Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report -

Background@#Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case: Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. @*Conclusions@#REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.

The effect of endotracheal 1% lidocaine administration to reduce emergence phenomenon after general anesthesia

BACKGROUND: Endotracheal intubation often causes sore throat and coughing. The aim of this study was to decrease the incidence and severity of cough, sore throat, and hemodynamic changes after extubation by endotracheal administration of 1% lidocaine. METHODS: Sixty patients physical status American Society of Anesthesiologists classes I, II, and III who received a surgery under general anesthesia were randomly divided into two groups. L group was given 1% lidocaine 0.5 mg/kg by endotracheal administration. The other group, N group, received the same volume of normal saline. The number of cough, the severity of sore throat with numerical rating score (NRS), incidence of local anesthetic systemic toxic reaction, laryngospasm, and hoarseness were recorded. In addition, the number of coughs was divided into three levels by its severity, and it was converted into an indicator of cough score. RESULTS: L group had a significantly lower number of cough and sore throat NRS (P value < 0.05) than the N group, and also hoarseness did not occur. The changes in the hemodynamic parameters, before and after the emergence of anesthesia, were more stable in the L group than those in the N group, but not statistically significant. CONCLUSIONS: The results of this study suggest that endotracheal administration of 1% lidocaine is effective and safe method to reduce cough and sore throat caused by extubation.

Efficacy of minimal invasive cardiac output and ScVO₂ monitoring during controlled hypotension for double-jaw surgery

BACKGROUND: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH.METHODS: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared.RESULTS: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits.CONCLUSION: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.