Successful airway management with combined use of McGrath® MAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter: a case report / 대한마취과학회지

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.

Hemoptysis during general anesthesia in a diabetic patient with healed tuberculosis: a case report / 대한마취과학회지

Hemoptysis is a common complication of pulmonary tuberculosis. Most of the cases of hemoptysis originate from hypertrophied bronchial arteries. Also, diabetes induces pulmonary vascular abnormalities such as endothelial dysfunction, inflammatory infiltration and pulmonary vascular remodeling. A 27-year-old male, with diabetes and a history of tuberculosis, underwent the procedure of pars plana vitrectomy under general anesthesia. After an uneventful intra-operative period, he had hemoptysis prior to extubation. Emergency fiberoptic bronchscopy showed blood plugs and spotted fresh blood at the right upper lobar bronchus. After successful embolization of the bronchial artery, the patient made a recovery and was discharged without experiencing any complication. Predisposing factors of hemoptysis in this case are presumed to be tuberculosis and diabetes. The bleeding might had been caused by the rupture of a weakened artery within the cavity in the right upper lobe, through expansion of the lung during manual ventilation by positive pressure.

Cranial nerve XII (hypoglossal nerve) palsy after arthroscopic shoulder surgery under general anesthesia combined with sono-guided interscalene brachial plexus block: A case report

Neurologic complications after shoulder surgery may result from surgical procedures or anesthesia. Hypoglossal nerve is a pure motor nerve that supplies mylohyoid and hyoglossus muscles. Isolated hypoglossal nerve injury may be caused by direct trauma, head malposition (hyperextension or hyperflexion), and indirect compression or traction during intubation. We report a case of left hypoglossal nerve palsy after arthroscopic left shoulder surgery in the beach chair position under general anesthesia combined with brachial plexus block.

Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report / 대한마취과학회지

Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.

Tracheal granuloma after thyroidectomy with difficult intubation / 대한마취과학회지

No abstract available.

Transient unilateral vocal cord paralysis following endotracheal intubation in elderly patient with the abdominal surgery: A case report

Vocal cord paralysis is one of the most serious complications, which, in most situations, is preventable, associated with tracheal intubation. Unilateral vocal cord paralysis following tracheal intubation usually causes hoarseness. Postoperative vocal cord paralysis may be due to mechanical or neurogenic factors. The patient complained of hoarseness one day after operation and coughing on swallowing water ten days after operation. The vocal cords were examined with a fiberoptic nasopharyngolaryngoscopy and the right vocal cord was fixed in the paramedian position. We present a case of unilateral vocal cord paralysis following endotracheal intubation in a 71-year-old male patient with descending colon carcinoma and left renal cell carcinoma.

Airway fire injury during rigid bronchoscopy in a patient with a silicon stent: A case report / 대한마취과학회지

Therapeutic bronchoscopy is widely employed as an effective first-line treatment for patients with central airway obstructions. Airway fires during rigid bronchoscopy are rare, but can have potentially devastating consequences. Pulmonologist and anesthesiologist undertaking this type of procedure should be aware of this serious problem and be familiar with measures to avoid this possibly fatal complication. We report the case of a 24-year-old patient with a silicone stent who experienced an electrocautery-induced airway fire during rigid bronchoscopy.

Airway obstruction in heat & moisture exchanger filter: A case report

Heat and moisture exchanger filters (HMEF), used for humidification of patient respiratory gas and filtering microorganisms can cause airway obstruction. We experienced serious airway obstruction in a HMEF after making hydrothorax for high intensity focused ultrasound (HIFU) procedure. The airway obstruction was difficult to differentiate from severe bronchospasm irresponsive to bronchodilator therapy. It was relieved dramatically after we removed the filter from the breathing circuit as soon as we detected air-fluid meniscus in it.

The hemodynamic responses and adequacy of infusion volume in acute hypervolemic hemodilution assessed with transesophageal Doppler apparatus

BACKGROUND: Acute hypervolemic hemodilution (AHH), an alternative of acute normovolemic hemodilution (ANH) is simpler, less expensive and less time-consuming than ANH. We examined hemodynamic responses and adequacy of 15 ml/kg infusion volume with transesophageal Doppler apparatus. METHODS: We induced AHH in 26 patients undergoing major abdominal surgery by fluid administration with volume of 15 ml/kg. During AHH, we observed hemodynamic parameters of cardiac index (CI), stroke index (SI), left ventricular ejection time corrected (LVETc), acceleration (Acc), peak velocity (PV), total systemic vascular resistance (TSVR) by transesophageal Doppler device and measured central venous pressure (CVP) via subclavian catheter every 2 minutes (H0, H2, H4, H6, H8, H10). RESULTS: After AHH, hemoglobin and arterial oxygen content value were decreased about 14% and tolerable. During AHH, CVP and SI increased first from H2. CI and LVETc, representing blood flow like SI increased from H4. TSVR decreased from H4, but Acc and PV representing cardiac contractility did not change through the AHH. Through AHH by infusion volume of 15 ml/kg, hemodynamic changes were tolerable. CONCLUSIONS: AHH increased aortic blood flow, decreased afterload, but did not affect cardiac contractility at all. The volume of 15 ml/kg for AHH is acceptable in clinical situation.

