Respiratory Failure following Tetramine poisoning after Ingestion of Sea Snail: A Case Report

Tetramine toxicity due to sea snail ingestion is generally mild and has a good prognosis. Tetramine toxicity acts on the acetylcholine receptor, affecting the neuromuscular junction and autonomic nervous system. A 78-year-old female patient visited the emergency room with vomiting and dyspnea after eating sea snails. At the time of admission, the vital signs recorded were 140/80 mmHg-105/min-24/min-36.5。C, and 90% oxygen saturation. Arterial blood test revealed hypercapnia (pCO2 58.2 mmHg) and respiratory acidosis (pH 7.213, HCO3 - 22.5 mmol/L), whereas other blood tests showed no specific findings. Due to decreased consciousness and hypoxia, endotracheal intubation and mechanical ventilation were administered to the patient. Successful weaning was accomplished after 12 hrs, and the patient was discharged without any further complications. Although tetramine toxicity rarely results in acute respiratory failure due to paralysis of the respiratory muscle, caution is required whilst treating the patient.

A Comparative Study on the Clinical Features and Complications of Snake Bite Patients in Urban and Rural Areas / 農村醫學 地域保健

Purpose@#The purpose of this study is to compare the clinical features and complications of snake bite patients in urban and rural areas. @*Methods@#A retrospective study was conducted on patients over 18 years of age who were hospitalized for snake bites from January 2013 to December 2019. Patients were categorized into urban and rural groups according to their respective locations at the time of the snake bite and the clinical characteristics and complications of the two patient groups were researched and compared. @*Results@#Of the 77 snake bite patients, 44 patients were categorized into the rural group (57.1%). The rura1 group showed significant differences in old age (p=0.011), delayed hospital visits (p=0.010), far hospital distance (p<0.001), high local effect score (p<0.001), high traditional snake-bite severity grading scale (p=0.008) and use of large amounts of antivenins (p=0.026). There was a significantly higher incidence of acute kidney injury (p=0.030), rhabdomyolysis (p=0.026), and coagulopathy (p=0.033) in the rural group as well as a longer hospitalization period (p<0.011). @*Conclusion@#Snake bites that occurred in rural areas resulted in patients with more complications compared to urban areas due to farther distances from hospitals, causing a delay in antivenom treatment.

Sequential bipolar radiofrequency lumbar sympathectomy in Raynaud's disease: A case report / 대한마취과학회지

A 39-year-old female was suffering from cold-induced Raynaud's attacks in both hands and feet, with symptoms being most severe in her left foot. The patient did not respond to medical treatments and was referred to our department of pain medicine. We performed sequential bipolar radiofrequency lumbar sympathectomy to the patient, which offered a long duration of symptom relief. Sequential bipolar radiofrequency lesions could create continuous strip lesion, and thus, could achieve better results, while the potential risk of liquid neurolytic agents could be avoided.

Unilateral phrenic nerve block guided by ultrasonography and nerve stimulator for the treatment of hiccup developed after tongue cancer operation: A case report / 대한마취과학회지

Hiccups are common benign and usually transient phenomenon that occur in nearly everyone. However, persistent or intractable hiccups can cause multiple problems including malnutrition, weight loss, fatigue, dehydration, insomnia, and wound dehiscence. We have experienced a case of postoperative persistent hiccup. The patient was formerly diagnosed tongue cancer and developed persistent hiccup after partial glossectomy with modified radical neck dissection and a radial forearm free-flap operation. He was unsuccessfully managed using pharmacologic methods, and then we tried phrenic nerve block guided by ultrasonography and a nerve stimulator because the surface anatomy of neck was deformed by the previous operation. Thirty minutes after the block, the hiccups disappeared.

Degenerative Osteoarthritis of the Hip Misconceived as a Failed Back Surgery Syndrome: A case report / 대한마취과학회지

We report the treatment experience of a patient who developed pain in the right anterior thigh and buttock 3 months later after lumbar disc surgery. He was treated as failed back surgery syndrome and had no symptom improvement. On physical examination, groin pain was elicited by Patrick's test and internal rotation of the hip. Plain radiographs of the pelvis showed calcification or osteophytes near the superior lip of the acetabulum. On magnetic resonance imaging, the lesion was identified as osteophytes and joint effusion was also noted. Under C-arm guidance, we injected corticosteroids and local anesthetics, and the patient obtained dramatic pain relief and no recurrence of symptoms.

