Effect of ulinastatin on the inflammatory response after video-assisted thoracic lobectomy in patients with lung cancer: a randomized controlled study / 中华医学杂志(英文版)

BACKGROUND@#The first-line treatment for lung cancer is surgical resection, and one-lung ventilation (OLV) is the most basic anesthetic management method in lung surgery. During OLV, inflammatory cytokines are released in response to the lung tissue damage and promote local and contralateral lung damage through the systemic circulation. We designed a randomized, prospective study to evaluate the effect of the urinary trypsin inhibitor (UTI) ulinastatin on the inflammatory response after video-assisted thoracic lobectomy in patients with lung cancer.@*METHODS@#Adult patients aged 19 to 70 years, who were scheduled for video-assisted thoracic lobectomy surgery to treat lung cancer between May 2020 and August 2020, were enrolled in this randomized, prospective study. UTI (300,000 units) mixed with 100 mL of normal saline in the ulinastatin group and 100 mL of normal saline in the control group was administered over 1 h after inducing anesthesia.@*RESULTS@#The baseline (T0) interferon-γ (IFN-γ)/interleukin-4 (IL-4) ratio was not different between the groups (6941.3 ± 2778.7 vs. 6954.3 ± 2752.4 pg/mL, respectively; P  > 0.05). The IFN-γ/IL-4 ratio was significantly higher in ulinastatin group at 30 min after entering the recovery room than control group (20,148.2 ± 5054.3 vs. 6674.0 ± 2963.6, respectively; adjusted P < 0.017).@*CONCLUSION@#Administering UTI attenuated the anti-inflammatory response, in terms of INF-γ expression and the IFN-γ/IL-4 ratio, after video-assisted thoracic surgery in lung cancer patients.@*TRIAL REGISTRATION@#Clinical Research Information Service of Korea National Institute of Health (CRIS), KCT0005533.

Alternating asystole and atrial fibrillation after infusion of propofol and remifentanil with target-controlled infusion / 대한마취과학회지

No abstract available.

Alternating asystole and atrial fibrillation after infusion of propofol and remifentanil with target-controlled infusion / 대한마취과학회지

No abstract available.

A Case Report of Takotsubo Cardiomyopathy During Breast Augmentation

PURPOSE: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. METHODS: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. RESULTS: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. CONCLUSION: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.

Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation / 대한마취과학회지

BACKGROUND: The pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality. METHODS: Perioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox's proportional hazards regression. RESULTS: The 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P or =24 hours were the earliest independent predictors of 1-year mortality. CONCLUSIONS: A sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.

Traumatic Pseudoaneurysm of the Superficial Temporal Artery: Two Cases Report

PURPOSE: It is even less common traumatic pseudoaneurysm of the superficial temporal artery and rare with fewer than 200 cases reported in the recent literature. Most common causes of traumatic pseudoaneurysm is sequelae of blunt, penetrating, or iatrogenic surgical trauma. The diagnosis is based on physical findings and can be confirmed by duplex ultrasonogram, computed tomography, and angiography. Surgical resection, percutaneous embolization and conservative treatment have all been used to treat pseudoaneurysm. However recently, non invasive technique like percutaneous thrombin injection under ultrasonographic guidance has been done rather than surgical ligation. In this report, we proposed the several treatment options such as conservative treatment, thrombin injection, and surgical ligation according to the multifarous conditions of pseudoaneurysm, patient, and causes. METHODS: We describe two cases of traumatic pseudoaneurysm of superficial temporal artery in which CT angiography was effective in diagnosis and characterization. One is chronic pseudoaneurysm after traffic accident, which is fusiform shape and small size. Since the patient prefered it, we proposed percutaneous thrombin injection first. But we recognize that this method failed, we used surgical ligation according to information of CT angiographic findings. The other is acute pseudoaneurysm after blunt trauma, which is large size accompanying large hematoma. So we proposed compressive dressing and aspiration of hematoma. RESULTS: Two cases were well treated with no recurrence or complication. CONCLUSION: In conclusion, when selecting a treatment options, followings should be considered: pseudoaneurysm in CT angiography, chronicity, cause, and patient's preference.