The two stage flexible fiberoptic bronchoscoptic awake intubation in a patient with the symptomatic vallecular cyst: A case report

Large symptomatic vallecular cyst is rare, but may cause difficulty or inability in conventional tracheal intubation during induction of general anesthesia. A flexible fiberoptic bronchoscope is the most useful general purpose aid to awake intubation in the patient with a known difficult airway. We experienced a case of flexible video image fiberoptic bronchoscopic awake orotracheal intubation in a patient with the large symptomatic vallecular cyst. A 35-year-old male suffered from foreign body sensation, voice change and dyspnea one month after upper respiratory tract infection. The two step flexible fiberoptic bronchoscopic approach was performed in the management of a known difficult intubation due to a vallecular cyst. We had an uneventful general anesthesia for removal of large symptomatic vallecular cyst because we anticipated difficult intubation.

The two stage flexible fiberoptic bronchoscoptic awake intubation in a patient with the symptomatic vallecular cyst: A case report

Large symptomatic vallecular cyst is rare, but may cause difficulty or inability in conventional tracheal intubation during induction of general anesthesia. A flexible fiberoptic bronchoscope is the most useful general purpose aid to awake intubation in the patient with a known difficult airway. We experienced a case of flexible video image fiberoptic bronchoscopic awake orotracheal intubation in a patient with the large symptomatic vallecular cyst. A 35-year-old male suffered from foreign body sensation, voice change and dyspnea one month after upper respiratory tract infection. The two step flexible fiberoptic bronchoscopic approach was performed in the management of a known difficult intubation due to a vallecular cyst. We had an uneventful general anesthesia for removal of large symptomatic vallecular cyst because we anticipated difficult intubation.

The accidental renal artery embolism in patient with aortoiliac occlusive disease with unilateral renal atrophy during aortobifemoral bypass graft: A case report

Aortoiliac occlusive disease occurs commonly in patients with peripheral arterial disease. Aortofemoral bypass is the most common surgical procedure to treat aortoiliac occlusive disease. Intraoperative renal artery embolism is rare complication that may occur during aortofemoral bypass in patients with aortoiliac occlusive disease. It is very important to prevent the risk of subsequent renal artery thrombotic or atheromatous embolism during aortofemoral bypass in patients with juxtarenal aortic occlusion because of accidentally dislodging fragments or atheromatous emboli into the renal arteries. Emboli to one or more major renal arteries are an occasional cause of renal failure. We report a case of renal artery embolism in patient with aortoiliac occlusive disease and unilateral renal atrophy during aortobifemoral bypass graft.

Airway obstruction due to post intubation circumferential tracheal web formation: A case report

Tracheal stenosis is well known complication of endotracheal intubation. However, severe post intubation tracheal stenosis that requires interventional bronchoscopy or tracheal surgery is un-common. Necrosis induced by cuff pressure-related loss of regional blood flow is the central injury leading to postinubation tracheal stenosis. The large volume, low pressure cuff of endo-tracheal tubes have markedly reduced the occurrence cuff-induced injury. However, in any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, possibility of tracheal stenosis should be considered. We report a case of severe tracheal stenosis by tracheal web formation a 52-year-old following ventilator therapy for ARDS.

Ileus after ketamine anesthesia in pediatric patient : A case report

Ketamine is a rapidly acting dissociative anesthetic that can be administered as a sole agent, an induction agent, or a supplement to low potency anesthetic agents.It is usually used for the minor surgery or outpatient surgery in pediatric anesthesia because of the undesirable psychotomimetic side effects of ketamine are less common in the children. We report that a pediatric patient had experienced a profound paralytic ileus after ventilation tube insertion with ketamine anesthesia.

Ileus after ketamine anesthesia in pediatric patient : A case report

Ketamine is a rapidly acting dissociative anesthetic that can be administered as a sole agent, an induction agent, or a supplement to low potency anesthetic agents.It is usually used for the minor surgery or outpatient surgery in pediatric anesthesia because of the undesirable psychotomimetic side effects of ketamine are less common in the children. We report that a pediatric patient had experienced a profound paralytic ileus after ventilation tube insertion with ketamine anesthesia.

Refractory Hypotension after Anesthesia Induction in a Patient with Diabetic Autonomic Neuropathy and Chronic Renal Failure: A case report / 대한마취과학회지

Patients with diabetes or chronic renal failure may develop profound hypotension after anesthesia induction. In a patient with chronic renal failure, inappropriate dialysis may aggravate the hypotension. Combined autonomic neuropathy in diabetes mellitus is the main cause of the undesirable changes in blood pressure after anesthesia induction. We report a case of hypotension refractory to fluid replacement and inotropes in a patient with chronic renal failure for 10 years and diabetes mellitus for 5 years. The patient received hemodialysis on the day before surgery and had developed various symptoms suggestive of autonomic neuropathy (i.e., dizziness on standing, esophageal spasm, intermittent diarrhea).

