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Cranial nerve XII (hypoglossal nerve) palsy after arthroscopic shoulder surgery under general anesthesia combined with sono-guided interscalene brachial plexus block: A case report.

Chang Jae KIM ; Hyun Seok OH ; Jun Jae PARK ; Mee Young CHUNG

Anesthesia and Pain Medicine.2016;11(3):322-325. doi:10.17085/apm.2016.11.3.322

Neurologic complications after shoulder surgery may result from surgical procedures or anesthesia. Hypoglossal nerve is a pure motor nerve that supplies mylohyoid and hyoglossus muscles. Isolated hypoglossal nerve injury may be caused by direct trauma, head malposition (hyperextension or hyperflexion), and indirect compression or traction during intubation. We report a case of left hypoglossal nerve palsy after arthroscopic left shoulder surgery in the beach chair position under general anesthesia combined with brachial plexus block.
Anesthesia ; Anesthesia, General* ; Brachial Plexus Block* ; Brachial Plexus* ; Cranial Nerves* ; Craniocerebral Trauma ; Equipment and Supplies ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Hypoglossal Nerve* ; Intubation ; Muscles ; Paralysis* ; Shoulder* ; Traction

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Rhabdomyolysis after prolonged laparoscopic radical nephrectomy: A case report.

Ho Sik MOON ; Dong Kyu KIM ; Sang Ho SHIN ; Ji Young LEE

Anesthesia and Pain Medicine.2016;11(3):318-321. doi:10.17085/apm.2016.11.3.318

Rhabdomyolysis is characterized by the breakdown of skeletal muscle and the subsequent release of intracellular contents into the circulatory system. It is potentially life-threatening because it is sometimes associated with very high creatine kinase levels, myoglobinuria, and acute renal failure. We experienced a case of postoperative rhabdomyolysis after prolonged laparoscopic radical nephrectomy in the semi-lateral decubitus position. It was associated with suspicious gluteal compartment syndrome. Fortunately, the patient's renal function was normal through his hospital course. Rhabdomyolysis is well worth considering at the point of intraoperative positioning and postoperative care after prolonged surgery.
Acute Kidney Injury ; Compartment Syndromes ; Creatine Kinase ; Muscle, Skeletal ; Myoglobinuria ; Nephrectomy* ; Postoperative Care ; Rhabdomyolysis*

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Painful Horner syndrome after thyroidectomy: A case report.

Myung Su LEE ; Young Joong SUH ; Eun Ha SUK ; Cheon Hee PARK

Anesthesia and Pain Medicine.2016;11(3):313-317. doi:10.17085/apm.2016.11.3.313

Horner syndrome is characterized by miosis, partial blepharoptosis and anhidrosis on the affected side of the face. This syndrome develops when the oculosympathetic nerve pathways to the eye and face are interrupted by various causes such as tumor in the brain, intrathoracic region or neck, surgery, drugs, trauma, carotid artery dissection, and others. It is referred to as painful Horner syndrome when Horner syndrome is accompanied by hemifacial pain. Pain is probably related to trigeminal nerve injury. Horner syndrome is a rare complication of thyroidectomy. Here, we report the case of a patient who experienced ipsilateral painful Horner syndrome after total thyroidectomy and unilateral neck dissection for thyroid cancer.
Blepharoptosis ; Brain ; Carotid Artery Injuries ; Horner Syndrome* ; Humans ; Hypohidrosis ; Miosis ; Neck ; Neck Dissection ; Thyroid Neoplasms ; Thyroidectomy* ; Trigeminal Nerve Injuries

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A comparison of ProSeal laryngeal mask airway, I-gel and endotracheal tube insertion by novices in a simulated difficult airway scenario.

Sang Jin PARK ; Jiyoon JUNG ; Soo Young SHIM ; Deok Hee LEE

Anesthesia and Pain Medicine.2016;11(3):307-312. doi:10.17085/apm.2016.11.3.307

BACKGROUND: Insertion of supraglottic airway devices (SADs) can be technically easier to perform for novices than endotracheal intubation (ETI), particularly in a situation with difficult airway management. We evaluated the efficacy and usefulness of the ProSeal laryngeal mask airway (PLMA), I-gel, and ETI when used by novices in a simulated difficult airway scenario. METHODS: A total of 109 novices participated in a brief educational session about PLMA, I-gel and ETI. The sequence of the airway devices was randomized for each participant using a computer-generated random table, and the devices were inserted in a manikin with restricted cervical spine movement. A nasogastric (NG) tube was then inserted through each SAD. In the case of ETI, the NG tube was inserted through the manikin's nostril. RESULTS: The success rate at the first insertion attempt was 93.6% for the I-gel compared with 72.5% for the PLMA and 19.3% for ETI. The I-gel also enabled a significantly shorter insertion time than the PLMA (I-gel 26.3 ± 21.9 sec and PLMA 36.0 ± 35.4 sec). The novices showed high success rates for NG tube insertion using SADs (PLMA 96.3% and I-gel 98.1%) compared with ETI (24.8%). CONCLUSIONS: We found that the I-gel provided a better first time success rate and a shorter insertion time than PLMA and ETI, which indicated that the I-gel may be preferable for difficult airway management by novices.
Airway Management ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Manikins ; Spine

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Comparison of the streamlined liner of the pharynx airway (SLIPA™) with the I-gel™ in paralyzed, anesthetized patients.

