Intrathecal baclofen pump implantation for complex regional pain syndrome in a patient with a spinal cord stimulator: consideration about optimal location of intrathecal catheter tip: A case report

Intrathecal baclofen (ITB) pump implantation can be used to control dystonia and severe pain associated with complex regional pain syndrome (CRPS) with or without a spinal cord stimulator (SCS). A 45-year-old female patient had gotten an SCS to control the pain of CRPS. However, she suffered from chronic intractable pain in her left ankle and foot despite paresthesia in the entire painful area because the effectiveness of the SCS gradually diminished over time. In a trial of intrathecal drug administration, baclofen was superior to morphine for pain relief, had fewer side effects, and was superior in terms of patient satisfaction. To achieve the greatest degree of pain relief from the ITB pump, the tip of the intrathecal catheter was carefully placed in relation to the SCS. Over a one-year follow-up period, the patient experienced mild pain without any adverse effects.

Cardiac arrest after sugammadex administration in a patient with variant angina: a case report / 대한마취과학회지

A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.

Inter-arm arterial pressure difference caused by prone position in the thoracic outlet syndrome patient: A case report / 대한마취과학회지

Thoracic outlet syndrome has neurologic symptoms caused by compression of brachial plexus, blood vessel symptoms are caused by compression of the artery or vein. The authors report a case of sudden decrease in blood pressure of the left arm after turning the patient from supine position to prone position. They confirmed that the patient had thoracic outlet syndrome after performing computed tomography.

Unilateral administration of a drug into the lung of a small animal / 대한마취과학회지

BACKGROUND: The selective unilateral administration of drugs into a single lung of a rat is difficult because of the small airway diameter. Therefore, a simple method for unilateral administration into rat lung is needed. METHODS: Rats were assigned to 1 of 2 groups according to the direction of the catheter used for drug administration. Anesthetized rats were intubated, and curved epidural catheters were rotated up to a maximum of 90degrees toward the left lung (group L) or right lung (group R). Bronchial catheters were then inserted via a tracheal tube and fixed. Methylene blue (0.3 ml) was injected via the epidural catheter. Additionally, to compare survival rates, rats were assigned to one of two groups according to the drug administration route. In group T, bleomycin hydrochloride (20 mg/kg) in 0.3 ml of phosphate-buffered saline (PBS) was administrated into the lung intratracheally via a tracheal tube. In group B, the same dose of bleomycin was administrated into the lung intrabronchially via a bronchial catheter, targeting the left lung. RESULTS: Gross examination revealed that targeted administration was 100% successful. Methylene blue was observed in the right lung of all rats in the R group and in the left lung of all rats in the L group. The survival rate was higher in group B than in group T. CONCLUSIONS: The intrabronchial method offers an advantage over tracheal administration as it decreases mortality and allows the administration of a drug unilaterally into a single lung or into a localized area without the need for double-lumen tubes or more invasive procedures.

Comparison of the effects of acetaminophen to ketorolac when added to lidocaine for intravenous regional anesthesia / 대한마취과학회지

BACKGROUND: This study was done to evaluate the effect on pain relief when acetaminophen was added to lidocaine for intravenous regional anesthesia (IVRA). METHODS: Sixty patients undergoing hand or forearm surgery received IVRA were assigned to three groups: Group C received 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml (n = 20), Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml (n = 20) and Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketorolac 10 mg made up to a total volume of 40 ml (n = 20). Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed. RESULTS: Sensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C (P < 0.001). CONCLUSIONS: The addition of acetaminophen to lidocaine for IVRA shortens the onset time of sensory block and delays tourniquet pain onset time, but not with ketorolac. Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.

Clinical and Pathologic Analysis of Thin Glomerular Basement Membrane Disease in Children

PURPOSE : Clinical manifestations and pathologic findings of thin glomerular basement membrane disease, recognized as a common underlying disease of benign, familiar and asymptomatic hematuria has not been reported systemically in Korea. We analyzed clinical and pathologic findings of patients who were diagnosed as thin glomerular basement membrane disease. METHODS : We analyzed clinical and pathologic findings of twenty-six patients who were diagnosed as thin glomerular basement membrane disease by renal biopsy among who complained asymptomatic hematuria from 1990 to 2000. RESULTS : The subjects were aged 9.4+/-3.2 (3.0-15.8) years-old at onset of hematuria, and 11.1+/-2.2 (4.7-16.3) years-old at renal biopsy. Sexual discrepancy was more common in girls (eight boys and eighteen girls). A family history of hematuria was found in 8 patients(30.7%). Major clinical manifestation on admission was microscopic hematuria according to the findings of 3cases(11.5%) of gross hematuria, 23cases(88.5%9) of microscopic hematuria, and 1case(3.8%) of proteinuria. Microscopic hematuria persisted in all cases. Kidney biopsy showed few changes by light microscopy, but IgM, C3 and fibrinogen deposit in mesangium was found by immunofluorescent microscopy in a few cases. Electron microscopic findings have revealed thinning of the glomerular basement membrane varied from 180.9+/-35.8nm. CONCLUSION : Thin glomerular basement membrane disease might be a common cause of microscopic hematuria of children and family history was revealed in about 30%. Clinical progression was good in majorities.