A novel technique of handling the blade for videolaryngoscopy intubation in patients with a semi-rigid neck collar: a prospective randomized controlled trial / 대한마취과학회지

Background@#Semi-rigid neck collars to protect the cervical spine can limit the extent of neck movement and mouth opening; this may further complicate orotracheal intubation. We aimed to compare intubation environments obtained with videolaryngoscopy using the technique of gliding a blade under the epiglottis and that obtained using the conventional Macintosh blade technique of blade tip placement on the vallecula. @*Methods@#This prospective randomized study included patients aged ≥ 20 years with American Society of Anesthesiologists physical status I–III scheduled for cervical spine surgery between October 2020 and August 2021. Patients were divided into two groups according to the placement of the blade of the McGrathTM videolaryngoscope: the gliding and conventional groups. The percentage of glottic opening (POGO) score was the primary endpoint. We also recorded the time to obtain the optimal laryngoscopic view, intubation duration, and ease and satisfaction of the researcher performing intubation. @*Results@#Among 176 patients, the POGO scores were significantly higher in the gliding group than in the conventional group (88.9 ± 14.7 vs. 63.8 ± 27.4, P < 0.001). The time to achieve the optimal glottic view for intubation and duration of intubation were also shorter, and ease and satisfaction in performing intubation were better in the gliding group than in the conventional group. @*Conclusion@#Our findings demonstrated a superior glottic view and more favorable intubation environments when the blade tip was placed under the epiglottis than using the conventional Macintosh technique in patients with immobilized cervical spine.

Acute Myeloid Leukemia in Suspected Sepsis after Caesarean Section / 대한구급학회지

The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.

The effect of fentanyl pretreatment on propofol sedation during spinal anesthesia

BACKGROUND: To test whether propofol with fentanyl pretreatment produces better sedative efficacy than that of propofol alone in patients under spinal anesthesia. METHODS: Fifty-four patients undergoing lower leg orthopedic surgery were sedated randomly with propofol-normal saline (PN, n = 27) or propofol-fentanyl (PF, n = 27). In both groups, sedation was maintained with an initial loading dose of propofol 0.4 mg/kg, and subsequent infusion at a rate of 50 microg/kg/min. Prior to propofol administration, normal saline 0.02 ml/kg or fentanyl 1 microg/kg was given intravenously to Group PN and Group PF, respectively. We measured bispectral index (BIS) and the Observer's Assessment of Alertness/ Sedation (OAA/S) scale scores to investigate sedative efficacy, prior to and at 5 minute intervals for 1 hour after propofol infusion. RESULTS: BIS and OAA/S scores were decreased in both groups over time after starting propofol infusion (P < 0.0001). Comparison between the PF group and the PN group at each time point did not demonstrate statistically significant differences, and group effect was also not found to be statistically significant for BIS and OAA/S [BIS, P = 0.4644 (group effect), P = 0.7817 (time*group interaction)], [OAA/S scale, P = 0.4373 (group effect), P = 0.125 (time*group interaction)]. CONCLUSIONS: Judging from the BIS and OAA/S scores, propofol with fentanyl pretreatment did not produce an additional sedative effect compared to propofol alone in spinal anesthesia.

The effect of fentanyl pretreatment on propofol sedation during spinal anesthesia

BACKGROUND: To test whether propofol with fentanyl pretreatment produces better sedative efficacy than that of propofol alone in patients under spinal anesthesia. METHODS: Fifty-four patients undergoing lower leg orthopedic surgery were sedated randomly with propofol-normal saline (PN, n = 27) or propofol-fentanyl (PF, n = 27). In both groups, sedation was maintained with an initial loading dose of propofol 0.4 mg/kg, and subsequent infusion at a rate of 50 microg/kg/min. Prior to propofol administration, normal saline 0.02 ml/kg or fentanyl 1 microg/kg was given intravenously to Group PN and Group PF, respectively. We measured bispectral index (BIS) and the Observer's Assessment of Alertness/ Sedation (OAA/S) scale scores to investigate sedative efficacy, prior to and at 5 minute intervals for 1 hour after propofol infusion. RESULTS: BIS and OAA/S scores were decreased in both groups over time after starting propofol infusion (P < 0.0001). Comparison between the PF group and the PN group at each time point did not demonstrate statistically significant differences, and group effect was also not found to be statistically significant for BIS and OAA/S [BIS, P = 0.4644 (group effect), P = 0.7817 (time*group interaction)], [OAA/S scale, P = 0.4373 (group effect), P = 0.125 (time*group interaction)]. CONCLUSIONS: Judging from the BIS and OAA/S scores, propofol with fentanyl pretreatment did not produce an additional sedative effect compared to propofol alone in spinal anesthesia.

Bilateral hydrothorax and cardiac tamponade after right subclavian vein catheterization: A case report / 대한마취과학회지

Central venous catheterization is typically used for the anesthetic management of patients undergoing a major surgery or care of patients in Intensive Care Unit (ICU). The occurrence of complications associated with central venous catheterization such as pneumothorax or vascular injury have decreased, while delayed complications such as hydrothorax, hydromediastinum, or cardiac tamponade have risen recently. We report a case of complications of bilateral hydrothorax with cardiac tamponade by superior vena cava perforation due to continuous mechanical force of the looped central venous catheter tip against SVC wall after subclavian vein cannulation.