Il Jae YOON ; Hyun KANG ; Geun Joo CHOI ; Yong Hee PARK ; Jong In OH ; Chong Wha BAEK ; Yong Hun JUNG ; Young Cheol WOO ; Jin Yun KIM

Anesthesia and Pain Medicine.2016;11(3):299-306. doi:10.17085/apm.2016.11.3.299

BACKGROUND: I-gel™ and Streamlined Liner of the Pharynx Airway (SLIPA™) are the second generation supraglottic airway devices characterized by disposability and non-inflatable cuff that provide adequate sealing pressure and easy use. This study was designed to compare oro-pharyngeal leakage pressure of the I-gel™ with the SLIPA™. METHODS: Seventy-eight adult patients were randomly assigned to undergo general anesthesia with either I-gel™ or SLIPA™. Hemodynamic changes and Oro-pharyngeal leakage pressure were assessed at one minute after the insertion. The total insertion time, number of attempts, ease of insertion, and presence of blood staining and regurgitation were recorded. After surgery, postoperative sore throat and other complications (dysphonia, dysphagia or paresthesia of tongue) were evaluated. RESULTS: Oro-pharyngeal leakage pressure after device insertion was higher in the SLIPA™ group than the I-gel™ group. Insertion time was significantly shorter in the I-gel™ group than the SLIPA™ group. Blood staining was presented in 21.1% of the SLIPA™ group vs. 2.6% of the I-gel™ group. In the recovery room, postoperative sore throat measured in visual rating scale (VAS) was significantly higher in the SLIPA™ group than in the I-gel™ group. Ease of insertion, regurgitation, respiratory index and hemodynamic change after insertion showed no significant differences. CONCLUSIONS: In this study, the SLIPA™ devices provided higher oro-pharyngeal leakage pressure than I-gel™. However, the results verified ease of insertion, and safety of ventilation and hemodynamic changes, without any severe complications in both I-gel™ and SLIPA™.
Adult ; Anesthesia, General ; Blood Stains ; Deglutition Disorders ; Hemodynamics ; Humans ; Laryngeal Masks ; Paresthesia ; Pharyngitis ; Pharynx* ; Recovery Room ; Ventilation

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Ultrasound-guided placement of a permanent peripheral nerve stimulator in a patient with complex regional pain syndrome: A case report.

Woosuk CHUNG ; Yohan KIM ; Jiyong LEE ; Sunyul LEE ; Yoonhee KIM ; Yongsup SHIN ; Wonhyung LEE ; Youngkwon KO

Anesthesia and Pain Medicine.2016;11(3):295-298. doi:10.17085/apm.2016.11.3.295

A 56-year-old man complained of continuous pain in the right foot that began 6 months after undergoing surgery on the right calcaneus bone. The patient was diagnosed with complex regional pain syndrome (CRPS) type I and was treated with medication, lumbar sympathetic ganglion blocks, epidural nerve blocks, and spinal cord stimulation. However, all treatments were halted because they were ineffective or complications developed. Peripheral nerve stimulation (PNS) was planned after confirming the analgesic effects of a sciatic nerve block, and the patient received PNS via minimally invasive ultrasound-guided electrode placement. PNS reduced the pain intensity and the incidence of paroxysmal pain. Other than discomfort at the battery insertion site (resolved with re-implantation), the patient developed no complications. These results suggest that ultrasound-guided minimally invasive PNS is a safe and effective treatment for patients with CRPS in the lower extremities.
Calcaneus ; Complex Regional Pain Syndromes ; Electrodes ; Foot ; Ganglia, Sympathetic ; Humans ; Implantable Neurostimulators ; Incidence ; Lower Extremity ; Middle Aged ; Nerve Block ; Neuralgia ; Pain Management ; Peripheral Nerves* ; Sciatic Nerve ; Spinal Cord Stimulation ; Ultrasonography

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Ultrasound-guided pararadicular block using a paramedian sagittal oblique approach for managing low back pain in a pregnant woman: A case report.

