Venous air embolism during vitrectomy: a rare but potentially fatal complication / 대한마취과학회지

No abstract available.

Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report / 대한마취과학회지

A 23-year-old male underwent a left internal jugular vein catheterization during extended surgery for treatment of multiple fractures due to a traffic accident. Although the catheterization was performed under ultrasound (US) guidance, iatrogenic perforation of the central vein and pleura occurred. The catheter was removed, and the perforated site was addressed under thoracoscopy rather than an open thoracotomy. This case suggests that using US does not completely guarantee a complication-free outcome, and that catheter placement should be carefully confirmed. In addition, this case suggests that thoracoscopy may be an ideal method of resolving a perforation of the central vein and pleura.

Postoperative nausea and vomiting / 대한마취과학회지

Postoperative nausea and vomiting (PONV) is a long-standing issue, not a new concept in anesthesiology. Despite many studies over the last several decades, PONV remains a significant problem due to its complex mechanism. This review presents a summary of the mechanism underlying the pathogenesis of PONV, focusing on preventive treatment, particularly the use of new drugs. In addition, we discuss the latest meta-analysis results regarding correct clinical use of classic drugs. I also summarize the latest trends of postdischarge nausea and vomiting and the pharmacogenetics, which is attracting a great deal of attention from other medical fields in PONV-related studies. Finally, we discuss the drawbacks of existing studies on PONV and suggest a focus for future investigations.

Paradoxical reaction to midazolam in children / 대한마취과학회지

No abstract available.

Treating and preventing relapse of drug abuse by healthcare providers

Drug abuse by healthcare providers is a serious public problem affecting not only the providers themselves but also their families, colleagues, and patients. It is not a new problem, but the medical community has historically been unwilling to accept and publicly acknowledge the problem, particularly a problem of its own members. Therefore, drug abuse by healthcare providers has either gone unnoticed or has been treated punitively, which has led to high prevalence and mortality. In South Korea, drug-abusing healthcare providers are considered criminals rather than patients. However, many studies have reported that punitive action alone is ineffective. This article describes the treatment principles, prognosis, and possibilities of returning to practice for drug-abusing healthcare providers. Early detection of drug abuse is key to subsequent treatment and prognosis. Furthermore, why relapse prevention as well as treatment is significant and which factors intensify the risk of relapse will be discussed. The use of opioids, coexisting psychiatric illness, and a family history of drug abuse are statistically significant factors. Finally, continuous and close monitoring is effective for relapse prevention, so it is considered another kind of therapy. An organized system for treating drug abuse is currently lacking in South Korea, not only for the general population but also for healthcare providers. In the future, a systematic approach and management by the medical community is necessary to resolve drug abuse by healthcare providers.

Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation / 대한마취과학회지

No abstract available.

Effect of 1 mg of prophylactic haloperidol for postoperative nausea and vomiting after gynecological laparoscopic surgery using IV patient controlled analgesia

BACKGROUND: Haloperidol, a major tranquilizer similar to droperidol, has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the supporting evidence was incomplete, especially in Korea.Therefore we evaluated the prophylactic effect of haloperidol on opioid-based IV patient-controlled analgesia (PCA) related PONV in susceptible patients after gynecological laparoscopic surgery. METHODS: Ninety-six adult women scheduled gynecological laparoscopic surgery were enrolled in a randomized, double-blinded and placebo study.Patients received haloperidol 1 mg (Group H) or saline (Group C) 30 min before the end of surgery.Fentanyl-based IV PCA was administered after surgery.The incidences and severity of nausea, vomiting, rescue antiemetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed for 24 h after surgery.The sedation score was recorded in the post-anesthesia care unit for 2 h. RESULTS: The incidences and severity of nausea and the number of antiemetic administration were significantly lower in Group H than Group C (P < 0.05). But the sedation and pain score were similar. There was no QTc prolongation or extrapyramidal symptom in both groups. CONCLUSIONS: Prophylactic haloperidol 1 mg is effective in preventing PONV related to fentanyl-based IV PCA, with less adverse effects, in patients undergoing gynecological laparoscopic surgery.

