Epidural Granuloma after Intrathecal Pump Implantation in the Spinal Cord: A Case Report

Intrathecal pump (ITP) is a procedure performed for pain control in patients with cancer pain and refractory pain. Complications such as catheter-related infection, granuloma, and migration may occur, so continuous management is required. In this case, ITP insertion was performed due to central cord syndrome that occurred after a traffic accident. T-L spine computed tomography was performed due to persistent pain exacerbation 22 months after insertion, and epidural granuloma was confirmed. After that, granuloma removal and ITP revision surgery were performed, and pain control has been good so far. The purpose of this case was to investigate the risk factors and evaluation methods for catheter-related granuloma.

Effect of Stellate Ganglion Block in Patients with Ventricular Electrical Storm: A Case Report

If cardiac sympathetic activity increases after myocardial injury, a ventricular electrical storm (VES) may occur. The stellate ganglion block is a minimally invasive technique performed to control VES through temporary sympathetic cessation. This case was treated after 3 stellate ganglion blocks in VES developed after non-ST elevation myocardial infarction. This patient underwent prophylactic stellate ganglion block prior to radical nephrectomy for a renal mass found during hospitalization, and the operation was safely completed. Stellate ganglion block is expected to be a safe treatment option for patients with unstable VES.

Effect of intravenous dexamethasone on the duration of postoperative analgesia for popliteal sciatic nerve block: a randomized, double-blind, placebo-controlled study / 대한마취과학회지

Background@#Intravenous (IV) dexamethasone prolongs the duration of a peripheral nerve block; however, there is little available information about its optimal effective dose. This study aimed to evaluate the effects of three different doses of IV dexamethasone on the duration of postoperative analgesia to determine the optimal effective dose for a sciatic nerve block. @*Methods@#Patients scheduled for foot and ankle surgery were randomly assigned to receive normal saline or IV dexamethasone (2.5 mg, 5 mg, or 10 mg). An ultrasound-guided popliteal sciatic nerve block was performed using 0.75% ropivacaine (20 ml) before general anesthesia. The duration of postoperative analgesia was the primary outcome, and pain scores, use of rescue analgesia, onset time, adverse effects, and patient satisfaction were assessed as secondary outcomes. @*Results@#Compared with the control group, the postoperative analgesic duration of the sciatic nerve block was prolonged in groups receiving IV dexamethasone 10 mg (P < 0.001), but not in the groups receiving IV dexamethasone 2.5 mg or 5 mg. The use of rescue analgesics was significantly different among the four groups 24 h postoperatively (P = 0.001) and similar thereafter. However, pain scores were not significantly different among the four groups 24 h postoperatively. There were no statistically significant differences in the other secondary outcomes among the four groups. @*Conclusions@#This study demonstrated that compared to the controls, only IV dexamethasone 10 mg increased the duration of postoperative analgesia following a sciatic nerve block for foot and ankle surgery without the occurrence of adverse events.

Effect of intravenous dexamethasone on the duration of postoperative analgesia for popliteal sciatic nerve block: a randomized, double-blind, placebo-controlled study / 대한마취과학회지

Background@#Intravenous (IV) dexamethasone prolongs the duration of a peripheral nerve block; however, there is little available information about its optimal effective dose. This study aimed to evaluate the effects of three different doses of IV dexamethasone on the duration of postoperative analgesia to determine the optimal effective dose for a sciatic nerve block. @*Methods@#Patients scheduled for foot and ankle surgery were randomly assigned to receive normal saline or IV dexamethasone (2.5 mg, 5 mg, or 10 mg). An ultrasound-guided popliteal sciatic nerve block was performed using 0.75% ropivacaine (20 ml) before general anesthesia. The duration of postoperative analgesia was the primary outcome, and pain scores, use of rescue analgesia, onset time, adverse effects, and patient satisfaction were assessed as secondary outcomes. @*Results@#Compared with the control group, the postoperative analgesic duration of the sciatic nerve block was prolonged in groups receiving IV dexamethasone 10 mg (P < 0.001), but not in the groups receiving IV dexamethasone 2.5 mg or 5 mg. The use of rescue analgesics was significantly different among the four groups 24 h postoperatively (P = 0.001) and similar thereafter. However, pain scores were not significantly different among the four groups 24 h postoperatively. There were no statistically significant differences in the other secondary outcomes among the four groups. @*Conclusions@#This study demonstrated that compared to the controls, only IV dexamethasone 10 mg increased the duration of postoperative analgesia following a sciatic nerve block for foot and ankle surgery without the occurrence of adverse events.