Traumatic Pseudoaneurysm of the Superficial Temporal Artery: Two Cases Report

PURPOSE: It is even less common traumatic pseudoaneurysm of the superficial temporal artery and rare with fewer than 200 cases reported in the recent literature. Most common causes of traumatic pseudoaneurysm is sequelae of blunt, penetrating, or iatrogenic surgical trauma. The diagnosis is based on physical findings and can be confirmed by duplex ultrasonogram, computed tomography, and angiography. Surgical resection, percutaneous embolization and conservative treatment have all been used to treat pseudoaneurysm. However recently, non invasive technique like percutaneous thrombin injection under ultrasonographic guidance has been done rather than surgical ligation. In this report, we proposed the several treatment options such as conservative treatment, thrombin injection, and surgical ligation according to the multifarous conditions of pseudoaneurysm, patient, and causes. METHODS: We describe two cases of traumatic pseudoaneurysm of superficial temporal artery in which CT angiography was effective in diagnosis and characterization. One is chronic pseudoaneurysm after traffic accident, which is fusiform shape and small size. Since the patient prefered it, we proposed percutaneous thrombin injection first. But we recognize that this method failed, we used surgical ligation according to information of CT angiographic findings. The other is acute pseudoaneurysm after blunt trauma, which is large size accompanying large hematoma. So we proposed compressive dressing and aspiration of hematoma. RESULTS: Two cases were well treated with no recurrence or complication. CONCLUSION: In conclusion, when selecting a treatment options, followings should be considered: pseudoaneurysm in CT angiography, chronicity, cause, and patient's preference.

Anatomical Variations Which Can Result in Inadvertent Dural Puncture When Performing Caudal Block: A report of 3 cases / 대한마취과학회지

There are reports showing considerable morphological abnormalities in the lumbosacral region, which are usually caused by certain diseases or simply by anatomical variations. It is possible that if a caudal block is performed in patients with these anatomical abnormalities it will either fail or another unexpected difficult situation will result. However, there is no case report regarding such issues. We experienced two cases of an unexpected dural puncture during a trial of caudal block, and one case in whom the dural puncture would most likely have been caused by a trial of caudal block. The dural punture was caused by morphological abnormalities in the lumbosacral region i.e., diffuse ectasia of the lumbosacral dura and a posterior sacral meningocele with an enlargement of the lumbosacral canal. The dural termination was located more distally in the potential dural puncture case than in the normal cases.

Anesthetic Management in a Patient with Charcot-Marie-Tooth Disease: A case report / 대한마취과학회지

A 35-year old woman was scheduled to undergo a total hystectomy due to uterine myoma. She had been diagnosed with Charcot-Marie-Tooth disease 2 years ago. In addition, she had previously received a Cesarean section under epidural anesthesia 10 years ago and reported a prolonged motor blockade at that time. General anesthesia was induced with propofol 120 mg in a divided dose and the intubating condition was achieved with vecuronium 3 mg. Anesthesia was maintained with 1.5-2.5% enflurane with air and O2. During surgery, the body temperature and end tidal concentration of CO2 were maintained within the normal range. Despite the continuous monitoring of the train-of-four (TOF) response, no more muscle relaxants were required during surgery and the patient recovered without a delay in awakening. In the management of patients with Charcot-Marie-Tooth disease, it is desirable to evaluate the patient carefully, select the appropriate anesthetics and adjust the dosage of the drug according to the patients requirements.

Atrial Fibrillation Developed during Recovery from General Anesthesia: A case report / 대한마취과학회지

Laparoscopic cholecystectomy was performed in a 69-year old woman due to perforated acute gangrenous cholecystitis. After completion of the surgery, we administered 10 mg pyridostigmine for the reversal of neuromuscular block and 4 mg ondansetron for the prevention of nausea and vomiting. Twenty minute after arrival in the recovery room, atrial fibrillation and tachycardia occurred. Even with the continuous infusion of esmolol and then administration of digoxin, atrial fibrillation and tachycardia continued in the recovery room. After transfer to the general ward, the heart rate was gradually decreased, and next morning, we could find the atrial fibrillation disappeared.

Atrial Fibrillation Developed during Recovery from General Anesthesia: A case report / 대한마취과학회지

Laparoscopic cholecystectomy was performed in a 69-year old woman due to perforated acute gangrenous cholecystitis. After completion of the surgery, we administered 10 mg pyridostigmine for the reversal of neuromuscular block and 4 mg ondansetron for the prevention of nausea and vomiting. Twenty minute after arrival in the recovery room, atrial fibrillation and tachycardia occurred. Even with the continuous infusion of esmolol and then administration of digoxin, atrial fibrillation and tachycardia continued in the recovery room. After transfer to the general ward, the heart rate was gradually decreased, and next morning, we could find the atrial fibrillation disappeared.