No abstract available.
Cholecystectomy, Laparoscopic* ; Humans ; Mosaicism* ; Myelodysplastic Syndromes* ; Trisomy*

Electromyogpraphic endotracheal tube (EMG tube) is a new device used to monitor recurrent laryngeal nerve integrity during thyroid surgery. The EMG tube has 2 pairs of electrodes on the surface of silicon-based tube reached to inner space of tube cuff. We experienced an unusual endotracheal tube-related problem from the distinct structural feature of the EMG tube. In this case, we intubated a patient who had difficult airway with the EMG tube using a lightwand. After successful endotracheal intubation, we could not expand the pilot balloon and ventilate the patient effectively. We removed the EMG tube and found that one of electrodes of the EMG tube is bended and made a right angle with the long axis of the tube, and perforated the tube cuff. So we report this case to make anesthesia providers aware that much more attention is needed to use EMG tube during endotracheal intubation.
Anesthesia ; Axis, Cervical Vertebra ; Electrodes ; Humans ; Intubation ; Intubation, Intratracheal ; Organothiophosphorus Compounds ; Recurrent Laryngeal Nerve ; Thyroid Gland

No abstract available.
Aneurysm* ; Neck* ; Rupture*

A case of an epidural abscess, a rare but possibly devastating complication of epidural instrumentation and catheterization, which occurred in a cancer pain patient with an epidural port connected to the epidural catheter, is described. Although cases of a catheter related epidural abscess have been intermittently reported, those following epidural port implantation are very rare, with no case having been reported in Korea. Herein, the case of a 31-year-old man, who developed an epidural abscess 54 days after subcutaneous implantation of an epidural port connected to an epidural catheter, is reported. Methicillin-sensitive staphylococcus aureus was detected in a culture of the purulent discharge. Magnetic resonance imaging was essential, not only for the diagnosis of the epidural abscess, but also for determining the extent of spread. The patient refused further evaluation and treatment, and expired 22 days later.
Adult ; Catheterization ; Catheters ; Diagnosis ; Epidural Abscess* ; Humans ; Korea ; Magnetic Resonance Imaging ; Staphylococcus aureus

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: Sixty patients undergoing total abdominal hysterectomy or myomectomy, ASA physical status I or II, aged 30-65 yr, received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) at the end of surgery (n = 30 each). A standard general inhalational anesthesia and postoperative IV patient-controlled analgesia were used. At postoperative 3, 24 and 48 hours, we assessed pain score (VAS), incidence of PONV, rescue drug consumption, adverse events associated with study medications and overall satisfaction scores. RESULTS: The incidence of PONV showed no difference between groups at each time points after surgery (overall incidence; 59% in group R, 69% in group O). There was no difference in the severity of nausea, pain score and analgesic drug usage. However, the consumption of rescue drug in the ramosetron group was markedly less than that of ondansetron group at postoperative 3 hrs (none vs. 8 patients). No clinically serious adverse events were observed in either of the groups. Overall satisfaction scores were also comparable in both groups (6.5 +/- 3.0 vs. 6.2 +/- 2.7). CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in women undergoing general anesthesia for gynecologic surgery. Severity of PONV seems significantly less with ramosetron than with ondansetron in the early postoperative period.
Analgesia, Patient-Controlled ; Anesthesia ; Anesthesia, General ; Female ; Gynecologic Surgical Procedures* ; Humans ; Hysterectomy ; Incidence ; Nausea* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Vomiting*

High-dose steroid therapy is known as effective adjuvant therapy for refractory bone pain due to metastasis of solid cancer. However, the standard dose and duration have not been established to date. Long term maintenance with steroid therapy is not encouraged due to its potential adverse effects. Here, we report a case of a terminal cancer patient who maintained high dose steroid therapy to alleviate refractory bone pain with complication of systemic fungal infection.
Candida ; Humans ; Neoplasm Metastasis ; Steroids

No abstract available.
Humans ; Prone Position* ; Respiratory Mechanics*

No abstract available.
Humans ; Prone Position* ; Respiratory Mechanics*

Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months.
Airway Management ; Anesthesia, General ; Cranial Nerves ; Head ; Humans ; Intubation, Intratracheal ; Paralysis ; Tongue ; Vocal Cords

We report a case of an erroneously elevated bispectral index (BIS) during robot assisted thyroidectomy using an electromyographic endotracheal tube (EMG tube), which is safe and useful for laryngeal electromyographic monitoring. Ten minutes after start of the operation, a sudden increase of BIS value up to 98 was noticed. The BIS values were not decreased to < 65 with supplemental anesthetics. The anesthetic method was changed from total intravenous anesthesia to balanced anesthesia. The BIS sensor and monitor were changed and other models were used. These interventions did not alter BIS values. BIS levels remained between 60 and 70 throughout the main procedure and intermittently increased to the mid-90s without any trace of poor signal quality. At the end of the surgery, the BIS values returned to normal range. The patient did not complain of intraoperative recall. Knowledge of potential interference from the use of an EMG tube must be considered when interpreting BIS.
Anesthesia, Intravenous ; Anesthetics ; Balanced Anesthesia ; Humans ; Organothiophosphorus Compounds ; Reference Values ; Thyroidectomy