Therapeutic agents such as antibiotics, hormonal drugs and retinoids are usually applied for the treatment of acne vulgaris. Adult patients with acne vulgaris may suffer from various side effects of the therapeutic agents. Stellate ganglion blocks are known to be effective for general dermatological conditions such as atopic dermatitis and acne vulgaris. We experienced that a stellate ganglion block showed significant therapeutic effects in two patients with severe acne that did not respond to other treatments including medications. A stellate ganglion block should be considered as an effective treatment method for patients with acne vulgaris, especially in cases where little improvement is seen with the use of other treatment methods.
Acne Vulgaris ; Adult ; Anti-Bacterial Agents ; Dermatitis, Atopic ; Humans ; Retinoids ; Stellate Ganglion

Intraoperative airway obstruction is usually manifested as high peak inflation pressures and decreased exhaled tidal volume. The simultaneous occurrence of increased peak inflation pressure and unchanging plateau pressure generally indicates a mechanical obstruction of the tracheal tube. We experienced a reinforced tube obstruction after intraluminal bulging of the tube. A 59 year-old woman was scheduled for a neck mass excision and ventral hernia repair. The patient was intubated with a 7.0 mm new reinforced tube without any problems. Three hours later, signs of airway obstruction presented, and passage of a suction catheter failed. Examination with the naked eye showed a partial obstruction by intraluminal bulging of the inner layer of the tube. We report this case of partial airway obstruction with a reinforced tube.
Airway Obstruction ; Catheters ; Eye ; Female ; Hernia, Ventral ; Humans ; Inflation, Economic ; Neck ; Suction ; Tidal Volume

BACKGROUND: This study was designed to figure out how anesthesiologists think about their job values and expected tendencies through questionnaires. METHODS: The directions for completing internet questionnaires were sent to all members and semi-members of the Korean Society of Anesthesiologists by email. Paper version of the same questionnaires was sent to residents of some university hospitals, who did not answer the internet questionnaires. The questionnaires consisted of items of basic, 14 job values and 80 expected tendencies. The answerers were asked to choose 4 items among job values and 10 items among 80 tendencies. The answers were analyzed according to the groups of job positions, subspecialties, ages and gender. RESULTS: Among items of job values, 'decision making', 'taking care of people', 'working with my hands' and 'working with my mind' were chosen by more than 40% of answerers, and answer rates were similar between each comparative groups. Among items of expected tendencies, 'be calm in crisis', 'make decisions rapidly', 'be perfectionistic', 'be good coordinators', 'be self-confident', 'think logically', 'be tolerant of others', 'be able to do more than one thing at a time', and 'be persevering' showed high answer rate, but the answer rate of individual items showed some differences between groups. CONCLUSIONS: Although there were some items that showed different answer rates between groups, there was little difference in job values and expected tendencies between groups on the whole.
Electronic Mail ; Hospitals, University ; Internet ; Surveys and Questionnaires

BACKGROUND: In laparoscopic surgery with pneumoperitoneum, end-tidal CO2 (PeTCO2) monitoring may inaccurately estimate PaCO2 due to ventilation/perfusion mismatch. This study assessed the clinical usefulness and accuracy of transcutaneous CO2 (PtCCO2) monitoring during laparoscopic surgery. METHODS: Thirty-two patients with ASA physical status 1 requiring laparoscopic surgery were recruited. We measured PaCO2, PeTCO2, and PtCCO2 before and 20 min after pneumoperitoneum. To compare differences in PeTCO2/PaCO2 and PtCCO2/PaCO2, we determined bias values (mean difference between values) and precision (standard deviation of bias) with a Bland-Altman plot and compared them with a Student's t-test. RESULTS: Bias and precision values of PeTCO2/PaCO2 and PtCCO2/PaCO2 were 6.6 +/- 2.0 mmHg, 1.2 +/- 2.8 mmHg before pneumoperitoneum and 8.5 +/- 2.8 mmHg, 2.1 +/- 4.5 mmHg 20 min after pneumoperitoneum. PtCCO2/PaCO2 differences were significantly smaller than PeTCO2/PaCO2 differences (P< 0.05). CONCLUSIONS: In laparoscopic surgery, PtCCO2 monitoring is more accurate than PeTCO2 monitoring for assessing PaCO2 levels.
Bias (Epidemiology) ; Carbon Dioxide ; Humans ; Laparoscopy ; Pneumoperitoneum

