Hydrothorax due to extravasation of intravenous contrast through left subclavian catheter -A case report- / 대한마취과학회지

Central venous catheterization is associated with a large number of complications, such as pneumothorax, hydrothorax, hemothorax, phlebothrombosis, pericardial tamponade, air embolism, aberrant placement and line sepsis. There are many case reports of the extravasation of various central venous catheter fluids, including the intravenous fluids, total parenteral nutrition and chemotherapeutic agents into the pleural cavity and mediastinum. These have led to hydrothorax, hydromediastinum and pericardial effusions. We report a case of the extravasation of intravenous contrast into the pleural cavity after dynamic CT through a left subclavian catheter.

Ventricular fibrillation due to coronary spasm at the site of myocardial bridge: A case report / 대한마취과학회지

Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography.

Very late stent thrombosis of DES implanted patient during noncardiac surgery: A case report / 대한마취과학회지

Very late stent thrombosis after implantation of drug eluting stent is rare, but its consequences are potentially fatal. Stent thrombosis may be occurred in perioperative period because of interruption of anticoagulation therapy and intraoperative hypercoagulability. We report a case of very late stent thrombosis in a 49-year-old male patient during total gastrectomy. ST-segment elevation in lead II occurred during the surgery and followed by cardiac arrest. After external cardiac massage and electrocardioversion, normal sinus rhythm was restored. Postoperative 12 lead ECG showed ST-segment elevation in leads II, III, aVF and serum cardiac enzymes such as CPK, CK-MB, and Troponin T were markedly elevated. Postoperative coronary angiography showed complete occlusion of the right coronary artery stent. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.

Oculocardiac Reflex during Endoscopic Sinus Surgery: A case report / 대한마취과학회지

The oculocardiac reflex is provoked by pressure applied to the globe of the eye or traction on the surrounding structures. It has been known that children and adults undergo eye muscle surgery under general anesthesia are most susceptible. When it occurs the most common manifestation is sinus bradycardia and other arrhythmia including atrioventricular block, ventricular premature beat and cardiac arrest. Endoscopic sinus surgery has been used popularly for treatment of chronic paranasal sinusitis. However endoscopic sinus surgery can be difficult for narrow visual field and anatomical variations. Oculocardiac reflex during endoscopic sinus surgery is rare case but potentially it can be life threatening event. The authors report the case of oculocardiac reflex during endoscopic sinus surgery with a review of literature.

Epidural Anesthesia for Percutaneous Endoscopic Lumbar Discectomy during Pregnancy: A case report / 대한마취과학회지

Low back pain is common during pregnancy and has been reported in as many as 56% of pregnant women.However, the incidence of symptomatic lumbar disc displacement in pregnancy is exceedingly rare, and anesthetic management is particularly important in such cases because the attending anesthesiologist and surgeon must consider the effects of the anesthesia, the patient's position, and surgery on the fetus.We administered an epidural anesthesia for percutaneous endoscopic lumbar discectomy at 35 weeks of gestation with the patient in the prone position.The patient maintained an uneventful pregnancy and delivered a healthy baby at 38 weeks of gestation

Combined Continuous Psoas Compartment Block and Sciatic Nerve Block for Revision Arthroplasty of the Hip in a Patient with Ankylosing Spondylitis : A case report / 대한마취과학회지

Ankylosing spondylitis is a chronic and systemic disease invloving the axial skeleton. In patient with involved cervical spine of the ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult or impossible because they have a limitation of cervical movement and anatomical anomalies. Additionally, ossification of the interspinous ligaments and the formation of bony bridges (syndesmophytes) between vertebrae, resulting in a classic "bamboo spine" appearance make difficult or impossible placement of an epidural or spinal needle. We report a case of a patient with long standing ankylosing spondylitis who underwent revision arthroplasty of the hip using combined continuous psoas compartment block and sciatic nerve block.

Interscalene Brachial Plexus Block Following Suprascapular Nerve Block for Humeral Head Surgery in a Patient with Difficult Supine Position: A case report / 대한마취과학회지

Although shoulder surgery is usually performed during general anesthesia, the use of an interscalene block alone or in combination with other anesthetic procedures is increasing. Blockade of the suprascapular nerve is used in the diagnosis and treatment of shoulder pain and to provide temporary relief from muscle spasm or strain in the supraspinatus or infraspinatus muscle We report a case of a patient that presented with severe shoulder pain who underwent surgery for traumatic humeral head fracture. Anesthesia was provided by an interscalene block follwing suprascapular nerve block.