Persistent Hiccups after Cervical Selective Nerve Root Block

Persistent hiccups are rare complications following epidural steroid injections. Although the underlying etiology is not clearly understood, corticosteroids are the drug group referenced most frequently in the literature as being associated with hiccups. A 54-year-old man occurred a persistent hiccup after cervical root block due to cervical radiculopathy. A stellate ganglion block was performed, but the hiccup continued. After that, the hiccup did not stop, so metoclopramide 10 mg was prescribed. After taking the drug the next day, hiccups started to decrease in frequency, the hiccup was completely stopped from the second day of taking the drug, the hiccup was completely stopped. He reported that he had not experienced recurrent hiccups. This report highlights the importance of evaluating the cause of hiccups and determining the treatment strategy accordingly.

Persistent Hiccups after Cervical Selective Nerve Root Block

Persistent hiccups are rare complications following epidural steroid injections. Although the underlying etiology is not clearly understood, corticosteroids are the drug group referenced most frequently in the literature as being associated with hiccups. A 54-year-old man occurred a persistent hiccup after cervical root block due to cervical radiculopathy. A stellate ganglion block was performed, but the hiccup continued. After that, the hiccup did not stop, so metoclopramide 10 mg was prescribed. After taking the drug the next day, hiccups started to decrease in frequency, the hiccup was completely stopped from the second day of taking the drug, the hiccup was completely stopped. He reported that he had not experienced recurrent hiccups. This report highlights the importance of evaluating the cause of hiccups and determining the treatment strategy accordingly.

Inadvertent thermal injury following knee arthroscopic surgery in a pediatric patient / 대한마취과학회지

Inadvertent thermal injury can occur in pediatric patients under general anesthesia during knee arthroscopic surgery. Here, we report the case of a 10-year-old boy who underwent knee arthroscopic surgery under general anesthesia. After the surgery, he complained of pain in the left lower part of his chin and was diagnosed as having a thermal burn. At three-month follow-up, he recovered without any abnormalities except mild hypertrophy of the wound area. Although rare, arthroscopic surgery has the potential to cause thermal injury from the light source. We recommend that the light source should be connected to the arthroscope before switching the power on and disconnected after a considerable time of switching the power off when not in use.

Segregation for reduction of regulated medical waste in the operating room: a case report / 대한마취과학회지

One-third of all hospital-regulated medical waste (RMW) comes from the operating room (OR), and it considerably consists of disposable packaging and wrapping materials for the sterilization of surgical instruments. This study sought to identify the amount and type of waste produced by ORs in order to reduce the RMW so as to achieve environmentally-friendly waste management in the OR. We performed an initial waste segregation of 4 total knee replacement arthroplasties (TKRAs) and 1 total hip replacement arthroplasty, and later of 1 extra TKRA, 1 laparoscopic anterior resection of the colon, and 1 pelviscopy (with radical vaginal hysterectomy), performed at our OR. The total mass of non-regulated medical waste (non-RMW) and blue wrap amounted to 30.5 kg (24.9%), and that of RMW to 92.1 kg (75.1%). In the course of the study, we noted that the non-RMW included recyclables, such as papers, plastics, cardboards, and various wrapping materials. The study showed that a reduction in RMW generation can be achieved through the systematic segregation of OR waste.

A comparison of palonosetron and dexamethasone for postoperative nausea and vomiting in orthopedic patients receiving patient-controlled epidural analgesia / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the major concerns after anesthesia and surgery, and it may be more frequent in orthopedic patients receiving patient-controlled epidural analgesia (PCEA). The purpose of this study was to compare the effect of palonosetron and dexamethasone on the prevention of PONV in patients undergoing total joint arthroplasty and receiving PCEA. METHODS: Patients scheduled for total hip or knee arthroplasty under spinal anesthesia/PCEA were randomly allocated to receive either intravenous palonosetron (0.075 mg, n = 50) or dexamethasone (5 mg, n = 50). Treatments were administered intravenously to the patients 30 min before the beginning of surgery. The total incidence of PONV and incidence in each time period, severity of nausea, need for rescue anti-emetics, pain score, and adverse effects during the first 48 h postoperatively were evaluated. RESULTS: The total incidence of PONV was lower in the palonosetron group compared with the dexamethasone group (18.4% vs. 36.7%, P = 0.042), but there were no statistically significant differences in incidence between the groups at all time points. No significant intergroup differences were observed in the severity of nausea, use of rescue anti-emetics, pain score, and adverse effects. CONCLUSIONS: Although there were no significant differences in the incidence of PONV between the treatment groups at all time points, intravenous palonosetron reduced the total incidence of PONV in orthopedic patients receiving PCEA compared with dexamethasone.

