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Airway obstruction in heat & moisture exchanger filter: A case report.

Mee Young CHUNG ; Weon Joon YANG ; Ji Young LEE

Anesthesia and Pain Medicine.2011;6(1):96-99.

Heat and moisture exchanger filters (HMEF), used for humidification of patient respiratory gas and filtering microorganisms can cause airway obstruction. We experienced serious airway obstruction in a HMEF after making hydrothorax for high intensity focused ultrasound (HIFU) procedure. The airway obstruction was difficult to differentiate from severe bronchospasm irresponsive to bronchodilator therapy. It was relieved dramatically after we removed the filter from the breathing circuit as soon as we detected air-fluid meniscus in it.
Airway Obstruction ; Bronchial Spasm ; Hot Temperature ; Humans ; Hydrothorax ; Respiration

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Acute liver injury after desflurane anesthesia: A case report.

Jae Chan CHOI ; Kwang Ho LEE ; Jong Soo KIM ; Hoon RYU ; Sungwoo RYOO ; Hyun Kyo LIM

Anesthesia and Pain Medicine.2011;6(1):93-95.

Most general anesthesia procedures are performed without any complications, but volatile agents may have adverse effects on various organ systems. Volatile anesthetic agents can cause mild to fulminant liver failure. However, while desflurane is a theoretical cause of hepatotoxicity, such cases have rarely been reported. We present here a 49-year-old man who developed hepatic dysfunction after laparoscopic cholecystectomy and this procedure was done under desflurane anesthesia.
Anesthesia ; Anesthesia, General ; Anesthetics ; Cholecystectomy, Laparoscopic ; Humans ; Isoflurane ; Liver ; Liver Failure, Acute ; Middle Aged

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Anesthetic management of a neonate with Antley-Bixler syndrome: A case report.

Young Suk KWON ; Jae Keun JO ; Yun Hee LIM ; Jun Heum YON ; Kye Min KIM

Anesthesia and Pain Medicine.2011;6(1):89-92.

Antley-Bixler syndrome is a congenital anomaly of multiple bones and cartilage, and this was first reported by Antley and Bixler in 1975. It is characterized by craniosynostosis, midface hypoplasia with choanal stenosis and atresia, radiohumeral synostosis and femoral bowing. This is sometimes accompanied by cardiac, renal, gastrointestinal and genital malformations. The risk of respiratory distress is high in the infants with this syndrome, and this is most commonly caused by choanal stenosis and atresia. Careful anesthetic management is needed for these infants because of the potential risk of a difficult airway and respiratory complications. We report here on our experience with the anesthetic management of a neonate with Antley-Bixler syndrome and we review the relevant literature.
Anesthesia ; Antley-Bixler Syndrome Phenotype ; Cartilage ; Constriction, Pathologic ; Craniosynostoses ; Humans ; Infant ; Infant, Newborn ; Synostosis

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An anesthetic experience in a patient with Stickler sydrome: A case report.

Youn Hee CHOI ; Yong Sup SHIN ; Sun Yeul LEE ; Hae Jin PAK ; Guen Seok CHOI ; Boo Hwi HONG

Anesthesia and Pain Medicine.2011;6(1):85-88.

Stickler syndrome is a connective tissue dysplasia disorder with characteristic midface hypoplasia, retromicrognathia, cleft palate, and a moon-shaped appearance. Incidence of the syndrome is estimated at around 1/10000 and the disorder is considered to be caused by mutations in the COL2A1, COL11A1, COL11A2, COL9A1 procollagen genes of type 2 and 11 collagen. Patients with a mandibular hypoplasia like Stickler syndrome present the anesthesiologist with considerable problems when mask ventilation or endotracheal intubation is attempted. We report a successful anesthetic experience, including blind endotracheal intubation with rigid laryngoscope without neuromuscular blockade, in a 9-year-old boy with Stickler syndrome for scleral buckling with cryotherapy.
Anesthesia, General ; Child ; Cleft Palate ; Collagen ; Connective Tissue ; Cryotherapy ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngoscopes ; Masks ; Neuromuscular Blockade ; Procollagen ; Scleral Buckling ; Ventilation

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Malignant hyperthermia during cesarean section: A case report.