Kawasaki Disease Presenting as Cervical Lymphadenitis and Retropharyngeal Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Kawasaki diseases (KD) sometimes present themselves as cervical lymphadenitis or deep neck infection. These unusual Kawasaki diseases then lead to unnecessary antibiotic therapy or surgical intervention or delaying therapy. The purpose of this study is to determine clinical characteristics of early expressions of atypical Kawasaki diseases presenting as deep neck infection. SUBJECTS AND METHOD: We reviewed the medical records of the 6 patients who had been treated for Kawasaki disease that initially presented as fever and cervical lymphadenitis between March, 2007 and December, 2008. RESULTS: The contrast neck CT scan of four of the cases revealed no ring enhancement but retropharyngeal space fluid collection suggestive of retropharyngeal abscess. The contrast neck CT scan of the other two cases showed homogenous nonsuppurative cervical lymph node enlargement. We administered intravenous antibiotics but patients did not response to them. We then immediately administered intravenous immunoglobulin and aspirin after making the diagnosis of Kawasaki disease. The clinical condition of all the cases improved dramatically with defervescence. CONCLUSION: The possibility of Kawasaki disease should be considered in the following three situations: first, if the fever is refractory to intravenous antibiotic treatment in the febrile child with cervical lymphadenopathy, secondly, if the neck CT scan reveals a soft tissue swelling with no ring enhancement, and lastly, if the fever subsides dramatically after starting intravenous immunoglobulin and aspirin. Echocardiography should be performed as early as possible.

The effects of callander modification of laryngoscopic blade on hemodynamic changes according to the degree of difficult airway / 대한마취과학회지

BACKGROUND: Laryngoscopy and tracheal intubation are known to have profound cardiovascular effects. The Callander modification of Macintosh blade is associated with greater field of laryngoscopic view and decreased risk of dental contact. The purpose of this study was to compare the hemodynamic responses to laryngoscopy and tracheal intubation according to the degree of difficult airway, and to evaluate the usefulness of Callander modification of Macintosh blade for attenuating the hemodynamic responses. METHODS: One hundred, forty-eight patients scheduled for elective surgery were divided into Easy group and Difficult group by Wilson's risk sum score. Laryngoscopy was performed using either an ordinary Macintosh No. 3 blade or the modified Macintosh blade. The modification consisted of reducing the height of the flange by partial removal, as described by Callander et al. Hemodynamic variables (systolic, diastolic, mean blood pressure, heart rate and rate pressure product) were noted before induction (baseline) and immediately after intubation. RESULTS: The hemodynamic changes after tracheal intubation in Difficult group were significantly greater than those in Easy group (P < 0.05). When using the modified blade, systolic, diastolic and mean blood pressure after tracheal intubation were lower than those using the conventional blade regardless of Wilson's risk sum score, but no statistical significances could be found. CONCLUSIONS: The hemodynamic changes after tracheal intubation increased as the degree of airway difficulty increased. Laryngoscopy with the Callander's modified blade did not reduce the degree of hemodynamic stimulation compared with the conventional Macintosh blade.

The Surgical Outcome of Endoscopic Dacryocystorhinostomy According to the Obstruction Levels of Lacrimal Drainage System

OBJECTIVES: Many factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level. METHODS: A retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam. RESULTS: Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%). CONCLUSION: In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.

