Anesthetic management of an elderly COVID-19 patient with pulmonary thromboembolism for hip surgery - A case report -

Background@#COVID-19 and delayed hip surgery are well-known risk factors for thromboembolism in elderly patients.Case: We report the case of an 88-year-old female patient with COVID-19 and pulmonary thromboembolism (PTE) who underwent delayed hip surgery 21 days after the injury. Heparinization and inferior vena cava filters were used to treat and prevent PTE. Transesophageal echocardiography and extracorporeal membrane oxygenation (ECMO) sheaths were inserted as a precaution in case of emergencies during surgery; the procedure was performed without any specific event. @*Conclusions@#COVID-19-infected patients suffering from a hip fracture have a high risk of thromboembolism, and therefore, require utmost attention for appropriate evaluation and prevention.

Catatonia associated with prolonged stupor after general anesthesia in a patient with multiple neuropsychiatric disorders -a case report- / 대한마취과학회지

Background@#Delayed emergence after general anesthesia may significantly affect a patient’s condition. We present the case of a patient who experienced prolonged delayed recovery of consciousness, language, and motor response due to catatonia after eight hours of total elbow arthroplasty under general anesthesia.Case: A 68-year-old woman with neuropsychiatric disorders and Parkinson’s disease did not respond adequately during recovery after more than eight hours of general anesthesia. Following the operation, the patient was semi-comatose and appeared to have nonconvulsive status epilepticus upon awakening from anesthesia. However, subsequent examinations did not reveal any organic causes. The patient was subsequently diagnosed with catatonia, treated, and discharged following gradual improvement. @*Conclusions@#Although rare, patients taking psychiatric drugs for an extended period may experience delayed emergence after prolonged general anesthesia without identifiable causes. Catatonia should be considered in the differential diagnoses of these patients.

Application of competency-based education in the Korean anesthesiology residency program and survey analysis / 대한마취과학회지

Background@#Although competency-based education (CBE) is becoming a popular form of medical education, it has not been used to train residents. Recently, the Korean Society of Anesthesiologists completed a pilot implementation and evaluation of a CBE program.This study aims to outline the experience. @*Methods@#The chief training faculty from each hospital took a one-hour online course about CBE. Emails on the seven core competencies and their evaluation were sent ahead of a pilot core competency evaluation (CCE) to residents and faculty. The pilot CCE took place in late 2021, followed by a survey. @*Results@#A total of 68 out of 84 hospitals participated in the pilot CCE. The survey response rate was 55.9% (38/68) for chief training faculty, 10.2% (91/888) for training faculty, and 30.2% (206/683) for residents. More than half of the training faculty thought that CCE was necessary for the education of residents. Residents’ and training faculty’s responses about CCE were generally positive, although their understanding of CCE criteria was low. More than 80% of the hospitals had a defibrillator and cardiopulmonary resuscitation manikin while the rarest piece of equipment was an ultrasound vessel model. Only defibrillators were used in more than half of the hospitals. Thoughts about CCE were related to various factors, such as length of employment, location of hospitals, and the number of residents per grade. @*Conclusions@#This study’s results may be helpful in improving resident education quality to meet the expectations of both teaching faculty and residents while establishing CBE.

Severe pulmonary edema occurred during endobronchial ultrasound under monitored anesthesia care - A case report -

Endobronchial ultrasound (EBUS) is widely used to diagnose lung cancer. Monitored anesthesia care (MAC) can enhance patient comfort and procedural conditions during EBUS. EBUS under MAC is usually safe but can lead to various complications. Case: A 34-year-old male who had increased sputum for two months showed an enlarged paratracheal lymph node and planned for lymph node biopsy by EBUS. During EBUS under MAC, an unexpected oxygen saturation decline required intervention. After intubation, copious frothy fluid was suctioned from the bronchi, and oxygenation was recovered. A narrowed trachea and the EBUS bronchoscope might have resulted in upper airway obstruction, and suction performed under these conditions might have caused pulmonary edema. The patient received non-invasive ventilation and high-flow nasal cannula and recovered without complications. Conclusions: When there is an expected risk of upper airway obstruction during EBUS, careful preoperative evaluation and preparation are essential to prevent negative pressure pulmonary edema.

Two cases of late-onset cardiovascular toxicities after a single injection of local anesthetics during supraclavicular brachial plexus block - A report of two cases -

Local anesthetics systemic toxicity (LAST) is a grave complication of regional anesthesia that usually occurs immediately after local anesthetics injection. Here, we report on rare late-onset toxicity cases after supraclavicular brachial plexus blocks. Case: Two patients underwent surgery for radius fractures. We used lidocaine 100 mg and ropivacaine 150 mg for blocking and infused dexmedetomidine for intraoperative sedation. The 63-year-old male patient’s blood pressure dropped to 87/60 mmHg after 3 h 15 min after blocking. Ventricular fibrillation occurred 10 min later. After five defibrillations, electrocardiography showed ventricular tachycardia that was normalized through one cardioversion. The 54-year-old female patient’s heart rate decreased to 35 beats/min 2 h 30 min after blocking. Her vital signs returned to normal after administering atropine, ephedrine, epinephrine, and lipid emulsion. Conclusions: Physicians should remember that LAST may occur long after local anesthetic injection and be aware of factors that may adversely affect the course of LAST.