A Simultaneous Application of Brachial Plexus Block and Combined Spinal-Epidural Anesthesia for the Reduction of Radioulnar Fracture and Iliac Bone Graft : A Case Report / 대한마취과학회지

Brachial plexus block is a suitable, technique for surgery of the forearm, because it provides good intraoperative anesthesia and prolonged postoperative analgesia when long-acting local anesthetics are used. An eighty-year-old male patient was admitted to our hospital for right radioulnar fracture. He had active pulmonary tuberculosis, severe valvular heart disease, hypertension, mild subarachnoid hemorrhage and a difficult airway. So, we performed an infraclavicular block to treat the fracture site and used a nerve stimulator when median nerve dital response and musculocutaneous nerve response were sought, and combined spinal-epidural block for the iliac bone graft at the same time. Regional anesthesia many advantages compared to general anesthesia in extremity operation. Peripheral nerve block and neuraxial block, when used properly in combination, should be able to replace general anesthesia in the majority of cases.

A Comparison of the Effect of Fentanyl and Fentanyl-Nalbuphine for Postoperative Analgesia Using IV-PCA / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) is effectively used for postoperative pain control. Fentanyl has a strong analgesic effect but has some side effects. The purpose of this study was to compare the side effects and analgesic effects of fentanyl alone and combination with nalbuphine in patients using intravenous PCA. METHODS: Forty six ASA class 1 or 2 patients were randomly divided into two groups. Group F (n = 23) received fentanyl 1,200microgram in 100 ml of normal saline. Group NF (n = 23) received nalbupine 60 mg and fentanyl 600microgram in 100 ml of normal saline. All patients used the same background infusion rate (2 ml/hr), bolus dose (2 ml) and lockout interval (15 min) just after emergence from general anesthesia. The analgesic effect was evaluated by using a visual analogue scale (VAS) at 1 hr, 6 hr, 12 hr, 24 hr and 48 hr postoperatively. Side effects and satisfaction degree were also checked. RESULTS: No significant differences were observed between the two groups in terms of pain scores and satisfaction degrees. The side effects were similar in both groups except that sedation was significantly (P<0.05) lower in group NF. CONCLUSIONS: We conclude that nalbuphine with fentanyl in combination is a useful method for intravenous PCA. On comparing the incidence of side effects in the two groups, sedation was found to be lower for the combined regimen.

A Study on the Preemptive Analgesic Effect of Low Dose Intravenous Ketamine and Combined Ketamine-Clonidine / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the preemptive analgesic effect of a single intravenous infusion of low dose ketamine-clonidine. We compared the placebo with low dose ketamine and low dose ketamine-clonidine in patients undergoing an appendectomy. METHODS: Sixty ASA class 1 or 2 patients who received general anesthesia for an appendectomy were allocated randomly to three groups. Group 1 received intravenous normal saline 6 ml and group 2 received ketamine 0.15 mg/kg in normal saline 6 ml and group 3 received ketamine 0.15 mg/kg and clonidine 1microgram/kg in normal saline 6 ml 5 minutes before surgical incision. In the recovery room postoperative analgesia was assessed by the verbal numerical rating scale (VNRS) at 0 min, 15 min, 30 min, 60 min, 90 min and 120 min. Vital signs, sedation score and side effects were also checked. For postoperative analgesia, morphine 2 mg was given intravenously whenever a patient complained of pain, or the VNRS score was above 7. RESULTS: There were no intergroup differences of individual morphine requirements for postoperative pain control among the three groups. VNRS score, blood pressure, heart rate, sedation score and side effects were not significantly different among the three groups. CONCLUSIONS: A single low dose of ketamine-clonidine may not produce a postoperative analgesic effect in the recovery room, and a single low dose of ketamine also may not produce the preemptive effect for at least 2 hours.

Effect of Mixed Administration of Lidocaine-Propofol on Vascular Pain after Tramadol Pretreatment / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and many different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of saline pretreatment with that of lidocaine mixed with propofol after tramadol pretreatment on propofol injection pain. METHODS: Eighty patients scheduled for general anesthesia were randomly divided into four groups. Control group (n = 20) received 2 ml of 0.9% saline pretreatment, Group 1 (n = 20) received 50 mg of tramadol pretreatment, Group 2 (n = 20) received 40 mg of 2% lidocaine pretreatment and Group 3 (n = 20) received 40 mg of 2% lidocaine mixed with propofol after 50 mg of tramadol pretreatment. Each patient received one of the pretreatment drugs via 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 70 mmHg. The tourniquet was released 1 minute later, followed intravenous injection of 2 mg/kg of propofol at a rate of 1 ml/sec. After 50 mg of propofol were injected, patients were assessed for pain score. The severity of pain was classified as 0, 1, 2, 3 (none, mild, moderate, severe) by one observer. RESULTS: The severity and incidence of pain were significantly reduced in group 2 and group 3 compared with control group for intravenous injection of propofol (P<0.05). but there was no significant difference between control group and group 1. CONCLUSIONS: Mixed administration of lidocaine-propofol after tramadol pretreatment could significantly reduce the severity and incidence of pain for intravenous injection of propofol.