The Effect of Bilateral Femoral Nerve Block Combined with Intravenous Patient-controlled Analgesia after a Bilateral Total Knee Replacement / 대한통증학회지

BACKGROUND: Postoperative pain after bilateral total knee replacement (TKR) is expected to be more severe than unilateral TKR. Intravenous patient-controlled analgesia (IV PCA) is less effective than other methods of pain management especially immediately after an operation even though it is an easily controlled method for managing pain. This study was designed to evaluate the effect of femoral nerve blocks combined with IV PCA after bilateral TKR for postoperative pain control. METHODS: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) were given bilateral femoral nerve blocks with 12 ml of 0.25% bupivacaine and epinephrine 1: 400,000 before extubation followed by an IV PCA. Main outcome measures included numerical rating pain score, cumulative opioid consumption, hourly dose during each time interval, and side effects. RESULTS: The pain score in group II was significantly lower than that in group I immediately after recovery of awareness and at 3, 6, 12 hours postoperatively. Cumulative opioid consumption was significantly decreased in group II during the first 48 hours postoperatively. The hourly dose in group II was also significantly lower than that in group I until 12 hours postoperatively. There was no difference in side effects between the groups. CONCLUSIONS: We concluded that bilateral femoral nerve blocks improve analgesia and decrease morphine use during IV PCA after bilateral TKR.

The effect of femoral nerve block combined with intravenous patient-controlled analgesia after a unilateral total knee replacement / 대한마취과학회지

BACKGROUND: Postoperative pain is a major concern after total knee replacement (TKR). Intravenous patient-controlled analgesia (IV PCA) is very easily controlled method for managing pain, however it is less effective than other methods, especially immediately after TKR. Therefore, we evaluated the effect of the femoral nerve block combined with IV PCA after a unilateral TKR for postoperative pain control. METHODS: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) taken femoral nerve block before extubation followed by IV PCA. We evaluated the effects of the femoral nerve block with 12 ml of 0.25% bupivacaine and epinephrine 1:400,000 on the postoperative cumulative opioid consumption, hourly dose during each time interval, numerical rating pain score, side effects and hemodynamics. RESULTS: Cummulative opioid consumption was decreased in group II. The pain score in group II was lower than that in group I immediately after recovery of awareness and 3, 6 hours postoperatively. The hourly dose in group II was also lower than that in group I until 6 hours postoperatively. But there was no difference in side effects between the groups. CONCLUSIONS: We concluded that femoral nerve block is effective as an easy adjuvant of IV PCA for pain management during early postoperative period after TKR.

The effect of femoral nerve block combined with intravenous patient-controlled analgesia after a unilateral total knee replacement / 대한마취과학회지

BACKGROUND: Postoperative pain is a major concern after total knee replacement (TKR). Intravenous patient-controlled analgesia (IV PCA) is very easily controlled method for managing pain, however it is less effective than other methods, especially immediately after TKR. Therefore, we evaluated the effect of the femoral nerve block combined with IV PCA after a unilateral TKR for postoperative pain control. METHODS: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) taken femoral nerve block before extubation followed by IV PCA. We evaluated the effects of the femoral nerve block with 12 ml of 0.25% bupivacaine and epinephrine 1:400,000 on the postoperative cumulative opioid consumption, hourly dose during each time interval, numerical rating pain score, side effects and hemodynamics. RESULTS: Cummulative opioid consumption was decreased in group II. The pain score in group II was lower than that in group I immediately after recovery of awareness and 3, 6 hours postoperatively. The hourly dose in group II was also lower than that in group I until 6 hours postoperatively. But there was no difference in side effects between the groups. CONCLUSIONS: We concluded that femoral nerve block is effective as an easy adjuvant of IV PCA for pain management during early postoperative period after TKR.

The effect of vitamin C on hemodynamics and arterial blood gas in tourniquet induced ischemia-reperfusion injury during unilateral total knee replacement in elderly patients

BACKGROUND: Free radicals, such as reactive oxygen species which are released abruptly after deflation of an ischemic tourniquet, cause reperfusion injuries. Vitamin C produce cytoprotective effects due to reduction of free radicals. This study was designed to investigate the effect of vitamin C on hemodynamics and arterial blood gas during unilateral total knee replacement. METHODS: In the vitamin C group (VC group: N = 19), patients were administrated with vitamin C:a priming bolus of vitamin C 0.06 g/kg mixed with 100 ml saline infused for 20 min at 10 min before deflation of tourniquet, followed by vitamin C 0.02 g/kg mixed with 30 ml saline at 0.5 ml/min. In the control group (control group: N = 15), patients were infused by 100 ml saline. Mean arterial blood pressure, heart rate and arterial blood gas were measured at 20 min after anesthesia induction, just before deflation, 5 min after deflation and 20 min after deflation of tourniquet. RESULTS: Mean arterial blood pressure in the VC group was maintained higher than control group at 1 min after deflation of the tourniquet. Arterial O2 tension and saturation in the VC group were higher than control group at 5 min and 20 min after deflation of the tourniquet. CONCLUSIONS: We concluded that the administration of vitamin C during total knee replacement could inhibit decline of mean arterial blood pressure and arterial oxygenation induced by ischemiareperfusion significantly.