Emergency cesarean section of a patient with refractory status epilepticus: A case report of challenges during anesthesia.

INTRODUCTION: Maternal epilepsy is a critical condition that can significantly affect mothers and fetuses. Notably, the admission of a laboring mother with uncontrolled refractory status epilepticus (RSE) to the operating room presents a challenging scenario for anesthesiologists. THE MAIN SYMPTOMS OF THE PATIENT AND THE IMPORTANT CLINICAL FINDINGS: A 30-year-old primigravida was transferred to the operating room for an emergency cesarean section. Cesarean section was performed after a provisional diagnosis of preeclampsia was made. THE MAIN DIAGNOSES, THERAPEUTIC INTERVENTIONS, AND OUTCOMES: Cesarean section was performed under general anesthesia. During the postoperative period, the patient exhibited no seizure activity in the brain; however, she experienced mild cognitive dysfunction for up to 6 months postdelivery. The neonate were discharged without any complications. CONCLUSION: Inducing anesthesia in pregnant women with ongoing seizure activity are challenging; however, anesthesiologists provide judgment based on the balance between the safety of the mother and fetus and the balance between patient monitoring and the progression of anesthesia. This challenge can be addressed through multidisciplinary collaboration.

Coronary artery spasm induced by carotid sinus stimulation during arthroscopic shoulder surgery: A case report.

RATIONALE: Variant angina is characterized by coronary artery spasm irrespective of the presence of fixed stenotic coronary lesions. Perioperative coronary artery spasm may be induced by the supersensitivity of vascular smooth muscle cells caused by various stimuli, including stimulation of the parasympathetic nervous system. PATIENT CONCERNS: A 57-year-old male patient was undergoing arthroscopic rotator cuff repair under combined interscalene brachial plexus block and general anesthesia in the lateral decubitus position. While compressing the right shoulder to remove residual irrigation fluid in the shoulder through the surgical site, ventricular fibrillation occurred without ST elevation. INTERVENTIONS: The patient achieved a return of spontaneous circulation after chest compression, defibrillation, and an epinephrine infusion. DIAGNOSIS: Postoperative coronary angiography showed no significant stenosis, but it did show that the right coronary artery contracted rapidly and was completely obstructed after an intravascular injection of ergonovine, and that the contracted area returned to its normal size after nitroglycerin was injected into the coronary artery. Based on these observations, the patient was diagnosed with variant angina. OUTCOMES: The patient was discharged on postoperative day 20 without any sequelae and is currently under follow-up in the Cardiology Department. LESSONS: Surgeons should be vigilant and take relevant precautions, as compressing the shoulder to remove residual irrigation fluid during arthroscopic shoulder surgery in the lateral decubitus position may stimulate the carotid sinus and cause coronary artery spasm.

Malfunction of a central venous multilumen access catheter caused by kinking: A case report.

RATIONALE: A multilumen access catheter (MAC) is a large-bore catheter that prevents kinking or collapsing. Misplacement is a frequently reported complication. PATIENT CONCERNS: A 59-year-old man who was diagnosed with a hemoperitoneum due to a liver laceration after a fall. DIAGNOSIS: After catheterization, we were able to aspirate blood through the 9 Fr, but not the 12-gauge line. Thus, we assumed that the catheter was misplaced. Nevertheless, ultrasonographic findings did not reveal the reason for the malfunction. We found kinking in the distal part of the catheter after removing it. INTERVENTION: The MAC was removed soon after stopping the active bleeding. OUTCOMES: A hemihepatectomy was successfully performed, and the patient was transferred to the intensive care unit. LESSONS: Anesthesiologists should consider kinking of large-bore catheters, including MACs.

Effect of intraperitoneal CO2 concentration on postoperative pain after laparoscopic cholecystectomy.

PURPOSE: This study set out to identify the association between the intraperitoneal CO2 concentrations and postoperative pain by dividing the participants into a control group and 2 experimental groups receiving irrigation (1 L and 2 L), and directly measuring their intraperitoneal CO2 concentrations with a CO2 gas detector. METHODS: A total of 101 patients, American Society of Anesthesiologists physical status classification I and II patients aged 18-65 years were enrolled in the study. Group 1 did not receive irrigation with normal saline, while groups 2 and 3 were administered irrigation with 1 L and 2 L of normal saline, respectively, after laparoscopic cholecystectomy. Intraperitoneal CO2 concentrations were measured with a CO2 gas detector through the port, and postoperative pain was assessed on a visual analogue scale at 6, 12, and 24 hours after surgery. RESULTS: The intraperitoneal CO2 concentrations were 1,016.0 ± 960.3 ppm in group 1, 524.5 ± 383.2 ppm in group 2, and 362.2 ± 293.6 ppm in group 3, showing significantly lower concentrations in groups 2 and 3. Postoperative pain was significantly lower in group 3 at 6 hours after surgery, and in groups 2 and 3 at 12 hours after the surgery. However, there was no significant difference between the 3 groups in postoperative pain 24 hours after the surgery. CONCLUSION: This study found a causal relationship between the amount of normal saline used for irrigation and the intraperitoneal CO2 concentrations in that irrigation with normal saline reduces pain on the day of the surgery.

