Rescue of hemodynamic compromise in superior vena cava syndrome with transesophageal echocardiography / 대한마취과학회지

No abstract available.

Iatrogenic catheter sheath shearing during radial artery cannulation / 대한마취과학회지

No abstract available.

Cardiac arrest associated with carbon dioxide gas embolism during laparoscopic surgery for colorectal cancer and liver metastasis: A case report / 대한마취과학회지

Clinically apparent carbon dioxide (CO2) gas embolism is uncommon, but it may be a potentially lethal complication if it occurs. We describe a 40-year-old woman who suffered a CO2 gas embolism with cardiac arrest during laparoscopic surgery for colorectal cancer and liver metastasis. Intra-abdominal pressure was controlled to less than 15 mmHg during CO2 gas pneumoperitoneum. The right hepatic vein was accidentally disrupted during liver dissection, and an emergent laparotomy was performed. A few minutes later, the end-tidal CO2 decreased, followed by bradycardia and pulseless electrical activity. External cardiac massage, epinephrine, and atropine were given promptly. Ventilation with 100% oxygen was started and the patient was moved to the Trendelenburg position. Two minutes after resuscitation was begun, a cardiac rhythm reappeared and a pulsatile arterial waveform was displayed. A transesophageal echocardiogram showed air bubbles in the right pulmonary artery. The patient recovered completely, with no cardiopulmonary or neurological sequelae.

Left atrial appendage thrombus detected by intraoperative transesophageal echocardiography in a patient with acute small bowel infarction: A case report / 대한마취과학회지

Acute mesenteric ischemia and infarction is an emergent situation associated with high mortality, commonly due to emboli or thrombosis of the mesenteric arteries. Embolism to the mesenteric arteries is most frequently due to a dislodged thrombus from the left atrium, left ventricle, or cardiac valves. We report a case of 70-year-old female patient with an acute small bowel infarction due to a mesenteric artery embolism dislodged from a left atrial appendage detected by intraoperative transesophageal echocardiography and followed by anticoagulation therapy.

Kinked J-tip guidewire within the tracheal lumen during retrograde intubation: A case report

Retrograde intubation is an alternative option for gaining airway access for patients with a difficult airway.We report a successful management of a kinked J-tip guidewire within a tracheal lumen with flexible fiberoptic laryngoscope in a patient with type II odontoid fracture.It is helpful to adjusting the depth of angiocatheter and handling of J-tip guidewire if J-tip guidewire does not come out into the oral cavity at the expected length during retrograde intubation.

A comparative study on the analgesic effect of continuous intraarticular infusion with ropivacaine, ropivacaine/fentanyl and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery / 대한마취과학회지

BACKGROUND: Arthroscopic shoulder surgery can result in severe postoperative pain. A variety of methods have been used to control pain in postoperative period and the results are variable. The purpose of this study was to compare the relative analgesic efficacies of the postoperative intraarticular infusion of ropivacaine, ropivacaine/fentanyl, and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery. METHODS: Thirty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. At the end of surgery, 0.5% ropivacaine 20 ml was infused into the articular space and a continuous infusion catheter was inserted into intraarticular operated site. After surgery, continuous infusion of 0.5% ropivacaine 100 ml (Group 1, n = 10), 0.5% ropivacaine 100 ml including fentanyl 10 microg/kg (Group 2, n = 10), or 0.5% ropivacaine 100 ml including fentanyl 10 microgram/kg and ketorolac 150 mg (Group 3, n = 10) was started through catheter at rate of 2 ml/hr with bolus dose of 0.5 ml with a lock out time of 15 minutes for 2 days. The level of pain was assessed using a visual analogue scale (VAS) postoperative 2, 6, 12, 24 and 48 hours and the amounts of supplemental analgesics were recorded. RESULTS: The VAS was significantly lower after 2, 6, 12 hours in Group 2 than in Group 1. In Group 3, the VAS was significantly lower all hours than in the other two groups. CONCLUSIONS: The combination of fentanyl and ketorolac with ropivacaine did provide better postoperative analgesia than the other groups after arthroscopic shoulder surgery.

