BACKGROUND: Rocker bottom shoes (RBS) are popular among patients with different foot, leg, or back problems in Korea. Patients with knee osteoarthritis concurrent weakness in the quadriceps femoris muscle, who wear these shoes, are often assumed to develop piriformis syndrome (PS). This study was performed to improve the understanding about the effect of wearing such shoes on duration of the syndrome in knee osteoarthritis. METHODS: We randomly assigned 150 patients with PS, who had used RBS daily for at least 6 months, to 2 groups, the S (stopped wearing) and K (kept wearing) groups. Both the groups were subdivided into the O and N groups, comprising patients with and without knee osteoarthritis, respectively. The effects of the treatment, including piriformis muscle injections and a home exercise program, were compared between the 2 groups by using a flexion-adduction-internal rotation (FAIR) test, a numeric rating scale (NRS), and the revised Oswestry disability index (ODI) during the 12-week follow-up. RESULTS: The positive FAIR test ratios, mean NRS scores, and revised ODIs were higher in the KO group than the SN group from 4?12 weeks after treatment. CONCLUSIONS: RBS may extend duration of the PS in osteoarthritis patients.
Back Pain ; Foot ; Humans ; Knee ; Korea ; Leg ; Muscles ; Osteoarthritis ; Osteoarthritis, Knee ; Piriformis Muscle Syndrome ; Quadriceps Muscle ; Shoes

Deep sedation or general anesthesia has been frequently required daily radiation therapy in pediatric patients. We experienced repeated sedation with propofol in a 16-year-old patient who underwent consecutive radiation therapy due to brain tumor. During treatment, the patient showed increased susceptibility to propofol. The brain magnetic resonance imaging (MRI) showed gradual increase in size of brain tumor regardless of radiation therapy. The increased susceptibility of propofol may be related with growth of brain tumor.
Adolescent ; Anesthesia, General ; Brain Neoplasms* ; Brain* ; Deep Sedation ; Humans ; Magnetic Resonance Imaging ; Propofol*

Kasabach-Merritt syndrome presents various problems for anesthetic management, which include thrombocytopenia, bleeding tendency, and problems arising from the hemangioma mass itself. A 1-month-old male was given sclerotherapies, platelet transfusions, steroid, interferon alpha, vincristine because of the bleeding from the right lower leg hemangioma, but platelet numbers were decreased and seizures occurred due to frontal lobe focal hemorrhage. After all, he was scheduled for his right lower leg amputation when he was 7 months old. Anesthesia was carefully induced with thiopental, rocuronium, fentanyl, and flexible bronchoscope. It was maintained with sevoflurane and air/oxygen with fentanyl injection. Although excessive bleeding was expected during anesthesia and surgery, the operation was performed without correction of platelet number. Two days later, postoperative course was improved almost normal.
Amputation ; Androstanols ; Anesthesia ; Bronchoscopes ; Fentanyl ; Frontal Lobe ; Hemangioma ; Hemorrhage ; Humans ; Infant, Newborn ; Interferon-alpha ; Kasabach-Merritt Syndrome ; Leg ; Male ; Methyl Ethers ; Platelet Count ; Platelet Transfusion ; Sclerotherapy ; Seizures ; Thiopental ; Thrombocytopenia ; Vincristine

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.
Central Venous Catheters* ; Drainage ; Dyspnea ; Female ; Humans ; Intensive Care Units ; Mediastinitis* ; Mediastinum ; Middle Aged ; Ovarian Neoplasms ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Patients' Rooms ; Pleural Effusion ; Subclavian Vein ; Thoracentesis ; Vascular System Injuries*

BACKGROUND: Nicardipine or nitroglycerin has been used to induce controlled hypotension in healthy patients undergoing orthopedic surgery. Despite the fact that controlled hypotension reduces the amount of blood loss during surgery, the changes in the regional blood flow (RBF) are unclear. This study compared the effects of nicardipine and nitroglycerin on the RBF using a laser Doppler flowmeter. METHODS: Twenty adult patients, ASA physical status I or II, who were scheduled for hip or spine surgery under general anesthesia, were randomly divided into two groups. After inducing general anesthesia, Group N (n = 10) was infused with nitroglycerin to induce hypotension, and group P (n = 10) was infused with nicardipine. The RBF was measured at the upper arm (1 cm lateral from the acromion of the scapula and deltoid region) and the second fingernail of the same side during the prehypotensive and hypotensive states. RESULTS: There was no significant difference in the estimated level of blood loss and urine output between the groups. The reduction in the mean arterial pressure was faster in group P than in group N. There was no difference in the time for the mean arterial pressure to return to the baseline after the stopping drug infusion. Although the change in the RBF during the hypotensive period was significantly higher in group N than in group P, there was a similar estimated level of blood loss. CONCLUSIONS: Nicardipine is better than nitroglycerin in maintaining the regional blood flow in the peripheral tissue during controlled hypotension and induces controlled hypotension more rapidly.
Acromion ; Adult ; Anesthesia, General ; Arm ; Arterial Pressure ; Flowmeters ; Hip ; Humans ; Hypotension ; Hypotension, Controlled* ; Nails ; Nicardipine* ; Nitroglycerin* ; Orthopedics ; Regional Blood Flow* ; Scapula ; Spine

