Factors contributing to episodes of bradycardia hypotension during shoulder arthroscopic surgery in the sitting position after interscalene block / 대한마취과학회지

BACKGROUND: Arthroscopic shoulder surgery has been performed in the sitting position under interscalene block (ISB). Bradycardia hypotension (BH) episodes have a reported incidence of 13-29% in this setting. We performed a retrospective study to investigate contributing factors to the occurrence of BH episodes. METHODS: According to BH episodes, we divided 63 patients into two groups: BH group (n = 13) and non-BH group (n = 50). Anesthetic records and block data sheets were reviewed for demographic data, intraoperative medications, sites of ISB, use of epinephrine in local anesthetics, degree of sensory blockade, and percent change of heart rate or systolic blood pressure (SBP). Statistical analysis was done using Chi square test and Student's t-test. RESULTS: There were no significant differences in the use of epinephrine in local anesthetics between the two groups. The location of ISB site was different between the two groups in that there were relatively more right-sided ISBs in the BH group than in the non-BH group (P = 0.048). The degree of sensory blockade was lower, but not significantly, in the C8 and T1 dermatomes of the BH group than in the non-BH group (P = 0.060 and 0.077, respectively). There was a relatively higher incidence of fentanyl supplementation in the BH group than in the non-BH group (P = 0.000). CONCLUSIONS: These results suggest that right ISB and perioperative supplementation of fentanyl due to incomplete block are possible contributing factors to the occurrence of BH episodes in the sitting position during shoulder surgery using ISB.

A case of mucinous borderline tumour showing persistently elevated tumor markers progressed into invasive mucinous cystadenocarcinoma / 부인종양

Mucinous tumors account for 10-15% of all epithelial of ovarian tumors, and 40% of them are borderline. Not many factors are known about progression into mucinous carcinoma of borderline ovarian tumors. The incidence of progression into invasive carcinoma is reported about 2.4% for borderline serous tumous, and 1.6% for borderline mucinous ovarian tumors. Mucinous tumors often exhibit a morphologic continuum of beningn, borderline, and invasive, so a pathologist should pay attention when examine the pathologic specimen not to miss carcinoma. This is the case of 54 female patients who developed invasive mucinous ovarian carcinoma 6 months after surgical treatment of borderline mucinous ovarian tumour.