Very late stent thrombosis after implantation of drug eluting stent is rare, but its consequences are potentially fatal. Stent thrombosis may be occurred in perioperative period because of interruption of anticoagulation therapy and intraoperative hypercoagulability. We report a case of very late stent thrombosis in a 49-year-old male patient during total gastrectomy. ST-segment elevation in lead II occurred during the surgery and followed by cardiac arrest. After external cardiac massage and electrocardioversion, normal sinus rhythm was restored. Postoperative 12 lead ECG showed ST-segment elevation in leads II, III, aVF and serum cardiac enzymes such as CPK, CK-MB, and Troponin T were markedly elevated. Postoperative coronary angiography showed complete occlusion of the right coronary artery stent. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.
Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Emergencies ; Gastrectomy ; Heart Arrest ; Heart Massage ; Humans ; Male ; Middle Aged ; Perioperative Period ; Stents ; Thrombophilia ; Thrombosis ; Troponin T

Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography.
Anesthesia, General ; Arrhythmias, Cardiac ; Asthma ; Bradycardia ; Bronchial Spasm ; Coronary Angiography ; Coronary Vessels ; Humans ; Hypotension ; Methyl Ethers ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Piperidines ; Running ; Spasm ; Systole ; Ventricular Fibrillation

Brachial plexus block is a suitable, technique for surgery of the forearm, because it provides good intraoperative anesthesia and prolonged postoperative analgesia when long-acting local anesthetics are used. An eighty-year-old male patient was admitted to our hospital for right radioulnar fracture. He had active pulmonary tuberculosis, severe valvular heart disease, hypertension, mild subarachnoid hemorrhage and a difficult airway. So, we performed an infraclavicular block to treat the fracture site and used a nerve stimulator when median nerve dital response and musculocutaneous nerve response were sought, and combined spinal-epidural block for the iliac bone graft at the same time. Regional anesthesia many advantages compared to general anesthesia in extremity operation. Peripheral nerve block and neuraxial block, when used properly in combination, should be able to replace general anesthesia in the majority of cases.
Analgesia ; Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Anesthetics, Local ; Brachial Plexus* ; Extremities ; Forearm ; Heart Valve Diseases ; Humans ; Hypertension ; Male ; Median Nerve ; Musculocutaneous Nerve ; Peripheral Nerves ; Subarachnoid Hemorrhage ; Transplants* ; Tuberculosis, Pulmonary

BACKGROUND: Patient-controlled analgesia (PCA) is effectively used for postoperative pain control. Fentanyl has a strong analgesic effect but has some side effects. The purpose of this study was to compare the side effects and analgesic effects of fentanyl alone and combination with nalbuphine in patients using intravenous PCA. METHODS: Forty six ASA class 1 or 2 patients were randomly divided into two groups. Group F (n = 23) received fentanyl 1,200microgram in 100 ml of normal saline. Group NF (n = 23) received nalbupine 60 mg and fentanyl 600microgram in 100 ml of normal saline. All patients used the same background infusion rate (2 ml/hr), bolus dose (2 ml) and lockout interval (15 min) just after emergence from general anesthesia. The analgesic effect was evaluated by using a visual analogue scale (VAS) at 1 hr, 6 hr, 12 hr, 24 hr and 48 hr postoperatively. Side effects and satisfaction degree were also checked. RESULTS: No significant differences were observed between the two groups in terms of pain scores and satisfaction degrees. The side effects were similar in both groups except that sedation was significantly (P<0.05) lower in group NF. CONCLUSIONS: We conclude that nalbuphine with fentanyl in combination is a useful method for intravenous PCA. On comparing the incidence of side effects in the two groups, sedation was found to be lower for the combined regimen.
Analgesia* ; Analgesia, Patient-Controlled ; Anesthesia, General ; Fentanyl* ; Humans ; Incidence ; Nalbuphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Complications

BACKGROUND: A postoperative ileus after anesthesia and surgery may be bothersome to recovery and prolong hospitalization periods. The object of this study was to investigate the effect of lidocaine and ketorolac combined to fentanyl IV PCA on the recovery of bowel function after surgery. METHODS: Forty-nine patients undergoing a total abdominal hysterectomy were divided into three groups (F, FT, LFT). All patients received IV PCA for postoperative pain control. PCA contents were fentanyl 1,000 microgram only in saline 100 ml in group F (n = 16) and fentanyl 500 microgram-ketorolac 150 mg in saline 100 ml in group FT (n = 17) and LFT (n = 16). Group LFT received a lidocaine bolus (1.5 mg/kg) before induction and a continuous infusion of lidocaine (2 mg/min) until one hour after surgery. We measured postoperative pain scores (at postoperative 1 hour, 6 hours, 24 hours, and 48 hours) and checked the first flatus time, the first defecation time, and the side effects. RESULTS: The intravenous lidocaine infusion group showed better pain scores at postoperative 1 hour only. The FT and LFT groups provided a more rapid return of bowel function than group F. A combined infusion of lidocaine and ketorolac had no difference in the return of bowel function. There were no significantly different incidences of nausea, vomiting and other side effects. CONCLUSIONS: Ketorolac allowed an earlier recovery of bowel function after surgery. However, an additional infusion of lidocaine was not helpful in the return of bowel function.
Anesthesia ; Defecation ; Fentanyl* ; Flatulence ; Hospitalization ; Humans ; Hysterectomy ; Ileus ; Incidence ; Ketorolac* ; Lidocaine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Vomiting