The Chromosomal Aberrations in the Head and Neck Squamous Cell Carcinoma Cell Lines:PCI-1, PCI-13 and PCI-50 / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The knowledge about chromosomal aberrations manifestated in cancer has been spotlighted recently. The genetic analyses based on the knowledge about chromosomal aberrations are important for the development of diagnotic methods and evaluation of prognostic factors in cancers. Comparative genomic hybridization (CGH) is a powerful tool for evaluating chromosomal aberrations and array CGH significantly enhances these diagnostic effectiveness. The incidence of head and neck squamous cell carcinoma (HNSCC) has been increasing worldwide but the treatment outcomes still have been limited. The aim of this study is to evaluate the location of chromosomal aberrations in HNSCC cell lines with the combination of CGH and array CGH. Materials and MethodZZThe locations of chromosomal aberrations were evaluated in 3 HNSCC cell lines (PCI-1, PCI-13, PCI-50) using the combination of CGH and array CGH. RESULTS: The sites of chromosomal gain shown by CGH in all 3 cell lines were 8q22-qter, 9q32- qter, 10q22, 10q26-qter, 16q12.1-qter, 17p10-p13, 17q21-qter, 19p13.2-pter and 20q. The chromsomal loss found in 2 cell lines were 3p, 4q21-qter, and 18q21-qter. In array-CGH, gained loci were AHRR, MYT1 and PTGIS, etc. Loci of genetic losses were ELAVL4 and GRM7. CONCLUSION: In this study, we identified various genetic gains and losses using CGH and high resolution array-CGH. These data about the patterns of chromosomal aberrations in HNSCC cell lines would be a basic step for understanding more detailed genetic events in the carcinogenesis. CGH combined with array CGH can be a powerful option for transitional oncologic research.

Clinical Characteristics and Treatment Results of Sudden Deafness in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness, an important disease characterized by abrupt sensorineural hearing loss, is rare in children and the prognosis in children is accepted to be worse than that in adults. However, clinical studies are not sufficient to define the clinical characteristics and prognosis of sudden deafness in children. The author analyzed clinical manifestation of sudden deafness in children and compared the treatment results of children with those of adults. SUBJECTS AND METHOD: A retrospective analysis was performed in 25 patients (29 ears) who were treated for sudden deafness from January 1993 to May 2008. RESULTS: 1) The overall hearing recovery rate (79%) was significantly higher in adults (53.7%). The prognosis in children less than 10 years old (73%) was also higher than that in adults. 2) The rate of complete recovery (61%) was higher in children than in adults (38.5%). CONCLUSION: The sudden deafness in children has unique clinical characteristics and the recovery rate is more favorable than in adults.

The effect of music on the effect-site concentration of propofol for loss of consciousness / 대한마취과학회지

BACKGROUND: Music reduces anxiety and the need for sedatives in preoperative patients. Currently, propofol is usually infused using target controlled infusion device. With the use of such a device, we investigated the effects of music on the effect-site concentration of propofol for loss of consciousness. METHODS: Sixty-five ASA 1 or 2 patients aged 35 to 55 years who were scheduled for general anesthesia were randomly allocated to either the control, music or headphone group. The control group patients were exposed to the ambient operating room atmosphere (n = 17), the music group patients listened to music (n = 25), and headphone group wore a headphone alone without listening to music (n = 23). Propofol was infused with a predetermined effect-site concentration and we determined loss of consciousness in patients by a verbal response and eyelash reflex for 3 minutes. Each concentration of propofol was predetermined by the up-and-down method with 0.4microgram/ml as the step size. RESULTS: Loss of consciousness was observed at a concentration of 4.20 +/- 0.25microgram/ml in the control group, 3.60 +/- 0.34microgram/ml in the music group, and 3.73 +/- 0.47microgram/ml in the headphone group. The effect-site concentration for loss of consciousness was significantly lower in the music group as compared to the control group (P < 0.05). The effect-site concentration in the headphone group, however, showed no statistical difference as compared to the control group (P = 0.117). CONCLUSIONS: Listening to music reduced overall propofol effect-site concentration for loss of consciousness that was required by patients.

Hemomediastinum Caused by Subclavian Catheterization : A case report

Central venous catheterization has been widely used in the anesthetic management. Unfortunately, the use of central venous catheter may be associated with adverse events that are hazardous to patients. We experienced a lethal hemomediastinum following subclavian venous catheterization and we discussed the facts that should be kept in mind to prevent the serious complications.