Seul Gi AHN ; Jisoo LEE ; Hue Jung PARK ; Young Hoon KIM

Anesthesia and Pain Medicine.2016;11(3):291-294. doi:10.17085/apm.2016.11.3.219

Lumbar radicular pain is conventionally treated with transforaminal epidural injection under the guidance of fluoroscopy or computer tomography. However, fluoroscopic radiation can be hazardous in certain populations, including pregnant women. An adjustment of the amount of local anesthetic is required in this population. An alternative method of lumbar root block using ultrasound (US) guidance has recently been introduced. Here, we present the case of a pregnant woman with worsening lumbar radicular pain during her pregnancy and the management of her pain using US-guided pararadicular block.
Female ; Fluoroscopy ; Humans ; Injections, Epidural ; Low Back Pain* ; Methods ; Pregnancy ; Pregnant Women* ; Ultrasonography

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Changes of the T-wave on range of spinal blockade after low dose epinephrine administration.

Jeongwoo LEE ; Sungmin OH ; Bong Gon KIM ; Young Jin HAN

Anesthesia and Pain Medicine.2016;11(3):285-290. doi:10.17085/apm.2016.11.3.285

BACKGROUND: Epidural test solution is administered to confirm the correct positioning of an epidural catheter. Hemodynamic changes after administration of epidural test solution reportedly help confirm intravenous (IV) placement of epidural catheters. The change in T wave amplitude is important for checking intravascular placement of epidural catheters. We examined changes in T wave amplitude according to the level of spinal anesthesia after IV epinephrine administration. METHODS: Eighty-one healthy patients undergoing spinal anesthesia were randomized into three groups: group C (control), group L (low spinal block), and group H (high spinal block). All patients received an IV administration of test solution, 3 ml of 1% lidocaine and epinephrine 10 µg. Systolic blood pressure (SBP), heart rate (HR), and T wave amplitude were measured up to 5 min after test solution administration. Adverse reactions post administration of test solution were also recorded. RESULTS: In all groups, after administration of IV test solution, SBP and HR increased, and the T wave amplitude decreased. There were no significant differences in HR, SBP, and T wave amplitude changes between the groups after administrating test solution. Fifteen out of 25 patients (60.0%), 10 out of 24 (41.6%), and 11 out of 23 (47.8%) complained of adverse symptoms in groups C, L, and H, respectively. CONCLUSIONS: This study suggests that change in T wave amplitude after administration of a low dose of epinephrine is not affected by the spinal block range.
Anesthesia, Spinal ; Blood Pressure ; Catheters ; Electrocardiography ; Epinephrine* ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine

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Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform.

Dae Hee KIM ; Ji Young YOO ; Sook Young LEE ; Yeo Jin KIM ; Se Ryeon LEE ; Sung Yong PARK

Anesthesia and Pain Medicine.2016;11(3):280-284. doi:10.17085/apm.2016.11.3.280

BACKGROUND: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo™ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. METHODS: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. RESULTS: The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%. CONCLUSIONS: Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.
Arterial Pressure* ; Blood Pressure* ; Cardiac Output* ; Catheters ; Hemodynamics ; Humans ; Pulmonary Artery

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Influence of acute normovolemic hemodilution on the potency and time course of action of rocuronium in rabbits.

Jeoung Hyuk LEE ; Kyo Sang KIM ; Tae Yeon KIM ; You na OH ; Wonho LEE

Anesthesia and Pain Medicine.2016;11(3):273-279. doi:10.17085/apm.2016.11.3.273

BACKGROUND: We performed this study to evaluate the potency and time course of rocuronium-induced neuromuscular block following moderate or severe acute normovolemic hemodilution (ANH) in rabbits. METHODS: Forty five rabbits were randomly assigned to the control (C) group, the moderate ANH (M) group, or the severe ANH (S) group. After stabilization of sevoflurane anesthesia, ANH was achieved by drainage of arterial blood and an intravenous infusion of 6% hydroxyethyl starch, during which hematocrit (Hct) decreased to 26.2 ± 2.5% in the M group and 17.6 ± 2.2% in the S group. We determined dose-response relationships of rocuronium in the three groups and created a time course of the action of 0.6 mg/kg rocuronium. RESULTS: The 50% effective dose (ED50) for rocuronium was 45% and 50% lower in the M and S groups, respectively, than in the C group (50.9 ± 6.3 µg/kg) (P < 0.001). The onset time after 0.6 mg/kg rocuronium was faster in the ANH groups compared with the C group (P < 0.001). The duration of neuromuscular block was prolonged by 38% and 43% in the M and S groups, respectively, compared with the C group (49.1 ± 6.9 min) (P < 0.001). CONCLUSIONS: ANH resulted in high potency, rapid onset, and prolonged duration of rocuronium. However, the severity of ANH did not alter the potency and duration of action of rocuronium.
Anesthesia ; Drainage ; Hematocrit ; Hemodilution* ; Infusions, Intravenous ; Neuromuscular Blockade ; Rabbits* ; Starch

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