Pneumocephalus and headache following craniotomy during the immediate postoperative period.

BACKGROUND: Pneumocephalus may be responsible for post-craniotomy headache but is easily overlooked in the clinical situation. In the present study, the relationship between the amount of intracranial air and post-craniotomy headache was investigated. METHODS: A retrospective observational study was performed on 79 patients who underwent minimal invasive craniotomy for unruptured cerebral aneurysms. Those who had undergone previous neurosurgery, neurological deficit before and after surgery were excluded The amount of air in the cranial cavity was measured using brain computed tomography (CT) taken within 6 h after surgery. To measure the degree of pain due to intracranial air, daily and total analgesic administration amount were used as a pain index. Correlation between intracranial air volume and total consumption of analgesic during hospitalization was tested using Spearman rank correlation coefficients. Receiver operating characteristics (ROC) analysis was used to determine the amount of air associated with increased analgesic consumption over 72 h postoperatively. RESULTS: The mean amount of intracranial air was 15.6 ± 9.1 mL. Total administration of parenteral and oral analgesics frequency were 6.5 ± 4.5, 13.2 ± 7.9 respectively. A statically significant correlation was observed between daily and total parenteral analgesic consumption after surgery and the amount of intracranial air at followed-up brain CT postoperatively within 24 h (r = 0.69, p < 0.001), within 48 h (r = 0.68, p < 0.001), and total duration after surgery (r = 0.84, p < 0.001). The optimal cut-off value of 12.14 mL of intracranial air predicts the use of parenteral analgesics over 72 h after surgery. CONCLUSIONS: Pneumocephalus may be a causative factor for post-craniotomy pain and headache with surgical injuries.

Risk factors of emergency reoperations.

BACKGROUND: Emergency reoperation is considered to be a quality indicator in surgery. We analyzed the risk factors for emergency reoperations. METHODS: Patients who underwent emergency operations from January 1, 2017, to December 31, 2017, at our hospital were reviewed in this retrospective study. Multivariate logistic regression was performed for the perioperative risk factors for emergency reoperation. RESULTS: A total of 1,481 patients underwent emergency operations during the study period. Among them, 79 patients received emergency reoperations. The variables related to emergency reoperation included surgeries involving intracranial and intraoral lesions, highest mean arterial pressure ≥ 110 mmHg, highest heart rate ≥ 100 beats/min, anemia, duration of operation >120 min, and arrival from the intensive care unit (ICU). CONCLUSIONS: The type of surgery, hemodynamics, hemoglobin values, the duration of surgery, and arrival from ICU were associated with emergency reoperations.

Risk factors of emergency reoperations

Background@#Emergency reoperation is considered to be a quality indicator in surgery. We analyzed the risk factors for emergency reoperations. @*Methods@#Patients who underwent emergency operations from January 1, 2017, to December 31, 2017, at our hospital were reviewed in this retrospective study. Multivariate logistic regression was performed for the perioperative risk factors for emergency reoperation. @*Results@#A total of 1,481 patients underwent emergency operations during the study period. Among them, 79 patients received emergency reoperations. The variables related to emergency reoperation included surgeries involving intracranial and intraoral lesions, highest mean arterial pressure ≥ 110 mmHg, highest heart rate ≥ 100 /min, anemia, duration of operation ＞120 min, and arrival from the intensive care unit (ICU). @*Conclusions@#The type of surgery, hemodynamics, hemoglobin values, the duration of surgery, and arrival from ICU were associated with emergency reoperations.

Retrospective investigation of anesthetic management and outcome in patients with deep neck infections

BACKGROUND: Although incidence of deep neck infection has decreased after the introduction of antibiotics and improvement of oral hygiene, the disease may remain serious to anesthesiologists and patients, especially relative to postoperative prognosis and airway management. The objective of this study is to clarify clinical characteristics and consider anesthetic implications. METHODS: This study reviews the experience of 116 patients that received operations for deep neck infections 1997–2017 in a university hospital. Variables included in data were age, sex, lesion, etiology, underlying disease, result of culture, anesthetic techniques, C-reactive protein level, and a variety of scores including ASA physical status, APACHE II, and SOFA. Scores were analyzed statistically to elucidate prognostic ability, and influences on intubation. RESULTS: The following background variables were associated postoperative complication; age, presence of diabetes, hypertension, and infectious disease, extended space and use of N2O. APACHE II ≥ 7 and SOFA ≥ 3 were revealed to be associated with postoperative complication. The following background variables were associated with difficult intubation: date of surgery ≤ 2009, non-otolaryngology department, and submental space. CONCLUSIONS: This study revealed the possibility that the preoperative evaluation, including the determination of scoring system, may be useful in predicting outcome and making a clinical decision of airway management in deep neck infections.

Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period.

Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient's symptoms resolved rapidly, within 24 hours, with supportive care.

