Interscalene brachial plexus block (ISBPB) provides optimal analgesia for shoulder surgery. However, several limitations still exist, including the short duration of analgesia, rebound pain, a high incidence of unilateral diaphragmatic paresis, and potential risk of nerve damage, prompting the search for alternative techniques. Many alternatives to ISBPB have been studied to alleviate these concerns, and clinicians should choose an appropriate option based on the patient’s condition. In this mini-review, we aimed to present recent updates on ISBPB while discussing our clinical experiences in shoulder surgery.

Central venous catheters can provide important hemodynamic information in patients with cardiopulmonary disease and access for medicine, fluid, and blood administration during surgery. The placement of central venous catheters is associated with a complication rate of 0.4% to 20%, including pneumothorax, arterial puncture, infection and cardiac tamponade. In addition, malposition of central venous catheter is another complication of central venous catheterization. We report a case of malpositioning of central venous catheter which is located in the right subclavian vein via internal jugular vein in a liver transplant recipient. The malpositioning was confirmed by portable X-ray after several field attempts to advance Swan-Ganz catheter and achieve normal sequences of pressure waves.
Cardiac Tamponade ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Hemodynamics ; Humans ; Jugular Veins ; Liver ; Pneumothorax ; Punctures ; Subclavian Vein

Persistent neurologic injury is a rare but feared complication of neuroaxial anesthesia. Local anesthetics are believed to be an important cause. A 68-year-old man with an ASA physical status of 2 was scheduled to undergo elective knee arthroplasty. He had no clinical evidence of neurological deficits before the operation. Spinal anesthesia was administered using 10 mg of 0.5% bupivacaine and 20microgram of fentanyl without difficulty or complications during the procedure. On the second postoperative day, the patient complained of bilateral weakness in his lower extremities.
Aged ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Arthroplasty ; Bupivacaine ; Fentanyl ; Humans ; Knee ; Lower Extremity ; Polyradiculopathy

We report a case of combined off-pump coronary artery bypass grafting (OPCAB) and living-donor liver transplantation (LDLT). Patient was admitted to undergo liver transplantation due to Child C cirrhosis secondary to hepatitis B infection, and incidentally, his preoperative cardiac evaluation revealed silent ischemia due to the two-vessel coronary artery disease (CAD). Patient underwent OPCAB followed by LDLT. There was no perioperative cardiovascular event during the days of hospitalization. From the successful anesthetic experience of a combined OPCAB and LDLT, we cautiously suggest that a combined OPCAB and LDLT could be a surgical treatment for the patients with end-stage liver disease (ESLD) and advanced CAD.
Child ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Fibrosis ; Hepatitis B ; Hospitalization ; Humans ; Ischemia ; Liver ; Liver Diseases ; Liver Transplantation ; Living Donors ; Transplants

Right aortic arch, a congenital malformation of the great vessels, can cause compression of trachea and/or esophagus. We experienced a case of ventilatory compromise in an infant with tetralogy of Fallot and right aortic arch immediately after insertion of transesophageal echocardiography probe during cardiac surgery. Although intraoperative transesophageal echocardiography can be safely performed in infants with congenital heart disease, it should be done with caution in patient with similar vascular malformation.
Aorta, Thoracic ; Echocardiography, Transesophageal ; Esophagus ; Heart Diseases ; Humans ; Infant ; Tetralogy of Fallot ; Thoracic Surgery ; Trachea ; Vascular Malformations

No abstract available.
Hypothermia* ; Liver Transplantation* ; Liver*

Pregnancy is considered a period of high risk for cardiovascular complications in patients with Marfan syndrome. Therefore the choice of anesthetic technique for delivery should be focused on minimizing hemodynamic fluctuations, and preferably provide adequate post-operative pain control. For this purpose, neuraxial blocks, such as spinal or epidural anesthesia, may be deemed a safe option. However, dural ectasia is present in 63-92% of patients with Marfan syndrome, and the increased amount of cerebrospinal fluid volume is thought to be one of main reasons for spinal anesthesia failure. We report herein the peri-operative management of a patient with Marfan syndrome and dural ectasia for cesarean section using epidural anesthesia.
Anesthesia, Epidural ; Anesthesia, Spinal ; Cesarean Section ; Dilatation, Pathologic ; Female ; Hemodynamics ; Humans ; Marfan Syndrome ; Pregnancy

Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
Airway Obstruction ; Analgesia ; Anesthesia ; Cervical Plexus Block* ; Cervical Plexus* ; Classification ; Head ; Methods ; Neck ; Ultrasonography