A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Catheterization* ; Catheters* ; Central Venous Catheters ; Child* ; Drug Therapy ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Infant ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pulmonary Circulation ; Pulmonary Embolism* ; Subclavian Vein ; Thrombosis

Tension pneumothorax (PTx) was diagnosed in a preterm baby during surgery for tracheoesophageal fistula (TEF). The PTx occurred around 90 minutes after skin incision, while the baby was breathing spontaneously with intermittent positive pressure ventilation (PPV) at low pressure. A sudden decrease in oxygen saturation (SpO2), hemodynamic compromise, and decreased breath sounds on the right side suggested a right-sided tension PTx. After prompt radiological confirmation, needle aspiration of air through the surgical site restored the patient's condition immediately. Although the sudden unexpected hypoxemia and circulatory problems may confuse anesthesiologists, prompt diagnosis and proper treatment are required for successful clinical outcomes in tension PTx.
Anoxia ; Diagnosis ; Hemodynamics ; Intermittent Positive-Pressure Ventilation ; Needles ; Oxygen ; Pneumothorax* ; Respiration ; Skin ; Tracheoesophageal Fistula*

This study was undertaken to evaluate the antitumor activities of Cordyceps militaris of silkworm pupa (CMP) and silkworm larva (CML), as compared with the effect of cordycepin, an active compound found in Cordyceps militaris. Antiproliferation effect of the test materials were evaluated in the sarcoma-180 cells using the MTT test. For the in vivo study, ICR mice were inoculated i.p. with 1.0 X 10(6) sarcoma-180 cells/mouse on Day 0, and were again i.p. injected with one of the following substances from Day 1 to Day 10 : saline (control group), 50 mg/kg (CMP50, CML50) ,100 ma/kg (CMP100, CML100), or 200 mg/kg (CMP200, CML200) of Cordyceps militaris water extracts, or 1 mg/kg (C1), 2 mg/kg (C2), or 4 mg/kg (C4) of cordycepin. Pretreatment of the sarcoma-180 cells with 100 mg/ml, 500 mg/ml, and 1000 mg/ml of CML (60.1+/-2.5%, 49.8+/-3.7%, and 45.4+/-0.1% of the value for untreated control cells, respectively) or CMP (68.3+/-2.1%, 55.1+/-0.9%, and 51.4+/-3.5% of the value for control cells, respectively) for 48 hrs significantly decreased the survival rate (proliferation) of tumor cells (p<0.05). Body weight of the control mice bearing ascites tumor and injected with saline was 1.4 times of the value for normal animals at day 18. Mice bearing ascites tumor and injected with cordycepin (1, 2, or 4 mg/kg) exhibited a significantly lighter body weight compared with the control mice, while animals injected with CMP or CML (50, 100, or 200 mg/kg) showed a significantly lighter body weight compared with the mice injected with cordycepin. Mice injected with CMP50, CMP100, or CMP200 mg/kg (or CML50, CML100, or CML200 mg/kg) showed a 133% (or 90%), 80% (or 62%), and 68% (or 52%) longer mean survival time, and those treated with C1, C2, or C4 exhibited a 54%, 91% and 80% longer survival time compared to the value for control mice injected with saline. These results indicate that the hot-water extracts of Cordyceps militaris of both silkworm pupa and silkworm larva have an anti-proliferation effect of tumor cells as well as the life prolongation effect in mice bearing ascites tumor, which are superior to the activities of cordycepin.
Animals ; Ascites ; Body Weight ; Bombyx ; Cordyceps* ; Larva ; Life Support Care ; Mice ; Mice, Inbred ICR* ; Pupa ; Survival Rate ; Water*

Anaphylaxis is a type I allergic reaction and its clinical features occur after re-exposure to the same allergen. Numerous types of drugs can cause anaphylaxis during general anesthesia. Topical bovine thrombin (TBT) is usually used for hemostasis during surgery. However, TBT can cause interruption of the normal blood coagulation pathways, delay wound repair, and lead to uncontrolled bleeding, anaphylaxis, or death. Anaphylaxis caused by TBT during the perioperative period is very rare. We report the case of a patient who developed severe hypotension, tachycardia, and bronchospasm while undergoing discectomy for herniated nucleus pulposus. Based on the symptoms and signs, anaphylaxis was considered most likely. Identification of the causative agents is important in these cases because it can be very helpful for the management and prevention of anaphylaxis.
Anaphylaxis* ; Anesthesia, General ; Blood Coagulation ; Bronchial Spasm ; Diskectomy ; Epinephrine ; Hemorrhage ; Hemostasis* ; Humans ; Hypersensitivity ; Hypotension ; Perioperative Period ; Tachycardia ; Thrombin* ; Wounds and Injuries

