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

Low back pain is common during pregnancy and has been reported in as many as 56% of pregnant women.However, the incidence of symptomatic lumbar disc displacement in pregnancy is exceedingly rare, and anesthetic management is particularly important in such cases because the attending anesthesiologist and surgeon must consider the effects of the anesthesia, the patient's position, and surgery on the fetus.We administered an epidural anesthesia for percutaneous endoscopic lumbar discectomy at 35 weeks of gestation with the patient in the prone position.The patient maintained an uneventful pregnancy and delivered a healthy baby at 38 weeks of gestation
Anesthesia ; Anesthesia, Epidural ; Back Pain ; Diskectomy ; Displacement (Psychology) ; Humans ; Incidence ; Pregnancy ; Prone Position

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

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and many different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of saline pretreatment with that of lidocaine mixed with propofol after tramadol pretreatment on propofol injection pain. METHODS: Eighty patients scheduled for general anesthesia were randomly divided into four groups. Control group (n = 20) received 2 ml of 0.9% saline pretreatment, Group 1 (n = 20) received 50 mg of tramadol pretreatment, Group 2 (n = 20) received 40 mg of 2% lidocaine pretreatment and Group 3 (n = 20) received 40 mg of 2% lidocaine mixed with propofol after 50 mg of tramadol pretreatment. Each patient received one of the pretreatment drugs via 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 70 mmHg. The tourniquet was released 1 minute later, followed intravenous injection of 2 mg/kg of propofol at a rate of 1 ml/sec. After 50 mg of propofol were injected, patients were assessed for pain score. The severity of pain was classified as 0, 1, 2, 3 (none, mild, moderate, severe) by one observer. RESULTS: The severity and incidence of pain were significantly reduced in group 2 and group 3 compared with control group for intravenous injection of propofol (P<0.05). but there was no significant difference between control group and group 1. CONCLUSIONS: Mixed administration of lidocaine-propofol after tramadol pretreatment could significantly reduce the severity and incidence of pain for intravenous injection of propofol.
Anesthesia, General ; Arm ; Humans ; Incidence ; Injections, Intravenous ; Lidocaine ; Propofol ; Tourniquets ; Tramadol*

Stroke is defined as a focal neurological deficit lasting more than 24 hours. The complications related to the central nervous system after general surgery is unusual and is difficult to discover the exact causes. We are going to report a case of an unexpected cerebral infarction after a Whipple's operation. The patient was a sixty-three years old female weighing 53 Kg with a diagnosis of cancer of ampulla of Vater scheduled for a Whipple's operation under general anesthesia. Preanesthetic assessment revealed a history of hypertension and hypercholesterolemia. After surgery, she was alert but she appeared to have right hemiparesis, aphasia and right facial palsy. A brain MRI showed a cerebral infarction in the bilateral basal ganglia, left medial temporal lobe and insular cortex. The cause of the cerebral infarction in this patient was unclear. Cerebral thrombosis was first thought of, but we couldn't completely exclude other possible causes e.g., embolism etc. In cases where risk factors of a stroke were found in preoperative evaluation, it is important to correct risk factors preoperatively. Furthermore, it is necessary to prevent hypotension, keep proper hematocrit levels and temperature during an operation, and use hemocoagulase carefully in cases of patients having risk factors of thrombosis and embolism.
Ampulla of Vater ; Anesthesia, General* ; Aphasia ; Basal Ganglia ; Batroxobin ; Brain ; Central Nervous System ; Cerebral Infarction* ; Diagnosis ; Embolism ; Embolism and Thrombosis ; Facial Paralysis ; Female ; Hematocrit ; Humans ; Hypercholesterolemia ; Hypertension ; Hypotension ; Infarction ; Intracranial Thrombosis ; Magnetic Resonance Imaging ; Paresis ; Risk Factors ; Stroke ; Temporal Lobe

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