Degenerative Osteoarthritis of the Hip Misconceived as a Failed Back Surgery Syndrome: A case report / 대한마취과학회지

We report the treatment experience of a patient who developed pain in the right anterior thigh and buttock 3 months later after lumbar disc surgery. He was treated as failed back surgery syndrome and had no symptom improvement. On physical examination, groin pain was elicited by Patrick's test and internal rotation of the hip. Plain radiographs of the pelvis showed calcification or osteophytes near the superior lip of the acetabulum. On magnetic resonance imaging, the lesion was identified as osteophytes and joint effusion was also noted. Under C-arm guidance, we injected corticosteroids and local anesthetics, and the patient obtained dramatic pain relief and no recurrence of symptoms.

Cervical Transforaminal Axis Measured by MRI and Its Relation to the Internal Jugular Vein, Internal Carotid Artery and Vertebral Artery / 대한통증학회지

BACKGROUND: The safety of cervical transforaminal epidural block has been the subject of debate, therefore, this study was conducted to measure the angle of the cervical transforaminal axis and to investigate its relationship to the internal jugular vein, internal carotid artery and vertebral artery. METHODS: One hundred cases of cervical MRI were reviewed. The angle between a line passing through the center of the vertebral body and spinous process and a line passing through the center of the lamina in C3-4, C4-5 and C5-6 was measured and designated as A-degree. Additionally, we drew a line at the back of the vertebral artery that ran parallel to a line passing through the center of the lamina, which was presented as A-line. We then examined the distribution of the area in which the internal jugular vein and the internal carotid artery were located. RESULTS: The mean values of the A-degree in C3-4, C4-5 and C5-6 were 53.5 +/- 4.3, 54.2 +/- 4.6 and 54.3 +/- 4.8, respectively. There were no statistically significant differences among age groups or vertebral levels (ANOVA test, P > 0.05). The A-line was distributed primarily throughout zone 3, 4, and 5 in C3-4 and zone 5 in C4-5 and C5-6. CONCLUSIONS: The results of this study indicate that the mean values of A-degree were not statistically different among each age group and each vertebral level. However, the A-line may be located in the zone in which the internal jugular vein and the internal carotid artery lie and individual differences in the A-degree remain.

Hemoptysis after Left Subclavian Central Venous Catheterization during Anesthesia Induction for Open Heart Surgery : Two cases report / 대한마취과학회지

Central venous catheters allow a measurement of the hemodynamic variables that cannot be measured accurately by noninvasive means, and allow the delivery of medications and nutritional support that cannot be administered safely through peripheral venous catheters. Unfortunately, the use of central venous catheters is associated with adverse events that are hazardous to patients. Hemoptysis is a significant clinical presentation in respiratory medicine. Often a life threatening emergency, it mandates a prompt assessment and intervention. Fiberoptic bronchoscope is useful and essential for investigating the cause of hemoptysis as well as for managing airway hygiene. We report two cases of hemoptysis after left subclavian central venous catheterization along with the use of a fiberoptic bronchoscope for hemoptysis.

Video Imaging to Assess the Neuromuscular Effect at the Larynx / 대한마취과학회지

BACKGROUND: Rocuronium has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence intubation. The purpose of this study was to compare the onset of rocuronium at the adductor pollicis and the larynx and to determine the time suitable for intubation. METHODS: Fifteen ASA physical status 1 and 2 adult patients were studied. Anesthesia was induced and maintained with propofol and alfentanil. The recurrent laryngeal nerve was stimulated superficially and movement of the vocal cords were recorded on video tape by using a fiberoptic bronchoscope passed via a laryngeal mask airway. Neuromuscular function was recorded at the adductor pollicis by using mechanosensor. After the administration of rocuronium 0.9 mg.kg(-1), the times to loss of fourth twitch response in train -of - four stimulation at the larynx and hand were observed. RESULTS: The times to loss of fourth twitch response in train-of-four stimulation at the larynx and hand are 47.3 +/- 12.8 sec and 70 +/- 13.6 sec respectively. CONCLUSIONS: Video imaging may be a useful research technique for estimating the neuromuscular blockade at the larynx and showing the onset time of rocuronium is significantly faster at the larynx than hand.

