Ventricular fibrillation due to coronary spasm at the site of myocardial bridge: A case report / 대한마취과학회지

Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography.

Hydrothorax due to extravasation of intravenous contrast through left subclavian catheter -A case report- / 대한마취과학회지

Central venous catheterization is associated with a large number of complications, such as pneumothorax, hydrothorax, hemothorax, phlebothrombosis, pericardial tamponade, air embolism, aberrant placement and line sepsis. There are many case reports of the extravasation of various central venous catheter fluids, including the intravenous fluids, total parenteral nutrition and chemotherapeutic agents into the pleural cavity and mediastinum. These have led to hydrothorax, hydromediastinum and pericardial effusions. We report a case of the extravasation of intravenous contrast into the pleural cavity after dynamic CT through a left subclavian catheter.

Pulsed Radiofrequency Treatement of the Stellate Ganglion in Acute Herpes Zoster: A case report / 대한마취과학회지

Herpes zoster represents the reactivation of latent varicella-zoster virus located in the dorsal root ganglion. The virus multiplies and migrates to the skin surface producing a characteristic, usually painful, pustular eruption. Severe pain during the acute phase of herpes zoster has been associated with a higher risk of developing postherpetic neuralgia. Sympathetic ganglion block and somatic nerve block have been used for patients in the acute phase of herpes zoster to alleviate pain and prevent postherpetic neuralgia. Sympathetic nerve block appears to achieve these goals by blocking the profound sympathetic stimulation that is a result of the viral inflammation of the nerve and ganglion. However, they require repeated local anesthetic injections to relieve the symptoms of acute herpes zoster as well as to prevent the occurrence of postherpetic neuralgia. Pulsed radiofrequency has been proposed as safe, nondestructive treatment method. We present a case of acute herpes zoster that was managed with pulsed radiofrequency treatment. The results were satisfactory.

Combined Continuous Psoas Compartment Block and Sciatic Nerve Block for Revision Arthroplasty of the Hip in a Patient with Ankylosing Spondylitis : A case report / 대한마취과학회지

Ankylosing spondylitis is a chronic and systemic disease invloving the axial skeleton. In patient with involved cervical spine of the ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult or impossible because they have a limitation of cervical movement and anatomical anomalies. Additionally, ossification of the interspinous ligaments and the formation of bony bridges (syndesmophytes) between vertebrae, resulting in a classic "bamboo spine" appearance make difficult or impossible placement of an epidural or spinal needle. We report a case of a patient with long standing ankylosing spondylitis who underwent revision arthroplasty of the hip using combined continuous psoas compartment block and sciatic nerve block.

Interscalene Brachial Plexus Block Following Suprascapular Nerve Block for Humeral Head Surgery in a Patient with Difficult Supine Position: A case report / 대한마취과학회지

Although shoulder surgery is usually performed during general anesthesia, the use of an interscalene block alone or in combination with other anesthetic procedures is increasing. Blockade of the suprascapular nerve is used in the diagnosis and treatment of shoulder pain and to provide temporary relief from muscle spasm or strain in the supraspinatus or infraspinatus muscle We report a case of a patient that presented with severe shoulder pain who underwent surgery for traumatic humeral head fracture. Anesthesia was provided by an interscalene block follwing suprascapular nerve block.

A Simultaneous Application of Brachial Plexus Block and Combined Spinal-Epidural Anesthesia for the Reduction of Radioulnar Fracture and Iliac Bone Graft : A Case Report / 대한마취과학회지

Brachial plexus block is a suitable, technique for surgery of the forearm, because it provides good intraoperative anesthesia and prolonged postoperative analgesia when long-acting local anesthetics are used. An eighty-year-old male patient was admitted to our hospital for right radioulnar fracture. He had active pulmonary tuberculosis, severe valvular heart disease, hypertension, mild subarachnoid hemorrhage and a difficult airway. So, we performed an infraclavicular block to treat the fracture site and used a nerve stimulator when median nerve dital response and musculocutaneous nerve response were sought, and combined spinal-epidural block for the iliac bone graft at the same time. Regional anesthesia many advantages compared to general anesthesia in extremity operation. Peripheral nerve block and neuraxial block, when used properly in combination, should be able to replace general anesthesia in the majority of cases.

