scheduled for thoracoscopy after a position change from supine to lateral decubitus. The hypoxia was unable to be easily corrected by endobronchial suction, rechecking of DLT position with fiberoptic bronchoscope, and manual positive ventilation, even after a position change to supine. An emergent chest X-ray revealed total atelectasis of the right lung that was relieved gradually by general supportive care at the intensive care unit.

Comparison of Thiopental Sodium and Ketamine Induction on Emergence Agitation after Desflurane Anesthesia in Children undergoing a Tonsillectomy / 대한마취과학회지

BACKGROUNDs: It is widely known that desflurane provides fast emergence but with a high incidence of emergence agitation. This study was designed to investigate the emergence agitation resulting from thiopental or ketamine induction with desflurane anesthesia for pediatric patients. METHODS: Forty patients, aged 3-8 years, scheduled for a tonsillectomy or a tonsillectomy and adenoidectomy were randomly allocated into two groups. Anesthesia was induced using 5 mg/kg thiopental sodium (Group T patients) or 2 mg/kg ketamine (Group K patients), and was maintained using O2-N2O-desflurane. The recovery time and incidence of emergence agitation were assessed. RESULTS: The incidence of emergence agitation was less in patients in the ketamine induction group. There were no differences in the recovery time and reported side effects. CONCLUSIONS: We conclude that ketamine induction provides less emergence agitation when compared to thiopental induction for desflurane anesthesia for a pediatric tonsillectomy or a tonsillectomy and adenoidectomy without delayed recovery.

Pharmacological Cardioversion with Phenylephrine for Paroxysmal Supraventricular Tachycardia during Lung Resection Surgery: A Case Report / 대한구급학회지

Supraventricular arrhythmias during and after thoracotomy for pulmonary resections are well documented, and risk factors of post-pulmonary resection arrhythmias are old age, magnitude of surgery, and coexisting cardiopulmonary disease etc. Among of supraventricular arrhythmias, atrial fibrillation is the most common rhythm disturbance that may be associated with increased morbidity and mortality. We experienced a case of paroxysmal supraventricular tachycardia with severe hypotension which was escalated from atrial fibrillation during pulmonary bilobectomy for tuberculosis in a 44-year old male patient. Instead of usual electrical cardioversion or common antiarrhythmic agents, we selected phenylephrine bolus injection which induced normal sinus rhythm successfully from paroxysmal supraventricular tachycardia of the patient.