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.

The Incidence of Abnormal Electrocardiogram Findings in Preoperative Screening Tests / 대한마취과학회지

BACKGROUD: To study the prevalence of abnormalities found in routine preoperative eletrocardiograms (ECGs) and to analyze abnormal ECG findings in different age groups. METHODS: 9,709 patients undergoing elective surgery requiring anesthesia at Busan Paik Hospital from January to December 2002 were retrospectively studied. Preoperative ECGs were analyzed in terms of age, sex and specific abnormal ECG findings that might alter anesthetic management. RESULTS: 1,683 of 9,709 patients (17.3%) had abnormal electrocardiogram findings. The incidences of ventricular hypertrophy, bundle branch block, myocardial ischemia, arrhythmia, myocardial infarction and atrioventricular block were 5.3%, 4.1%, 3.9%, 2.5%, 1.0% and 0.5%. Those over 75 years, 43% had abnormal findings and the incidence of myocardial ischemia, arrhythmia and ventricular hypertrophy were 11.7%, 9.7% and 8.7%. CONCLUSIONS: The prevalence of unexpected preoperative ECG abnormalities among elective surgery patients is high, especially among older patients. Given the wealth of information provided by preoperative ECG at low cost, ECG is necessary to establish the components of routine preoperative assessment for cardiovascular disease, especially for older adults.