A Case of Skin Burns Occurring during Laparoscopic Surgery

Skin burn injury from light cables is a rare complication of laparoscopic surgery. We report the case of a 57-year-old female who underwent laparoscopic-assisted right hemicolectomy under general anesthesia. During surgery, the anesthesiologist discovered that the tip of the light cable, with the light source powered on, penetrated the surgical drape and was positioned on the right forearm of the patient, where a bulla measuring 2.0× 2.5 cm in size and a second-degree burn were identified. All medical personnel participating in laparoscopic and arthroscopic procedures should always be aware that the light cable can cause burns to the patient. Additionally, after connecting the light cable to the scope, the light source should be activated. The light cable should not be placed around the patient or on the surgical drape while the light source is active. Immediately after completing the surgery, the power to the light source should be turned off, and the light cable should be placed in a safe place.

Comparison of Methods to Confirm the Cervical Epidural Space

BACKGROUND: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral levels. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the midline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space. The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. METHODS: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. RESULTS: Using the drip infusion method, we identify the epidural space in all the patients as +/++ grade. The catheter insertion method was also successful in identifying those epidural spaces over a +/- grade. The pseudo LOR was over micro grade in 47 patients. CONCLUSIONS: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space.