A Comparison of the Effect of Fentanyl and Fentanyl-Nalbuphine for Postoperative Analgesia Using IV-PCA / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) is effectively used for postoperative pain control. Fentanyl has a strong analgesic effect but has some side effects. The purpose of this study was to compare the side effects and analgesic effects of fentanyl alone and combination with nalbuphine in patients using intravenous PCA. METHODS: Forty six ASA class 1 or 2 patients were randomly divided into two groups. Group F (n = 23) received fentanyl 1,200microgram in 100 ml of normal saline. Group NF (n = 23) received nalbupine 60 mg and fentanyl 600microgram in 100 ml of normal saline. All patients used the same background infusion rate (2 ml/hr), bolus dose (2 ml) and lockout interval (15 min) just after emergence from general anesthesia. The analgesic effect was evaluated by using a visual analogue scale (VAS) at 1 hr, 6 hr, 12 hr, 24 hr and 48 hr postoperatively. Side effects and satisfaction degree were also checked. RESULTS: No significant differences were observed between the two groups in terms of pain scores and satisfaction degrees. The side effects were similar in both groups except that sedation was significantly (P<0.05) lower in group NF. CONCLUSIONS: We conclude that nalbuphine with fentanyl in combination is a useful method for intravenous PCA. On comparing the incidence of side effects in the two groups, sedation was found to be lower for the combined regimen.

A Study on the Preemptive Analgesic Effect of Low Dose Intravenous Ketamine and Combined Ketamine-Clonidine / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the preemptive analgesic effect of a single intravenous infusion of low dose ketamine-clonidine. We compared the placebo with low dose ketamine and low dose ketamine-clonidine in patients undergoing an appendectomy. METHODS: Sixty ASA class 1 or 2 patients who received general anesthesia for an appendectomy were allocated randomly to three groups. Group 1 received intravenous normal saline 6 ml and group 2 received ketamine 0.15 mg/kg in normal saline 6 ml and group 3 received ketamine 0.15 mg/kg and clonidine 1microgram/kg in normal saline 6 ml 5 minutes before surgical incision. In the recovery room postoperative analgesia was assessed by the verbal numerical rating scale (VNRS) at 0 min, 15 min, 30 min, 60 min, 90 min and 120 min. Vital signs, sedation score and side effects were also checked. For postoperative analgesia, morphine 2 mg was given intravenously whenever a patient complained of pain, or the VNRS score was above 7. RESULTS: There were no intergroup differences of individual morphine requirements for postoperative pain control among the three groups. VNRS score, blood pressure, heart rate, sedation score and side effects were not significantly different among the three groups. CONCLUSIONS: A single low dose of ketamine-clonidine may not produce a postoperative analgesic effect in the recovery room, and a single low dose of ketamine also may not produce the preemptive effect for at least 2 hours.

Effect of Mixed Administration of Lidocaine-Propofol on Vascular Pain after Tramadol Pretreatment / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and many different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of saline pretreatment with that of lidocaine mixed with propofol after tramadol pretreatment on propofol injection pain. METHODS: Eighty patients scheduled for general anesthesia were randomly divided into four groups. Control group (n = 20) received 2 ml of 0.9% saline pretreatment, Group 1 (n = 20) received 50 mg of tramadol pretreatment, Group 2 (n = 20) received 40 mg of 2% lidocaine pretreatment and Group 3 (n = 20) received 40 mg of 2% lidocaine mixed with propofol after 50 mg of tramadol pretreatment. Each patient received one of the pretreatment drugs via 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 70 mmHg. The tourniquet was released 1 minute later, followed intravenous injection of 2 mg/kg of propofol at a rate of 1 ml/sec. After 50 mg of propofol were injected, patients were assessed for pain score. The severity of pain was classified as 0, 1, 2, 3 (none, mild, moderate, severe) by one observer. RESULTS: The severity and incidence of pain were significantly reduced in group 2 and group 3 compared with control group for intravenous injection of propofol (P<0.05). but there was no significant difference between control group and group 1. CONCLUSIONS: Mixed administration of lidocaine-propofol after tramadol pretreatment could significantly reduce the severity and incidence of pain for intravenous injection of propofol.

