Stellate Ganglion Block for the Treatment of Adult Onset Still's Disease: A case report / 대한마취과학회지

A 31-year-old woman was referred to our pain clinic department under the diagnosis of an adult onset Still's disease. She had been suffering from high fever, skin rash, multiple arthralgia, morning stiffness and lymph node enlargement for 16 months. She had taken conventional medication with steroid and NSAIDs, but the symptoms were a remittent nature. And also, she complained of systemic side effects of corticosteroids. Stellate ganglion block with 0.25% bupivacaine was performed 67 times for the treatment of adult onset Still's disease and then, her symptoms were improved eventually. We could discontinue steroid and NSAIDs, laboratory data were satisfactory. As we experienced an adult onset still's disease improved with stellate ganglion block, we report this case with a review of the literature.

Anesthetic Management of a patient with Primary Aldosteronism caused by Adrenal Adenoma / 대한마취과학회지

Increased and inappropriate production of aldosterone from the adrenal gland is known as primary aldosteronism and leads to sodium retention with hypertension, suppression of plasma renin, and hypokalemia and its manifestations. It is due mainly to a solitary adenoma, bilateral hyperplasia, or rarely an adrenal carcinoms. Primary aldosteronism due to an adenoma is usually treated by surgical excision. Preoper-ative managements include the correction of hypokalemia, volume derangement, and metabolic alkalosis with spironolactone and the trestment of existing hypertension. The authors report a case of unilateral adrenalectomy and anesthetic considerations during perioperative periods.

Malignant Hyperthermia during General Anesthesia / 대한마취과학회지

Malignant hyperthermia is a genetically transmitted, catastrophic, hypermetabolic syndrome that is induced by potent volatile anesthetics and/or depolarizing muscle relaxants. It is now well established that the pathophysiology is related to a malfunction of the intracellular calcium homeostasis in skeletal muscle. Morbidity has been correlated to the duration of symptoms. Dantrolene decreased release of calcium from the sarcoplasmic reticulum. We recently encountered a fulminant case during halothane anesthesia. Anesthesia was induced with thiopental and succinylcholine without jaw tightness or stiffness. After induction, tachycardia, arrhythmias, increased end-tidal CO2, and high body temperature were noted. Arterial blood gas analysis showed a severe, mixed acidosis. Intensive treatment with body cooling was immediately initiated. But dantolene could not be available. The patient died of renal failure and disseminated intravascular coagulation 41 hours after induction of anesthesia.

Evaluation of CVP Values according to the Location of Catheter / 대한마취과학회지

Central vanous pressure is an extremely useful parameter in the effective monitoring of a patient who is seriously ill. Central venous pressure may be defined as a dynamic measurement of the ability of the right heart and the placement of the catheter in either the right atrium or the superior cava is considered satisfactory. The purpose for this study is to evaluate CVP values according to the placement of the catheter in clinical practice because we have used a short anglocath instead of a long intracath for the measurement of CVP. Ten patients were catheterized with a 20cm in tracathin the right subclavian vein by a supraclavicular approach. AS a control group CVP was measured at 13cm from the puncture site to the tip of catheter which was estimated to be in the right atrium. In the second group, CVP was measured at 8cm which goes the innominate vein and in the fourth group, measured at 5cm which locates in the subclavian vein. Mean values of venous pressures in each location are as follows: The right atrium(13cm from the puncture site): 8.68cm H2O. THe superior vena cava (10cm from the puncture site): 8.69cm H2o/ The innominate vein(8cm from the puncture site): 8.64cm H2O. The subclavian vein (5cm from the puncture site):8.68cm H2O. As a result of this study, we came to the conclusion that the CVP values in all four groups(right atrium, superior vena cava, innominate vein, subclavian vein) are almost the same, so that we can use a short angiocath with no problems for the measurements of CVP which is anchored in the innominate vein or the subclavian vein.

Hemothorax Resulting from Subclavisn Vein Catheterization / 대한마취과학회지

Serious complications from subelavian vein cannulation have been reported, i.e., pneumothorax, hydrothorax, hemothorax and catheter embolism, etc. A 42 year old female with a diagnosis of septic cholangitis was catheterised in the right subclavian vein by the supraclavicular approach for the measurement of CP and on the 3rd day of admission and developed a hemothorax subsequently. She had a cholecystectomy on the 4th day. Aensthesia was induced with the injection of pentothal and succinylcholine through the CVP line and was maintained with Ethrane. Her vital signs were not stable during the surgery as well as post-operatively. She also was not able to breathe by herself so that her respiration was assisted with a MA-J respirator. On the 2nd post-operative day, blood gases suggested respiratory failure and a chest P-A showed right pleural effusion. A chest tube was then inserted and about 3,200ml of blood was drained. She recovered from the hemothorax and superimposed pneumonia with intensive respiratory care for 20 days.