Won Jae LEE ; Jung Sam LEE

Anesthesia and Pain Medicine.2011;6(1):79-84.

Malignant hyperthermia is manifestated in susceptible individuals exposed to triggering drugs, such as depolarizing muscle relaxants and inhalational anesthetics. Various musculoskeletal abnormalities, such as scoliosis, hernias and strabismus, have been associated with malignant hyperthermia susceptibility. During cesarean section of the patient who had undergone scoliosis correction surgery, we experienced malingnant hyperthermia due to succinylcholine and inhalation anesthetics. In our case, as soon as we suspected the episode, all anesthetics were stopped and anesthetic machines were changed to unexposed anesthetic machine for inhalational anesthetics. Dantrolene was given intravenously and the patient was cooled by tepid sponging, cooled fluids. The patient recovered normal temperature and consciousness without any complications.
Anesthetics ; Anesthetics, Inhalation ; Cesarean Section ; Consciousness ; Dantrolene ; Female ; Fever ; Hernia ; Humans ; Malignant Hyperthermia ; Musculoskeletal Abnormalities ; Neuromuscular Depolarizing Agents ; Pregnancy ; Scoliosis ; Strabismus ; Succinylcholine

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Comparison of the effects of preoxygenation between pregnant and non-pregnant patients.

Dong Yeon KIM ; Seol Joo JEONG ; Jong Hak KIM

Anesthesia and Pain Medicine.2011;6(1):75-78.

BACKGROUND: Preoxygenation is a standard anesthetic technique using 100% oxygen for the prevention of hypoxia during the induction of anesthesia. Measuring end-tidal oxygen is the most useful indicator for determining the end-point of preoxygenation. We studied the effects of preoxygenation between pregnant and non-pregnant patients during 5 min of tidal volume breathing. METHODS: Non-pregnant women who were scheduled for general surgery (Group I, n = 25) and pregnant women who were scheduled for elective cesarean section (Group II, n = 20) were explained the technique of preoxygenation, which was conducted with 100% oxygen during 5 min of tidal volume breathing. End-tidal oxygen concentration was measured at 10 sec intervals for 5 min, simultaneously. RESULTS: Group II showed significantly higher end-tidal oxygen concentration than Group I from 30 sec to 170 sec during preoxygenation (P < 0.05). The mean time required for end-tidal oxygen concentration > or =90% was 110.0 +/- 31.7 sec for Group II and 152.8 +/- 34.5 sec for Group I. Therefore, Group II showed a significantly shorter time than Group I (P < 0.05). CONCLUSIONS: We concluded that the time for complete preoxygenation was shorter in pregnant patients compared to non-pregnant patients.
Anesthesia ; Anoxia ; Cesarean Section ; Female ; Humans ; Oxygen ; Pregnancy ; Pregnant Women ; Respiration ; Tidal Volume

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Estimation and simulation of kinetic-pharmacodynamic parameters of rocuronium by Bragg's dose-response-time model.

Soo Il LEE ; Chan Jong CHUNG ; Seung Cheol LEE ; Jung Hoon JANG

Anesthesia and Pain Medicine.2011;6(1):67-74.

BACKGROUND: The effect-time data involves some pharmacokinetic (PK) information. Bragg model could derive the information from pharmacodynamic (PD) data alone. After administering rocuronium, we collected tension data without these plasma concentration values. We determined kinetic-pharmacodynamic (K-PD) parameters, simulated the predictions of effect-time relation at different amount of dose, and validated the calculated infusion rates (IR) by comparing with IR directly measured. METHODS: Thirteen dexterous male patients were given rocuronium 300microg/kg during propofol-fentanyl anesthesia. Twitch tensions of the right adductor pollicis in response to supramaximal single twitch stimulation every 10 seconds were measured until muscle paralysis recovered by 70 +/- 10% of control. The above data were fitted to Bragg equation, using Tablecurve3D(R). The parameters, k1, k2, IR50, and gamma, were derived with either individual regression or population regression. The correlations between individual parameter and time, the simulation, and validation by infusing rocuronium 3.66microg/kg/min were examined. RESULTS: Based on population regression, IR50 was 3.70microg/kg/min, gamma was 4.51, k1 (keo) was 0.71/min, and k2 (k10) was 0.022/min. The longer the duration of rocuronium action was, the smaller the values of IR50 and k2 were (correlation coefficient: -0.92, -0.61, respectively). ED50 calculated (= IR50/k2) was 168microg/kg. The effects of rocuronium 3.66microg/kg/min were estimated (45% by direct measurement, 49% by population parameters, and 21% by individual parameters). CONCLUSIONS: The results of infusion rate validation suggests that population parameters may better be applicable than individual post hoc parameters to predicting the clinically relevant effect-time relations.
Androstanols ; Anesthesia ; Humans ; Male ; Muscles ; Neuromuscular Blockade ; Paralysis ; Plasma