Epidural Block with Prior Dural Puncture versus Combined Spinal Epidural Block for a Cesarean Section / 대한마취과학회지

BACKGROUND: Epidural anesthesia became most popular for a cesarean section, but it is more time consuming and involves a higher incidence of insufficient or superficial blockade, especially of the motor root, despite large doses of local anesthesia. Combined spinal epidural anesthesia has gained an increasing interest as it combines the reliability of the spinal block and the flexibility of an epidural block. A dural puncture using the combined spinal epidural technique making an early sacral blockade might be a solution to disadvantages in epidural anesthesia. We investigated the efficacy of combined spinal epidural anesthesia and epidural anesthesia with prior dural puncture for a cesarean section. METHODS: Sixty pregnant women at full term were divided into three groups. Group I (EPI, n = 20) received epidural anesthesia with 100 mg of 0.5% bupivacaine. Group II (CSE, n = 20) received combined spinal epidural anesthesia with 1.2 1.4 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by sensory block at T10 after by 7 8 ml of 0.5% bupivacaine through the epidural catheter. Group III (DP, n = 20) received epidural anesthesia with prior dural puncture. A dural puncture with a 27 G whitacre needle was done before an infusion of 20 ml of 0.5% bupivacaine through the epidural catheter. The quality and side effects of surgical anesthesia were compared between the three groups. RESULTS: Time to T10 (P< 0.001) and surgical onset time (P< 0.001) were significantly shorter in the CSE group. Maximal sensory block level (P< 0.001) was significantly higher in the CSE group. Muscle relaxation (P< 0.05) and motor block (P< 0.001) were much better in the CSE group. Hypotension occurred in 25% (EPI group), 40% (CSE group) and 20% (DP group) of the patients. While 65% of the EPI group and 50% of the DP group complained of intraoperative pain, only 25% of CSE group did (P< 0.05). CONCLUSIONS: We can conclude that combined spinal epidural anesthesia has great efficacy and less side effects for a cesarean section than epidural anesthesia and epidural anesthesia with prior dural pucture.

The Effect of Lidocaine and Ketorolac Combined to Fentanyl IV PCA on Postoperative Bowel Function / 대한마취과학회지

BACKGROUND: A postoperative ileus after anesthesia and surgery may be bothersome to recovery and prolong hospitalization periods. The object of this study was to investigate the effect of lidocaine and ketorolac combined to fentanyl IV PCA on the recovery of bowel function after surgery. METHODS: Forty-nine patients undergoing a total abdominal hysterectomy were divided into three groups (F, FT, LFT). All patients received IV PCA for postoperative pain control. PCA contents were fentanyl 1,000 microgram only in saline 100 ml in group F (n = 16) and fentanyl 500 microgram-ketorolac 150 mg in saline 100 ml in group FT (n = 17) and LFT (n = 16). Group LFT received a lidocaine bolus (1.5 mg/kg) before induction and a continuous infusion of lidocaine (2 mg/min) until one hour after surgery. We measured postoperative pain scores (at postoperative 1 hour, 6 hours, 24 hours, and 48 hours) and checked the first flatus time, the first defecation time, and the side effects. RESULTS: The intravenous lidocaine infusion group showed better pain scores at postoperative 1 hour only. The FT and LFT groups provided a more rapid return of bowel function than group F. A combined infusion of lidocaine and ketorolac had no difference in the return of bowel function. There were no significantly different incidences of nausea, vomiting and other side effects. CONCLUSIONS: Ketorolac allowed an earlier recovery of bowel function after surgery. However, an additional infusion of lidocaine was not helpful in the return of bowel function.

A Case Report of Cerebral Infarction Following General Anesthesia / 대한마취과학회지

Stroke is defined as a focal neurological deficit lasting more than 24 hours. The complications related to the central nervous system after general surgery is unusual and is difficult to discover the exact causes. We are going to report a case of an unexpected cerebral infarction after a Whipple's operation. The patient was a sixty-three years old female weighing 53 Kg with a diagnosis of cancer of ampulla of Vater scheduled for a Whipple's operation under general anesthesia. Preanesthetic assessment revealed a history of hypertension and hypercholesterolemia. After surgery, she was alert but she appeared to have right hemiparesis, aphasia and right facial palsy. A brain MRI showed a cerebral infarction in the bilateral basal ganglia, left medial temporal lobe and insular cortex. The cause of the cerebral infarction in this patient was unclear. Cerebral thrombosis was first thought of, but we couldn't completely exclude other possible causes e.g., embolism etc. In cases where risk factors of a stroke were found in preoperative evaluation, it is important to correct risk factors preoperatively. Furthermore, it is necessary to prevent hypotension, keep proper hematocrit levels and temperature during an operation, and use hemocoagulase carefully in cases of patients having risk factors of thrombosis and embolism.