Retrospective anesthetic evaluation of non-obstetric surgery during pregnancy: single center experience

BACKGROUND: Laparoscopic procedures and ultrasonography are now commonly used in the obstetric field, and more non-obstetric procedures are being performed. However, little domestic data has been published on the topic. This present retrospective study investigated the clinical information and the effect on perinatal outcomes of non-obstetric surgery during pregnancy. METHODS: This retrospective study was performed using data of all adult pregnant women that underwent non-obstetric surgery at our institute between from July 2009 to December 2016. Data was collected from the institutional computerized database. The causes, types, and the gestational ages at surgery were collected as our primary outcomes. Basic characteristics of patients, operation times, anesthesia times, anesthetic methods, anesthetic agents, and adverse perinatal outcomes such as abortion or preterm delivery were evaluated as secondary outcomes. RESULTS: During the study period, there were 2,421 deliveries and 60 cases of non-obstetric surgery, an operation rate of 2.48%. The most common cause of non-obstetric surgery was abdominal surgery, followed by orthopedic surgery and neurosurgery. Most of abdominal surgeries were performed laparoscopically during the first trimester. The incidence of adverse perinatal outcomes was increased in the first trimester, was not related with anesthesia. CONCLUSIONS: The rate of non-obstetric surgery was found to be 2.48%, which was higher than those reported in previous domestic studies. This increase seems to have resulted from early diagnosis by ultrasonography and non-invasive surgery using laparoscopy. Adverse perinatal outcomes are not related with age, surgery and anesthetic-related factors but seem to be associated with surgery exposure stage, especially the first trimester.

Preliminary study of anesthetic risk factors in surgery for pathologic fractures secondary to metastatic tumors

BACKGROUND: Despite advances in the treatment of primary cancer, metastatic pathologic fractures still affect the survival of cancer patients. The goals of surgery, such as those with terminal cancer, are to maintain a maximum level of independence and improve the quality of life. A patient may be a poor surgical candidate because of a short life expectancy or illness that is too severe to benefit from surgical fixation. Moreover, this surgery is an operation accompanied with significant morbidity and mortality. This retrospective study investigated the characteristics of these patients and assessed the influence of anesthetic risk factors on the outcome. METHODS: The records of 45 patients with pathologic fractures who underwent surgical stabilization for metastatic factors from 1 January 1995 to 31 December 2013 at our hospital were reviewed. Demographic data, various severity scores, anesthetic factors, and survival were reviewed. RESULTS: The most common sites of primary tumors were lung, liver and stomach. The predominant sites of pathologic fractures were the femur (71.1%); six lesions were in the humerus and four in the spine. Univariate and multivariate analyses identified several prognostic factors with a significantly worse influence on survival, including lung tumor and Acute Physiology and Chronic Health Evaluation (APACHE) II score. CONCLUSIONS: Although the number of patients was too small to result in a satisfactory appraisal, the most important step is to select candidates to gain the benefits of palliative surgery. We suggest the possibility of APACHE II scoring and the recognition of lung cancer in making the clinical decision of performing the palliative osteosyntheses for patients with pathologic fractures.

An analysis of consultations requested to a pain clinic

BACKGROUND: The study investigated in detail the current status of the consultations requested in a pain clinic. We evaluated the characteristics of the consultations to determine the kind of contents requested, referring departments and factors including demographics, co-morbidities, previous medical problems, and the descriptions of the reasons for the consultation to the pain clinic. METHODS: Clinical data were collected in the authors' institution between 1 January 2009 and 31 December 2013. The medical records were reviewed and compared. Characteristics of both outpatients and inpatients were analysed. RESULTS: Data from 1,140 patients was available for this study. Seven hundred thirteen individuals belonged to the outpatient group and 427 individuals belonged to the inpatient group. Orthopedic surgery, neurosurgery, and otolaryngology were the main departments that requested consultations to the pain clinic. The most frequent requested lesion and diagnostic term were low back and lumbar spinal stenosis, respectively, and the most common reason for consulting was for "control of pain not controlled by medications." Factors that were significantly different between the two groups were gender, questions about other illnesses apart from the main diagnoses, history of specific diseases, acute onset, cancer, operation within 3 months, and physical system abnormalities. CONCLUSIONS: The medical problems addressed by a pain clinic consultation service were diverse. It is rational to develop standardized guidelines for pain consultations, and treatment strategies aimed at alleviating pain per se as well as caring for comorbid conditions.

Thiopental-induced burst suppression measured by the bispectral index is extended during propofol administration compared with sevoflurane.

