Teatment by Emergency Cesarean Section Immediately Followed by Operative Repair of the Aortic Dissection under General Anesthesia in a Patient with Pregnancy-Induced Hypertension: A case report / 대한마취과학회지

Acute aortic dissection can occur in pregnancy in association with severe hypertension due to preeclampsia, coarctation of the aorta, or connective tissue diseases such as Marfan syndrome. The aims of anesthesia are to minimize fetal exposure to cardiopulmonary depressant drugs prior to delivery while ensuring a well-controlled hemodynamic environment for the mother. We encountered a case of a 31-year-old pregnant woman (gestational age 38 weeks) with preeclampsia, gestational DM, and acute aortic dissection (Stanford type A, DeBakey type II). The patient successfully underwent an emergency cesarean section and the subsequent repair of the aortic dissection under general anesthesia. We report this experience with a brief review of the relevant literature.

Intraoperative Topographic Mappings of the Central Sulcus by Somatosensory Evoked Potential Phase Reversals on Subdural Electrodes

BACKGROUND: Topographic mappings of somatosensory evoked potentials (SEP) on subdural electrodes help identify the motor cortex quickly during chronic subdural recordings or during the operation. We tried to assess the ease and reliability of the routine use of SEP for identification of the sensorimotor cortex depending on pathology and location of the lesion. METHODS: We reviewed 75 SEP studies of 63 patients who needed functional mappings of the sensorimotor area. The phase reversal (PR) of SEP around the 20 msec latency in response to contralateral median nerve stimulations by subdural electrodes was used to identify the position of the central sulcus. The patients included 20 with nonlesional epilepsy, 30 with tumor, 12 with arteriovenous malformation (AVM), and 1 with cavernous angioma. RESULTS: SEP-PRs were successfully recorded in 67 SEP among 75 studies (89.3%). SEP-PRs were recorded in 37 of 43 patients with lesions (86.0%), and in all patients without lesions (100.0%). In regards to pathology, the absence of SEP-PR was noted in 3 out of 12 patients with AVM (25.0%), 3 out of 30 patients with tumor (10.0%), and 0 out of 1 patient with cav-ernous angioma (0.0%). The SEP-PRs were obtained the least frequently for the location of lesions when the lesions involved both the frontal and parietal areas. CONCLUSIONS: Intraoperatively, the SEP-PR can be easily obtained and the median nerve SEP is an useful test for confirming the identification of the central sulcus. SEP-PR can be detected more frequently in patients without lesions rather than in those with lesions, especially patients with AVM or whose lesions are over the frontoparietal areas.

A Comparison about the Infusion Rate of the Balloon Type Infusor / 대한마취과학회지

BACKGROUND: Many infusion devices have been used in anesthetic practice, some of them are balloon type infusor consisted of rubber or silicone materials. This study was done on the basis of that the flow rate will vary according to the volume of balloon type infusor because the shape and elasticity of the balloon is changed. METHODS: We examed infusor-A consisted of silicone (n=15) and Infusor-B consisted of rubber (n=15). Each model was 2 ml/h, total volume 100 ml type. The infusor was filled with normal saline 100 ml and the inside pressure of the infusor was measured according to the reservoir volume change. Infusion rate was calculated by dividing the infused volume by infused time. The infused volume was measured by the weight reduction of the reservoir. RESULTS: The monitored inside pressure of the reservoir was divided into 3 ranges; the range of the pressure decreasing (100-85 ml), maintaining (85-8 ml), and increasing (8-0 ml) with the infusor volume. The flow rate varied with the infusor volume; in the large (100-85 ml) and small (8-0 ml) infusor volume, the infusion rate was higher than other volume range (85-8 ml). CONCLUSIONS: In the balloon type infusor, the inside pressure of the balloon reservoir was not sustained evenly in the total reservoir volume range. But the infusion rate was parallel with the inside pressure of the reservoir and influenced by the reservoir volume. This may be owing to the change of the elasticity and tensile force of the reservoir according to the time and volume.

Comparison of the Cervical Spine Motion during Endotracheal Intubation with Lightwands and Macintosh Laryngoscopes / 대한마취과학회지

BACKGROUND: Endotracheal intubation with direct laryngoscope requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomical reasons or because of cervical spine injury. The lightwand requires less neck flexion and head extension than the conventional laryngoscope. The purpose of this study was to compare the extension of cervical spine obtained with lightwand and Macintosh laryngoscope. METHODS: Twenty patients requiring general anesthesia with endotracheal intubation were studied. Patients were placed on the operating table and anesthesia was induced. Intubation were performed on two occasions: with lightwands and Macintosh #3 laryngoscopes. Cricoid pressure was not applied. To determine cervical spine extension, five radiographs were taken in each patient (before induction, during mask ventilation, during intubation with lightwand, during laryngoscopy with the Macintosh blade: in the best glottic view or during intubation). RESULTS: Of 20 cases, we excluded 2 cases due to the technical error. Significant reduction of radiographic cervical spine extension were found in the lightwand compared to Macintosh blade at all cervical level. Mean atlantooccipital extension angles were 6.2o and 11.7o for the lightwand and Macintosh, respectively. There were no significant differences between mask ventilation and intubation with lightwand. CONCLUSIONS: Lightwand may be better than the conventional intubation in patients whose cervical spine movement is limited or undesirable, especially in the patients in whom awake intubation is not available.