Incidental left main bronchus obstruction during left-sided double-lumen tube intubation of a patient with an unrecognized tracheal bronchus: A case report.

INTRODUCTION: Tracheal bronchus is a right-sided anomalous bronchus arising from the trachea above the main carina and occurs in 0.1% to 2% of the general population. CASE PRESENTATION: We present a case of left main bronchus obstruction during a left-sided double-lumen tube intubation in a patient with an unrecognized tracheal bronchus. After the intubation, to confirm the position of the tube, we observed what we believed was the carina with a fiberoptic bronchoscope, but it was a site between the tracheal bronchus and the right main bronchus. Thus, a right-sided intubation was performed, and the left main bronchus was obstructed with a bronchial cuff. As a result of the inappropriate ventilation, peak inspiratory pressure was elevated and arterial oxygen saturation decreased. CONCLUSION: Anesthesiologists should keep in mind the possibility of anatomical variation in the large airways, and bronchoscopy should be accompanied by cautious auscultation and confirmation of the division of the bronchus.

A comparison of oxycodone and fentanyl in intravenous patient-controlled analgesia after laparoscopic hysterectomy.

BACKGROUND: We planned to compare the effect of intravenous oxycodone and fentanyl on post-operative pain after laparoscopic hysterectomy. METHODS: We examined 60 patients were randomized to postoperative pain treatment with either oxycodone (n = 30, Group O) or fentanyl (n = 30, Group F). The patients received 10 mg oxycodone/100 µg fentanyl with ketorolac 30 mg before the end of anesthesia and then continued with patient-controlled analgesia for 48 h postoperatively. RESULTS: The accumulated oxycodone consumption was less than fentanyl during 8, 24 and 48 h postoperatively. Numeric rating score of Group O showed significantly lower than that of Group F during 30 min, 2, 4, 8 and 24 h postoperatively. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea was higher in the Group O during the 24 and 48 h postoperative period. CONCLUSIONS: Oxycodone IV-PCA was more advantageous than fentanyl IV-PCA for laparoscopic hysterectomy in view of accumulated oxycodone consumption, pain control and cost beneficial effect. However, patient satisfaction was not good in the group O compared to group F.

Effect of stellate ganglion block on laryngopharyngeal reflux disease.

BACKGROUND: Laryngopharyngeal reflux (LPR) disease has many symptoms such as globus pharyngeus, excessive throat clearing and hoarseness. The aim of this study was to investigate the effect of stellate ganglion block (SGB) in addition to proton pump inhibitors (PPI) on LPR. METHODS: Fifty patients complaining of more than 3 typical LPR symptoms for over 3 months were enrolled in the study. The P group took PPI for 8 weeks. The SP group took PPI and interwent a series of 8 SGB procedure once a week during the period of treatment. The blocks were performed one at a time unilaterally on the right and left stellate ganglions by injecting 1% mepivacaine 6 ml. We evaluated the reflux symptom index (RSI) before treatment and following 4 weeks and 8 weeks of treatment in both groups. RESULTS: After 4 weeks of treatment, the RSI of the P group decreased, but not significantly, to 16.6 ± 6.8 compared with the baseline value of 19.2 ± 2.7 (P = 0.093), whereas the RSI of the SP group decreased significantly to 9.8 ± 3.3 compared with the baseline value of 19.0 ± 4.7 (P = 0.000). After 8 weeks of treatment, the RSI of the P group decreased significantly to 13.7 ± 6.7 (P = 0.001) and the RSI of the SP group also decreased significantly to 7.7 ± 3.4 (P = 0.000). There were significant differences in the RSI between the two groups after 4 weeks (P = 0.000) and 8 weeks (P = 0.001) of treatment. CONCLUSIONS: The symptoms of LPR improved earlier when PPI therapy was combined with SGB compared with PPI therapy alone.