Effects of the modified blade on reducing the risk of dental trauma by novice laryngoscopists in anticipated difficult airway / 대한마취과학회지

BACKGROUND: Dental trauma is one of the most common complications during laryngoscopy, especially by novice. As the chance of making direct contact with the teeth is decreased during laryngoscopy, the chance of applying direct pressure to the teeth is decreased, thus the injury by the blade also can be decreased. The purpose of this study was to determine the effectiveness of a modified Macintosh blade on reducing dental contact and the risk of dental trauma by novice laryngoscopists in anticipated difficult airway. METHODS: Sixty-six patients scheduled for elective surgery were divided into Easy group and Difficult group according to Wilson's risk sum score. Laryngoscopy was performed twice on each patient by novice, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We compared the blade-tooth distances and the chance of directly contacting the tooth between two blades. RESULTS: The modified blade provided more distance than the regular Macintosh blade in both group (P < 0.001). It is also associated with decreased chance of directly contacting the teeth, especially in Difficult group (73.7% with regular blade vs 10.6% with the modified blade) (P < 0.001). CONCLUSIONS: The modified Macintosh blade used in this study proved to be an effective device for novice laryngoscopists in reducing likelihood of dental injuries in anticipated difficult intubation.

Effects of the modified blade on reducing the risk of dental trauma by novice laryngoscopists in anticipated difficult airway / 대한마취과학회지

BACKGROUND: Dental trauma is one of the most common complications during laryngoscopy, especially by novice. As the chance of making direct contact with the teeth is decreased during laryngoscopy, the chance of applying direct pressure to the teeth is decreased, thus the injury by the blade also can be decreased. The purpose of this study was to determine the effectiveness of a modified Macintosh blade on reducing dental contact and the risk of dental trauma by novice laryngoscopists in anticipated difficult airway. METHODS: Sixty-six patients scheduled for elective surgery were divided into Easy group and Difficult group according to Wilson's risk sum score. Laryngoscopy was performed twice on each patient by novice, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We compared the blade-tooth distances and the chance of directly contacting the tooth between two blades. RESULTS: The modified blade provided more distance than the regular Macintosh blade in both group (P < 0.001). It is also associated with decreased chance of directly contacting the teeth, especially in Difficult group (73.7% with regular blade vs 10.6% with the modified blade) (P < 0.001). CONCLUSIONS: The modified Macintosh blade used in this study proved to be an effective device for novice laryngoscopists in reducing likelihood of dental injuries in anticipated difficult intubation.

Comparison of clinical effect of intrathecally administered fentanyl for elderly patients undergoing urologic surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.

Comparison of clinical effect of intrathecally administered fentanyl for elderly patients undergoing urologic surgery / 대한마취과학회지

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.

Delayed Reduction of Pure Medial Blowout Fracture of the Orbital Wall / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The timing of surgery is an important consideration point in the management of blowout fracture (BOF) of the orbit. This study aimed to compare the surgical outcome of early and delayed reduction and to suggest the best timing of surgery in the pure medial BOF of the orbit. SUBJECTS AND METHOD: Fifty-two patients who had endoscopic endonasal reduction of medial BOF were studied retrospectively. Patients were divided into an early group (N=42) who had surgery within one month after the trauma and a delayed group (N=10) who had surgery after one month from the trauma. Surgical indications, results of the surgery, and complications were compared between the two groups. RESULTS: The surgical indications in the early group were persistent diplopia, large defect expecting later enophthalmos and limitation of EOM, whereas the delayed group complained mainly of enophthalmos and diplopia. There were no significant differences in surgical outcomes and the rate of complications between the two groups. CONCLUSION: When patients with pure medial BOF have large defects without any persistent diplopia and limitation of EOM, surgery would be safely deferred until significant enophthalmos occurs.

A Case of Pulsatile Tinnitus from Dehiscent High Jugular Bulb Treated by Reconstruction of the Hypotympanum / 대한이비인후과학회지

Vascular tinnitus, a sort of pulsatile tinnitus, should be differentiated with other sensorineural tinnitus because it is possible to be cured by correction of underlying systemic disease or surgery. The dehiscent high jugular bulb, a common cause of venous pulsatile tinnitus, can be cured by reconstruction of hypotympanum. We present a case of pulsatile tinnitus with dehiscent high jugular bulb which has been treated by surgery. Preoperative microscopic finding showed dark bluish pulsating mass in posteroinferior portion of tympanic membrane. Temporal bone CT showed high jugular bulb with bone defect of hypotympanum. The hypotympanum was reconstructed and high jugular bulb lowered using the harvested bony fragment from mastoid cortical bone. The pulsatile tinnitus disappeared immediately after surgery.