A 68-year-old man with a right common iliac artery aneurysm perforating the inferior vena cava showed cardiomegaly and pulmonary congestion with left leg edema and dyspnea on exertion. The patient demonstrated a hyperdynamic circulation characterized by increased filling pressure, low systemic resistance, and high cardiac output (9.81l/min/m²) before surgery with a pulmonary-to-systemic blood flow ratio of 1.36. At operation, the right iliac artery to the inferior vena cava fistula, 5×10mm across, was closed along with resection and replacement of the aneurysm with a woven dacron graft of 10mm in diameter. The procedure caused acute and dramatic changes both in pre- and after-loads associated with aortic clamping as well as with elimination of A-V shunt through the fistula. Diligent attention was required both by surgeons and anesthesiologists to cope with these rather dramatic hemodynamic shifts during and after surgery. The patient did well and was discharged with normal hemodynamic parameters.

Purpose: We report a case whose anal pain accompanied by rectal cancer was remarkably eliminated by subarachnoid phenol block and sacral nerve root thermocoagulation. Case Report: The subject was a sixty-one-year old male. His anal pain failed to respond to opioid whereas his pain was alleviated by subarachnoid phenol block, but was exacerbated a few weeks later. This relapsing pain was completely eradicated by sacral nerve root thermocoagulation. Conclusion: Anal pain associated with rectal cancer recurrence of pelvic space is sometimes hard to be controlled only by subarachnoid phenol block, but there is a possibility of pain control by combination use with sacral nerve root thermocoagulation. Palliat Care Res 2010; 5(2): 314-316