The Use of Remifentanil during General Anesthesia for Emergency Cesarean Section in a Patient with HELLP Syndrome: A case report / 대한마취과학회지

HELLP syndrome (Hemolysis, Elevated Liver enzymes, and a Low Platelet count) is a severe complication of preeclampsia or eclampsia, and is associated with a high risk of maternal and neonatal morbidity and mortality. In cases of delivery management in patients with HELLP syndrome, general anesthesia is required for cesarean sections in the presence of severe thrombocytopenia. These patients have a high risk of uncontrollable hypertension under stressful conditions, such as laryngoscopic intubation, surgical incision, and delivery. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action. In addition, remifentanil has a potent analgesic effect and provides cardiovascular stability during surgery. This paper reports a 33-year-old patient with HELLP syndrome, who was referred to our hospital for a cesarean section. The procedure was performed under general anesthesia with remifentanil being used as an adjunct for cardiovascular stability.

Asystole via Trigeminocardiac Reflex during Skin Flap Elevation in a Patient Undergoing Craniotomy for Cerebral Aneurysm Clipping: A case report / 대한마취과학회지

The trigeminocardiac reflex (TCR) consists of the sudden development of severe bradycardia or even asystole with arterial hypotension during manipulation of branches of the trigeminal nerve. TCR can occur during craniofacial surgery, rhizolysis of the trigeminal ganglion, and tumour resection in the cerebellopontine angle. We report a case of TCR-induced asystole during skin flap elevation in a patient undergoing craniotomy for cerebral aneurysm clipping.

Predicting the Depth of Insertion of Left-sided Double-Lumen Endotrachial Tubes in Koreans

BACKGROUND: Proper positioning of a double-lumen endobronchial tube is very important for lung isolation. This is best achieved by using a fiberoptic bronchoscope. Yet it is also important to predict the proper length when performing bronchoscopy is not possibe. In a previous report, the ideal depth of insertion of the left-sided double lumen endobronchial tube (DLT) was significantly correlated with the patient's height and the clavicular-to-carinal distance of the trachea. The aim of our study is to see whether that result can be applied to Koreans or not. METHODS: Forty eight patients who undergoing one lung ventilation (OLV) were intubated with a left-sided DLT. After proper positioning was achieved by bronchoscopy, we measured the depth of the tube at the upper incisor. Multiple linear regression analysis was done to determine the correlation of the depth of insertion with other factors. RESULTS: In Koreans, the depth of insertion was 9.216 + 0.104 x height + 1.797 x gender (male = 1, female = 0, R = 0.912, P = 0.003). CONCLUSIONS: In Koreans, the depth of insertion was only correlated with the gender and height of the patient, but not with the clavicle-to-carinal distance.