Accidental epidural injection of ephedrine: A case report / 대한마취과학회지

We report a case of accidental epidural ephedrine injection. A 29-year-old male with left femoral artery occlusion was scheduled for thromboembolectomy. The operation was performed under epidural anesthesia. During the operation, ephedrine (30 mg/6 ml) was accidentally injected through epidural catheter instead of ropivacaine (45 mg/6 ml). Following the incident, we injected normal saline (10 ml) in the epidural space to dilute the solution. The patient had no complaint but blood pressure rose to 165/115 mmHg transiently. We observed the patient closely in recovery room and no further complication was found. In previous reports, various attempts have been tried to manage such incidents, but no definitive treatment for accidental injection is known. We present this case to remind the importance of confirming the drug everytime before injection.

The Effect of Intraoperative and Postoperative Music on Patients of Regional Anesthesia / 대한마취과학회지

BACKGROUND: Music influences the body and mental well-being of humans. Almost all patients undergoing surgery experience perioperative anxiety. This study was designed to determine the effect of music during surgery and the post-operation period under regional anesthesia on the level of anxiety, relaxation and fatigue. METHODS: Sixty-four patients who underwent orthopedic surgery under regional anesthesia were randomly assigned to Group 1 (listening to music) and Group 2 (no music). The premedication and anesthesia were standardized for both groups. The level of anxiety, fatigue and psychological well-being were examined as outcome variables. RESULTS: The level of anxiety and psychological well-being was significantly lower (anxiety: P = 0.012, psychological well-being: P = 0.006) in Group 1 than in Group 2. The level of fatigue was similar in both groups. CONCLUSIONS: The results suggested that music might be effective in reducing the level of intra and post-operative anxiety and improving the psychological well-being of patients undergoing surgery under regional anesthesia.

The Effects of Intrathecal Midazolam Added to Bupivacaine on Duration of Sensory Block and BIS Sedation Score / 대한마취과학회지

BACKGROUND: The antinociceptive action of intrathecal midazolam is well documented and the administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. This study was designed to evaluate the duration of sensory block and BIS sedation score of intrathecal midazolam-bupivacaine mixture in patients undergoing knee arthroscopy. METHODS: In this double-blind prospective study, one hundred twenty seven patinets were randomly assigned to receive 4.5 ml of one of the following intrathecal solutions: 15 mg of 0.5% isobaric bupivacaine plus 1.5 ml of 0.9% saline (Group C; n = 34); 15 mg of 0.5% bupivacaine plus 0.5 ml of 0.1% midazolam and normal saline 1 ml mixture (Group 0.5; n = 28); 15 mg of 0.5% bupivacaine plus 1 ml of 0.1% midazolam and normal saline 0.5 ml mixture (Group 1; n = 27); 15 mg of 0.5% bupivacaine plus 1.5 ml of 0.1% midazolam (Group 1.5; n = 38). Time of sensory block until L5-S1 level regression occurred and sedation score using BIS, duration of effective analgesia connecting IV-PCA pump, blood pressure, heart rate, oxygen saturation and nausea/vomiting were recorded and observed. RESULTS: A significantly longer sensory block duration was seen in group 0.5, 1, 1.5 patients compared with group C (P < 0.01). Correlation coefficent of midazolam dose and sensory block duration was 0.95. Duration of effective analgesia was also prolongated in midazolam-bupivacaine mixture groups (P < 0.01). Blood pressure, heart rate, oxygen saturation and nausea/ vomiting showed no differences among the groups. Sedation score was slightly decreased in only group 1.5, but not to the level of unconsciousness. CONCLUSIONS: The results suggest that addition of midazolam 1.5 mg to 0.5% bupivacaine intrathecally provided prolongation of sensory block without any adverse effects.

Endoscopic Hemoclipping in a Terminal Ileal Dieulafoy's Lesion / 대한소화기내시경학회지

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping.

