Acute Bacterial Meningitis after Continuous Epidural Analgesia: A case report / 대한마취과학회지

Recently, continuous epidural catheter insertion is common practice not only in anesthesia but also in pain clinic. Meningitis is rare but serious complication of epidural analgesia. Acute bacterial meningitis occurred in a 82-year-old female patient with thoracic herpes zoster after continuous thoracic epidural analgeia. An MRI of thoracic region did not show an epidural abscess or granulation tissue. Gram stain and culture of the epidural catheter tip and the CSF yielded Staphylococcus aureus. Immediate treatment with antibiotics and supportive therapy was instituted and then the patient discharged without neurologic sequalae.

The Effects of the Body Positions and the Durations of CO2 Pneumoperitoneum to the PaCO2 and PETCO2 during Laparoscopy / 대한마취과학회지

During laparoscopic surgery with carbon dioxide (CO2) pneumoperitoneum, PaCO2 (arterial CO2 gas tension) and P(ET)O2 (end-tidal CO2 gas tension) will be affected by the durations of CO2 pneumo-peritoneum and the body positions. PaCO2 and P(ET)CO2 were investigated 5 minutes after induction of general anesthesia(control value), 10 minutes, 30 minutes and 60 minutes after CO2 gas insufflation, and 15 minutes after CO2 gas excretion. Seventy-two patients undergoing laparoscopic surgery under general anesthesia were allocated to two study groups: group I, laparoscopic appendectomy under the Trendelenburg position; group II, laparoscopic cholecystectomy under the reverse Trendelenburg position. In results, PaCO2 and P(ET)CO2 were significantly increased during laparoscopic surgery that associated with times of CO2 pneumoperitoneum. PaCO2 and P(ET)CO2 at 60 minutes after CO2 gas insufflation were increased from P(ET)CO2 control value 35.8+/-4.2 mmHg, P(ET)CO2 . control value 34.0+/-3.6 mmHg to P(ET)CO2 . 39.98.0 mmHg, P(ET)CO2 42.3+/-4.7 mmHg(p<0.05). PaCO2 and PO in group I were more increased compared with group II. PaCO and P(ET)CO2 in group I were increased from PaCO2 control value 35.9+/-4.8 mmHg, P(ET)CO2 control value 34.9+/-3.7 mmHg to PaCO2 45.7+/-2.5 mmHg, P(ET)CO2 48.0+/-3.6 mmHg(p<0.05), in group II from PaCO control value 35.7+/-3.2 mmHg, P(ET)CO2 control value 32.8+/-3.0 mmHg to PaCO2 38.4+/-8.3 mmHg, P(ET)CO2 40.4+/-3.2 mmHg(p<0.05). In conclusion, to minimize the risk of a carbon dioxide retension during laparoscopy especially under the Trendelenburg position, we recommend that ventilation should be adjusted to to the normal range of PaCO2 and P(ET)CO2.

Anesthetic management for repair of Tracheoesophageal fistula with proximal esophageal atresia / 대한마취과학회지

A two days old female baby was transferred to our hospital from local clinic due to respiratory difficulty. The baby was born at 38 weeks gestation through cesarian section in the clinic. At birth, the body weight of the baby was 2280 grams and the Apgar score at 1 minute and 5 minute were 5 and 7. The child had frothing about the nose and mouth, and regurgitated the first feeding almost immediately. Coughing and mild cyanosis were associated with regurgitation. She was diagnosed as distal tracheo-esophageal fistula with proximal esophageal atresia and transferred to our hospital for further evaluation and corrective surgery. She had no other congenital anomaly. The most common defect consists of a blind upper esophageal pouch and a fistula between the lower esophagus and trachea. The preferred surgical approach for treatment of the newborn with this disease is ligation of the defect and primary anastomosis of the esophageal segments by an extra-pleural approach. Proper placement of the tracheal tube is critical. It should be above the carina but below the tracheoesophageal fistula. Nitrous Oxide should be used with caution in a neonate without a gastrostomy, as diffusion of this gas into the distended stomach would be undesirable. The emergency operation was done under general anesthesia. She was tolerable anesthesia and operation. Special respiratory care and continuous antibiotic administration were done. She discharged 18 days later without significant pulmonary complication or sequelae.