BACKGROUND: The current study evaluated whether the level of preoperative anxiety assessed by the state-trait anxiety inventory (STAI) affects cardiovascular response during anesthetic induction. Furthermore, we evaluated the utility of the preoperative anxiety scale as a predictive factor for hemodynamic changes. METHODS: One hundred twenty patients who were scheduled to undergo elective surgery under general anesthesia were enrolled in this prospective study. The patients were asked to fill out STAI questionnaires the night before the day of surgery. For 5 minutes after tracheal intubation, changes in vital signs were recorded. The correlation between STAI scores and the percent changes in vital signs during the induction of anesthesia for each subgroup was assessed. In addition, the predictability of the 20% change in vital signs by STAI scores was analyzed using receiver operating characteristics curves. RESULTS: The state anxiety scores of patients 45 years of age or older showed a significant correlation with percent changes in mean blood pressure and heart rate, whereas the state anxiety scores in other subgroups showed no significant correlation with changes in vital signs during the induction of anesthesia. Furthermore, the state anxiety scores in patients 45 years of age or older were shown to be useful in predicting a 20% change in vital signs during anesthetic induction. CONCLUSIONS: The state anxiety scores of patients 45 years of age or above could be a useful tool for predicting changes in vital signs during anesthetic induction. Thus, physician should be mindful of preoperative anxiety.
Anesthesia ; Anesthesia, General ; Anxiety ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Prospective Studies ; Surveys and Questionnaires ; ROC Curve ; Vital Signs

A 38-year-old female patient had bradycardia in the preoperative electrocardiogram (ECG), and she showed severe bradycardia, with the heart rate (HR) under 40 beats per minute (bpm) even after arrival in the operating room. Immediately after endotracheal intubation, ventricular tachycardia with HR over 200 bpm occurred, but it disappeared voluntarily. The surgery was postponed for additional cardiac evaluation because of the persistent severe bradycardia. On postanesthesia day 2, complete atrioventricular (AV) block appeared. We expected spontaneous recovery over 2 weeks, but the complete AV block persisted. A permanent pacemaker was eventually inserted, and the patient was discharged without other complications on day 4 after insertion of the pacemaker. We report this case because complete AV block has commonly occurred in patients with risk factors such as first AV block, secondary AV block, or bundle branch block, but complete AV block has occurred despite the absence of arrhythmia in this patient.
Adult ; Anesthesia, General ; Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Bundle-Branch Block ; Electrocardiography ; Female ; Heart Rate ; Humans ; Intubation, Intratracheal ; Operating Rooms ; Risk Factors ; Tachycardia, Ventricular

Tetanus is a bacterial infection by Clostridium tetani. Its neurotoxin causes spastic paralysis and autonomic dysfunction. Intrathecal infusion of baclofen has been suggested as a pertinent treatment for generalized spasm. Our case describes a patient who had a severe generalized form of tetanus, and was effectively treated with intrathecal baclofen infusion. He showed cerebral and brainstem dysfunction during baclofen infusion, which were reversed without sequelae when baclofen was discontinued.

“Chronic pain after spinal surgery” (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.

Patients with heart failure undergoing surgery that requires general anesthesia face substantial perioperative risks; however, clear guidelines are not available for anesthesia management in patients with a reduced left ventricular ejection fraction. Traditional intravenous and volatile anesthetics require careful administration to prevent severe hypotension and bradycardia in patients with heart failure. Remimazolam has emerged as a promising alternative to conventional anesthetics because of its reduced cardiovascular depressive effects. We present three cases illustrating the successful use of remimazolam to induce and maintain general anesthesia in patients with heart failure and reduced cardiac function. Our cases demonstrate the safe use of remimazolam for general anesthesia in patients with heart failure and a reduced ejection fraction.