The Characteristics of Clinical Anesthesia Based on the Duration of Lateral Decubitus in Low Dose Hyperbaric Bupivacaine Induced Unilateral Spinal Block / 대한마취과학회지

BACKGROUND: When attempting a unilateral spinal anesthesia, many factors must be considered including patient's position, density and amount of the local anesthetics, needle design, injection speed. We evaluated a duration of lateral decubitus with low dose hyperbaric bupivacaine for maximizing the benefit. METHODS: Hyperbaric 0.5% bupivacaine 6 mg was administered slowly through a 25-gauge Whitacre needle to 60 ASA 1-2 patients undergoing unilateral lower extremity surgery. The patients were randomly allocated to four groups based on the duration of lateral decubitus after spinal anesthesia: 5 minutes in Group I; 10 minutes in Group II; 15 minutes in Group III; 20 minutes in Group IV. Circulatory variables, sensory and motor block level were recorded. RESULTS: The circulatory variables were stable in all patients. In the Group I, the success rate of unilateral motor block was significantly lower than other groups. In the Group IV, the success rate of unilateral sensory block was significantly higher than group I. In the Group II, III, IV, the patient's satisfaction scores were significantly higher than Group I. CONCLUSIONS: When unilateral spinal anesthesia was attempted with 0.5% hyperbaric bupivacaine 6 mg, cardiovascular stability was achieved in the groups that patients are kept in a lateral decubitus for more than 5 minutes after spinal injection, and patient's higher satisfaction scores were achieved in the unilateral motor block and in the groups that patients are kept in a lateral decubitus for more than 15 minutes after spinal injection.

Atlantoaxial Joint Syndrome Misconceived as an Idiopathic Neuralgia: A case report / 대한통증학회지

Although the atlantoaxial joint is the most common site of rheumatoid arthritis, our patient had no symptoms or signs suggestive of rheumatoid arthritis. The atlantoaxial joint is frequently involved in degenerative osteoarthritis, especially in elderly patients. An 81-year old man presented with severe intermittent electric shock like, lancinating pain from the occipital to the temporal and parietofrontal areas. He also had neck pain and a limited range of motion. After many examinations and laboratory tests, at the department of neurology and neurosurgery, he was diagnosed with idiopathic neuralgia. The diagnosis of atlantoaxial joint syndrome was confirmed, and treated successfully with atlantoaxial joint block.

Changes of Serum Histamine Concentration during General Anesthesia with Propofol-N2O in Korean / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effect of propofol on the histamine release during general anesthesia. METHODS: Ten premedicated adult patients, ASA physical status I or II, 20-55 yrs scheduled for elective surgery were included. Venous blood samples (3 ml each) were obtained from median cubital vein before induction as a control and at 1, 3, 5, 10, 30, 60, 120 minutes after the administration of propofol and postoperative one hour to measure the plasma histamine concentrations. After intubation with vecuronium, anesthesia was maintained with propofol in combination with 60% N2O and 40% O2. Mean arterial pressure, heart rate were measured and the development of skin wheal, facial flushing, bronchospasm were monitored. RESULTS: The changes of the serum histamine concentration did not show any significant differences, and hypersensitivity reactions were not observed. Hemodynamic changes at 1, 3 minutes may be due to the effect of propofol on mean arterial pressure and heart rate, so these changes did not correlate with plasma histamine concentration. CONCLUSIONS: Propofol was found to be a useful anesthetic agent without histamine release for patients with allergy or asthma.

Plasma Lidocaine Concentration and Hemodynamic Effect after 10% Lidocaine Spray on Laryngopharyngeal and Intratracheal Site during the Endotracheal Intubation / 대한마취과학회지