Epidural analgesia versus intravenous analgesia after minimally invasive repair of pectus excavatum in pediatric patients: a systematic review and meta-analysis / 대한마취과학회지

Background@#Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. @*Methods@#We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized controlled trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. @*Results@#Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in the IV group. The epidural group showed lower VAS than the IV group at 12 to 48 h after the surgery. Postoperative nausea, operation time and length of hospital stay was not different between two groups. The epidural group had a significantly longer total operating room time due to epidural catheter insertion time. @*Conclusions@#Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Successful anesthetic management of a giant lower lip hemangioma patient using high flow nasal cannula-a case report- / 대한마취과학회지

Background@#Giant lip hemangioma is a rare disease that may cause difficulty in preoxygenation and ventilation when using face masks and intubation during general anesthesia induction.Case: A laparoscopic cholecystectomy was planned for a 77-year-old woman. The patient had a giant lower lip hemangioma that was 12 x 5 x 5 cm, which made preoxygenation and ventilation through a face mask impossible and put her at risk of hemangioma rupture. We preoxygenated her through a high-flow nasal cannula (HFNC). Following propofol and succinylcholine administration, we intubated the patient with a video laryngoscope without desaturation, hemangioma rupture, or CO2 retention. @*Conclusions@#HFNC is a useful tool when difficult intubation is expected in patients who have problems using conventional face masks.

Epidural analgesia versus intravenous analgesia after minimally invasive repair of pectus excavatum in pediatric patients: a systematic review and meta-analysis / 대한마취과학회지

Background@#Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. @*Methods@#We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized controlled trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. @*Results@#Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in the IV group. The epidural group showed lower VAS than the IV group at 12 to 48 h after the surgery. Postoperative nausea, operation time and length of hospital stay was not different between two groups. The epidural group had a significantly longer total operating room time due to epidural catheter insertion time. @*Conclusions@#Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Downward bias of conductivity based point-of-care hemoglobin measurement compared with optical methods

BACKGROUND: Point-of-care (POC) arterial blood gas analysis (ABGA) is widely used for checking hemoglobin (Hb) level. However, there is the tendency of downward bias of conductivity-based POC ABGA Hb measurement compared with optical methods. Authors tried to correct that bias by linear regression equation. METHODS: We retrospectively collected a total of 86 Hb result pairs during surgeries. Hb measured by the Sysmex XE-2100 in the laboratory was set as the gold standard and was compared with that measured by the GEM Premier 3500. Data were compared using the Bland-Altman analysis, the reliability of transfusion decision was assessed using three-zone error grid. The linear regression analysis was performed to find out the relation between the Hb results of POC ABGA and those of laboratory based test. RESULTS: The bias of the Hb measured between Sysmex XE-2100 and GEM Premier 3500 was −0.9 g/dl (P < 0.001, 95% confidence interval, −1.038 to −0.665 g/dl). The percentage error was 16.4%. According to error grid methodology, zone A, B and C encompassed 89.5%, 10.5% and 0% of data pairs. After adjusting the POC ABGA Hb values, the bias of the Hb measured by two methods was 0 g/dl (P = 0.991). The percentage error was 18.2%. The zone A, B and C encompassed 91.9%, 8.1% and 0% of data pairs. CONCLUSIONS: Hb measurements obtained with reference to conductivity via a POC ABGA were significantly lower than those obtained via optical methods. This bias may deserve attention of anesthesiologists when POC ABGA Hb level is used as a transfusion guideline.

Postpartum spinal subdural hematoma: irrelevant epidural blood patch: a case report / 대한마취과학회지

We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies.

The Inter-Rater Reliability of Simplified Acute Physiology Score 3 (SAPS3) among Intensive Care Unit Nurses / 대한중환자의학회지

BACKGROUND: Simplified acute physiology score 3 (SAPS3) was developed in 2005 to evaluate intensive care unit (ICU) performance and to predict patient mortality or disease severity. The score is usually calculated by doctors, but it requires substantial human resources. And many nurse-lead studies use this scoring system. In the present study, we examined the inter-rater reliability of SAPS3 among nurses in an ICU. METHODS: Five ICU nurses who worked in an ICU for a mean length of 7.8 years were educated for 2 hours about SAPS3 score and its components. Each nurse scored 26 patients, and the intraclass correlation coefficient (ICC) of the total scores and each subset were evaluated. RESULTS: The ICC (95% confidence interval) of SAPS3 score was 0.89 (0.82-0.95), that of subset I was 0.90 (0.82-0.95), subset II was 0.54 (0.35-0.73), and subset III was 0.95 (0.91-0.97). The ICC of predicted mortality was 0.91 (0.85-0.96). CONCLUSIONS: The ICC of SAPS3 score and predicted mortality among ICU nurses were reliable. According to these ICC values, SAPS3 score is a reliable scale to be used by nurses. The ICC of subset II was lower than those of the other subsets, suggesting that education of SAPS3 should focus on the definition of each subset II component.

