Risk factors of morbidity and mortality following hip fracture surgery / 대한마취과학회지

BACKGROUND: The preoperative coexisting chronic systemic illness, delay in surgery, gender, and age were considered as risk factors for the complications after hip fracture surgery. The wider range of surgical delay and immobility-related pulmonary morbidity may affect postoperative complications and mortality. This study examined the risk factors for morbidity and mortality following the hip fracture surgery. METHODS: The patient data was collected retrospectively. The consecutive 506 patients with hip fracture surgery, aged 60 years or older, were included. The patients' age, gender, preexisting diseases, American Society of Anesthesiologists (ASA) classification, delay in surgical repair, duration of surgical procedure, and methods of anesthesia were noted. The thirty-day postoperative complications were reviewed, and cardiac complications, pulmonary complications, delirium, and death were recorded. The data was analyzed for postoperative complications and risk factors. RESULTS: Atelectasis was associated with postoperative pulmonary complications. Male gender and age > or = 80 years were associated with an increased incidence of postoperative delirium. ASA classification 3 was associated with death. A delay in surgery was not associated with any complications. Preexisting diseases and methods of anesthesia did not affect mortality and postoperative complications. CONCLUSIONS: The results suggest that a delay in surgery did not affect the postoperative complications and morbidity.

Hyperamylasemia following the trans-sphenoidal resection of pituitary tumor: can propofol-remifentanil TIVA cause postoperative hyperamylasemia?: A case report

The trans-sphenoidal resection of a recurred pituitary tumor was performed in a 42 years old man under general anesthesia with propofol and remifentanil. Neither massive bleeding nor hypotension was observed intraoperatively, but bradycardia was sustained over five hours. The patient did not suffer from hypertriglyceridemia and there was no evidence of drug toxicity or vigorous intervention during the surgery, however hyperamylasemia was observed one day after the surgery. It is presumed that vagal stimulation by propofol and remifentanil infusion might induce bradycardia and abnormal pancreatic enzyme secretion consequently.

Extensive demyelinating change in cerebrum after a total knee replacement: A case report / 대한마취과학회지

Demyelination is characterized by the loss of myelin with the preservation of axons. Demyelinating diseases can be classified into several categories: demyelination due to inflammation, viral infection, osmotic derangements and hypoxic ischemia. In particular, osmotic myelinolysis is representative, and is associated with hyperosmolality, hypokalemia or rapid correction of hyponatremia. Osmotic myelinolysis was reported to be associated with underlying conditions, such as alcoholism, diuretics and malnutrition. A 67-year-old woman with hypertension was scheduled to undergo both total knee replacements (TKR). She was observed to be lethargic with dysphagia and quadriplegia after the second TKR. She had been taking diuretics for a long time, and did not have an adequate amount of food intake due to patient controlled analgesia and a gastric ulcer after the first TKR. A laboratory examination revealed hypokalemia but normonatremia. T2 weighted-MRI revealed abnormal high signal intensity in the basal ganglia and periventricular area. This case was diagnosed with osmotic myelinolysis associated with hypokalemia without an apparent sodium imbalance.

Anesthetic Induction in a Sitting Position for a Patient with Congestive Heart Failure / 영남의대학술지

A 67-year-old woman with severe congestive heart failure (New York Heart Association, NYHA class IV) was set to receive general anesthesia for cardiac surgery. For several months, she had been in a constant sitting position from which the slightest change evoked dyspnea. A patient in such a condition is rarely considered a candidate for general anesthesia, because such patients are never eligible for any type of surgery other than that used to fix the heart problem itself. We report this case to explain how anesthesia was induced with the patient sitting in a crouching position and discuss other methods of induction that can probably be used in similar situations.