BACKGROUND: Thiopental is used to suppress cerebral metabolism during temporary clip ligation of the cerebral arteries. Electroencephalogram (EEG) can measure intraoperative burst suppression as evidence of cerebral metabolic suppression, but EEG is not always available during clip ligation. This study was conducted to compare the effect of propofol-based total intravenous anesthesia (TIVA) with sevoflurane-based inhalational anesthesia on thiopental-induced burst suppression during aneurysm surgery. The effect of thiopental was measured by burst suppression ratio (BSR) using the bispectral index (BIS) monitor. METHODS: Forty-six patients who underwent temporary clipping during aneurysm surgery were randomized into 2 groups. The inhalation group (n=21) received sevoflurane-N(2)O anesthesia and the TIVA group (n=25) received propofol-remifenatanil-N(2)O anesthesia. The anesthesia level maintained a BIS value between 40 and 55. Pharmacological burst suppression was induced with bolus administration of thiopental (5 mg/kg) before temporary clipping. The BIS number, BSR values, the onset time and duration of BSR, and hemodynamic variables were recorded every minute in both groups. RESULTS: There were no significant differences between groups in the onset time of burst suppression (P=0.394) and BIS changes (P=0.878). However, statistically significant longer duration (P<0.001) and significantly higher degree of burst suppression (P=0.006) were observed in the TIVA group compared with the inhalation group. CONCLUSIONS: Our results suggest that at equivalent BIS values TIVA with propofol anesthesia provides longer duration and greater cerebral metabolic suppression compared with sevoflurane-N(2)O inhalation anesthesia. BIS may be an acceptable alternative to standard EEG monitoring when assessing burst suppression during temporary clipping.

A Case of Angiocentric Glioma with Unusual Clinical and Radiological Features

Angiocentric glioma was recently recognized as a distinct clinicopathological entity in the 2007 World Health Organization classification of tumors of the central nervous system. Typically, it presents with seizure in children and young adults. However, our patient did not have a history of seizure. Seizure did not occur up to 6 months after operation. Although it usually does not have calcification brain magnetic resonance imaging in our patient showed T1-hyperintense and T2-hypointense signals with calcification.

Anesthetic experience of patients with Fournier's syndrome / 대한마취과학회지

No abstract available.

Significance of Clopidogrel Resistance Related to the Stent-Assisted Angioplasty in Patients with Atherosclerotic Cerebrovascular Disease

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.

Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy.

BACKGROUND: Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques. METHODS: Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation. RESULTS: The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05). CONCLUSIONS: The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.

Rhabdomyolysis after laparoscopic radical nephrectomy -A case report-.

Rhabdomyolysis is a rare but potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. This devastating disease could be due to muscle compression caused by urologic positioning for a lengthy nephrectomy. In this regard, laparoscopic renal surgery may be a risk for the development of rhabdomyolysis. This phenomenon of massive muscle necrosis can produce secondary acute renal failure. The risk factors have to be managed carefully during anesthetic management. Here, we report a case of a patient with rhabdomyolysis that developed in the flexed lateral decubitus position during laparoscopic nephrectomy.

Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy / 대한마취과학회지

BACKGROUND: Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques. METHODS: Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation. RESULTS: The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05). CONCLUSIONS: The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.

Rhabdomyolysis after laparoscopic radical nephrectomy: A case report / 대한마취과학회지

Rhabdomyolysis is a rare but potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. This devastating disease could be due to muscle compression caused by urologic positioning for a lengthy nephrectomy. In this regard, laparoscopic renal surgery may be a risk for the development of rhabdomyolysis. This phenomenon of massive muscle necrosis can produce secondary acute renal failure. The risk factors have to be managed carefully during anesthetic management. Here, we report a case of a patient with rhabdomyolysis that developed in the flexed lateral decubitus position during laparoscopic nephrectomy.

Anesthetic management in an angiographic suite: a retrospective review of 88 cases.

BACKGROUND: Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS: Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS: Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS: We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.

Anesthetic experience of a patient with hereditary factor XI deficiency (Hemophilia C) : A case report.

Factor XI deficiency (also called Hemophilia C) rarely occurs among ethnicities other than Ashkenazi Jews. A boy was scheduled for frontoethmoidectomy due to bilateral chronic rhinosinusitis. He was incidentally found to have factor XI deficiency due to prolonged aPTT on preoperative laboratory finding. His medical history reveals frequent epistaxis 2 or 3 times per day and his factor XI and XII activity were 17% (normal; 60-140%) and 34% (normal; 60-140%), respectively on furthermore laboratory evaluation. He was diagnosed as hereditary factor XI deficiency. He underwent the operation with administration of the fresh frozen plasma without complication.

Anesthetic experience of a patient with hereditary factor XI deficiency (Hemophilia C) : A case report / 대한마취과학회지

Factor XI deficiency (also called Hemophilia C) rarely occurs among ethnicities other than Ashkenazi Jews. A boy was scheduled for frontoethmoidectomy due to bilateral chronic rhinosinusitis. He was incidentally found to have factor XI deficiency due to prolonged aPTT on preoperative laboratory finding. His medical history reveals frequent epistaxis 2 or 3 times per day and his factor XI and XII activity were 17% (normal; 60-140%) and 34% (normal; 60-140%), respectively on furthermore laboratory evaluation. He was diagnosed as hereditary factor XI deficiency. He underwent the operation with administration of the fresh frozen plasma without complication.