Rupture of the Hidden Intracranial Arteriovenous Malformation during General Anesthesia: A case report / 대한마취과학회지

Rupture of intracranial vessel during general anesthesia dramatically jeopardise patient's state and may lead to death. A sudden cardiovascular change during intubation and extubation in general anesthesia is dangerous, especially in patient with coronary and intracranial vascular disease. Myocardial infarction, congestive heart failure or intracranial hemorrhage can occur in such condition, but these occur rarely. We discovered the rupture of the hidden intracranial arteriovenous malformation in 13 years old female patient after tonsillectomy. We discuss about prognosis, prophylaxis and management of the intracranial arteriovenous malformation rupture during general anesthesia.

Bilateral Ilioinguinal and Iliohypogastric Nerve Blockade for Analgesia after Surgery through a Pfannenstiel Incision / 대한마취과학회지

BACKGROUND: Epidural administration of morphine is a common method for postoperative analgesia in the lower abdominal surgery, but many complications can be produced. Since the pfannenstial incision lies within L1 dermatome, bilateral ilioinguinal and iliohypogastric nerve blocks(IINB) should provide analgesia after surgery through that incision. METHODS: Forty patients undergoing cesarean delivery or total abdominal hysterectomy(TAH) through a pfannenstiel incision were randomly assigned to one of two groups: epidural morphine group(n=20) received 3 mg of morphine epidurally after surgery with epidural anesthesia; IINB group(n=20) performed IINB with 0.5% bupivacaine, 10 ml to each side after surgery with general anesthesia. Visual analogue scale(VAS) scores at resting and moving state, and complications were checked at 0, 2, 4, 8, 12, 24 hours after surgery. RESULTS: Postoperative VAS scores did not show significant differences between the two groups at rest after 0, 2, 4, 8, 12, 24 hours and at moving state after 0, 2, 4 hours, but IINB group had less pain with movement than epidural morphine group at 8, 12, 24 hours after surgery(p<0.05). The incidence of pruritus was rare in IINB group(P<.05), but incidences of other complications were not significantly different between the two groups. CONCLUSIONS: IINB is effective for analgesia after surgery through a pfannenstiel incision because of a lower incidence of complications and less postoperative pain with movement than epidural morphine, and can be performed to patients who have contraindications and difficulty for epidural analgesia.