Herpes Zoster in Healthy Child: A case report / 대한통증학회지

Herpes zoster in childhood is uncommon, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk for childhood herpes zoster. However, some controversies persist on risk factors, diagnosis, and the natural history of childhood disease. We report a 10-year-old healthy boy with shingles and review the risk factors, prognosis, and treatment of pediatric zoster.

The Effects of Esmolol on BIS, Patient Movement, and Hemodynamic Changes during General Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: Lidocaine, alpha, beta-adrenergic blocker, angiotensin converting enzyme inhibitor, and various other analgesics have been used for blocking awakening, movements, and hemodynamic instability during general anesthesia. The purpose of this study was to evaluate the ability of esmolol to attenuate the cardiovascular, motor, and central nervous system responses to nociceptive stimulation, such as intubation, during general anesthesia. METHODS: Forty randomly selected patients participated in this study either as a control (n = 20) or as a study (n = 20) group, respectively. As soon as patients lost consciousness, at a propofol effect-site concentration of 4 microgram /ml, a touniquet was applied to one arm and inflated to 150 mmHg higher than the systolic pressure, and then vecuronium (1 mg/kg) was injected. Simultaneously esmolol (1 mg/kg + 250 microgram /kg/min) or normal saline were injected in the study and control groups respectively. Four minutes after starting esmolol, orotracheal intubation was administered. We monitered the BP, HR, BIS and gross movement during the study. RESULTS: Statistically significant differences were observed in mean BP, HR, and BIS between the two groups during esmolol injection. CONCLUSIONS: Esmolol can reduce anesthetic requirements during general anesthesia with propofol.

A Comparison of the Incidence of Hypotension During Unilateral vs Conventional Spinal Anesthesia with Hyperbaric Bupivacaine / 대한마취과학회지

BACKGROUND: Hypotension is the most frequent side effect of spinal anesthesia. Unilateral spinal anesthesia may be advantageous because it reduce the extent of spinal block. The aim of this study was to compare the incidence of hypotension and the difference of heart rate between unilateral and conventional bilateral spinal anesthesia. METHODS: Seventy patients were randomly allocated into two groups, which both received 2.0 ml (10 mg) of 0.5% hyperbaric bupivacaine. In group 1, local anesthetic was injected for two minutes with the needle orifice turned toward the dependent side; the lateral position was maintained for 20 minutes (unilateral, n = 35). In group 2, local anesthetic was injected through a cranially directed needle orifice, then patients were immediately turned supine (conventional, n = 35). Observers recorded noninvasive hemodynamic variables, as well as loss of cold and touch sensation and motor block on both side. RESULTS: In the unilateral group, 16 patients (45.7%) showed a unilateral loss of cold sensation and 23 patients (65.7%) had no motor block on the nondependent side for the duration of the study, whereas all conventional patients had bilateral distribution of spinal block (P < 0.001). The incidence of hypotension was higher in the conventional (22.9%) than unilateral group (5.7%) (P < 0.01). Considering the mean changes from baseline values of arterial blood pressure, patients of the conventional group showed greater decreases in systolic arterial blood pressure at 40, 50, 60, and 70 min (P < 0.05). Maximum percentage changes from baseline values of systolic arterial blood pressure and heart rate were greater in the conventional group (-17.8 +/- 9.8% and -19.7 +/- 10.4%) than in unilateral group (-14.6 +/- 5.5% and -16.9 +/- 11.2%). CONCLUSIONS: Unilateral spinal anesthesia reduces the incidence of hypotension during spinal anesthesia.

Accidental Subdural Block during Epidural Anesthesia: A case report / 대한마취과학회지

Despite the high incidence of subdural block (SDB) during epidural anesthesia, the condition is unfamiliar to anesthesiologist. We experienced a case of SDB: severe hypotension, transient hemiplegia, wide extent of block and late onset and recovery from block. The case described is an examples of SDB and should remind anesthesiologist of the clinical course and treatment.