The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery / 대한마취과학회지

BACKGROUND: Conventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure. METHODS: Twenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20degrees Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated. RESULTS: Following creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes. CONCLUSIONS: The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.

Cranial subdural hematoma developing after spinal anesthesia: A case report / 대한마취과학회지

Intracranial subdural hematoma is an exceptionally rare complication of spinal anesthesia. An 88-year-old female patient diagnosed with grade V uterine prolapse with rectocystocele received a vaginal hysterectomy and anteroposterior repair under spinal anesthesia. At 4 days postoperatively, she appeared to have decreased orientation, inappropriate behavior, and right side weakness grade III. Brain MR diffusion and CT revealed a bilateral subdural hematoma. She was improved after burr hole drainage. We report a case of intracranial subdural hematoma developing after spinal anesthesia, a rare complication.

Cardiopulmonary arrest due to sick sinus syndrome: A case report / 대한마취과학회지

Sick sinus syndrome (SSS) is an abnormality of sinus nodal impulse formation by intrinsic or extrinsic causes. Patients with SSS often are asymptomatic, or have mild or nonspecific symptoms, including dizziness, palpitations, fatigue, and confusion related to the decreased cardiac output. SSS can rarely cause conditions like syncope, congestive heart failure, thromboembolism, pulmonary edema, cardiac arrest, or sudden death. We report here on a severe bradycardia during general anesthesia for aneurysmal clipping and tachycardia-bradycardia syndrome followed by cardiac arrest postoperatively in the ICU, which was subsequently diagnosed as SSS with 24-hour Holter monitoring.

Ketamine Infusion Therapy in a Patient of Posttraumatic Syringomyelia / 대한통증학회지

The clinical syndrome of posttraumatic syringomyelia can complicate major spinal trauma and develops many months after spinal injury. The 50-90% of patients experienced the pain and especially the component of central pain. In patients with central pain following spinal cord injury, ketamine has been shown to be an effective analgesic. We report a case of posttraumatic syringomyelia in a 30-year-old woman who complained of central pain, weakness of both legs and dysesthesia. She had not responded to pulsed radiofrequency, or lidocaine infusion therapy, but a continuous intravenous infusion of ketamine, an N-methyl-D-asparate receptor antagonist, reduced her severe central pain. In conclusion, a ketamine infusion therapy resulted in a significant reduction of central pain without decreasing of motor power and function.