Complete atrioventricular nodal block after propofol administration in an elderly patient undergoing total knee replacement arthroplasty: A case report / 대한마취과학회지

Complete atrioventricular (AV) block is defined as a dissociation of atrial and ventricular activities. Complete AV block that occurs during the perioperative period is difficult to reverse and usually requires implantation of a pacemaker. Propofol does not affect a normal AV conduction system but may act as a trigger for AV block. It can also potentiate vagal stimulation factors and reduce sympathetic activity. We report a case of complete AV block that may have been related to administration of propofol.

Opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia using fentanyl after lumbar spinal fusion surgery / 대한마취과학회지

BACKGROUND: The opioid sparing effect of low dose ketamine is influenced by bolus dose, infusion rate, duration of infusion, and differences in the intensity of postoperative pain. In this study, we investigated the opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia (PCA) using fentanyl after lumbar spinal fusion surgery, which can cause severe postoperative pain. METHODS: Sixty patients scheduled for elective lumbar spinal fusion surgery were randomly assigned to receive one of three study medications (K1 group: ketamine infusion of 1 microg/kg/min following bolus 0.5 mg/kg, K2 group: ketamine infusion of 2 microg/kg/min following bolus 0.5 mg/kg, Control group: saline infusion following bolus of saline). Continuous infusion of ketamine began before skin incision intraoperatively, and continued until 48 h postoperatively. For postoperative pain control, patients were administered fentanyl using IV-PCA (bolus dose 15 microg of fentanyl, lockout interval of 5 min, no basal infusion). For 48 h postoperatively, the total amount of fentanyl consumption, postoperative pain score, adverse effects and patients' satisfaction were evaluated. RESULTS: The total amount of fentanyl consumption was significantly lower in the K2 group (474 microg) compared to the control group (826 microg) and the K1 group (756 microg) during the 48 h after surgery. Pain scores at rest or with movement, the incidence of adverse events and patient satisfaction were not significantly different among the groups. CONCLUSIONS: Low-dose ketamine at 2 microg/kg/min following bolus 0.5 mg/kg significantly reduced the total amount of fentanyl consumption during the 48 h after lumbar spinal fusion surgery without increasing adverse effects.

The effect of intravenous low dose ketamine for reducing postoperative sore throat / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effectiveness of intravenous low dose ketamine for reducing the incidence and severity of postoperative sore throat (POST). METHODS: This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 70 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the ketamine group received an intravenous injection of 0.5 mg/kg of ketamine just before induction, followed by 10 microgram/kg/min throughout the operation. Patients in the control group received intravenous saline instead of ketamine. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. RESULTS: No significant differences in the incidence and severity of POST during the 24 h after the operation were found between the two groups (21/31 in the ketamine group vs. 26/34 in the control group, P = 0.398). CONCLUSIONS: Intravenous injection of low dose ketamine was not effective for reducing POST.

Prevention of pain with the injection of microemulsion propofol: a comparison of a combination of lidocaine and ketamine with lidocaine or ketamine alone / 대한마취과학회지

BACKGROUND: Aquafol, a microemulsion propofol, causes more severe and frequent pain on injection than propofol. The purpose of this study was to compare a combination of lidocaine and ketamine on aquafol-induced pain with lidocaine or ketamine alone during the induction of anesthesia. METHODS: In this prospective, randomized, double-blinded study, 130 healthy patients who were undergoing elective surgery under general anesthesia were enrolled. The patients received IV lidocaine 40 mg plus ketamine 25 mg (Group LK, n = 43), lidocaine 40 mg (Group L, n = 42), or ketamine 25 mg (Group K, n = 45) with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol. The pain score was assessed by a 4-point verbal rating scale (VRS) at 10 seconds after injection of microemulsion propofol 30 mg and during the injection of the remaining total dose. RESULTS: The incidence and severity of pain was significantly lower in Group LK than Group L or Group K at 10 seconds after the injection of microemulsion propofol 30 mg (P < 0.05). And the incidence and severity of pain was significantly lower in Group LK and Group K than Group L during the injection of the remaining total dose (P < 0.05). CONCLUSIONS: Pretreatment with IV lidocaine 40 mg plus ketamine 25 mg with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol is more effective than lidocaine 40 mg or ketamine 25 mg alone in preventing pain from the injection of microemulsion propofol.

