A patient with Churg-Strauss syndrome who underwent endoscopic sinus surgery under general anesthesia: A case report / 대한마취과학회지

There are many cause of cholinesterase deficiency, including drugs, liver disease, chronic anemia, malignant states, cardiac failure, severe acute infection, surgical shock, severe burn, collagen disease and vasculitis syndromes. Vasculitis syndromes are relatively rare, and among them, Churg-Strauss syndrome (CSS) is even rarer. We report here on a case of a patient with CSS who underwent endoscopic sinus surgery under general anesthesia.

Factores relacionados con mortalidad por shock y/o insuficiencia respiratoria aguda ocurridos en post-operatorios inmediatos de fracturas de cadera / Factors related to mortality because of shock and/or acute rspiratory failure occurring in the immediate postoperative period after surgery for hip fracture

Se realizó un estudiio retrospectivo que incluyó la totalidad de las historias clínicas de pacientes mayiores de 55 años, operados por fractura de cadera durante un período de 9 años, seleccionándose las de aquellos que fallecieron tras sufrir shock y/o insuficiencia respiratoria aguda aparecidos durante el postoperatorio inmediato. Los objetivos, fueron estimar: 1) la frecuencia del fenómenos mencinado 2) si la edad promedio de los pacientes fallecidos fue superior a la de los no fallecidos 3) si el porcentaje de pacientes fallecidos fue superior en aquellos en quienes se realizaron artroplastias cementadas 4) si existieron diferencias significativas en la mortalidad entre pacientes a quienes se les realizó una artroplastia total y aquelloos a quienes se les realizó una hemiartroplastia 5) si el tiempo de espera preoperatorio promedio fue superior en los pacientes fallecidos

The influence of escharectomy during shock stage on skeletal muscle proteolytic rate in severely scalded rats / 中华外科杂志

<p><b>OBJECTIVES</b>To observe the changes in proteolytic rate and the influence of escharectomy and skin-grafting during shock stage on the proteolytic rate of skeletal muscle in severely scalded rats, and to investigate necessity of escharectomy during shock stage.</p><p><b>METHODS</b>Wistar rats afflicted with 30%TBSA (total body surface area) full-thickness burn on the back were randomly divided into 3 groups: burn injury group (group B), escharectomy during shock stage group (group S), and escharectomy after shock stage group (group N). Escharectomy and skin-grafting was performed on the postburn day 1 (PBD1) and PBD4 in group S and N. The extensor digitorium longus (EDL) muscle was collected using a technique without injury to the muscle, and the proteolytic rate of the EDL was determined by the in-vitro muscle incubation system with sufficient oxygen supply and amino acid automatic analyzer.</p><p><b>RESULTS</b>The total proteolytic rate (TPR) in rat EDL muscles increased significantly (t > 2.988, P < 0.01) on PBD1, but no prominent changes were observed at other time points. There were no statistically significant changes in TPR between group S and group N, but the myofibrillar proteolytic rate (MPR) in rat EDL muscles increased markedly at each time point after scald (t > 2.988, P < 0.01). The MPR in group S decreased significantly as compared with that in group N on PBD2, 4, 5 (t = 2.311, P < 0.05; t = 3.054, 3.319, P < 0.01), and the mean values were 3.17, 2.33, 1.75 nmol/wet weight in g/3 h, respectively. No significant changes were observed between group N and S.</p><p><b>CONCLUSION</b>The high protein catabolism of skeletal muscle can be alleviated by escharectomy and skin-grafting during shock stage, and it is beneficial to organics.</p>

Some serum enzymes in burns and their probable correlation with surgical shock--a prospective combined surgicobiochemical study.

Serum enzymes such as phosphohexoisomerase, aldolase and amylase were estimated in serum of 100 patients with thermal burn of different degrees. These enzymes were estimated at the time of admission, at 12th hour, 24th hour, 36th hour, 72nd hour, 7th day and 14th day. The patients with high serum levels of these enzymes till 72nd hour showed grave prognosis and serial measurements of these enzymes might help in predicting the outcome.

Manejo del shock intraoperatorio / Intraoperative shock management

El séptico es un paciente gravemente enfermo, por lo cual debemos. 1.Intentar revertir la causa que condujo al shock. 2.Controlar el volumen sanguíneo, mantener la T.A. 3.Mantener una ventilación adecuada: considerar necesidad de ventilación mecánica y PEEP. 4.Suministrar los cuidados respiratorios necesarios: Terapia torácica, tos, drenaje postural, masajes percutorios cada 2 horas, humidificar el aire inspirado, oxigenación. 5.Corregir las alteraciones ácido-básicas. 6.Agentes cardiotónicos en falla cardiaca o edema pulmonar. -Inotrópicos. -Restricción de sales. -Diuréticos. -Agentes antiarrítmicos. 7.Vasopresores cuando no se haya podido controlar la hipotensión con otras medidas. 8.Prevenir la mal distribución de líquidos. 9.Controlar la infección con antibióticos y removiendo foco séptico. 10.Esteroides. Sigue siendo controversial. 11.Aporte nutricional de 2000 a 3000 calorias/sia. 12.Apoyar sus necesidades psicológicas y sociales.

The Failure to Regain Consiciouseness after General Anesthesia / 대한마취과학회지

A 4 years old Korean male child was presented with delay of regaining consciousness after general anesthesia for the correction of the right hand deformity and limitation of motion. In 1961 Frederich described the failure to regain consciousness after general anesthesia. 1.Hypoxia. 2. Excess of CO2.3. Anesthetic overdose, surgical shock, hypotension. 4. Miscellaneous factors: cerebro-vascular accidents, metabolic acidosis, hypoglycemia, uremia, hemorrhage, cerebral thrombosis, electrolyte imbalance. In this case, we believed that hypoxia was responsible for this complication.