Epidural Block with Prior Dural Puncture versus Combined Spinal Epidural Block for a Cesarean Section / 대한마취과학회지

BACKGROUND: Epidural anesthesia became most popular for a cesarean section, but it is more time consuming and involves a higher incidence of insufficient or superficial blockade, especially of the motor root, despite large doses of local anesthesia. Combined spinal epidural anesthesia has gained an increasing interest as it combines the reliability of the spinal block and the flexibility of an epidural block. A dural puncture using the combined spinal epidural technique making an early sacral blockade might be a solution to disadvantages in epidural anesthesia. We investigated the efficacy of combined spinal epidural anesthesia and epidural anesthesia with prior dural puncture for a cesarean section. METHODS: Sixty pregnant women at full term were divided into three groups. Group I (EPI, n = 20) received epidural anesthesia with 100 mg of 0.5% bupivacaine. Group II (CSE, n = 20) received combined spinal epidural anesthesia with 1.2 1.4 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by sensory block at T10 after by 7 8 ml of 0.5% bupivacaine through the epidural catheter. Group III (DP, n = 20) received epidural anesthesia with prior dural puncture. A dural puncture with a 27 G whitacre needle was done before an infusion of 20 ml of 0.5% bupivacaine through the epidural catheter. The quality and side effects of surgical anesthesia were compared between the three groups. RESULTS: Time to T10 (P< 0.001) and surgical onset time (P< 0.001) were significantly shorter in the CSE group. Maximal sensory block level (P< 0.001) was significantly higher in the CSE group. Muscle relaxation (P< 0.05) and motor block (P< 0.001) were much better in the CSE group. Hypotension occurred in 25% (EPI group), 40% (CSE group) and 20% (DP group) of the patients. While 65% of the EPI group and 50% of the DP group complained of intraoperative pain, only 25% of CSE group did (P< 0.05). CONCLUSIONS: We can conclude that combined spinal epidural anesthesia has great efficacy and less side effects for a cesarean section than epidural anesthesia and epidural anesthesia with prior dural pucture.

The Effect of Lidocaine and Ketorolac Combined to Fentanyl IV PCA on Postoperative Bowel Function / 대한마취과학회지

BACKGROUND: A postoperative ileus after anesthesia and surgery may be bothersome to recovery and prolong hospitalization periods. The object of this study was to investigate the effect of lidocaine and ketorolac combined to fentanyl IV PCA on the recovery of bowel function after surgery. METHODS: Forty-nine patients undergoing a total abdominal hysterectomy were divided into three groups (F, FT, LFT). All patients received IV PCA for postoperative pain control. PCA contents were fentanyl 1,000 microgram only in saline 100 ml in group F (n = 16) and fentanyl 500 microgram-ketorolac 150 mg in saline 100 ml in group FT (n = 17) and LFT (n = 16). Group LFT received a lidocaine bolus (1.5 mg/kg) before induction and a continuous infusion of lidocaine (2 mg/min) until one hour after surgery. We measured postoperative pain scores (at postoperative 1 hour, 6 hours, 24 hours, and 48 hours) and checked the first flatus time, the first defecation time, and the side effects. RESULTS: The intravenous lidocaine infusion group showed better pain scores at postoperative 1 hour only. The FT and LFT groups provided a more rapid return of bowel function than group F. A combined infusion of lidocaine and ketorolac had no difference in the return of bowel function. There were no significantly different incidences of nausea, vomiting and other side effects. CONCLUSIONS: Ketorolac allowed an earlier recovery of bowel function after surgery. However, an additional infusion of lidocaine was not helpful in the return of bowel function.

A Case Report of Cerebral Infarction Following General Anesthesia / 대한마취과학회지

Stroke is defined as a focal neurological deficit lasting more than 24 hours. The complications related to the central nervous system after general surgery is unusual and is difficult to discover the exact causes. We are going to report a case of an unexpected cerebral infarction after a Whipple's operation. The patient was a sixty-three years old female weighing 53 Kg with a diagnosis of cancer of ampulla of Vater scheduled for a Whipple's operation under general anesthesia. Preanesthetic assessment revealed a history of hypertension and hypercholesterolemia. After surgery, she was alert but she appeared to have right hemiparesis, aphasia and right facial palsy. A brain MRI showed a cerebral infarction in the bilateral basal ganglia, left medial temporal lobe and insular cortex. The cause of the cerebral infarction in this patient was unclear. Cerebral thrombosis was first thought of, but we couldn't completely exclude other possible causes e.g., embolism etc. In cases where risk factors of a stroke were found in preoperative evaluation, it is important to correct risk factors preoperatively. Furthermore, it is necessary to prevent hypotension, keep proper hematocrit levels and temperature during an operation, and use hemocoagulase carefully in cases of patients having risk factors of thrombosis and embolism.

