Multiple Psoas Abscess Formation after Pharmacopuncture: A Case Report

Acupuncture has been widely used in alternative medicine for pain relief but may have many complications due to lack of appropriate cares. Pharmacopuncture is a sort of acupuncture that injects a herbal ingredient through a thin tube for the purpose of combining the effects of the herb and acupuncture and it has many pitfalls. The agents used in pharmacopuncture are not refined for a desired effect and not produced by sterile standard processes under strict medical surveillance. We report a case of a 44-yr-old male patient who had multiple abscesses in the psoas region with fever, right low back and hip pain that began after the pharmacopuncture treatment. This case shows that although pharmacopuncture has been practiced widely, it is important that the appropriate aseptic technique should be used to prevent severe infections and other complications.

Use of an Epidural Catheter Placed Through a Fiberoptic Bronchoscope for Topical Anesthesia of the Larynx and Trachea in a Case of Difficult Intubation: A case report / 대한마취과학회지

Fiberoptic bronchoscope guided tracheal intubation is more popular in patient with expected difficult intubation by conventional laryngoscopy. We report a case of smooth fiberoptic bronchoscope guided tracheal intubation under local anesthesia. A 10% lidocaine spray 2-3 puffs of pharyngolaryngeal topical anesthesia and 2% lidocaine injection through a 19 gauge epidural catheter (ARROW(R)) placed over the fiberoptic bronchoscope suction channel for laryngeal and tracheal anesthesia were sufficient to prevent pain, coughing and nausea.

Use of an Epidural Catheter Placed Through a Fiberoptic Bronchoscope for Topical Anesthesia of the Larynx and Trachea in a Case of Difficult Intubation: A case report / 대한마취과학회지

Fiberoptic bronchoscope guided tracheal intubation is more popular in patient with expected difficult intubation by conventional laryngoscopy. We report a case of smooth fiberoptic bronchoscope guided tracheal intubation under local anesthesia. A 10% lidocaine spray 2-3 puffs of pharyngolaryngeal topical anesthesia and 2% lidocaine injection through a 19 gauge epidural catheter (ARROW(R)) placed over the fiberoptic bronchoscope suction channel for laryngeal and tracheal anesthesia were sufficient to prevent pain, coughing and nausea.

Difficult Endotracheal Intubation by Airway Trauma / 대한마취과학회지

We report a case of unsuspected difficult intubation in an adult due to anatomical abnormalities caused by a thermal burn injury on the right anterior pillar of the pharynx. After induction of anesthesia, vocal cords and epiglottis were not seen and the right half of the pharyngeal cavity was obstructed by a narrowed palatoglossal arch on the laryngoscopic view. Endotracheal intubation trials failed by oral and nasal routes. The laryngeal mask airway could not be passed into the narrowed oropharynx. We awaked the patient and took the patient's past history precisely and an otolaryngologic evaluation was taken. We found that at the age of six, the patient experienced a thermal burn injury on the right anterior pillar of the pharynx by heated iron and anatomical deformities by scar contracture formed thereafter. The next day a partial palatoglossal resection was done in sitting position under local anesthesia and then endotracheal intubation by direct laryngoscopy could be completed successfully.

A Comparison of the Bronchodilatory Effect of Halothane, Isoflurane and Desflurane in Isolated Rat Fourth Order Bronchi / 대한마취과학회지

BACKGROUND: Volatile anesthetics are potent bronchodilators of airway smooth muscle. Bronchodilation is occured by depressing reflex neural pathways innervating airway smooth muscle and by acting directly on the smooth muscle cell. We studied the direct relaxation effect and their potency of halothane, isoflurane and desflurane on isolated rat distal bronchial segment of fourth order precontracted with acetylcholine. METHODS: Isolated Sprague-Dawley rat bronchial rings were suspended in tissue bath with modified- Krebs's solution. Based on the dose-response curve, the ED50 of acetylcholine (ACh) was calculated for fourth bronchial segment and administered to each tissue bath, after which the stabilized response was recorded. After then each bronchial segment with intact epithelium was exposed to increasing concentration of halothane, isoflurane and desflurane (1.0, 1.5 and 2.0 MAC)and the relaxant responses were recorded by polygraph. RESULTS: Halothane, isoflurane and desflurane produced concentration-dependent bronchodilation (P<0.05 for either anesthetics; 22 4%, 18 6%, 24 5% for halothane, isoflurane and desflurane at 1.5 MAC, 32 6%, 27 7%, 38 5% for halothane, isoflurane and desflurane at 2.0 MAC). Overall, desflurane had a significantly greater relaxing effect as compared with halothane, isoflurane at 1.5 MAC and 2.0 MAC during ACh-mediated contraction. CONCLUSION: The mechanism of halothane, isoflurane and desflurane-mediated bronchodilation is not known, but may be due to an epithelium dependent effect. The potency of relaxing the ACh precontracted isolated rat bronchial smooth muscle is desflurane, halothane, isoflurane in ordered.

