Profound hypotension immediately following insertion of methyl methacrylate during bipolar endoprosthesis in a patient with long-term levodopa-treated paralysis agitans

Insertion of methyl methacrylate polymer into newly reamed bony cavities has sometimes resulted in profound hypotension, cardiac arrest, or sudden death which are more common in patients with hemodynamic instability or hypovolemia. In paralysis agitans(Parkinson's disease), dramatic worsening of the disease often occurs when another illness or trauma accompanies it. And it is possible that chronic medication with levodopa can cause the loss of ability to support blood pressure. So, it involves some risk to use methyl methacrylate in chronic levodopa-treated paralysis agitans. We present a case of paralysis agitans who demonstrated profound hypotension immediately following insertion of methyl methacrylate polymer in spite of normovolemia and proper anesthetic management.

Mediastinal and Bilateral Pleural Effusions due to Extravascular Migration of the Subclavian Catheter during Fluid Therapy / 대한마취과학회지

Among the various complications of central venous catheterization, extravsscular migra tion of the catheter during fluid therapy is a rare condition to be encountered. We experienced a case in which an uneventful, successful insertion of subclavian catheter was followed at greater than 33 hours by massive mediastinal and bilateral pleural effusions, which resulted in hypotension, severe dyspnea, and cyanosis. The symptoms were re- lieved immediately after the bilateral thoracostomy and removal of the subclavian catheter. The chemical assay of the effusion was revealed glucoae-rich fluid given exogenously. The inferred cause was that postoperstive extravascular migration of the subclavian catheter probably resulted from both intensive respiratory physiotherspy and movement. We conclude that, although the successful placement of central line may be confirmed on insertion, a continuous reexamination of both function and location of the line is necessary to avoid the hazards of delayed diagnosis.

Mediastinal and Bilateral Pleural Effusions due to Extravascular Migration of the Subclavian Catheter during Fluid Therapy / 대한마취과학회지

Among the various complications of central venous catheterization, extravsscular migra tion of the catheter during fluid therapy is a rare condition to be encountered. We experienced a case in which an uneventful, successful insertion of subclavian catheter was followed at greater than 33 hours by massive mediastinal and bilateral pleural effusions, which resulted in hypotension, severe dyspnea, and cyanosis. The symptoms were re- lieved immediately after the bilateral thoracostomy and removal of the subclavian catheter. The chemical assay of the effusion was revealed glucoae-rich fluid given exogenously. The inferred cause was that postoperstive extravascular migration of the subclavian catheter probably resulted from both intensive respiratory physiotherspy and movement. We conclude that, although the successful placement of central line may be confirmed on insertion, a continuous reexamination of both function and location of the line is necessary to avoid the hazards of delayed diagnosis.

Efficacy of Epidural Anesthesia on Uterine Contraction / 대한마취과학회지

The aim of this investigation was to determine whether epidural analgesia has any effect on the uterine activity. Uterine activity was checked by an intermal tocometer and calculated in uterine activity units (UAU) which were expressed as Montevideo units. Twenty two gravidas who had the term pregnancy in labor without any obstertical complications were selected and epidural analgesia was performed in 17 of these patients. Plain lidocaine was used in 10 of them, lidocaine mixed with epinephrine (200,000:1) was used in another 7 gravidas and 5 gravidas were chosen as a control group. The results were as follows: The uterine actvity of the continuous epidural anesthesia group did not differ from that of the control group. The uterine activity changes were not statistically significant between the plain Iidocaine group and the epinephrine mixed group.