BACKGROUND: Intraoperative monitoring of transcranial electrical motor evoked potentials (TCE-MEPs) can be a useful tool to detect iatrogenic spinal cord injury. But the efficacy of TCE-MEPs monitoring in the spine surgery has not been reported in South Korea. The purpose of this study is to investigate the reliability of intraoperative TCE-MEPs in spinal surgery. METHODS: Thirty five patients scheduled for elective surgery for spine correction were enrolled in the study. After induction of general anesthesia with target controlled infusion (TCI) system of propofol and remifentanil, intraoperative TCE-MEPs from upper or lower limb muscles were monitored. No additional muscle relaxants were given except for tracheal intubation. We recorded intraoperative abnormal signs of TCE-MEPs and postoperative neurologic deficits. From these results, sensitivity, specificity, positive predictive value, and negative predictive value of TCE-MEPs monitoring for the detection of neurologic damage during spinal surgery were calculated. RESULTS: Six patients showed decreases in amplitudes. Postoperative neurologic deficits occurred in 5 patients out of them. Only one patient developed postoperative neurologic deficit even though there were no intraoperative TCE-MEPs change. Sensitivity, specificity, positive predictive value, and negative predictive value of TCE-MEPs monitoring for the detection of neurologic deficits were 83.3%, 96.7%, 83.3%, 96.7%, odds ratio was 140 and relative risk was 24.2. CONCLUSIONS: Intraoperative TCE-MEPs monitoring is a reliable and sensitive method to detect the neurologic deficits during spinal surgery.
Anesthesia, General ; Evoked Potentials, Motor ; Humans ; Intubation ; Lower Extremity ; Monitoring, Intraoperative ; Muscles ; Neurologic Manifestations ; Odds Ratio ; Piperidines ; Propofol ; Republic of Korea ; Spinal Cord Injuries ; Spine

Tracheomalacia is a malformation of the tracheal membranosa. It is maintained during spontaneous breathing but can be altered by bronchoscopy or positive airway pressure. Tracheomalacia is associated with a high mortality and may cause prolonged intubation and ventilation. Here, the case of a 13-day-old infant with jejunoileal stenosis that had surgery is reported. During induction of general anesthesia, endotracheal intubation was attempted several times with different sized endotracheal tubes. Airway obstruction occurred after the endotracheal intubation. After the airway was maintained, the operation was completed. Tracheomalacia was diagnosed after otolaryngology evaluation postoperatively.
Airway Obstruction ; Anesthesia, General ; Bronchoscopy ; Constriction, Pathologic ; Humans ; Infant ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Otolaryngology ; Respiration ; Tracheomalacia ; Ventilation

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.
Cheek ; Herpes Zoster ; Humans ; Nose ; Pulsed Radiofrequency Treatment

Hemifacial spasm is defined as unilateral, involuntary, irregular twitching of all or parts of the muscles innervated by facial nerves. Here, we present a case of recurrent hemifacial spasm after microvascular decompression (MVD) treated with pulsed radiofrequency (PRF) treatment with good results. A 35-year-old woman suffered from recurrent hemifacial spasm after MVD that was refractory to medical treatment and botulinum toxin injections. We attempted a left facial nerve block twice. Then, we applied PRF at a maximum temperature of 42degrees C for 120 sec. Some response was observed, so we applied PRF two additional times. The frequency of twitch decreased from 3-4 Hz to < 0.5 Hz, and subjective severity on a visual analogue scale also decreased from 10/10 to 2-3/10. PRF treatment might be an effective medical treatment for refractory hemifacial spasm and has fewer complications and is less invasive compared with those of surgery.
Botulinum Toxins ; Facial Nerve ; Female ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Muscles ; Pulsed Radiofrequency Treatment