Acute cerebral infarction due to thrombus formation during GDC embolization for the treatment of intracranial aneurysm: A case report / 대한마취과학회지

Although Guglielmi Detachable Coil (GDC) endovascular treatment of intracranial aneurysms has become an alternative to surgery, the main complication continues to be thromboembolic events. In our patient, we found thrombus at the third branch of the right middle cerebral artery after coil embolization. We added intravenous heparin and gave abciximab, an antiplatelet agent through the catheter. We then elevated the blood pressure and administered intravenous colloid solution to maintain adequate collateral circulation. One day later, the patient presented with acute focal infartion in the right frontal lobe and we treated her with low molecular weight heparin. After seven days, the patient's symptoms disappeared, and there was no residual neurological deficit. Therefore, we believe potential clinical complications can be avoided through early recognition of thrombus and appropriate medical therapy. Furthermore, it is necessary to prevent hypotension and to maintain proper hematocrit levels during operations in patients having risk factors for thrombosis.

Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Referred Shoulder Pain due to Metastatic Liver Cancer: A case report / 대한통증학회지

A diagnosis of shoulder pain is varied and difficult to make. The initial onset of liver cancer is difficult to detect and patients typically do not complain of symptoms as most tumors are asymptomatic. If the symptoms of the patients develop, the first symptom is usually pain that extends from the abdomen to the back and shoulder. A suprascapular nerve block is used in the treatment of the referred shoulder pain due to a metastatic hepatoma, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 66-year-old male patient complaining of referred right shoulder pain due to metastatic liver cancer, which was relieved after PRF lesioning of the suprascapular nerve.

Acute Pulmonary Edema for Surgical Removal of Pheochromocytoma: A case report / 대한마취과학회지

This report describes the perioperative management of an adrenergic crisis and intraoperative pulmonary edema occurring during planned surgery for pheochromocytoma. We experienced the anesthetic management of a 45-year-old male patient with pheochromocytoma on the extra-adrenal retroperitoneum. The patient had been treated with prazosin for only 1 week before surgery. After inducing anesthesia with intravenous remifentanil, thiopental sodium, and rocuronium, anesthesia was maintained with nitrous oxide, oxygen, and isoflurane administration. The blood pressure was poorly controlled with sodium nitroprusside, esmolol, and remifentanil after manipulating the tumor. Pulmonary edema occurred intraoperatively but subsided with positive end expiratory pressure and the use of diuretics and morphine. After removing the tumor, the blood pressure was well controlled using a colloid solution, Hartman's solution, and dopamine administration. This complication occurred because of inadequate preoperative preparation. We reported this case of surgery for the removal of a pheochromocytoma with a review of the relevant literature.

Unanticipated Difficult Intubation in a Preeclamptic Parturient with Asymptomatic Subglottic Stenosis Caused by Unknown Origin : A case report

Subglottic stenosis can be caused by various etiology such as idiopathic, infectious disease, trauma from previous prolonged intubation, airway surgery, external blunt trauma, radiaton, or inhalation burn. Although extremely rare, subglottic stenosis may be present in pregnancy and engender a complex and technically challenging dilemma for anesthesiologist as how to evaluate and best manage these patients. A 36-year-old parturient was scheduled for Cesarean section. When most of the vocal cords were exposed clearly by laryngoscopy after injection of thiopental sodium & succinylcholine, the 7.0 mm internal diameter (ID) endotracheal tube could not be advanced below the level of the vocal cords because of resistance. So, intubation was re-attempted several times after oxygenation by mask with smaller tubes. Finally, a 6.0 mm ID cuffed tube was passed successfully through the vocal cords, and secured in place. because of the unexpected difficulties in intubation, an otolaryngologist was consulted to examine the larynx with a microscope. We present an unexpected case of the difficult endotracheal intubation caused by a unrecognized subglottic stenosis in a preeclamptic who underwent the induction of general anesthesia for Cesarean section.

Anesthetic Management of a Patient with Idiopathic Hypereosinophilic Syndrome: A case report / 대한마취과학회지

Idiopathic hypereosinophilic syndrome is characterized by prolonged markedly elevated peripheral blood eosinophil count and eosinophil-related tissue damage to variable organs without an identifiable underlying cause. Eosinophilopoiesis is related with T-lymphocyte activation and cytokine cascade controlling eosinophilic production. It shows tissue infiltration in many organs including endomyocardium, lung, liver, gastrointestinal tract. Here we report a case of idiopathic hypereosinophilic syndrome presenting ruptured rectus sheath hematoma due to coagulopathy involving the liver. Severe postoperative complications were developed after general anesthesia. The patient suffered from life-threatening acute respiratory distress syndrome (ARDS). This case suggest that, in patients with marked eosinophilia requiring general anesthesia, perioperative steroid cover is advisable. This may reduce or prevent serious lung damage and other complications.

Clinical Experience of Pain Management for Postlaminectomy Syndrome due to Pseudomeningocele: A case report / 대한통증학회지

Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.