Massive Hydrothorax as a Complication of Percutaneous Nephrolithotomy: A case report / 대한마취과학회지

Percutaneous nephrolithotomy (PCNL) has largely replaced open surgical intervention for the management of renal pelvis calculi as it reduces patient morbidity and shortens hospital stay. However, major complications such as hydrothorax or pneumothorax can be encountered uncommonly. A 64-year-old, 48 kg, female patient underwent PCNL under general anesthesia. The preoperative chest X-ray showed normal findings. Elevated airway pressure was noted and then breathing sounds were not audible on the right lung field during the procedure. A chest X-ray and chest computerized tomographic scan, taken immediately after the operation, showed massive hydrothorax and total collapse in the right lung. After drainage of the pleural effusion via chest tube, the patient recovered completely. Anesthesiologists should be aware that hydrothorax can occur during the PCNL procedure and must be prepared to intervene quickly.

The Effects of the Preoperative Education about Analgesics and Patient-Controlled Analgesia (PCA) on the Consumption of Analgesics after Operation / 대한마취과학회지

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.

Repeating Cardiac Arrest and One Hour of Cardiopulmonary Resuscitation due to Severe Hyperkalemia after Reperfusion during a Liver Transplantation: A case report / 대한마취과학회지

Liver transplantation still carries considerable risks even if the improvements in surgical and anesthetic techniques lead to a significant decrease in complications. Cardiac arrest during liver transplantation occurs most frequently immediately after the reperfusion due to the influx of hyperkalemic blood from donor liver into a recipient. Cardiac arrest caused by hyperkalemia shows a favorable response to cardiopulmonary resuscitation; however, prolonged cardiopulmonary resuscitation can damage the transplanted liver as well as brain and kidney resulting increased mortality and morbidity rates. The authors experienced repeating cardiac arrest and one hour cardiopulmonary resuscitation due to severe hyperkalemia (8.8 mmol/L) just after the reperfusion during cadaveric liver transplantation. Consciousness was returned 6 hours after operation and vital signs was stable. Transplanted liver well functioned although postoperative course was complicated with acute renal failure, pneumonia and pleural effusion. The patient recovered and discharged 97 days after operation.