Pheochromocytoma associated with cyanotic congenital heart disease / 소아과

Pheochromocytoma is a rare tumor of childhood, arising from adrenal medullary and chromaffin tissue. Because chronic hypoxia may induce pheochromocytoma, there have been several reports of pheochromocytoma development in cyanotic patients after corrective or palliative cardiac surgery. The variable clinical presentation of pheochromocytoma is obscured by both underlying heart disease and medications. If sudden hypertension, aggravation of a heart condition, or unusual symptoms such as diabetes mellitus develops in a cyanotic patient with congenital heart disease, pheochromocytoma must be ruled out. We report two patients presenting with cyanotic single-ventricle heart disease with pheochromocytoma.

Long term prognosis of patients who had a Fontan operation / 소아과

PURPOSE: This study assessed the long term survival rate and long term complications of patients who had a modified Fontan operation for functionally univentricular cardiac anomaly. METHODS: Between June 1986 and December 2000, 302 patients with a functional single ventricle underwent surgical interventions and were followed up until February 2006. The mean follow-up period was 8.3+/-5.3 years (range 3.5-18 years). Their median age was 2.4 years at the Fontan operation. The survival rate, the incidence and the risk factor of late complications were evaluated retrospectively. RESULTS: The verall survival rate was 91 percent at 5 years and 87 percent at 10 years. In multivariate analysis, early calendar year of operation and significant regurgitation were risk factors of death. The surviving patients showed NYHA functional class I in 82 percent, class II in 15 percent, and class III in 3 percent. Redo Fontan operations were necessary in 8.8 percent of patients at average 12.8+/-3.6 years after initial Fontan operation. The most common cause of Fontan conversion was atrial arrhythmia. The incidence of thromboembolic events was 9.3% and these complications were associated with the occurrence of atrial tachyarrhythmia. Supraventricular tachycardia including atrial flutter or fibrillation were reported on the follow-up examination by 11.2 percent of survivors after 8.4+/-5.6 years. Atriopulmonary connection showed higher rates of late tachycardia than lateral tunnel operation. CONCLUSIONS: This study revealed that the recent survival rate of Fontan type operation was satisfactory, but the occurrence of late complications after a Fontan type operation increased with the longer survival. There is a need for strict follow up and early treatment of late complications in patients who had a Fontan operation.

A Case of Pulmonary Artery Sling Associated with Tracheobroncheal Hypoplasia

Pulmonary artery sling is a rare vascular anomaly wherein the left pulmonary artery arises from the right pulmonary artery and then traverses between the esophagus and the trachea toward the hilum of the left lung. Associated anomalies are common, particularly those of the tracheobronchial tree, which have been found in more than 50% of patients. Cardiovascular anomalies such as persistent left superior vena cava, atrial septal defect, ventricular septal defect, patent ductus arteriosus and aortic arch anomalies are also found not infrequently. We have experienced a 20 day-old female who had showed severe respiratory distress and cyanosis. She was diagnosed as pulmonary artery sling associated with tracheobronchial hypoplasia by echocardiography, angiography, esophagography and bronchography. We report this case with related literature review.

Two Cases of Double-Chambered Right Ventricle by Abnomal Muscle Bundles

The double-chambered right ventricle is congenital or acquired cardiac anomaly, which is characterized by aberrent hypertrophied muscular bands that divide the right ventriclar cavity into two different pressure chamber. This anomaly can complicate the natural history of patient with isolated ventricular septal defect. We experienced two cases of cases of acquired DCRV, which confirmed by two separate cardiac catherterization and angiography. The purpose of this report is to show that the aberrant muscular bands may be nonobstructive in early infancy and that the obstructive effect is developed with time as the bands become progressively more hypertrophied.

A Case of Trensient Myeloproliferative Disorder with Down Syndrome

No abstract available.