Evaluation of Factors Affecting the Outcome of Occlusion Treatment for Amblyopia

PURPOSE: To evaluate the factors affecting the outcome of occlusion treatment for amblyopia. METHODS: We analyzed 80 amblyopic patients who had been followed up more than 6 months after occlusion treatment according to the age at start of treatment, initial corrected visual acuity of amblyopic eye, difference of corrected visual acuity between two eyes, type of amblyopia, type of occlusion and patient compliance. RESULTS: Mean age was 6.01+/-1.76 (3~12) years at start of treatment and mean treatment period was 4.51+/-3.40 (2~12) months. Success of treatment was defined as optotype acuity of 0.5 or better in the amblyopic eye and less than one-line difference between the two eyes. The success rate was 74% (59/80) and the time for initial visual improvement was 1.57+/-0.77 months. The age at start of treatment did not correlate with the success rate and period of treatment. But the less the difference of corrected visual acuity between the two eyes and the greater the initial corrected visual acuity, the higher the success rate and the shorter the period of treatment. And the better the compliance, the higher the success rate. Aniosmetropic amblyopia and strabismic amblyopia had the higher success rate and shorter treatment of period than mixed type amblyopia. In anisometropic amblypia, hyperopic and astigmatic type had the shorter period of treatment than myopic type. In the group of the smaller difference in refractive error, the success rate was high and period of treatment was short. In strabismic amblyopia, exotropia had the higher success rate and shorter peroid of treatment than esotropia. But the prism diopter did not correlate with the success rate and period of treatment. CONCLUSIONS: For occlusion treatment of amblyopia, we must consider many factorsto establish the treatment plan and to predict the outcome of treatment.

The Changes of Scanning Laser Polarimeter(GDx) Values in LASIK

No Abstract Available.

Clinical Evaluation of Medpor(r) Orbital Implant

Recently the high-density porous polyethylene[Medpor(r)]has been used as a new orbital implant for the reconstruction after enucleation or evisceration to reduce the implant exposure and migration, and to increase the prosthesis motility. We performed 16 cases of Medpor(r) orbital implantation combined with enucleation, evisceration or secondary orbital implantation between November 1997 and December 1998. Then, we investigated the postoperative complication, prosthesis motility, fibrovascular ingrowth pattern into the implant and MCP[Medpor(r) Coupling Post]insertion to increase the prosthesis motility for the average of 10 months [range, 6 to 18 months]. We performed a total of 16 cases of implantation :10 cases after evisceration, 5 cases after enucleation and 1 case as secondary implantation. There were 3 cases of conjunctival dehiscence, 1 case of retrobulbar hemorrhage and 1 case of superior sulcus deformity. There were no implant exposure, migration or severe inflammation. Postoperative prosthesis motility was found in 13 cases as good, 2 cases as fair and 1 case as poor. After enucleation or evisceration, Medpor(r) orbital implantation showed no significant difference from the previous porous orbital implants in postoper ative complication, prosthesis motility and fibrovascular ingrowth into the implant. It appears to be a good orbital implant because of the lower material cost, convenience in the operative procedure and other advantages. But long-term follow-up may be necessary for the detection of clinical change, the complication of MCP insertion and for the evaluation of the fibrovascular ingrowth pattern after Medpor(r) implantation.

Cervical Epidural Anesthesia for Thyroidectomy in a Patient with Tracheal Deviation: A case report / 대한마취과학회지

Large thyroid tumors present distortion of the airway, endocrine disturbance and metastatic effect. It may compromise airway directly or indirectly through dysfunction of the recurrent laryngeal nerve. The management of abnormal airway structure and the potential for both difficult intubation and surgical access to the airway are based on the principle of burning no bridges. Thyroidectomy can be performed under regional anesthesia using cervical epidural anesthesia in which maintenance of the airway and monitoring of recurrent laryngeal nerve function are possible. We describe a patient in whom a large thyroid mass with marked tracheal deviation was treated successfully by cervical epidural anesthesia and spontaneous respiration.

