Anesthesia and Pain Medicine.2015;10(1):64-64. doi:10.17085/apm.2015.10.1.64
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Anesthesia and Pain Medicine
2006 to Present ISSN: 1975-5171
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Anesthesia and Pain Medicine.2015;10(1):61-63. doi:10.17085/apm.2015.10.1.61
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
Candida ; Humans ; Neoplasm Metastasis ; Steroids
Thyrotoxic storm diagnosed due to postoperative tachycardia: A case report.
Anesthesia and Pain Medicine.2015;10(1):57-60. doi:10.17085/apm.2015.10.1.57
Thyrotoxic storm is an extreme state of thyrotoxicosis and a medical emergency. The clinical presentation of thyrotoxic storm includes tachycardia, fever, organ effect of central nervous system, cardiovascular system, and gastrointestinal system dysfunction. It usually occurs in patients with untreated or partially treated Graves' disease. Although it is rare, its mortality rate has reached 10-20%. There are no specific tests for establishing the diagnosis; it can only be diagnosed based on the clinical expression and laboratory results. Rapid diagnosis and treatment are necessary when it unexpectedly occurs during the perioperative period. We report a case of unnoticed hyperthyroidism that was diagnosed due to thyrotoxic storm-induced tachycardia in the post anesthesia care unit.
Anesthesia ; Cardiovascular System ; Central Nervous System ; Diagnosis ; Emergencies ; Fever ; Graves Disease ; Humans ; Hyperthyroidism ; Liver Transplantation ; Living Donors ; Mortality ; Perioperative Period ; Tachycardia* ; Thyroid Crisis* ; Thyrotoxicosis
Anesthesia ; Cardiovascular System ; Central Nervous System ; Diagnosis ; Emergencies ; Fever ; Graves Disease ; Humans ; Hyperthyroidism ; Liver Transplantation ; Living Donors ; Mortality ; Perioperative Period ; Tachycardia* ; Thyroid Crisis* ; Thyrotoxicosis
Anesthesia and Pain Medicine.2015;10(1):52-56. doi:10.17085/apm.2015.10.1.52
Until now, we do not have a definitive treatment for intractable postherpetic neuralgia (PHN). But, there is relatively strong evidence for the efficacy of intrathecal methylprednisolone injection in the treatment of intractable PHN. In spite of the effectiveness, many clinicians hesitate to use intrathecal steroids due to adverse effects such as adhesive arachnoiditis. We experienced two cases of temporary severe burning pain after intrathecal steroid injection for treatment of PHN. On the next day, the patients did not have any burning pain, and they were discharged with decreased pain associated with PHN.
Adhesives ; Arachnoid ; Arachnoiditis ; Burns* ; Humans ; Methylprednisolone ; Neuralgia, Postherpetic* ; Steroids
Adhesives ; Arachnoid ; Arachnoiditis ; Burns* ; Humans ; Methylprednisolone ; Neuralgia, Postherpetic* ; Steroids
A clinical evaluation of i-gel(TM) during general anesthesia in children.
Anesthesia and Pain Medicine.2015;10(1):46-51. doi:10.17085/apm.2015.10.1.46
BACKGROUND: The i-gel(TM) (i-gel) is a new single-use supraglottic airway device with a non-inflatable cuff. This study investigated the safety and efficacy of the i-gel during general anesthesia in children. METHODS: Ninety-eight children at ASA physical status I-II who underwent general anesthesia were included in this prospective observatory study. The size of the i-gel was selected based on patient's body weight. We evaluated success rates, insertion time, airway leak pressure, fiberoptic examination, airway manipulation, airway quality, and postoperative complications. RESULTS: The first-attempt success rate was 96.9% with overall success rate of 98.0%. The insertion time was 15.6 +/- 4.7 seconds. The airway leak pressure was 28.2 +/- 5.9 cmH2O. The maximal peak inspiratory pressure was 15.4 +/- 3.0 cmH2O. On fiberoptic examination, vocal cords were visible in 86.5% of patients. During maintenance of anesthesia, manipulations of i-gel were required for 32 (33.3%) children to maintain airway. Controlled ventilation was possible in all cases, although excess leak transiently occurred in three children. Postoperative complications including blood-staining on device, cough, and sore throat were infrequent. CONCLUSIONS: The i-gel size at 1.5-2.5 provided a satisfactory airway and ventilation during anesthesia in children. However, i-gel required a number of manipulations to maintain patency of airway during general anesthesia.