The Inter-Rater Reliability of Simplified Acute Physiology Score 3 (SAPS3) among Intensive Care Unit Nurses / 대한구급학회지

BACKGROUND: Simplified acute physiology score 3 (SAPS3) was developed in 2005 to evaluate intensive care unit (ICU) performance and to predict patient mortality or disease severity. The score is usually calculated by doctors, but it requires substantial human resources. And many nurse-lead studies use this scoring system. In the present study, we examined the inter-rater reliability of SAPS3 among nurses in an ICU. METHODS: Five ICU nurses who worked in an ICU for a mean length of 7.8 years were educated for 2 hours about SAPS3 score and its components. Each nurse scored 26 patients, and the intraclass correlation coefficient (ICC) of the total scores and each subset were evaluated. RESULTS: The ICC (95% confidence interval) of SAPS3 score was 0.89 (0.82-0.95), that of subset I was 0.90 (0.82-0.95), subset II was 0.54 (0.35-0.73), and subset III was 0.95 (0.91-0.97). The ICC of predicted mortality was 0.91 (0.85-0.96). CONCLUSIONS: The ICC of SAPS3 score and predicted mortality among ICU nurses were reliable. According to these ICC values, SAPS3 score is a reliable scale to be used by nurses. The ICC of subset II was lower than those of the other subsets, suggesting that education of SAPS3 should focus on the definition of each subset II component.

Anesthetic management of a preterm neonate intracranial aneurysm clipping / 대한마취과학회지

No abstract available.

Lobar Bronchial Rupture with Persistent Atelectasis after Blunt Trauma / 대한중환자의학회지

Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.

Guide Wire Entrapment during Central Venous Catheterization / 대한구급학회지

We experienced a case of venous vessel wall entrapment between the introducer needle and the guide wire during an attempt to perform right internal jugular vein (IJV) catheterization. The guide wire was introduced with no resistance but could not be withdrawn. We performed ultrasonography and C-arm fluoroscopy to confirm the entrapment location. We assumed the introducer needle penetrated the posterior vessel wall during the puncture and that only the guide wire entered the vein; an attempt to retract the wire pinched the vein wall between the needle tip and the guide wire. Careful examination with various diagnostic tools to determine the exact cause of entrapment is crucial for reducing catastrophic complications and achieving better outcomes during catheterization procedures.

Lobar Bronchial Rupture with Persistent Atelectasis after Blunt Trauma / 대한구급학회지

Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.

A suspicious case of malignant hyperthermia during general anesthesia with desflurane: A case report

Malignant hyperthermia (MH) is an inherited disorder of skeletal muscle manifested as a life threatening hypermetabolic crisis in susceptible individuals following exposure to commonly used inhaled anesthetics and depolarizing muscle relaxants. We experienced a suspicious case of MH in 34-year-old male during transfemoral cerebral angiography embolization under general anesthesia with desflurane. The episode emerged 15 minutes after induction of general anesthesia using propofol, rocuronium, remifentanil, desflurane. Desflurane is a recently developed inhaled anesthetics and there has been no case report of MH related with it in Korea. When we suspected episode, vigorous treatment was carried out, symptoms were resolved without dantrolene administration.

Ventricular tachycardia-like electrocardiographic artifact on total thyroidectomy / 대한마취과학회지

No abstract available.

Left Atrial Wall Dissection after Mitral Valve Replacement

Left atrial dissection does occur, though rarely, after mitral valve surgery. A 68-year-old Korean female presented with moderate mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation and mild aortic regurgitation. She was scheduled for mitral valve replacement and tricuspid annuloplasty. We experienced a left atrial dissection after weaning from cardiopulmonary bypass and decided not to repair it. The patient recovered uneventfully. We suggest that a specific type of left atrial dissection can be treated conservatively.

Interruption of bispectral index monitoring by nerve integrity monitoring during tympanoplasty: A case report / 대한마취과학회지

We report that intraoperative NIM-2 monitoring devices can interfere with bispectral index monitoring. A 45-year-old male with chronic otits media underwent tympanolasty under general anesthesia with NIM-2 monitoring and bispectral index monitoring at our institution. And then, bispectral index monitoring was severely interrupted by facial nerve monitoring.