Spinal cord stimulator malfunction caused by radiofrequency neuroablation: A case report / 대한마취과학회지

The implantation of spinal cord stimulators (SCSs) to treat chronic intractable pain is steadily increasing. And there is an increased likelihood of instances where other therapies or procedures are found to interfere with SCS function, which in turn may result in pain. Since SCS utilize electric impulses as well as magnets, special considerations need for patients with a SCS in situ who require these procedures. The present report describes a case where radiofrequency (RF) ablation of the third occipital nerve resulted in spontaneous activation of a cervical SCS device.

Comparison of the Clinical Effectiveness of the CobraTM Perilaryngeal Airway and the ProSealTM Laryngeal Mask Airway during Anesthesia with Controlled Ventilation

BACKGROUND: Supraglottic airway devices are currently available. We compared the efficacy of the Cobra perilaryngeal airway (CobraPLATM) and the ProSealTM laryngeal mask airway (PLMA) during anesthesia with controlled ventilation for the insertion success rate, hemodynamic stability after insertion, intraoperative ventilatory parameters, and postoperative laryngeal discomfort. METHODS: Forty-three patients received either a CobraPLATM or a PLMA after induction with thiopental 5 mg/kg, fentanyl 1microg/kg and rocuronium 0.6 mg/kg, and manual controlled ventilation with N2O: O2 (1:1) and sevoflurane 5-6 vol% for 2 minutes. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The two devices were similar for hemodynamic stability after insertion, and for the intraoperative ventilatory parameters. The success rates of first-attempts were similar, but the insertion time was longer for the CobraPLATM. The cuff volume and pressure changes were significantly higher for the PLMA than the CobraPLATM. The cuff pressure was significantly higher for the CobraPLATM than the PLMA from insertion to 10 minutes after insertion, but at 30, 60 and 90 minutes after the insertion, there was no significant difference for the two devices. There were no differences with respect to the incidence of adverse events. CONCLUSIONS: During anesthesia with controlled ventilation, these two devices can be used successfully and effectively. We suggest that the CobraPLATM could be used an alternative device for airway management and further investigation is required.

Comparison of Fluid Kinetic Model of Normal Saline with Hartmann's Solution in Adult Volunteers

BACKGROUND: Changes in the volume of fluid space expanded by intravenous infusion of crystalloid solution have been analyzed using mathematical models. Crystalloids with similar osmolality would reveal no significant differences in distribution and elimination from the body. But each solution has different ionic composition, this can affect fluid volume kinetics. Therefore, we evaluated the fluid volume kinetics of normal saline and Hartmann's solution. METHODS: After infusion of 15 ml/kg of normal saline (n=5) and Hartmann's solution (n = 4) over 30 min and measured a serial hemoglobin concentration. The changes were expressed as fractional dilution and then plotted against time. The curves were fitted to two-volume model using non linear least square fitting process. RESULTS: Central and peripheral volume space were present. There were no significant differences between the two groups on central volume, peripheral volume and expansion ratio of fluid space per body weight and expansion ratio of peripheral volume. The expansion ratio of central volume was greater in Hartmann's solution than normal saline from 25 min to 60 min after infusion. Hartmann's solution expanded fluid space higher than normal saline on initial period. CONCLUSIONS: There were no significant differences in fluid kinetic parameters between normal saline and Hartmann's solution. However, the volume expansion effect of Hartmann's solution was more rapid than normal saline in early infusion period.

Unexpected Massive Bleeding during Liver Transplantation in Patients with Budd-Chiari Syndrome: A case report / 대한마취과학회지

Budd-Chiari syndrome (BCS) is a heterogenous group of disorders characterized by obstruction of hepatic venous outflow. Severe liver cirrhosis and limited cardiac reserve in patients with BCS makes them less tolerant to liver transplantation. We experienced two cases of massive bleeding during living donor liver transplantation in patients with BCS. Blood products and fluids were rapidly infused with a rapid infusion system, final infusion volume in these two patients were 177 L and 193 L, and the use of Cell Savers allowed for the patient's blood products to be saved. The patients were managed successfully and recovered uneventfully with advanced monitoring, including monitoring of their jugular venous oxygen saturation and continuous cardiac output. Therefore, rapid infusion systems and Cell Savers, along with advanced monitoring, are necessary in the event of massive bleeding during liver transplantation.