Ankylosing spondylitis is a chronic and systemic disease invloving the axial skeleton. In patient with involved cervical spine of the ankylosing spondylitis, endotracheal intubation by direct laryngoscope may be difficult or impossible because they have a limitation of cervical movement and anatomical anomalies. Additionally, ossification of the interspinous ligaments and the formation of bony bridges (syndesmophytes) between vertebrae, resulting in a classic "bamboo spine" appearance make difficult or impossible placement of an epidural or spinal needle. We report a case of a patient with long standing ankylosing spondylitis who underwent revision arthroplasty of the hip using combined continuous psoas compartment block and sciatic nerve block.
Arthroplasty* ; Hip* ; Humans ; Intubation, Intratracheal ; Laryngoscopes ; Ligaments ; Needles ; Sciatic Nerve* ; Skeleton ; Spine ; Spondylitis, Ankylosing*

Intradural lipomas not associated with spinal dysraphism are rare tumors of the spinal canal. The clinical course of most of the patients with intradural lipoma is slowly progressive with increasing leg weakness and gait disturbance during the first 5 years of life or early adulthood. Since neurologic deficits usually occur very slowly and insidiously, symptoms are present over 2 years in the majority of patients before a diagnosis is made. In view of such a clinical course, a huge intradural lipoma presenting with no neurological deficits in an adult is a very rare case. We present our recent experience with a case of a huge intradural lipoma of the cervical cord without any association with spinal dysraphism and other anomalies of the spine in a neurologically intact adult patient. A review of the literature is also discussed.
Adult ; Diagnosis ; Gait ; Humans ; Leg ; Lipoma* ; Neurologic Manifestations ; Spinal Canal ; Spinal Dysraphism ; Spine

BACKGROUND: The purpose of this study was to evaluate the preemptive analgesic effect of a single intravenous infusion of low dose ketamine-clonidine. We compared the placebo with low dose ketamine and low dose ketamine-clonidine in patients undergoing an appendectomy. METHODS: Sixty ASA class 1 or 2 patients who received general anesthesia for an appendectomy were allocated randomly to three groups. Group 1 received intravenous normal saline 6 ml and group 2 received ketamine 0.15 mg/kg in normal saline 6 ml and group 3 received ketamine 0.15 mg/kg and clonidine 1microgram/kg in normal saline 6 ml 5 minutes before surgical incision. In the recovery room postoperative analgesia was assessed by the verbal numerical rating scale (VNRS) at 0 min, 15 min, 30 min, 60 min, 90 min and 120 min. Vital signs, sedation score and side effects were also checked. For postoperative analgesia, morphine 2 mg was given intravenously whenever a patient complained of pain, or the VNRS score was above 7. RESULTS: There were no intergroup differences of individual morphine requirements for postoperative pain control among the three groups. VNRS score, blood pressure, heart rate, sedation score and side effects were not significantly different among the three groups. CONCLUSIONS: A single low dose of ketamine-clonidine may not produce a postoperative analgesic effect in the recovery room, and a single low dose of ketamine also may not produce the preemptive effect for at least 2 hours.
Analgesia ; Anesthesia, General ; Appendectomy ; Blood Pressure ; Clonidine ; Heart Rate ; Humans ; Infusions, Intravenous ; Ketamine* ; Morphine ; Pain, Postoperative ; Recovery Room ; Vital Signs

Although shoulder surgery is usually performed during general anesthesia, the use of an interscalene block alone or in combination with other anesthetic procedures is increasing. Blockade of the suprascapular nerve is used in the diagnosis and treatment of shoulder pain and to provide temporary relief from muscle spasm or strain in the supraspinatus or infraspinatus muscle We report a case of a patient that presented with severe shoulder pain who underwent surgery for traumatic humeral head fracture. Anesthesia was provided by an interscalene block follwing suprascapular nerve block.
Anesthesia ; Anesthesia, General ; Brachial Plexus* ; Diagnosis ; Humans ; Humeral Head* ; Nerve Block* ; Shoulder ; Shoulder Pain ; Spasm ; Supine Position*

The oculocardiac reflex is provoked by pressure applied to the globe of the eye or traction on the surrounding structures. It has been known that children and adults undergo eye muscle surgery under general anesthesia are most susceptible. When it occurs the most common manifestation is sinus bradycardia and other arrhythmia including atrioventricular block, ventricular premature beat and cardiac arrest. Endoscopic sinus surgery has been used popularly for treatment of chronic paranasal sinusitis. However endoscopic sinus surgery can be difficult for narrow visual field and anatomical variations. Oculocardiac reflex during endoscopic sinus surgery is rare case but potentially it can be life threatening event. The authors report the case of oculocardiac reflex during endoscopic sinus surgery with a review of literature.
Adult ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Cardiac Complexes, Premature ; Child ; Eye ; Heart Arrest ; Humans ; Muscles ; Reflex ; Reflex, Oculocardiac ; Sinusitis ; Traction ; Visual Fields