Cervical and Thoracic Spinal Cord Stimulation with Single Electrodes for Failed Back Surgery Syndrome: A case report / 대한통증학회지

Failed back surgery syndrome (FBSS) is a condition characterized by extreme pain after spinal surgery. Treatment of FBSS is aimed at improving function, using interdisciplinary approaches that encompass rehabilitation, psychological therapy, and pain management. If no response to conventional treatment is noted, a more interventional technique such as spinal cord stimulation (SCS) should be used. SCS is a well-established method of managing a variety of chronic neuropathic pain conditions. A 32 year-old male patient afflicted by FBSS that was irresponsive to both medication and several repeated nerve blocks showed improvement of symptoms after cervical and thoracic SCS with a single electrode. Centered on the midline of the spinal cord, single-electrode SCS can be an effective method for relieving pain and improving function.

Cervical Transforaminal Axis Measured by MRI and Its Relation to the Internal Jugular Vein, Internal Carotid Artery and Vertebral Artery / 대한통증학회지

BACKGROUND: The safety of cervical transforaminal epidural block has been the subject of debate, therefore, this study was conducted to measure the angle of the cervical transforaminal axis and to investigate its relationship to the internal jugular vein, internal carotid artery and vertebral artery. METHODS: One hundred cases of cervical MRI were reviewed. The angle between a line passing through the center of the vertebral body and spinous process and a line passing through the center of the lamina in C3-4, C4-5 and C5-6 was measured and designated as A-degree. Additionally, we drew a line at the back of the vertebral artery that ran parallel to a line passing through the center of the lamina, which was presented as A-line. We then examined the distribution of the area in which the internal jugular vein and the internal carotid artery were located. RESULTS: The mean values of the A-degree in C3-4, C4-5 and C5-6 were 53.5 +/- 4.3, 54.2 +/- 4.6 and 54.3 +/- 4.8, respectively. There were no statistically significant differences among age groups or vertebral levels (ANOVA test, P > 0.05). The A-line was distributed primarily throughout zone 3, 4, and 5 in C3-4 and zone 5 in C4-5 and C5-6. CONCLUSIONS: The results of this study indicate that the mean values of A-degree were not statistically different among each age group and each vertebral level. However, the A-line may be located in the zone in which the internal jugular vein and the internal carotid artery lie and individual differences in the A-degree remain.

Changes of Serum Histamine Concentration during General Anesthesia with Propofol-N2O in Korean / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effect of propofol on the histamine release during general anesthesia. METHODS: Ten premedicated adult patients, ASA physical status I or II, 20-55 yrs scheduled for elective surgery were included. Venous blood samples (3 ml each) were obtained from median cubital vein before induction as a control and at 1, 3, 5, 10, 30, 60, 120 minutes after the administration of propofol and postoperative one hour to measure the plasma histamine concentrations. After intubation with vecuronium, anesthesia was maintained with propofol in combination with 60% N2O and 40% O2. Mean arterial pressure, heart rate were measured and the development of skin wheal, facial flushing, bronchospasm were monitored. RESULTS: The changes of the serum histamine concentration did not show any significant differences, and hypersensitivity reactions were not observed. Hemodynamic changes at 1, 3 minutes may be due to the effect of propofol on mean arterial pressure and heart rate, so these changes did not correlate with plasma histamine concentration. CONCLUSIONS: Propofol was found to be a useful anesthetic agent without histamine release for patients with allergy or asthma.

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.

The Clinical Effectiveness and Selectivity of Radiofrequency Trigeminal Rhizotomy Using a 2 mm Active Tip Electrode for the Treatment of Trigeminal Neuralgia / 대한마취과학회지

BACKGROUND: To minimize the side effects of radiofrequency trigeminal rhizotomy by making a more selective minimal lesion for the target division of a trigeminal rootlet, we performed this study to evaluate the effectiveness and the selectivity of radiofrequency trigeminal rhizotomy using a 2 mm active tip electrode as compared to a 5 mm active tip electrode. METHODS: The authors evaluated 36 cases, in which radiofrequency thermocoagulation of a trigeminal rootlet was performed using a 2 mm active tip electrode or a 5 mm active tip electrode at 75oC for 60 seconds in patients suffering from trigeminal neuralgia. One month after each operation, we assessed the clinical effects, selectivity, and the side effects of these operations. RESULTS: Of the 36 patients, 34 patients experienced loss of tic pain. In terms of effectiveness, no difference was found between the two groups. In terms of selectivity, some superiority was shown by the 2 mm active tip electrode, but this was not statistically significant. Masseter weakness or dysesthesia occurred in six patients who suffered from tic pain in the V3 region, and who were operated upon with a 5 mm active tip electrode. Major complications like anesthesia dolorosa, and corneal anesthesia were absent in any patients. CONCLUSIONS: For target specific lesion generation of trigeminal rootlets, single lesion generation using a 2 mm active tip electrode may be as clinically effective as a 5 mm tip and is more selective in use.

