A Case on Diplopia after Epidural Catheterization for Postoperative Pain Control: A case report / 대한마취과학회지

A 53 year old man with gastric cancer was admitted for radical subtotal gastrectomy. The patient received general anesthesia with epidural analgesia. Epidural catheterization was performed using an 18-gauge Tuohy needle at the T10-11 interspace, and the epidural space was confirmed after a repeated attempt. An epidural catheter was then advanced smoothly 5 cm in cephalad direction without bleeding or CSF leakage. The patient received a test dose of lidocaine and epinephrine and continuous infusion with morphine and lidocaine 30 minutes before operation finished. Vital signs during the operation were stable. Two days after the operation, the patient complained of an orthostatic headache, and relieved ketolorac. On the seventh day, the patient complained of bilateral diplopia. Diffuse pachymeningeal gadolonium enhancement was seen on the brain MRI, and his CSF pressure was 0 mmHg by spinal tapping. We suspected abducent nerve palsy due to CSF hypovolemia and performed an epidural blood patch with 15 ml of autologus blood at the previous puncture site. The patient is receiving regular examinations at the Neurology and Opthalmology department. Abducent nerve palsy completely recovered by the Hess Screen test 6 months after operation, and diplopia disappeared 10 months after the operation.

Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State / 대한마취과학회지

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.

Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State / 대한마취과학회지

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.

Comparison of Bain-Spoerel's Method and Paik Hospital's Method in Mechanical Ventilation with Modified Mapleson D Circuit in Pediatric Anesthesia / 대한마취과학회지

BACKGROUND: Although modified Mapleson D systems connected to ventilators have been used for controlled ventilation of anesthetized infants and children, the complexity of factors affecting rebreathing within the Mapleson D circuit has resulted in a variety of recommendations for fresh gas flow and minute ventilation. We constructed a formula for ventilator settings which would provide normal tidal volume, respiratory rate, and minute ventilation without rebreathing during mechanical ventilation in pediatric anesthesia and would like to compare this method to commonly recommended Bain-Spoerel's method. METHODS: Seventy eight infants and small children who anesthetized with enflurane and nitrous oxide were studied. We performed controlled ventilation with each method and measured SpO2, PETCO2 at 10, 20, 30 min after anesthetic induction. At 20 min after anesthetic induction, we drew a arterial blood sample to evaluate PaCO2 and PaO2. RESULTS: In patients above 10 kg, mean PaCO2 was within normal range. But in patients below 10 kg, PaCO2 was significantly higher(p<0.01) with the Bain-Spoerel's method than with the Paik Hosp.'s method. CONCLUSIONS: We conclude that our method for ventilator settings can be safely and competently applied to mechanical ventilation with Modified Mapleson D circuit in pediatric anesthesia.