A 6-month-old boy was scheduled for a laryngeal mass excision and tracheal bougienage for secondary subglottic stenosis. Following successful excision of the laryngeal mass, a tracheal tube was temporarily extubated for tracheal bougination. However, tracheal re-intubation using a direct laryngoscope with the Miller blade failed because of mucosal swelling and bloody secretions. Following multiple intubation attempts, the patient's peripheral oxygen saturation had decreased to 52%. Immediately, a video laryngoscope was requested, and, by using the C-MAC® video laryngoscope, the patient was successfully re-intubated. Because pediatric patients are more vulnerable to desaturation, extreme caution should be used in securing airways even during a short apneic period. Using a video laryngoscope at the first intubation attempt would be useful for successful tracheal intubation.
Constriction, Pathologic ; Humans ; Infant* ; Intubation* ; Laryngoscopes* ; Male ; Oxygen ; Pediatrics

A 6-month-old boy was scheduled for a laryngeal mass excision and tracheal bougienage for secondary subglottic stenosis. Following successful excision of the laryngeal mass, a tracheal tube was temporarily extubated for tracheal bougination. However, tracheal re-intubation using a direct laryngoscope with the Miller blade failed because of mucosal swelling and bloody secretions. Following multiple intubation attempts, the patient's peripheral oxygen saturation had decreased to 52%. Immediately, a video laryngoscope was requested, and, by using the C-MAC® video laryngoscope, the patient was successfully re-intubated. Because pediatric patients are more vulnerable to desaturation, extreme caution should be used in securing airways even during a short apneic period. Using a video laryngoscope at the first intubation attempt would be useful for successful tracheal intubation.
Constriction, Pathologic ; Humans ; Infant* ; Intubation* ; Laryngoscopes* ; Male ; Oxygen ; Pediatrics

Diabetes mellitus is the most common metabolic disease characterized by elevated blood glucose, which results in damage to the heart, blood vessels, eyes, kidney, and nervous system. The incidence of diabetes mellitus has increased in Korea due to longer life expectancy or lifestyle improvement. Since diabetes affects multiple organs including the cardiovascular, neuroendocrine, and autonomic nervous systems, the risk of postoperative complications such as wound infection and cardiovascular events might be increased in patients with diabetes. In addition to postoperative complications, hypoglycemia or hyperglycemia in diabetes may also cause serious problems during surgery. Preoperative fasting and surgical stress may contribute to the derangement of the patient’s physiological status. For appropriate management of diabetic patients in the perioperative period, patients should be evaluated in detail preoperatively and their blood glucose levels should be checked repeatedly during the surgery and even after surgery. The present paper reviews preoperative, intraoperative, and postoperative management of patients with diabetes.

No abstract available.
Catheterization, Central Venous* ; Central Venous Catheters* ; Diagnostic Errors* ; Humans ; Pneumothorax* ; Ultrasonography*

Kounis syndrome is an acute coronary syndrome concurrently occurs with allergic or hypersensitivity reactions. In patient with this syndrome, inflammatory mediators released due to an allergic reaction implicate to induce coronary artery spasm and atheromatous plaque rupture. We describe a patient with coronary artery disease who developed acute perioperative myocardial infarction leading to cardiac arrest after the anaphylactic reaction to cisatracurium, which led to a suspicion of Kounis syndrome. Anesthesiologists should be aware that anaphylaxis or allergic reactions can progress to acute coronary syndrome, thereby significantly change the course of the disease.
Acute Coronary Syndrome ; Anaphylaxis* ; Coronary Artery Disease ; Coronary Vessels ; Heart Arrest ; Humans ; Hypersensitivity ; Myocardial Infarction ; Rupture ; Spasm

Intracranial pressure (ICP) monitoring is an important issue for liver transplant recipients, since increased ICP is associated with advanced hepatic encephalopathy or graft reperfusion during liver transplantation. Invasive monitoring of ICP is known as a gold standard method, but it can provoke bleeding and infection; thus, its use is a controversial issue. Studies have shown that optic nerve sheath diameter > 5 mm by ocular ultrasonography is useful for evaluating ICP > 20 mmHg noninvasively in many clinical settings. In this case report, we present experiences of using ocular ultrasound as a diagnostic tool that could detect changes in ICP noninvasively during liver transplantation.
Hemorrhage ; Hepatic Encephalopathy ; Intracranial Pressure ; Liver ; Liver Transplantation ; Optic Nerve ; Reperfusion ; Transplants

No abstract available.
Anesthetics* ; Brain* ; Humans ; Infant, Newborn*

BACKGROUND: A pneumatic tourniquet is commonly used in orthopedic surgery. However, neuromuscular blocking agent can be sequestered in the isolated limb and be reabsorbed into the systemic circulation after tourniquet release, potentially delaying extubation. To investigate the change in the train-of-four (TOF) ratio after tourniquet release and correlate the TOF ratio change with the extubation time. METHODS: Forty patients undergoing unilateral total knee arthroplasty were enrolled. Before and after the pneumatic tourniquet release, 10 measurements of the TOF ratio were averaged and compared. Additionally, we investigated the correlation between the percentage change in the TOF ratio before and after tourniquet release and the extubation time. RESULTS: Among the 40 patient subjects, 30 showed a TOF ratio before tourniquet release and 10 showed only a TOF count. Of the 30 patients with a TOF ratio, 21 showed a TOF ratio increase after tourniquet release and 9 showed a TOF decrease; both increase and decrease were statistically significant (P < 0.001 and P = 0.008, respectively). The extubation time showed a weak negative correlation with the percentage change in the TOF ratio after tourniquet release (P = 0.004). CONCLUSIONS: In orthopedic surgery using a pneumatic tourniquet, neuromuscular function monitoring may be required to monitor the change in the effect of neuromuscular blocking agent before and after tourniquet release, which may help to improve anesthesia safety.
Anesthesia ; Arthroplasty* ; Extremities ; Humans ; Knee* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Orthopedics ; Tourniquets*

A 54-year-old male patient was scheduled for an elective pylorus-preserving pancreaticoduodenectomy combined with video-assisted thoracic surgery at our hospital. This patient had a history of intubation failure in other institutions due to an epiglottic cyst. An airway assessment of the patient was normal. A preoperative laryngoscopy revealed a bulging epiglottic mass covering most of the epiglottis and occupying most of the pharyngeal space. The patient was administered intravenous midazolam 1 mg, fentanyl 50 microg, and glycopyrrolate 0.2 mg. A bilateral superior laryngeal nerve block was then performed with 2% lidocaine 2 ml on each side. A 10% lidocaine spray was applied on to the oropharynx. After preoxygenation with 100% oxygen over 10 minutes, a rigid fiberscope with an optical stylet loaded with a 37 Fr double lumen endotracheal tube was inserted orally and passed into the glottic aperture. The patient was fully awakened after surgical procedure and was transferred to the recovery room after extubation.
Airway Obstruction ; Epiglottis ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation* ; Laryngeal Nerves ; Laryngoscopy ; Lidocaine ; Male ; Midazolam ; Middle Aged ; Oropharynx ; Oxygen ; Pancreaticoduodenectomy ; Recovery Room ; Thoracic Surgery, Video-Assisted