A revision total hip arthroplasty (THA) that anticipated massive bleeding and the need for blood transfusion was scheduled. The patient was a 73-year-old man who had well controlled hypertension. A combined spinal and epidural anesthesia was performed. Dexmedetomidine was administered from the beginning of the arterial and central line catheterization, until the end of the operation. During the 10 hours and 30 minutes surgery, the estimated blood loss was about 7,000 mL, with a total infused red blood cell amount of 14 units, total fresh frozen plasma of 6 units, a total crystalloid of 6,850 mL and of colloid 1,500 mL. The Ramsay sedation score was maintained within 3 and the hemodynamic condition was stable. We found that dexmedetomidine can be safely used for sedation, even during an operation requiring massive transfusions and a prolonged operation time.
Aged ; Anesthesia, Epidural ; Anesthesia, Spinal ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Blood Transfusion ; Catheterization ; Catheters ; Colloids ; Dexmedetomidine ; Erythrocytes ; Hemodynamics ; Hemorrhage ; Hip ; Humans ; Hypertension ; Isotonic Solutions ; Plasma

After Middle East respiratory syndrome (MERS) was first confirmed in Korea on May 20, 2015, a total of 186 confirmed cases and 37 deaths occurred until the announcement of its cessation on December 23, 2015. MERS often causes severe pneumonia; accordingly, many patients require endotracheal intubation for mechanical ventilation. At our hospital, we treated 30 confirmed and 29 suspected cases and performed 9 endotracheal intubations in 8 of these patients, using conventional direct laryngoscopy (DL) and GlideScope video-laryngoscopy (GL). We faced difficulty in conducting endotracheal intubation due to the personal protective equipment and the limited bed height required for managing MERS patients. In such cases, GL improved the ease and direct confirmation of success of endotracheal intubation as compared to DL. In addition, we found that portable end-tidal CO2-monitoring devices may facilitate more precise and reliable confirmation of successful intubation.
Airway Management ; Coronavirus Infections* ; Humans ; Intubation ; Intubation, Intratracheal* ; Korea ; Laryngoscopy ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Personal Protective Equipment ; Pneumonia ; Respiration, Artificial

BACKGROUND: Hydroxyethyl starch (HES), a class of synthetic colloid solutions, has been widely used to treat perioperative hypovolemia. The use of HES, however, is associated with the risk of allergic reactions.CASE: An 83-year-old man was scheduled to undergo an open reduction and internal fixation of a pertrochanteric fracture under spinal anesthesia. He had no history of allergy. Five minutes after HES administration, hypotension, agitation, and skin rash were developed. HES infusion was terminated due to a suspected anaphylactic reaction. The vital signs recovered following administration of phenylephrine, dexamethasone, and hydrocortisone. Serum tryptase and total immunoglobulin E levels were elevated in plasma samples collected following the commencement of the allergic reaction during surgery.CONCLUSIONS: In the present report, the risk of anaphylactic reaction with HES and the laboratory tests needed to support the diagnosis are highlighted.
Aged, 80 and over ; Anaphylaxis ; Anesthesia ; Anesthesia, Spinal ; Colloids ; Dexamethasone ; Diagnosis ; Dihydroergotamine ; Exanthema ; Humans ; Hydrocortisone ; Hypersensitivity ; Hypotension ; Hypovolemia ; Immunoglobulin E ; Immunoglobulins ; Phenylephrine ; Plasma ; Starch ; Tryptases ; Vital Signs

Transurethral resection is the most efficacious and safest urologic procedure for the treatment of benign prostatic hypertrophy, prostate cancer, and bladder cancer. Complications of transurethral resection include hemorrhage, infection, transurethral resection syndrome, and bladder perforation. Early detection of bladder perforation is important because it can cause critical ventilation and hemodynamic changes. In this case, we detected bladder perforation as the cause of ventilation and hemodynamic change intraoperatively and treated it by immediate surgical repair.
Hemodynamics* ; Hemorrhage ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Ventilation*

Transurethral resection is the most efficacious and safest urologic procedure for the treatment of benign prostatic hypertrophy, prostate cancer, and bladder cancer. Complications of transurethral resection include hemorrhage, infection, transurethral resection syndrome, and bladder perforation. Early detection of bladder perforation is important because it can cause critical ventilation and hemodynamic changes. In this case, we detected bladder perforation as the cause of ventilation and hemodynamic change intraoperatively and treated it by immediate surgical repair.
Hemodynamics* ; Hemorrhage ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Ventilation*

Vena cava syndrome is caused by central venous obstruction and can be divided into superior vena cava syndrome and inferior vena cava (IVC) syndrome. Symptoms and signs of IVC syndrome vary from no symptoms to lower limb edema, hypotension, and typical venous stasis changes of the lower extremities, such as brownish discoloration of the skin, woody edema, and ulceration. Carbon dioxide pneumoperitoneum, lithotomy-Trendelenburg position, and abdominal obesity could increase intra-abdominal pressure. We report a patient undergoing laparoscopic surgery who showed intrathoracic herniation of peritoneal fat induced by elevated intra-abdominal pressure due to the reasons mentioned above, resulting in IVC syndrome and hypotension perioperatively. The patient was treated with a conservative approach because he was asymptomatic except for hypotension on the first postoperative day.
Carbon Dioxide ; Edema ; Humans ; Hypotension ; Laparoscopy ; Lower Extremity ; Obesity, Abdominal ; Pneumoperitoneum ; Skin ; Superior Vena Cava Syndrome ; Ulcer ; Vena Cava, Inferior