Drainage of an acute spinal epidural hematoma that developed without risk factors in the thoracic spine using epidural needle: A case report

Epidural hematoma after epidural block is a rare complication in healthy patients without risk factor. However, this rare disease can lead to neurological symptoms or paralysis. It is usually treated with surgical drainage. Herein we report a case of acute thoracic epidural hematoma associated with neurologic symptoms after epidural block in a healthy male without risk factors. We performed drainage of the epidural hematoma using 18-gauge Tuohy needle without surgical intervention. The patient's neurological symptoms and pain were relieved. He was discharged without sequelae.

Seborrheic dermatitis treatment with stellate ganglion block: a case report / 대한마취과학회지

Seborrheic dermatitis is a chronic recurrent inflammatory disorder presumed to be caused by increased sebaceous gland secretion, metabolic changes in the cutaneous microflora, and changes in the host immune function. Stellate ganglion block (SGB) is known to increase the blood flow rate without altering the blood pressure, heart rate, or cardiac output, to stabilize hypertonic conditions of the sympathetic nerves, and to affect the endocrine and immune systems. It is used in the differential diagnosis and treatment of autonomic nervous system disorders of the head, neck, and upper limbs. The authors report the first case of successful treatment of a patient with seborrheic dermatitis through repeated SGB trials.

Bilateral variant locations of the musculocutaneous nerve during ultrasound-guided bilateral axillary brachial plexus block: A case report

Ultrasound-guided peripheral nerve block has several advantages over traditional techniques for nerve localization. One is a reduction of local anesthetic dose required for successful nerve block, which might allow bilateral brachial plexus block to be performed without risk of local anesthetic toxicity. Another advantage is the ability to detect anatomical variations in nerve and vascular anatomy. We report the case of a patient with unilateral anatomical variations of the musculocutaneous nerve found in ultrasound-guided bilateral axillary brachial plexus block.

The optimal anesthetic depth for interventional neuroradiology: comparisons between light anesthesia and deep anesthesia / 대한마취과학회지

BACKGROUND: This study was designed to determine the optimal anesthetic depth for the maintenance and recovery in interventional neuroradiology. METHODS: Eighty-eight patients undergoing interventional neuroradiology were randomly allocated to light anesthesia (n = 44) or deep anesthesia (n = 44) groups based on the value of the bispectral index (BIS). Anesthesia was induced with propofol, alfentanil, and rocuronium and maintained with 1-3% sevoflurane. The concentration of sevoflurane was titrated to maintain BIS at 40-49 (deep anesthesia group) or 50-59 (light anesthesia group). Phenylephrine was used to maintain the mean arterial pressure within 20% of preinduction values. Recovery times were recorded. RESULTS: The light anesthesia group had a more rapid recovery to spontaneous ventilation, eye opening, extubation, and orientation (4.1 +/- 2.3 vs. 5.3 +/- 1.8 min, 6.9 +/- 3.2 min vs. 9.1 +/- 3.2 min, 8.2 +/- 3.1 min vs. 10.7 +/- 3.3 min, 10.0 +/- 3.9 min vs. 12.9 +/- 5.5 min, all P < 0.01) compared to the deep anesthesia group. The use of phenylephrine was significantly increased in the deep anesthesia group (768 +/- 184 vs. 320 +/- 82 microg, P < 0.01). More patients moved during the procedure in the light anesthesia group (6/44 [14%] vs. 0/44 [0%], P = 0.026). CONCLUSIONS: BIS values between 50 and 59 for interventional neuroradiology were associated with a more rapid recovery and favorable hemodynamic response, but also with more patient movement. We suggest that maintaining BIS values between 40 and 49 is preferable for the prevention of patient movement during anesthesia for interventional neuroradiology.

Delayed emergence from anesthesia resulting from posterior cerebral artery infarction after Guglielmi detachable coil embolization / 대한마취과학회지

No abstract available.

Delayed emergence from anesthesia resulting from posterior cerebral artery infarction after Guglielmi detachable coil embolization / 대한마취과학회지

No abstract available.

