[A Case of Hypoglossal Nerve Palsy after Cervical Spine Surgery].

A 46-year-old woman with cervical disc herniation underwent C4-6 laminoplasty and C4-5 foraminotomy under general anesthesia. The patient complained of the tongue deviation toward the right after surgery. She underwent several examinations and was diag- nosed as right hypoglossal nerve palsy caused by peripheral nerve disorder. It was considered that the main damage was the external branch of hypoglossal nerve which was likely to occur as a complication of compression because of the location. The cause of hypoglossal nerve palsy was assumed to be possibly direct compression of the hypoglossal nerve by the tracheal tube. In prone position surgery, it is important to take care of pressure to the tongue because the intraoral space tends to be reduced by edema of the face and neck.

[A case of prolongation of rocuronium neuromuscular blockade in a pregnant patient receiving magnesium].

A 35-year-old pregnant female with systemic lupus erythematosus and lupus nephritis underwent emergency cesarean section at 24 weeks of gestation under general anesthesia. The patient had received magnesium sulfate with a diagnosis of pregnancy-induced hypertension since 20 weeks of gestation. Anesthesia was induced with thiopental 3.5 mg x kg(-1) and tracheal intubation was facilitated by administration of rocuronium 1.0 mg x kg(-1). No additional rocuronium was needed during operation. After operation, no twitch was noted on the ulnar nerve TOF monitor. The TOF returned to 4/4 at postoperative 11 hours and the patient was extubated uneventfully. When rocuronium is used to facilitate general endotracheal anesthesia in a patient for emergency cesarean delivery, it is important to recognize that magnesium may prolong neuromuscular block significantly.

Dexmedetomidine suppresses proinflammatory mediator production in human whole blood in vitro.

BACKGROUND: It has been demonstrated that proinflammatory mediators increase in patients with sepsis, trauma, and burns. These mediators are associated with the development of septic shock and organ dysfunction. Dexmedetomidine (DEX), a selective agonist of the α2-adrenergic receptors, is used in intensive care units for sedation. However, it still remains unclear whether DEX administration has any effects on the production of proinflammatory mediators. In this study, we investigated the effects of DEX on lipopolysaccharide (LPS)-induced production of tumor necrosis factor α, interleukin 6 (IL-6), IL-8, and high-mobility group box 1 protein in human whole blood. METHODS: Human whole blood was cultured with LPS for up to 24 hours, and LPS-induced proinflammatory mediator production was measured. Next, we tested the effect of DEX on whole blood proinflammatory mediator production. Human whole blood was cultured with LPS and various concentrations of DEX for 12 hours. Then, we investigated the influence of yohimbine, an antagonist of the α2-adrenergic receptors, on the effects of DEX. The effect of DEX on necrosis factor κB (NFκB) activation was also investigated. RESULTS: DEX suppressed tumor necrosis factor α, IL-6, IL-8, and high-mobility group box 1 protein production in human whole blood. The suppressing effects of DEX on proinflammatory mediator production were reversed by yohimbine. The results suggested that the mechanism for the suppressive effects of DEX on proinflammatory mediator production is meditated via α2-adrenergic receptors. These effects of DEX also include an inhibitory effect on NFκB activation. CONCLUSION: We demonstrate the suppressing effect of DEX on inflammatory mediator production in human whole blood after LPS stimulation. The mechanism for the suppressive effect of DEX on proinflammatory mediator production may be through the α2-adrenergic receptors and NFκB inhibition.

[Left internal jugular venipuncture in real-time ultrasound-guided pediatric central venous cannulation].

The right internal jugular vein (IJV) is usually selected for pediatric central venous cannulation (CVC); however, the left is rarely selected. We investigated cases of CVC through left IJVs from Apr to Nov of 2011. In all 82 patients with the median age of 11 months, height of 72.2 cm, and weight of 7.4 kg, right IJVs were selected first for real-time ultrasound-guided CVC. Right IJVs were with median width of 7.3 mm, length of 5.0 mm, and depth of 6.8 mm. After three failed attempts through the right IJVs in three patients (3.7%), of 2 to 9 months of age out of the 82 patients, 24 G puncture needles were successfully inserted through left IJVs with the first attempt. One of the three patients, of 9 months of age with a persistent left superior vena cava, had a thinner 2.6-mm-wide right IJV and a thicker 8.3-mm-wide left IJV It was difficult but successful to insert a 0.018-inch guidewire in another patient due to a steep 90 degree angle between the left IJV and the brachiocephalic vein.

[Airway problem during the operation with beach-chair position: a case of arytenoid dislocation and the relationship between intra-cuff pressure of endotrachial tube and the neck position].

Shoulder arthroscopy has been performed in beach-chair position. In our hospital, the postoperative complications of the airway were reported in the patients who had undergone the operation in this position (hoarseness: 4 cases, paralysis of recurrent nerve: 2 cases, arytenoids dislocation: 1 case). We assumed that the neck bending during operation causes these complications. We investigated the relationship between the neck position and the intra-cuff pressure of endotrachial tube. The results showed that the neck bending significantly increases the intra-cuff pressure of endotrachial tube. Therefore, we conclude that it is necessary to pay attention to neck position to avoid postoperative complications of the airway in the patients who have the operation in beach-chair position.