The Characteristics of Clinical Anesthesia Based on the Duration of Lateral Decubitus in Low Dose Hyperbaric Bupivacaine Induced Unilateral Spinal Block / 대한마취과학회지

BACKGROUND: When attempting a unilateral spinal anesthesia, many factors must be considered including patient's position, density and amount of the local anesthetics, needle design, injection speed. We evaluated a duration of lateral decubitus with low dose hyperbaric bupivacaine for maximizing the benefit. METHODS: Hyperbaric 0.5% bupivacaine 6 mg was administered slowly through a 25-gauge Whitacre needle to 60 ASA 1-2 patients undergoing unilateral lower extremity surgery. The patients were randomly allocated to four groups based on the duration of lateral decubitus after spinal anesthesia: 5 minutes in Group I; 10 minutes in Group II; 15 minutes in Group III; 20 minutes in Group IV. Circulatory variables, sensory and motor block level were recorded. RESULTS: The circulatory variables were stable in all patients. In the Group I, the success rate of unilateral motor block was significantly lower than other groups. In the Group IV, the success rate of unilateral sensory block was significantly higher than group I. In the Group II, III, IV, the patient's satisfaction scores were significantly higher than Group I. CONCLUSIONS: When unilateral spinal anesthesia was attempted with 0.5% hyperbaric bupivacaine 6 mg, cardiovascular stability was achieved in the groups that patients are kept in a lateral decubitus for more than 5 minutes after spinal injection, and patient's higher satisfaction scores were achieved in the unilateral motor block and in the groups that patients are kept in a lateral decubitus for more than 15 minutes after spinal injection.

The Effect of Inhaled Desflurane Concentrations on the Bispectral Index / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been designed to objectively measure the degree of sedation and hypnosis for several anesthetics. The aim of this study was to evaluate the changes of the BIS during desflurane-N2O-O2 anesthesia. METHODS: With Institutional Review Board approval and informed consent, forty premedicated (atropine 0.5 mg, IM) male and female adult patients (ASA class 1 or 2, 18 55 yrs) scheduled for elective surgery were studied. After intubation with the aid of propofol (2.0 mg/kg) and vecuronium (0.15 mg/kg), anesthesia was maintained with desflurane in combination with 50% N2O and 50% O2. Several transitions between 3.0 and 12.0 vol% were performed. During anesthesia, the BIS was checked at least 30 min after induction to avoid the residual effect of propofol and after 15 min maintenance of a certain inhaled concentration for equilibration. RESULTS: The values of BIS were correlated closely with the desflurane concentrations (r = 0.88). Steep changes in the BIS were shown between 1.5 6.0 vol% and a ceiling effect regarding the BIS over 6.0 vol% was observed. CONCLUSIONS: The BIS is valuable for measuring the degree of sedaton and hypnosis in desflurane anesthesia. Above 6.0 vol%, desflurane showed a ceiling effect regarding the BIS.

Two Cases of Extragonadal Embryonal Carcinoma Originating in Unusual Sites / 대한비뇨기과학회지

Primary germ cell tumor of extragonadal origin are rare, accounting for approximately 3 to 5 percent of all germ tumors. Extragonadal germ cell tumors usually originate in midline body structures. We report a case of extragonadal germ cell tumor from the left superficial inguinal area, a nonmidline structure and a case of from the superficial suprapubic area unusual site of extragonadal germ cell tumor-with brief of the literature.

Periprostatic Pelvic Arteriovenous Malformation with Postejaculatory Hematuria / 대한비뇨기과학회지

Congenital arteriovenous malformations in the true pelvis are extremely rare : only 8 cases have been described in male patient. In most cases, the diagnosis may be obscure and the management is difficult due to frequent recurrence, so appropriate angiographic study is decisive in establishing the diagnosis and directing the mode of treatment. We report on 53 year old male patient who was treated with embolization due to congenital pelvic arteriovenous malformation with painless gross hematuria after erection or sexual intercourse. Diagnosis was established as periprostatic pelvic arteriovenous malformation by means of transrectal color Doppler ultrasonography and confirmed by angiography. Our attempt at management by embolization is described. A literature review and discussion of congenital arteriovenous malformation and worth of color Doppler ultrasonography are presented.