BACKGROUND: To minimize hemodynamic responses to laryngoscopy and endotracheal intubation, 10% lidocaine spray to laryngopharyngeal area seems to be favorable. The aim of this study was to evaluate plasma concentration and hemodynamic responses following different dose of 10% lidocaine spray before laryngoscopic intubation. METHODS: Fifteen patients (ASA I, II) were randomly allocated. Group I (n = 5) patients were received saline spray for control, group II (n = 5) patients were received 1 mg/kg 10% lidocaine spray on laryngopharynx before induction of anesthesia and received 1 mg/kg 10% lidocaine topical spray to trachea under direct laryngoscopic view one minute before intubation, group III (n = 5) patients were received 1.5 mg/kg lidocaine spray. Hemodynamic response were measured at baseline, postspray 1 min, postintubation, postspray 2, 4, 6, 8, 10 min. Arterial blood samples for lidocaine concentration analysis were obtained at baseline and 2, 4, 6, 8, 10, 20, 30, 60, 120 minutes after larygopharyngeal and intratracheal administration of lidocaine. RESULTS: The highest lidocaine concentrations in arterial blood were 1.76 +/- 0.52microgram/ml for group II, 2.86 +/- 0.40microgram/ml for group III (mean +/- SD) 2 to 10 minutes after laryngopharyngeal and intratracheal administration. There weren't any definitive toxic symptoms observed during the study. Hemodynamic responses of group II and III were not satisfactory but remarkably stable compared with group I. There were no differences between group II and III. CONCLUSION: Sympathetic responses after 2-3 mg/kg lidocaine spray on laryngopharynx are favorably but not sufficiently attenuated during endotracheal intubation.

Stereotactic S5 Dorsal Root Ganglionotomy Using Radiofrequency Lesion Generation: A case report / 대한마취과학회지

Dorsal root ganglionotomy of the S5 nerve is useful for pain around the coccyx. The S5 dorsal root ganglion lies behind the sacrum at a level 1 cm caudal to the S2 foraminal opening and approximately 2 mm lateral to the midline of the sacrum. A small burr-hole was made through the plates of the posterior sacrum to approach the dorsal root ganglion of S5 nerve. Sensory stimulation was performed at 0.3 V, 50 Hz. No motor fasciculations was noted at 0.6 V, 2 Hz. A thermal lesion was created at 75oC for 60 sec. The patient whom we report now was a 67-year-old male who suffered from the pain around the coccyx due to rectal cancer metastasis. He failed to respond to other oral and invasive conventional therapy. We experienced a successful result in the treatment of his intractable pain after the S5 dorsal root ganglionotomy.

Severe Hypotension and Supraventricular Tachycardia during Insertion of Subclavian Catheter on a Patient with Wolff-Parkinson-White Syndrome: A case report / 대한마취과학회지

Wolff-Parkinson-White (WPW) syndrome is characterized by classical electrocardiographic findings resulting from preexcitation of a part of the ventricular myocardium due to anomalous atrioventricular conduction via a accessory pathway. Anesthetic management with this syndrome is aimed at avoiding tachycardia and cardiac arrhythmia by using the techniques to avoid hypoxia, hypercarbia, acidosis and sympathetic stimulation. We experienced a case of severe hypotension and paroxysmal supraventricular tachycardia (PSVT) during insertion of subclavian vein catheter on a patient with this syndrome prior to operation, in spite of adequate anesthetic management. The patient's condition was recovered after infusion of adenosine and removal of catheter. Operation was postponed for further evaluation of WPW syndrome. After 3 days, electrophysiologic study was done and accessory pathway was ablated by radiofrequency catheter. After 6 days, the patient was operated uneventfully and discharged 2 weeks later. We report that minor stimulation such as central venous catheterization on a patient with WPW syndrome can cause life-threatening severe hypotension and PSVT.

Closed Intramedullary Nailing of Femoral Fracture without a Fracture Table / 대한정형외과학회잡지

The standard treatment of adult femoral shaft fractures is the closed intramedullary nailing using a fracture table, but in polytraumatized patients, this method may be difficult due to concomitant adjacent injury. So, we report on the technique of closed intramedullary nailing without a fracture table for adult femoral shaft fracture using "joystick" technique on radiolucent table in supine position. Among 15 cases, two were open fractures, three were proximal 1/3, seven were middle 1/3, two were distal 1/3, and theree were segmental fractures. According to the Winquist Hansen classification, five type I, four type II, three type III, three were type IV. The eleven patients out of the fifteen were operated within 48 hours. The average operation time was 105 minutes, and the amount of bleeding was below 300cc. Forty-seven percent was anatomically reduced, forty percent had below five degree of angular deformity or below five milimeter of shortening, thirteen percent had above five degree of angular deformity of above five milimeter of shortening. The closed intramedullary nailing of femoral shaft fractures without fracture table using radiolucent table and "joy stick" technique is an effective and safe method in multiple injuries. And it reduced the operation time by reducing the preoperation time including preparing of a fracture table.