A Case of Hydrogen Peroxide Proctitis / 대한소화기내시경학회지

Hydrogen peroxide is a safe and useful disinfectant that has achieved widespread utility in various clinical settings. However, hydrogen peroxide may cause mucosal damage and contact injury when applied to the surface of the gut wall. Endoscopically, hydrogen peroxide colitis and proctitis can mimic acute ulcerative colitis, ischemic colitis, or pseudomembranous colitis such as mucosal whitening, erythema, frothy bubbles, granularity and ulceration. We have experienced a case of hydrogen peroxide proctitis in a 37- year-old female patient. She visited our hospital due to symptoms such as hematochezia, anal pain and pelvic pain after insertion of 15 mL of 3% hydogen peroxide. Colonscopy revealed rectal mucosal whitening, severe erythema and scattered small ulcerations up to 12 cm from the anal verge. Pathologic finding revealed neutrophil infiltration in the lamina propria and intact colonic crypt. Herein we report a case of hydrogen peroxide proctitis with reviewed literatures.

4 Cases of Duodenal Diverticular Bleeding Treated by Endoscopic Therapy / 대한소화기내시경학회지

Duodenal diverticulum appears in 6% of upper gastrointestinal examinations and up to 23% of endoscopic retrograde cholangiopancreaticographies and up to 22% at autopsy. Most of these patients are asymptomatic, but a small fraction develop complications including choledocholithiasis, cholangitis, pancreatitis, diverticulitis, perforation, fistular formation and bleeding. Among these complications, only a few documented cases of bleeding have been reported in the literature, and the experience of endoscopist to the sequence of diagnosis, endoscopic treatment, and subsequent relief of the symptoms remains limited. Aggressive but careful endoscopic examination can help diagnosis of the cases. Also, endoscopic treatment of duodenal diverticular bleeding is very effective and proved to be an effective alternative to surgery. We report 4 patients with duodenal diverticular bleeding in whom both diagnosis and definitive treatment were successful by endoscopy alone.

A Case of Endoscopic Treatment of Bleeding in Duodenal Dieulafoy's Lesion / 대한소화기내시경학회지

Dieulafoy's lesions are often unrecognized cause of obscure, massive gastrointestinal bleeding, reported to be 0.3~1.5% of cases of major gastrointestinal bleeding. It is characterized by severe bleeding from rupture of an exposed submucosal artery. Dieulafoy's lesion is usually occured in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been described in the esophagus, duodenum, small intestine, colon, and rectum. The diagnosis is made by endoscopy, angiography, laparoscopy, or laparotomy. Endoscopy showed protruding and eroded artery with pulsatile bleeding or adherent thrombus. Currently, various therapeutic options are available to the endoscopist for the treatment of Dieulafoy's lesions. Therapeutic endoscopy should now become first-line therapy for Dieulafoy's lesions. We experienced a rare case of bleeding from the duodenal Dieulafoy's lesion. Endoscopic hemoclipping was performed successfully. We report this case with a review of the literature.

Two Cases of Multiple Carcinoid Tumors of the Rectum / 대한소화기내시경학회지

Carcinoid tumors of the rectum are relatively uncommon and comprise only about one percent of all rectal neoplasms. Typically, rectal carcinoids present as small, solitary submucosal nodules and have benign course. But, multicentricity is rare. The frequency of an associated second malignancy is about 13%. The explanation of the high frequency of other neoplasms associated with carcinoid tumors is still unclear. We have experienced two cases of multiple carcinoid tumors of the rectum, one was coexisted with adenocarcinoma of the sigmoid colon. They presented with mass on the right inguinal area and hematochezia. Carcnoids was found incidentally. Because the tumors measured 15 mm or less in diameter, did not infiltrate beyond the submucosal layer and had no histological atypia, carcinoids was treated by endoscopic polypectomy and mucosal resection. Thereafter, one underwent surgery for adenocarcinoma of the sigmoid colon. Herein we present our experience with reviewed literatures.