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Delayed hypoxemia due to endobronchial intubation as a result of positioning the patient under general anesthesia: A case report.

Saecheol OH ; Ji Hyun CHUNG ; Sang Mook LEE ; Kyu Don CHUNG ; Hyun Sook CHO ; Yun Joung HAN ; Byunggil KANG

Anesthesia and Pain Medicine.2011;6(1):63-66.

Undetected endobronchial intubation during general anesthesia can cause serious complications. However, it is very difficult to determine the exact location of the endotracheal tube when it is positioned in the middle of the trachea. We experienced a patient who showed hypoxia caused by the positioning of the endobronchial tube. We think that the tube might have been advanced from the upper part of the carina into the right main bronchus while the neck was being flexed by the neurosurgeon for achieving better surgical exposure.
Anesthesia, General ; Anoxia ; Bronchi ; Humans ; Intubation ; Neck ; Trachea

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Antinociceptive effects of vitamin E in formalin-induced nociceptive response in rats.

Boo Hwi HONG ; Young Kwon KO ; Young Jae LEE ; Kyucheol HAN ; Yoonhee KIM ; Wonhyung LEE

Anesthesia and Pain Medicine.2011;6(1):59-62.

BACKGROUND: Reactive oxygen species (ROS) are critically involved in generating pain in various painful conditions, including neuropathic and inflammatory pain. This experiment was conducted in order to assess the antinociceptive effects of vitamin E in the modulation of pain in rats subjected to the formalin test. METHODS: Five percent formalin was injected into the hind paw after intraperitoneal injection of either vitamin E 1 g/kg dissolved in olive oil or olive oil alone. The Number of flinches were measured in a 5 minute interval for 1 hour. RESULTS: Formalin injected into the left hind paw induced a biphasic nociceptive behavior. Intraperitoneal injection of vitamin E diminished the nociceptive behavior during phase 1 and 2. CONCLUSIONS: Systemic administration of vitamin E produces analgesia in a rat model of formalin-induced hyperalgesia. Furthermore, vitamin E affects pain of peripheral origin.
Analgesia ; Animals ; Formaldehyde ; Hyperalgesia ; Injections, Intraperitoneal ; Olea ; Plant Oils ; Rats ; Reactive Oxygen Species ; Vitamin E ; Vitamins ; Olive Oil

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The effects of superior cervical ganglionectomy on the ability of spatial memory using radial arm maze in the rats.

Eun Jung CHO ; Chong Min PARK

Anesthesia and Pain Medicine.2011;6(1):54-58.

BACKGROUND: Stress, elevated sympathetic nervous system, glucocorticoid concentration affect learning and memory. The aim of this study was to evaluate the effects of superior cervical ganglionectomy on the spatial memory using radial arm maze test. METHODS: Male Sprague-Dawley rats were used. Rats were divided into two groups: a superior cervical ganglionectomy group and a control group. Each rat was put into the radial arm maze two times per day for 4 days. We checked the number of the total visit, the total error, the reference memory error, the working memory error. And then a superior cervical ganglionectomy group received bilateral superior cervical ganglionectomy, and a control group received a sham operation. The radial arm maze test was then repeated and we evaluated the effect of superior cervical ganglionectomy on spatial memory. RESULTS: There were no significant differences in ratio of total error, reference memory error, and working memory error. CONCLUSIONS: Bilateral superior cervical ganglionectomy in rats does not effect the spatial memory. However, further studies are needed to determine the effect of superior cervical ganglionectomy on spatial memory.
Animals ; Arm ; Ganglionectomy ; Humans ; Learning ; Male ; Memory ; Memory, Short-Term ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Sympathetic Nervous System

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