THE AMOUT OF LOSS AND THE DEGREE OF SURFACE SMOOTHNESS OF GOLD ALLOY BY GOLD ALLOY POLISHING RUBBER POINT MATERIALS / 대한치과보철학회지

After clinical adjustment of dental casting restoration, re-polishing procedure is recommanded because the smooth gold sureface is lost. But there is the possibility to get more loose contact than that intended by loss of gold alloy according to the kinds of polishing materials and polishing time. Therefore in this study I polished type II gold alloy with 390gm force, 20,000rpm speed, and 8 kinds of gold alloy polishing materials, fabricated by 4 companies and then measured the amount of loss of gold alloy with Surfcorder SEF30D and observed alloy surfaces polished by 3 brown rubber points with SEM. The amount of loss of gold alloys polished with 8 kinds of polishing materials and the degree of smoothness of gold alloys according to polishing time and polishing materials were compared. The following results were obtained : 1. When the amount of loss of gold alloys polished with 3 kinds of brown rubber point was compared, Alphalex brown point had the most amount of alloy loss, followed in decreasing order by Shofu brown point and Eveflex brown point. There was statistically significant difference in the amount of alloy loss according to polishing materials. 2. When the amount of loss of gold alloys polished with 5 kinds of green rubber point was compared, Shofu green point had the most amount of alloy loss, followed in decreasing order by Alphaflex green point, Dedeco green clasp polisher, and Eveflex green point. There was statistically significant difference in the amount of alloy loss according to polishing materials except Alphaflex green point and Dedeco green clasp polisher. 3. When the amount of loss of gold alloys polished with all kinds of rubber point was compared, there was no significant difference in Eveflex brown point, Alphaflex green point, and Dedeco green claps polisher. 4. When average amount of alloy loss per 1 revolution by polishing materials was compared, Alphalex brown point had the greatest value as 0.329micrometer and Shofu supergreen point had the lowest value as 0.022micrometer. 5. When the degree of sureface smoothness of gold alloy polished with 3 kinds of brown rubber point was compared, in Alphalex brown point surface roughness was completely lost after 20 seconds polishing time, in Shofu brown point 30 seconds, in Eveflex brown point 40 seconds. But in every gold alloys fine scratch formed by rubber points was observed. Based on the results of this study, as rubber polishing materials used in polishing of dental casting restoration after clinical adjustment influenced on the tightness of occlusal or proximal contact, we should make dental casting restoration with minimum error through careful laboratory procedure and form very smooth surface of restoration with tripoli and rouge after use of silicone polishing materials.

THE AMOUT OF LOSS AND THE DEGREE OF SURFACE SMOOTHNESS OF GOLD ALLOY BY GOLD ALLOY POLISHING RUBBER POINT MATERIALS / 대한치과보철학회지

After clinical adjustment of dental casting restoration, re-polishing procedure is recommanded because the smooth gold sureface is lost. But there is the possibility to get more loose contact than that intended by loss of gold alloy according to the kinds of polishing materials and polishing time. Therefore in this study I polished type II gold alloy with 390gm force, 20,000rpm speed, and 8 kinds of gold alloy polishing materials, fabricated by 4 companies and then measured the amount of loss of gold alloy with Surfcorder SEF30D and observed alloy surfaces polished by 3 brown rubber points with SEM. The amount of loss of gold alloys polished with 8 kinds of polishing materials and the degree of smoothness of gold alloys according to polishing time and polishing materials were compared. The following results were obtained : 1. When the amount of loss of gold alloys polished with 3 kinds of brown rubber point was compared, Alphalex brown point had the most amount of alloy loss, followed in decreasing order by Shofu brown point and Eveflex brown point. There was statistically significant difference in the amount of alloy loss according to polishing materials. 2. When the amount of loss of gold alloys polished with 5 kinds of green rubber point was compared, Shofu green point had the most amount of alloy loss, followed in decreasing order by Alphaflex green point, Dedeco green clasp polisher, and Eveflex green point. There was statistically significant difference in the amount of alloy loss according to polishing materials except Alphaflex green point and Dedeco green clasp polisher. 3. When the amount of loss of gold alloys polished with all kinds of rubber point was compared, there was no significant difference in Eveflex brown point, Alphaflex green point, and Dedeco green claps polisher. 4. When average amount of alloy loss per 1 revolution by polishing materials was compared, Alphalex brown point had the greatest value as 0.329micrometer and Shofu supergreen point had the lowest value as 0.022micrometer. 5. When the degree of sureface smoothness of gold alloy polished with 3 kinds of brown rubber point was compared, in Alphalex brown point surface roughness was completely lost after 20 seconds polishing time, in Shofu brown point 30 seconds, in Eveflex brown point 40 seconds. But in every gold alloys fine scratch formed by rubber points was observed. Based on the results of this study, as rubber polishing materials used in polishing of dental casting restoration after clinical adjustment influenced on the tightness of occlusal or proximal contact, we should make dental casting restoration with minimum error through careful laboratory procedure and form very smooth surface of restoration with tripoli and rouge after use of silicone polishing materials.

A Case of Anterior Ischemic Optic Neuropethy

Anterior ischemic optic neuropathy is due to acute ischemia of the anterior part of the optic nerve, whose main source of blood supply is from the posterior ciliary circulation, either by direct branches or through the peripapillary choroid, with minor and differing contributions from other sources. The clinical features are charaterized by sudden visual impairment, optic nerve related visual field defect and optic disc edema. For pathogenetic as well as therapeutic reasons, these patient can be subdivided into two major subgroups: a nonarteritic group, an arteritic group. The authors experienced a case of AION, which occurred in a young male, probably arteritic. So, the literature of the AION was briefly reviewed and the purpose of this review is to increase awareness of this not uncommon condition.