Airway management is important during general anesthesia. Difficulties with a direct laryngoscopy can be managed successfully in a routine manner using a laryngeal mask airway. A 65-year-old woman was scheduled to undergo gynecologic surgery. After injecting the intravenous induction agents and muscle relaxants, intubation was attempted with a direct laryngoscope. However, the vocal cords could not be observed with only the epiglottis being slightly visible. Although intubation was re-attempted by another anesthesiologist, it failed. Intubation was successfully performed via an intubating laryngeal mask airway (ILMA) after additional 100% oxygen mask ventilation. We report a case of vocal cord palsy subsequent to tracheal extubation after endotracheal intubation via ILMA.
Aged ; Airway Extubation ; Airway Management ; Anesthesia, General ; Epiglottis ; Female ; Gynecologic Surgical Procedures ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Laryngoscopes ; Laryngoscopy ; Masks ; Muscles ; Oxygen ; Ventilation ; Vocal Cord Paralysis ; Vocal Cords

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.
Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Fibrin ; Hemorrhage ; Humans ; Placenta ; Placenta Accreta ; Postpartum Period ; Pregnancy ; Young Adult

Placenta accreta is a rare complication of pregnancy with high rates of maternal morbidity and mortality.It is usually discovered when removal of the placenta after delivery is difficult or there is substantial postpartum bleeding.Placenta accreta can be complicated by disseminated intravascular coagulation (DIC) and this increases maternal morbidity and mortality.DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessel.We report a 24-year-old woman with DIC, who developed severe pre- and intraoperative bleeding and massive transfusion during emergent cesarean section.
Dacarbazine ; Disseminated Intravascular Coagulation ; Female ; Fibrin ; Hemorrhage ; Humans ; Placenta ; Placenta Accreta ; Postpartum Period ; Pregnancy ; Young Adult

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.
Chest Pain ; Emergencies ; Hospitals, General ; Humans ; Inpatients ; Internal Medicine ; Nerve Block ; Neuralgia ; Outpatients ; Pain Clinics ; Prognosis ; Spine ; Thorax

BACKGROUND: Monitoring of anesthetic depth is important for successful general anesthesia. It is well known that entropy or BIS monitoring assisted titration of anesthetic drugs decreases their consumption. This study evaluated the effect of remifentanil on consumption of sevoflurane during entropy monitored general anesthesia. METHODS: Patients were randomly assigned to two groups. The R group was administered 0.1 microgram/kg/min of remifentanil and inhaled sevoflurane, while the S group was administered only inhaled sevoflurane. Anesthesia was maintained using sevoflurane with nitrous oxide, and entropy was monitored. In both groups, the concentration of sevoflurane was adjusted to keep the state entropy (SE) value between 40 and 60. End-tidal sevoflurane concentration (ET), entropy value, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured at 5 minute intervals, during a 25 minute period after intubation, skin suture and the end of surgery. RESULTS: ET was significantly lower in the R group than the S group. There were no significant differences in entropy value between R and S groups. CONCLUSIONS: Entropy monitored titration of sevoflurane with remifentanil administration decreased ET with stable hemodynamics.
Anesthesia ; Anesthesia, General ; Anesthetics ; Blood Pressure ; Entropy ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Methyl Ethers ; Nitrous Oxide ; Piperidines ; Skin ; Sutures

Long QT syndrome (LQTS) is an arrhythmogenic cardiovascular disorder resulting from mutations in cardiac ion channels. LQTS is characterized by prolonged ventricular repolarization and frequently manifests itself as QT interval prolongation on the electrocardiogram (ECG). A variety of commonly prescribed anesthetic drugs possess the adverse property of prolonging cardiac repolarization and may provoke serious ventricular tachyarrhythmia called 'torsades de pointes', ventricular fibrillation, and sudden death. We experienced a case of ventricular tachycardia and ventricular fibrillation after anesthetic induction and it came out into the open that anesthetic induction provoked long QT syndrome.
Anesthetics ; Death, Sudden ; Electrocardiography ; Heart Arrest ; Ion Channels ; Long QT Syndrome ; Porphyrins ; Tachycardia ; Tachycardia, Ventricular ; Ventricular Fibrillation

PURPOSE: This study comparedthe effectiveness and safety of laparoscopic adrenalectomy with conventional open adrenalectomy for the treatment of pheochromocytoma. METHODS: Medical records of 100 patients who underwent surgical removal of pheochromocytoma (open adrenalectomy, n=59; laparoscopic adrenalectomy, n=39) at Samsung Medical Center from June 1995 to August 2007 were retrospectively reviewed. RESULTS: To draw an appropriate comparison, patients with a tumor less than 7 cm in size were evaluated (open adrenalectomy, n=23; laparoscopic adrenalectomy n=31). No statistically significant differences were evident according to age, gender and tumor size. The mean operating time was 158 min for the open surgery group and 114 minfor the laparoscopic group (P<0.01). The mean postoperative hospital stay was 10.4 days following open surgery and 5.6 days following laparoscopic surgery (P<0.01). The mean volume of the estimated blood loss for the laparoscopic surgery group (482 ml) was less than for the open surgery group (mean 229 ml) (P=0.06), and the time to first oral intake was 1.7 days after laparoscopic adrenalectomy and 3.5 days after open surgery (P<0.01). The frequency of using analgesics for postoperative pain after laparoscopic adrenalectomy was markedly lower than following conventional open adrenalectomy. There was no recurrence or complications during the follow-up periods (mean: 30 months). CONCLUSION: Laparoscopic adrenalectomy offers advantages of less postoperative pain, shorter operative time and a shorter hospital stay as compared with conventional open adrenalectomy. Laparoscopic adrenalectomy for treating pheochromocytoma is a minimally invasive alternative to conventional open adrenalectomy.
Adrenalectomy* ; Analgesics ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Pain, Postoperative ; Pheochromocytoma* ; Recurrence ; Retrospective Studies