A suspected sugammadex-induced anaphylactic shock: A case report

BACKGROUND: The reversal of a neuromuscular blockade has typically been achieved with a cholinesterase inhibitor and the concomitant use of an anticholinergic agent, and this remains a popular method. Since the introduction of sugammadex in the market, its use has been increasing because of the rapid recovery from a neuromuscular blockade achieved by rocuronium. The occurrence of anaphylaxis or an anaphylactic reaction resulting from sugammadex is rare and has been reported sparsely. Thus, one may not recognize the possibility of sugammadex-induced hypersensitivity when sudden life-threatening hypotension occurs, especially without skin manifestations during the emergence of anesthesia. This may delay treatment and increase morbidity. CASE: We report a case of a sugammadex-related hypersensitivity reaction which manifested as pure cardiovascular collapse during the emergence of anesthesia. CONCLUSIONS: We emphasize that vigilance should be paid for at least five minutes following sugammadex administration in daily clinical practice.

Anesthetic Experience of Unexpected Change to One-Lung Ventilation with Bronchial Blocker

One-lung ventilation is an anesthesiological technique to accomplish surgical visualization during thoracic surgical procedures, and is often required unexpectedly during surgery. Traditionally the double lumen tube is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker to establish one-lung ventilation. We have experienced unexpected change to one-lung ventilation with bronchial blocker. A 40-year-old (158 cm, 48 kg) woman was scheduled for emergency exploratory laparotomy due to panperitonitis. A sudden diaphragmatic perforation occurred during the operation. Since oxygen saturation was reduced, intraoperative tube change was not available. Therefore, one-lung ventilation was done with bronchial blockers. After the bronchial blocker was placed, one-lung ventilation was well maintained and the operation was terminated successfully.

Epinephrine-Induced Acute Pulmonary Edema during Septoplasty

Epinephrine is used with lidocaine to provide bloodless surgical field and to prolong the action of local anesthetics. But epinephrine also has many adverse reactions, such as agitation, restlessness, headache, tachycardia, hypertension, and some significantly more dangerous conditions including myocardial ischemia, ventricular arrhythmia, cerebral hemorrhage and pulmonary edema, cardiac arrest, etc. We have experienced epinephrine-induced acute pulmonary edema due to submucosal intranasal application of epinephrine soaked gauze during septoplasty. The patient was successfully treated in intensive care unit with positive pressure ventilation, diuretics, and inotropic support. He was extubated after 5 hours and discharged after 7 days without any complications.

Iatrogenic Subtrochanteric Fractures Related to the Surgical Error: Two Cases Report

Iatrogenic fracture is not popular and might be recognized as a malpractice. Surgical error related to iatrogenic fracture which has occurred after an operation can be detected only by a surgeon. Stress riser fracture is another form of iatrogenic fracture also known as a Young's modulus fracture. As the majority of surgical related stress riser fractures can be preventive, the accurate prevalence is not known. The majority of fractures occurred in the weight bearing bones such as femur and tibia. The subtrochanter area is the most stress concentrated area in the human body, thus it is a common area for occurrence of stress riser iatrogenic fractures. We experienced 2 cases of stress riser iatrogenic fractures, which are related to technical errors, thus we report cases with literature review.

Failure of Long Spinal Construct and Pseudarthrosis in a Patient with Parkinson Disease for the Treatment of Degenerative Lumbar Spinal Disorder: Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a case of treated failure spinal construct and pseudarthrosis in a patient with Parkinson's disease. SUMMARY OF LITERATURE REVIEW: There have been no reports about revision surgery due to failure and pseuarthrosis of degenerative lumbar spine disease in patients with Parkinson's disease. MATERIALS AND METHODS: A 55-year-old female who had been diagnosed with Parkinson's disease 4 years ago presented with back pain and radiating pain on both legs. Radiographic assessment showed spinal stenosis from L2 to L5 combined with degenerative spondylolisthesis at L3-4. Posterior decompression, instrumentation, and posterolateral fusion were performed and her symptoms improved. RESULTS: Two years after the operation, she complained of severe back pain without injury. A simple X-ray showed the pull out of bilateral L5 screws, and revision surgery was performed. Three years after the revision, she underwent re-reoperation due to metal failure. The breakage of a unilateral pedicle screw at L5 was found, and her fusion level was extended to S1 with a posterior lumbar interbody fusion with cages and alar screws. Finally, she has not shown any further failure but, a sagittal imbalance and aggravation of pelvic incidence due to Parkinson's disease have been detected. CONCLUSIONS: Spine surgeons always should consider metal failure, pseudarthrosis, and aggravated spinal imbalance caused by natural history in patients with Parkinson's disease.