Airway management is challenging during general anesthesia particularly in small infants. Airway obstruction is prone to occur in premature infants during general anesthesia due to several reasons. We report a case of airway obstruction occurred during the induction of general anesthesia in a 2-month-old infant. Several attempts at endotracheal intubation with positive pressure ventilation resulted in repeated patterns of no end-tidal carbon dioxide output after each trial of endotracheal intubation, but it was reappeared after extubation. However, anesthetic induction with self-respiration and gentle assistance with manual bagging led to a successful intubation. This case was explained by hydromechanics in a collapsible premature airway.
Airway Management ; Airway Obstruction* ; Anesthesia, General* ; Bronchial Spasm* ; Carbon Dioxide ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intubation ; Intubation, Intratracheal ; Positive-Pressure Respiration

A 78-year-old female patient was undergone general anesthesia for total abdominal hysterectomy with bilateral salpingo-oopherectomy. Arterial blood pressure dropped 20 minutes after beginning of the surgery when uterine manipulation was started. From then, excessive sweating was found in the face and whole body and core temperature decreased to 34.3degrees C. Sweating and low body temperature were sustained despite of various aggressive warming efforts. Anticholinergic medication immediately put an end to an hour of excessive sweating and prevented further body temperature decline. Several possibilities of excessive sweating were discussed in this case: uterine manipulation during the light plane of general anesthesia, age related autonomic changes, use of intraoperative opioid and antihypertensive medications.
Aged ; Anesthesia, General* ; Arterial Pressure ; Body Temperature ; Female ; Humans ; Hypothermia* ; Hysterectomy* ; Sweat* ; Sweating*

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Catheterization ; Catheters ; Central Venous Catheters ; Child ; Drug Therapy ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Infant ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pulmonary Circulation ; Pulmonary Embolism ; Subclavian Vein ; Thrombosis

Digital therapeutics based on software, such as artificial intelligence, virtual reality, games, and smartphone applications, are in the spotlight as new therapeutic alternatives in child and adolescent psychiatry. It draws attention to overcoming conventional therapeutics’ limitations, such as toxicity, cost, and accessibility, and encourages patients to participate in the treatment attractively. The growth potential of the digital therapeutics market for psychiatric disorders in children and adolescents in Korea and abroad has been highlighted. Clinical studies and Food and Drug Administration approvals for digital therapeutics have increased, and cases approved by the Ministry of Food and Drug Safety have emerged in Korea. As seen above, digital transformation in child and adolescent psychiatry will change treatment paradigms significantly. Therefore, as this new field has just begun to emerge, it is necessary to verify the effectiveness and scope of the application of digital therapeutics and consider preparing a compensation system and institutional arrangements. Accordingly, this study analyzed the development trends and application status of digital therapeutics in children and adolescents and presented limitations and development directions from the perspective of application in healthcare. Further, the study is expected to identify the utility and limitations of digital therapeutics for children and adolescents and establish effective application measures.

OBJECTIVE: To compare the long-term effects and advantages of ultrasound (US)-guided selective cervical nerve root block with fluoroscopy (FL)-guided transforaminal block. METHODS: From March 2009 to November 2012, 162 patients received steroid injections for lower cervical radicular pain. A total of 114 patients fulfilled the inclusion criteria. All procedures were performed by using US or FL. We compared the intravascular injections during the procedure with the effects and functional scales at 3, 6, and 12 months after the procedure between the two groups. Successful treatments occurred when patients obtained significant pain reliefs (as measured by >50% improvements in the verbal numerical scale [VNS] score and >40% improvements in the neck disability index [NDI] score) and reported a patient satisfaction score of 3 or 4 points at 12 months after the injection. Image analysis of intravascular injection and chart review were performed. Logistic regression was performed to reveal the correlations between successful treatments and variables (patient's age, gender, duration of the disease, cause, injection method, and radiologic finding). RESULTS: The VNS and NDI improved 3 months after the injection and continued to improve until 12 months for both groups. But there were no statistical differences in changes of VNS, NDI, and effectiveness between these two groups. The proportion of patients with successful treatment is illustrated as 62.5% in US-guided group and 58% in FL-guided group at 12 months. There were no significant differences between the groups or during follow-up periods. Three cases of the intravascular injections were done in FL-guided group. CONCLUSION: The US-guided selective cervical nerve root blocks are facilitated by identifying critical vessels at unexpected locations relative to the foramen and to protect injury to such vessels, which is the leading cause of reported complications from FL-guided transforaminal blocks. On treatment effect, significant long-term improvements in functions and pain reliefs were observed in both groups after the intervention. However, significant differences were not observed between the groups. Therefore, the US-guided selective cervical nerve root block was shown to be as effective as the FL-guided transforaminal block in pain reliefs and functional improvements, in addition to the absence of radiation and protection vessel injury at real-time imaging.
Fluoroscopy ; Follow-Up Studies* ; Humans ; Logistic Models ; Neck ; Nerve Block ; Patient Satisfaction ; Radiculopathy ; Retrospective Studies* ; Ultrasonography* ; Weights and Measures