Symptomatic Large Spinal Extradural Arachnoid Cyst: A Case Report

Spinal extradural arachnoid cysts (SEACs) are relatively rare cause of compressive myelopathy. SEACs can be either congenital or acquired, but the etiology and the mechanism for their development are still unclear. A number of cases have been reported in the literature, and the one-way valve mechanism is the most widely accepted theory which explains the expansion of cysts and spinal cord compression. We report two cases of SEAC in this article. Patients had intermittent, progressive cord compressing symptoms. MRI image showed large SEAC which caused compression of the spinal cord. Pre-operative cystography and CT myelography were performed to identify the communicating tract. Pre-operative epidural cystography showed a fistulous tract. The patients underwent primary closure of the dural defect which was a communicating tract. The operative finding (nerve root herniation through the tract) suggested that the SEAC developed through a check-valve mechanism. Postoperatively, the patients had no surgical complications and symptoms were relieved. Based on our experience, preoperative identification of the communicating tract is important in surgical planning. Although surgical excision is the standard surgical treatment, primary closure of the dural defect which was a communicating tract can be an acceptable surgical strategy.

The effect of intraoperative colloid solutions coadministered with 6% hydroxyethyl starch (130/0.4) on platelet function in patients undergoing total intravenous anesthesia / 대한마취과학회지

BACKGROUND: Colloid solutions are used to treat hypovolemia and expanding plasma, but they may inhibit platelet function and reduce the level of coagulation factors during surgery. This study was conducted to compare the effects of hydroxyethyl starch (HES) on adenosine diphosphate (ADP)- and collagen-induced platelet aggregation in patients undergoing total intravenous anesthesia. METHODS: Patients undergoing endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil were divided into a group that underwent fluid management with only crystalloid solution (n = 15) and a group that was managed with crystalloid solution that included 6% HES (130/0.4) (n = 15). ADP- and collagen-induced platelet aggregation were measured 5 minutes before induction, after the first intraoperative hour, and one hour postoperatively. RESULTS: Significantly diminished ADP- and collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the patients that were managed with colloid solution that included HES. In addition, significantly diminished collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the group that was managed with the solution that only contained the crystalloid. However, ADP- and collagen-induced platelet aggregation were recovered postoperatively in both groups. CONCLUSIONS: The results of this study indicated that fluid therapy with colloid solution that contained 6% HES (130/0.4) may diminish ADP-induced platelet aggregation intraoperatively in patients subjected to total intravenous anesthesia.

Spinal anesthesia for cesarean section in a patient with myasthenia gravis : A case report

Myasthenia gravis, an autoimmune disease with antibodies directed against the nicotinic acetylcholine receptor, is relatively common in young women and sometimes associated with pregnancy. Because pregnancy can influence myasthenia gravis and the drugs used for its treatment influence gestation, obstetrical management can be complicated. Regional anesthesia during vaginal delivery is the anesthesia treatment of choice, and cesarean delivery should avoid epidural or spinal anesthesia to reduce postoperative problems. We performed spinal anesthesia with bupivacaine in a 38-year-old multipara myasthenic with normal lung function, with specific perioperative complications.

The Effects of Propofol-remifentanil Total Intravenous Anesthesia on Platelet Function / 대한마취과학회지

BACKGROUND: The majority of anesthetic agents, including inhalation anesthetics, inhibit platelet function, but the effect of propofol on platelets is controversial. This study was designed to compare the effects of propofol-remifentanil total intravenous anesthesia and sevoflurane inhalation anesthesia on platelet function. METHODS: Patients undergoing major hip surgery were divided into two groups: inhalation anesthesia with sevoflurane or total intravenous anesthesia with propofol and remifentanil. Hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and platelet aggregation were measured 5 minutes before induction, the first hour intra-operatively, and the first hour postoperatively. RESULTS: Total intravenous anesthesia with propofol and remifentanil significantly diminished collagen-induced platelet aggregation values intraoperatively compared with preoperative values. Also, intraoperative collagen- and adenosine diphosphate (ADP)-induced platelet aggregation was significantly lower in anesthesia with propofol and remifentanil compared with sevoflurane anesthesia.Sevoflurane did not induce significant changes in collagen- or ADP-induced platelet aggregation. CONCLUSIONS: Total intravenous anesthesia with propofol and remifentanil significantly reduced collagen-induced platelet aggregation intraoperatively, while inhalation anesthesia with sevoflurane did not reduce collagen-or ADP-induced platelet aggregation at all.