A Comparison of the Bronchodilatory Effect of Halothane, Isoflurane and Desflurane in Isolated Rat Fourth Order Bronchi / 대한마취과학회지

BACKGROUND: Volatile anesthetics are potent bronchodilators of airway smooth muscle. Bronchodilation is occured by depressing reflex neural pathways innervating airway smooth muscle and by acting directly on the smooth muscle cell. We studied the direct relaxation effect and their potency of halothane, isoflurane and desflurane on isolated rat distal bronchial segment of fourth order precontracted with acetylcholine. METHODS: Isolated Sprague-Dawley rat bronchial rings were suspended in tissue bath with modified- Krebs's solution. Based on the dose-response curve, the ED50 of acetylcholine (ACh) was calculated for fourth bronchial segment and administered to each tissue bath, after which the stabilized response was recorded. After then each bronchial segment with intact epithelium was exposed to increasing concentration of halothane, isoflurane and desflurane (1.0, 1.5 and 2.0 MAC)and the relaxant responses were recorded by polygraph. RESULTS: Halothane, isoflurane and desflurane produced concentration-dependent bronchodilation (P<0.05 for either anesthetics; 22 4%, 18 6%, 24 5% for halothane, isoflurane and desflurane at 1.5 MAC, 32 6%, 27 7%, 38 5% for halothane, isoflurane and desflurane at 2.0 MAC). Overall, desflurane had a significantly greater relaxing effect as compared with halothane, isoflurane at 1.5 MAC and 2.0 MAC during ACh-mediated contraction. CONCLUSION: The mechanism of halothane, isoflurane and desflurane-mediated bronchodilation is not known, but may be due to an epithelium dependent effect. The potency of relaxing the ACh precontracted isolated rat bronchial smooth muscle is desflurane, halothane, isoflurane in ordered.

The action of Halothane and Isoflurane in Aortic Rings of Rabbit Pretreated with LNAME (L-nitrow arginine methyl ester) and MB (methylene blue) / 대한마취과학회지

BACKGROUND: The action of the volatile anesthetics on various organs in the body is not well known. Since Furchgott (1980) discovered endothelium derived relaxing factor (EDRF) from endothelium, many studies have been tried. Many investigators were studied about the relationship between the EDRF and the effect of the volatile anesthetics on blood vessels too. But the effect of volatile anesthetics and the site of action on the blood vessel were still controversial. In this study, we evaluated that the effect and the action site of halothane and isoflurane on isolated aortic rings of the rabbit. METHODS: Each of obtained thoracic aorta from rabbits (1.5~2.5 Kg) was divided into 3~5 mm sized rings, and a half of that were denuded. All of the aortic rings were preconstricted with phenylephrine 1.5 10-7 Mole in warm organ bath filled with modified Krebs' solution, and then LNAME (inhibitor of nitric oxide synthase, 3 10-4Mole) was administered to one group of aortic rings. MB (inhibitor of soluble guanylate cyclase, 2 10-5Mole) was administered to another one group and neither of LNAME nor MB was administered to the other group. And then isoflurane or halothane was administered (1~4%) to all of aortic rings. The polygraph recorded the changes of tension of aortic ring which was transmitted through the force transducer. RESULTS: It was proved that basal EDRF was released from endothelium by the fact that intact aortic rings were more constricted after LNAME or MB administration. The intact aortic rings were constricted in all concentration of isoflurane and both intact and denuded rings were relaxed in 4% concentration of halothane. CONCLUSION: It is concluded that isoflurane in all concentrations has an endothelium -mediated vasoconstriction and 4% halothane produced vascular relaxation directly independent of existence of the endothelium of vessel.

The Effect of Diazepam and Midazolam Pretreatment on Succinylcholine Induced Fasciculation , Muscle Relaxation and Serum Potassium and Creatine Phosphokinase Changes / 대한마취과학회지

It has been already reported that diazepam pretreatment attenuated succinylcholine(Sch)-induced myalgia, fasciculation and potassium elevation. The effect of midazolam, a benzodiazepine derivative like diazepam, on Sch has not been investigated. So Midazolam, d-Tubocurarine and diazepam pretreatment were studied to determine the effect on subsequently administered Sch in 36 female patients. The patients were divided into 4 groups. Group 1 received no pretreatment, only Sch 1mg/kg(control). While Group 2 received d-Tubocurarine 0.05mg/kg, Group 3 received diazepam 0.05 mg/kg, and Group 4 received midazolam 0.025 mg/kg. After the pretreatment 4 minutes before Sch administration, the time to abolition and recovery of twitch height, the degree of fasciculation, the adequacy of relaxation for intubation, the changes in serum potassium and creatine pliosphokinase(CPK) were measured. The results are as follows: I) Group 2 showed increased time to abolition of twitch and decreased time to recovery of twitch. Group 3 showed increased time to recovery of twitch. 2) The incidence of fasciculation was decreased in Groups 2, 3 and 4. 3) Serum potassium was increased in Groups 1 and 2 but not in Groups 3 and 4. 4) Serum creatine phosphokinase was in- creased in all groups at post-Sch. 24 hours. It is concluded that diazepam and midazolam pretreatment attenuate Sch-inducedifasciculation and potassium increase.