Severe hypoxemia during carinal resection in the lateral position under one-lung ventilation of a non-dependent lung: a case report / 대한마취과학회지

During one-lung ventilation (OLV) in the lateral position, the dependent, ventilated lung receives more blood flow than the non-dependent, non-ventilated lung owing to gravity, improving the match of ventilation and perfusion. Conversely, in the rare clinical situations when OLV is applied to the non-dependent lung, arterial oxygenation can get worse due to considerable shunt flow to the dependent non-ventilated lung. We report a case of severe hypoxemia during carinal resection under OLV of a non-dependent lung. In this case, OLV had to be applied to the non-dependent lung in the lateral position because the bronchus of the non-dependent lung was anastomosed with the trachea, whereas the bronchus of the dependent lung had already been resected for carinal resection. The subsequent hypoxemia resulting from the shunt flow to the dependent non-ventilated lung was treated successfully by ligating the pulmonary artery of the dependent lung.

The optimal anesthetic depth for interventional neuroradiology: comparisons between light anesthesia and deep anesthesia / 대한마취과학회지

BACKGROUND: This study was designed to determine the optimal anesthetic depth for the maintenance and recovery in interventional neuroradiology. METHODS: Eighty-eight patients undergoing interventional neuroradiology were randomly allocated to light anesthesia (n = 44) or deep anesthesia (n = 44) groups based on the value of the bispectral index (BIS). Anesthesia was induced with propofol, alfentanil, and rocuronium and maintained with 1-3% sevoflurane. The concentration of sevoflurane was titrated to maintain BIS at 40-49 (deep anesthesia group) or 50-59 (light anesthesia group). Phenylephrine was used to maintain the mean arterial pressure within 20% of preinduction values. Recovery times were recorded. RESULTS: The light anesthesia group had a more rapid recovery to spontaneous ventilation, eye opening, extubation, and orientation (4.1 +/- 2.3 vs. 5.3 +/- 1.8 min, 6.9 +/- 3.2 min vs. 9.1 +/- 3.2 min, 8.2 +/- 3.1 min vs. 10.7 +/- 3.3 min, 10.0 +/- 3.9 min vs. 12.9 +/- 5.5 min, all P < 0.01) compared to the deep anesthesia group. The use of phenylephrine was significantly increased in the deep anesthesia group (768 +/- 184 vs. 320 +/- 82 microg, P < 0.01). More patients moved during the procedure in the light anesthesia group (6/44 [14%] vs. 0/44 [0%], P = 0.026). CONCLUSIONS: BIS values between 50 and 59 for interventional neuroradiology were associated with a more rapid recovery and favorable hemodynamic response, but also with more patient movement. We suggest that maintaining BIS values between 40 and 49 is preferable for the prevention of patient movement during anesthesia for interventional neuroradiology.

Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve in patient with pericardial effusion caused by ascending aortic dissection: A case report / 대한마취과학회지

Left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of mitral valve is not only limited to patients with hypertrophic cardiomyopathy. A diagnosis of LVOT obstruction with SAM is important because conventional inotropic support may potentially aggravate hemodynamic deterioration. We present a case of LVOT obstruction with SAM in a patient who underwent an emergent surgery for ascending aortic dissection with pericardial effusion. The patient showed refractory hypotension after standard pharmacologic interventions during induction of anesthesia. Transesophageal echocardiography (TEE) revealed LVOT obstruction with SAM and it was managed appropriately under the guidance of TEE. Intraoperative TEE can play an important role in diagnosis and management of LVOT obstruction with SAM caused by pericardial effusion.

Symptomatic Hallucal Interphalangeal Sesamoid Bones Successfully Treated with Ultrasound-guided Injection: A Case Report

The hallucal interphalangeal sesamoid bone is usually asymptomatic, but it is not uncommon for it to be symptomatic in cases of undue pressure, overuse, or trauma. Even in symptomatic cases, however, patients often suffer for extended periods due to misdiagnosis, resulting in depression and anxiety that can steadily worsen to the extent that symptoms are sometimes mistaken for a somatoform disorder. Dynamic ultrasound-guided evaluations can be an effective means of detecting symptomatic sesamoid bones, and a simple injection of a small dose of local anesthetics mixed with steroids is an easily performed and effective treatment option in cases, for example, of tenosynovitis.

Cervical nucleoplasty as an effective treatment method of cervical degenerative disc disease / 대한마취과학회지

No abstract available.

Predictability of passive leg raising test on anesthesia-induced hypotension in patients undergoing cardiac surgery

BACKGROUND: Hypotension often occurs after induction of general anesthesia. Although preload status has been considered as an important factor for the occurrence of this hypotension, there have been inconsistent results on this topic. The dynamic preload parameters have not been studied as a predictor of hypotension, and therefore we hypothesized that the passive leg raising (PLR) test, a dynamic preload parameter, could predict anesthesia-induced hypotension and conducted a prospective clinical study. METHODS: In 40 patients undergoing elective cardiac surgery, mean arterial pressure (MAP), stroke volume variation, stroke volume (SV) and cardiac index (CI) were measured using arterial line and FloTrac(TM)/Vigileo(TM) system before, during and after PLR test, respectively. Occurrence of anesthesia-induced hypotension was recorded. The ability of PLR test to predict hypotension was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The incidence of hypotension was 90%, which includes 12.5% of refractory hypotension. Changes in MAP and CI induced by PLR test predicted hypotension (area under ROC curves: 0.722 and 0.788, respectively). Changes in SV and CI induced by PLR test predicted refractory hypotension (area under ROC curves: 0.863 and 0.789, respectively). CONCLUSIONS: Our results suggest that PLR test can predict hypotension and refractory hypotension occurring after induction of anesthesia in patients undergoing cardiac surgery.

Regulation of Gene Expression in Murine Renal Cell Carcinoma Cells Growing in Ectopic or Orthotopic Organs of Syngenic Mice / 대한암학회지

PURPOSE: The biologic behavior of tumor cells is partially controlled by the microenvironment. We investigated the expression levels of several genes involved in metastasis and drug response in RENCA cells growing in ectopic (skin) and orthotopic (kidney) sites. MATERIALS AND METHODS: Murine renal carcinoma cells were injected into kidney (orthotopic) and subcutis (ectopic) of syngeneic mice. Mice were treated with doxorubicin (DXR) (8 mg/kg) on days 8 and 15 after tumor cell implantation. Drug response was measured both in vivo and ex vivo by measuring tumor size and MTT assay. We also performed an in situ mRNA hybridization to estimate the expression levels of mdr (multidrug resistance), EGFR (epidermal growth factor receptor) and type IV collagenase. RESULTS: RENCA cells growing in the kidney of syngeneic mice produced metastatic lesions in the lung (57% of mice), while the same cells growing in the subcutis did not. Tumors growing in the kidney were more resistant to DXR than tumors growing in the subcutis. MTT assays revealed that tumor cells derived from kidney were more resistant to DXR than those cells from subcutis. In situ hybridization analyses showed that transcripts of EGFR and type IV collagenase genes in kidney tumors were higher than those of subcutaneous tumors but mdr expression showed no difference between the two tumors. CONCLUSION: These results demonstrate that the organ environment influences the drug responsive ness and the expression of EGFR and type IV collagenase genes in murine renal cell carcinoma cells.