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.

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.

One-Lung Ventilation Using a Fogarty Catheter in a Patient with Tracheostomy after Pharyngectomy and Laryngectomy: A case report / 대한마취과학회지

One lung ventilation with a double-lumen endotracheal tube or Univent tube may be achieved difficultly or dangerously in some patient such as young age, anatomic anomaly, low body weight and tracheostomy patient. Bronchial blocker with a Fogarty catheter has been used successfully for such situations. Here, we reported the clinical experience in using a Fogarty embolectomy catheter as a bronchial blocker in patient with tracheostomy after pharyngectomy and laryngectomy. The patient was received left upper lobectomy with thoracotomy due to metastatic lung cancer.