CT Guided Cervical Transforaminal Steroid Injection for the Elderly Patient with Enlarged Internal Jugular Vein and Vertebral Artery: A case report / 대한마취과학회지

Seventy nine-year old female patient visited our department presenting radicular pain on her neck, left shoulder and arm. She had a history of hypertension and underwent coronary angiography and angioplasty 4 years ago. Cervical MRI showed central disc herniation with osteophyte and left foraminal stenosis at C5-6 level and bulging disc with osteophyte and foraminal stenosis (left > right) at C6-7. First plan was transforaminal steroid injection under C-arm fluoroscopy at C5-6 level. Unexpectedly, we could find enlarged internal jugular vein and vertebral artery on MRI scan, which is due to cardiovascular disease. These important vascular structures were expected to be injured by needle during the procedure if done under C-arm fluoroscopy. We decided to give transforaminal steroid injection under CT fluoroscopy to avoid injury to the large vessels and inadvertent complication. The procedure was successfully done using CT fluoroscopy (Brilliance 10(TM), Philips(R), USA) without any complication associated with vascular injury or intravascular injection.

Comparison of T2 Sympathetic Block Effects on Blood Pressure and Heart Rate by Clipping and Sympathicotomy / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, the main disadvantage of this procedure is irreversibility in additions so-called rebound sweating occurred in 30 40% of patients during the first 1 2 weeks after operation. Some patients regret the surgery, even to the extend of preferring the original sweaty hands. Recently clipping has been suggested one of the way to minimize such problem. Hypothesis of this study was that sympathetic nerve block effect by clipping may be weak compared to sympathicotomy. The aim of this study was to evaluate and compare the sympathicotomy by clipping effect on cardiovascular system. METHODS: Sixty-five patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathetic block were randomly divided into two groups: The Clipping group (N = 21) and the sympathicotomy (N = 44) group. Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/kg) and maintained with enflurane. The operation was done to the left side first and the to the right by an experienced surgeon. During the procedure, we measured blood pressure using a non invasive technique at the right forearm, heart rate and temperature after anesthetic induction as baseline values, immediately after the left side resection of the T2 sympathetic trunk or clipping, and after completely both sides resection. All the records were coded and analysed single blind by one author. RESULTS: After the T2 sympathicotomy, heart rate decreased from 87 +/- 14 to 76 +/- 17 (P < 0.05) and the mean blood pressure was reduced from 77 +/- 14 to 64 +/- 10 mmHg (P < 0.05). After T2 clipping, heart rate decrease from 88 +/- 18 to 73 +/- 14 (P < 0.05) and mean blood pressure was reduced from 74 +/- 12 to 67 +/- 13 mmHg (P < 0.05). CONCLUSION: The main result of this study was that there was no significant difference in sympathetic block effects on blood pressure and heart rate between clipping and sympathicotomy during the procedure.

Does low dose dopamine attenuate the decrease of renal function in the treatment of patients under controlled mechanical ventilation with positive end expiratory pressure?

Controlled mechanical ventilation (CMV) with positive and expiratory pressure (PEEP) is often used to improve the pulmonary gas exchange in patients with acute respiratory distress syndrome. However, this ventilatory technique may induce hemodynamic and hormonal changes which may lead to vital organ dysfunction, such as oliguria. Low dose dopamine, acting as a dopaminergic receptor agonist, may improve vital organ perfusions, i.e. renal, mesenteric and coronary perfusions. The purpose of this current study was to evaluate the effects of low dose dopamine on renal function and hemodynamic change during controlled mechanical ventilation with PEEP. The study was performed on 10 patients treated with PEEP in the surgical intensive care unit. Starting with 0 cmH2O of PEEP and adding 4 cmH2O of PEEP at 4-hour intervals until it reached 12 cmH2O of PEEP, dopamine, 2 ug/kg/min, was selectively, administered, intravenously during the last two hours of each four hour intervals. Following each procedure, hemodynamic parameters, urine output, creatinine clearance and fractional excretion of sodium were measured. The cardiac index and mean arterial pressure had both decreased, but the mean pulmonary arterial pressure was increased at 12 cmH2O of PEEP compared with 0 cmH2O of PEEP in both groups with and without low dose dopamine. The main result of this study was that low dose dopamine attenuated the decrease of the cardiac index, urine output and creatinine clearance induced by mechanical ventilation with PEEP at 12 cmH2O.