Lipiodol brain embolism through right inferior phrenic artery-pulmonary vein shunt after transcatheter arterial chemoembolization

Lipiodol brain embolism is a rare complication associated with transcatheter arterial cheomoembolization (TACE). The present case describes a patient with lipiodol brain embolism who presented with several symptoms, including drowsy mental state, right facial palsy, and weakness in the right upper and lower limbs. The patient's non-enhanced computed tomography scan and magnetic resonance imaging (MRI) findings revealed multifocal lipiodol deposition and an acute infarction of the brain. A retrospective review of the angiography findings revealed a right inferior phrenic artery-pulmonary vein shunt, which was not observed during the previous TACE. Three days after TACE, the patient's symptoms improved; however, the extent of the brain hyperintensity had widened further on the following MRI. The patient gradually recovered and was finally discharged.

Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia / 대한마취과학회지

BACKGROUND: Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia. METHODS: One hundred twenty patients aged 20 to 65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the group N received normal saline 1 hour before induction and after the resection of gall bladder. The patients in the group S1 received dexamethasone 8 mg 1 hour before induction and normal saline after the resection of gall bladder. The patients in the group S2 received normal saline 1 hour before induction and dexamethasone 8 mg after the resection of gall bladder. RESULTS: VAS scores of group S1 and S2 were lower than that of group N during 48 hours after laparoscopic cholecystectomy. There were no significant differences of VAS scores between the group S1 and the group S2. The analgesic consumption of group S1 and S2 were significantly lower than that of group N. CONCLUSIONS: A single dose of dexamethasone (8 mg) intravenously given 1 hour before induction or during operation was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. The analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during surgery was not significantly different.

General anesthesia for a spinal muscular atrophy type I patientundergoing feeding gastrostomy: A case report

Spinal muscular atrophy (SMA) in children leads to progressive muscle weakness, dysphagia, aspiration, and death. The most common and severe form of SMA is designated as type I, also known as Werdnig-Hoffman Disease or Floppy Baby syndrome. We anesthetized an 8 month-old female infant with SMA type I undergoing feeding gastrostomy. We planned to use inhalational anesthesia without muscle relaxants. Anesthesia and surgery were uneventful. We herein report a case of successful peri-operative anesthetic management for SMA type I infant with aspiration pneumonia.