Caudal Block Reduces Demand of Sevoflurane for Adequate Depth of Anesthesia in Children / 대한마취과학회지

BACKGROUND: It is generally known that neuraxial anesthesia for adults reduces the demand for hypnotics needed for adequate sedation. Therefore, this study examined the effect of a preoperative caudal block on the general anesthetic requirements for an adequate depth of anesthesia in children. METHODS: Twenty children aged 3-5 years, who were set to undergo inguinal herniorraphy, were divided into 2 groups of 10 children each, normal saline and lidocaine groups. Tracheal intubation was performed. After setting up the bispectral index (BIS) monitor, a caudal block was administered to both groups differently, normal saline 0.7 ml/kg was administered to the normal saline group and 1.5% lidocaine 0.7 ml/kg was administered to lidocaine group. The end-tidal concentration of sevoflurane was maintained at 1.5 vol% for 10 minutes in the first patient in both groups, and the BIS value, was measured 6 times every 10 seconds, and averaged. When the BIS was > or = 50, the end-tidal concentration of sevoflurane was increased by 0.2 vol% in the subsequent patient. When the BIS was less than or equal to 50, the end-tidal concentration of sevoflurane was decreased by 0.2 vol% in the subsequent patient. The MAC(BIS50) in both groups was calculated using probit analysis. Relative median potency analysis was used to compare the results in both groups. RESULTS: The MAC(BIS50) of sevoflurane was significantly lower with a 1.5% lidocaine caudal block (1.40 vol% [95% CI, 1.25-1.55 vol%]) compared with the normal saline group (1.77 vol% [95% CI, 1.61-2.00 vol%]). CONCLUSIONS: A preoperative caudal block reduces the demand for sevoflurane required for an adequate depth of anesthesia, as measured by the BIS in children.

Revision of High Fold with Pretarsal Fibromuscular Flap

In double eyelid operation, if the eyes have too little fat and soft tissue, or if the orbital fat were removed too much in the operation, the double eyelid crease is too high. And the supra-tarsal recess becomes hollow and the adhesion of eyelid crease occurs even in orbital septum and levator muscle. Secondary double eyelid operation in response to these problem needs to correct the height of eyelid crease or the supra-tarsal depression by releasing the inadequately high eyelid fold and preventing re-adhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of double eyelid should be appropriately lowered, the adhesion should be released, and the bulky lower flap should be flattened. In case the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, free-fat graft or dermis-fat graft has been done to correct supra-tarsal depression and re-adhesion. These graft materials are extracted from a distant donor site. Even if the adjacent tissue was not sufficient, we made the superiorly based local flap or graft of pre-tarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease and help prevent re-adhesion. Of the 1225 patients with high placement of supra-tarsal fold with bulky lower skin flap, we used pretarsal fibro-muscular flap in 914 patients and pretarsal fibro-muscular graft in treating 311 patients from November 1997 to October 2005. And we eventually found that the operation was successful in making a natural eye shape and preventing re-adhesion with no requirement of a distant donor site. We found that the pretarsal fibro-muscular flap or graft were effective in reducing the operative time and lowering the risk of post-operative infection, preventing the re-adhesion, correcting the supratarsal depression and making a natural eye shape with a slender eyelid line.

Cerebral Fat Embolism after External Fixation of Open Ankle Fracture in a Patient with Multiple Fracture: A case report / 대한마취과학회지

Even though cerebral fat embolism develops rarely after long bone fracture, it may be very important complication because it can be fatal and the early detection is not easy. Neurologic symptoms include confusion, restlessness, disorientation, seizure, and stroke with focal deficits. High intensive T2 signal MRI of the brain is most sensitive for diagnosis of cerebral fat embolism. We report a case of cerebral fat embolism diagnosed after external fixation of ankle open fracture in a 46 year old woman patient with multiple fracture.

Unilateral Atelectasis during Total Hip Replacement Surgery under Regional Anesthesia: A case report / 대한마취과학회지

Even though atelectasis develops rare during anesthesia and/or surgical operation, it may be very important complication because it can be fatal. Atelectasis may be due to airway or bronchus obstruction, compression of the lung by position, primary surfactant deficiency, increased pleural pressure due to fluid or air in the pleural space, chest wall restriction due to skeletal deformity and/or muscular weakness. We report a case of acute intraoperative unilateral lobar atelectasis in 87-years-old woman patient undergoing regional anesthetic for total hip replacement surgery.

Experimental study on vascularization of autogenous bone graft using fibrin sealant

No abstract available.