The Effects of Hypotensive Epidural Anesthesia for Total Hip Arthroplasty / 대한마취과학회지

BACKGROUND: Induced hypotension is effective in decreasing blood loss and providing better visibility in the surgical field. Extensive epidural block to T4 with intravenous infusion of low-dose epinephrine allows mean arterial pressure to 50 mmHg. We investigated the effects of hypotensive epidural anesthesia comparing with normotensive epidural anesthesia during total hip arthroplasty. METHODS: 40 patients scheduled for total hip arthroplasty under epidural anesthesia were randomly divided into two groups. In hypotensive group, 0.5% bupivacaine 20cc was injected into L1-2 epidural space and if sensory block reached to T4, then epinephrine 1~5 g/min was intravenously injected with continuous infusion pump. As a result, mean arterial pressure was maintained 50 mmHg, and heart rate, 55~80bpm. In normotensive group, 0.5% bupivacaine 20cc was injected into L4-5 epidural space, and sensory block reached to T8. Therefore blood pressure was maintained within 20% of preoperative baseline. RESULTS: There was apparent difference in blood loss between two groups (hypotensive group: 259 +/- 75 ml, normotensive group: 803 +/- 144*ml) (*:p<0.05). In addition, in the case of hypotensive epidral group, transfusion was not required and CVP, heart rate were not changed postoperatively. Cardiac, renal, and cerebral function were preserved too. CONCLUSIONS: Hypotensive epidural anesthesia with low dose of epinephrine infusion is safely lowering mean arterial pressure to 50 mmHg. This technique is associated with low blood loss, reduction in perioperative transfusion requirements, and has no side effects on CNS, liver, kidney and heart function.

Gas Embolism during Diagnostic Laparoscopy Combined with Hysteroscopic Procedure: A case report / 대한마취과학회지

Laparoscopy is a frequently used technique in surgery and gaining wide popularity replacing laparotomy. The advantages of laparoscopy are shorter hospital stay, faster recovery, more decreased postoperative pain and smaller scar than laparotomy. But inducing artificial pneumoperitoneum with gas causes various complications. Among them, gas embolism is a rare but fatal complication and may occur more frequently when laparoscopy is performed simultaneously with hysteroscopy. We experienced one case of gas embolism during diagnostic laparoscopy for secondary infertility and hysteroscopic resection of uterine myoma under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevent catastrophic outcome and the anesthesiologist should know about it's patho- physiology, preventive methods, diagnosis and treatment.

Two Case Reports of Seizure Following Inadvertent Injection of Tranexamic Acid into Subarachnoid Space / 대한마취과학회지

We experienced two cases of convulsive seizure, accompanied with tachycardia and hypertension following spinal anesthesia for inguinal herniorrhaphy and skin graft. Spinal anesthesia was performed with teracaine, 10% dextrose solution and epinephrine. Tranexamic acid was used instead of 10% dextrose solution inadvertently. About 2 hours after spinal anesthesia, the patients developed spastic rigidity at the upper extremities and chest wall that progressed to episthotonus and seizure preceded by tachycardia and hypertension. About 40 hours after vigorous symptomatic treatment using mechanical ventilator, oxygen, short acting barbiturate, antihypertensive drugs and anticonvulsants, the patients had recovered completely with clear mental state. And they didn't show any other neurologic deficits except amnesia.

Effect of Cooling & Lidocaine on Propofol Induced Vascular Pain / 대한마취과학회지

Propofol containing solvents such as soybean oil, egg phosphatide, glycerol, is known to arouse pain on intravenous injection in most patients. The study was undertaken to evaluate the efficacy of the two methods in preventing pain during injection of propofol on induction of anesthesia. Patients were allocated randomly into three groups. The one to receive unmodified propofol as control, the other to have injection of propofol with lidocaine added O.l mg/kg and another to have administration of propofol cooled in 0-4 degrees C. The results showed that propofol with lidocaine mixed and propofol cooled in 0-4 degrees C significantly lowered the incidence of pain during the intravenous injection of the drug and that addition of lidocaine and cooling had no untoward effect on the cardiovascular system.