Prune-belly syndrome is characterized by absent abdominal wall musculature with wrinkled overlying skin, urinary tract dilatation and cryptorchidism. Prune-belly syndrome is also associated with diseases of the respiratory, cardiovascular, skeletal, gastrointestinal and central nervous system. Because the congenital disease is uncommon, it is difficult to collect the information of anesthetic management of prune-belly syndrome. We report a case of 4 year-old-boy with prune-belly syndrome who underwent abdominoplasty and Mitrofanoff operation under general anesthesia.
Abdominal Wall ; Abdominoplasty ; Anesthesia, General ; Central Nervous System ; Cryptorchidism ; Dilatation ; Humans ; Male ; Prune Belly Syndrome ; Skin ; Urinary Tract

Myasthenia gravis, an autoimmune disease with antibodies directed against the nicotinic acetylcholine receptor, is relatively common in young women and sometimes associated with pregnancy. Because pregnancy can influence myasthenia gravis and the drugs used for its treatment influence gestation, obstetrical management can be complicated. Regional anesthesia during vaginal delivery is the anesthesia treatment of choice, and cesarean delivery should avoid epidural or spinal anesthesia to reduce postoperative problems. We performed spinal anesthesia with bupivacaine in a 38-year-old multipara myasthenic with normal lung function, with specific perioperative complications.
Adult ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal ; Antibodies ; Autoimmune Diseases ; Bupivacaine ; Cesarean Section ; Female ; Humans ; Lung ; Myasthenia Gravis ; Pregnancy ; Receptors, Nicotinic

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.
Aged ; Critical Care ; Fever ; Hematoma ; Hemorrhage ; Humans ; Immunoglobulins ; Leukocyte Count ; Leukocytosis ; Multiple Myeloma ; Respiration ; Respiratory Insufficiency ; Thorax

Irregular or unexpected antibodies are alloantibodies against serum or red blood cells after previous exposure to transfusion. When encountered in critical condition, however, risk of ongoing complication is not entirely predictable. Rapid transfusion of safe blood is thus, crucial not to compromise further procedure. A 78-year-old ASA IV man presented with Hunt-Hess grade IV subarachnoid hemorrhage with huge temporal bleeds. While in operating room, his blood pressure dropped when the dura was opened. Meanwhile, routine screening of blood typing repeatedly denoted Rh+O with irregular antibodies. Soon, compatible cross-matched blood was infused with 37 degrees C normal saline 200 ml at a rate of 4-5 ml/kg/hr. There was no laboratory evidence of hemolytic transfusion reaction. Postoperatively, BUN and creatinine increased slightly, but urination and respiration were unremarkable.
Aged ; Antibodies ; Blood Group Incompatibility ; Blood Grouping and Crossmatching ; Blood Pressure ; Creatinine ; Emergencies ; Erythrocytes ; Humans ; Isoantibodies ; Mass Screening ; Operating Rooms ; Respiration ; Subarachnoid Hemorrhage ; Urination

Tension pneumothorax is known as a rare complication of breast augmentation surgery, but can occur more than expected. This is a case of a 34-year-old woman who was to receive delay extended latissimus dorsi flap under general anesthesia. The patient was injected the tumescent solution by 25 gauge spinal needle preoperatively. In the course of operation, the peak inspiratory pressure was increased gradually. At the moment of changing the position from supine to sitting position, the blood pressure decreased to 75/45 mmHg. We took the chest radiography, which showed typical findings of tension pneumothorax of right side. Prompt needle aspiration and chest tube insertion relieved tension pneumothorax. The patient's vital signs got stabilized and there was no visible remained pneumothorax at following chest radiography taken. We should pay attention to the possible occurrence of devastating pneumothorax during breast augmentation surgery, especially local infiltration using long needle is performed.
Adult ; Anesthesia, General ; Blood Pressure ; Breast ; Chest Tubes ; Female ; Humans ; Needles ; Pneumothorax ; Thorax ; Vital Signs

Unidirectional obstruction of a bronchus from any cause results in hyperinflation or atelectasis of the distal area. We experienced a patient that showed expiratory airway obstruction and this was caused by check-valve mechanism of bronchial tumor during anesthetic induction for spine surgery. A 60-year-old-man, who had left hilar lung cancer, entered the operating room to undergo spine surgery for metastatic tumor. Immediately after intubation, the patient's breathing sounds were not heard at the left lung field, and the patient displayed severe hemodynamic instability. The chest X-ray showed hyperinflation of the left lung with mediastinal shifting to the right side. With spontaneous recovery of the patient's self-ventilation, the vital signs returned to normal. Three days later, the operation was performed successfully under spinal anesthesia.
Airway Obstruction ; Bronchi ; Hemodynamics ; Humans ; Intubation ; Lung ; Lung Neoplasms ; Operating Rooms ; Pulmonary Atelectasis ; Respiration, Artificial ; Respiratory Sounds ; Spine ; Thorax ; Vital Signs