Anesthesia ; Anesthesia, General* ; Body Weight ; Child* ; Cough ; Humans ; Pharyngitis ; Postoperative Complications ; Prospective Studies ; Ventilation ; Vocal Cords
Anesthesia ; Anesthesia, General* ; Body Weight ; Child* ; Cough ; Humans ; Pharyngitis ; Postoperative Complications ; Prospective Studies ; Ventilation ; Vocal Cords
Posterior reversible encephalopathy syndrome after normal vaginal delivery: A case report.
Anesthesia and Pain Medicine.2015;10(1):42-45. doi:10.17085/apm.2015.10.1.42
Benign primary headaches are common during the postpartum period. However, there are several other kinds of headaches caused by specific underlying pathologies like post-dural puncture headache (PDPH), pregnancy induced hypertension, cortical vein thrombosis, posterior reversible encephalopathy syndrome (PRES), subarachnoid hemorrhage, intracranial hemorrhage, brain tumor, and so on. These headaches are rare but each can be life threatening conditions when diagnosis is delayed. If a patient was treated for another type of headache, like a PDPH, the diagnosis would be even more difficult. We report on the case of a 24 year-old woman who suffered with PDPH followed by postpartum eclampsia with PRES.
Diagnosis ; Eclampsia ; Female ; Headache ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Intracranial Hemorrhages ; Pathology ; Post-Dural Puncture Headache ; Posterior Leukoencephalopathy Syndrome* ; Postpartum Period ; Pregnancy ; Seizures ; Subarachnoid Hemorrhage ; Thrombosis ; Veins
Diagnosis ; Eclampsia ; Female ; Headache ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Intracranial Hemorrhages ; Pathology ; Post-Dural Puncture Headache ; Posterior Leukoencephalopathy Syndrome* ; Postpartum Period ; Pregnancy ; Seizures ; Subarachnoid Hemorrhage ; Thrombosis ; Veins
Anesthesia and Pain Medicine.2015;10(1):36-41. doi:10.17085/apm.2015.10.1.36
BACKGROUND: A pneumatic tourniquet is commonly used in orthopedic surgery. However, neuromuscular blocking agent can be sequestered in the isolated limb and be reabsorbed into the systemic circulation after tourniquet release, potentially delaying extubation. To investigate the change in the train-of-four (TOF) ratio after tourniquet release and correlate the TOF ratio change with the extubation time. METHODS: Forty patients undergoing unilateral total knee arthroplasty were enrolled. Before and after the pneumatic tourniquet release, 10 measurements of the TOF ratio were averaged and compared. Additionally, we investigated the correlation between the percentage change in the TOF ratio before and after tourniquet release and the extubation time. RESULTS: Among the 40 patient subjects, 30 showed a TOF ratio before tourniquet release and 10 showed only a TOF count. Of the 30 patients with a TOF ratio, 21 showed a TOF ratio increase after tourniquet release and 9 showed a TOF decrease; both increase and decrease were statistically significant (P < 0.001 and P = 0.008, respectively). The extubation time showed a weak negative correlation with the percentage change in the TOF ratio after tourniquet release (P = 0.004). CONCLUSIONS: In orthopedic surgery using a pneumatic tourniquet, neuromuscular function monitoring may be required to monitor the change in the effect of neuromuscular blocking agent before and after tourniquet release, which may help to improve anesthesia safety.
Anesthesia ; Arthroplasty* ; Extremities ; Humans ; Knee* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Orthopedics ; Tourniquets*
Anesthesia ; Arthroplasty* ; Extremities ; Humans ; Knee* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Orthopedics ; Tourniquets*
Anesthesia and Pain Medicine.2015;10(1):32-35. doi:10.17085/apm.2015.10.1.32
Although tracheal injury after tracheal intubation has been reported often, the formation of acquired tracheal diverticulum as the complications of intubation has not been reported before. In a 57-year-old woman, emergency coil embolization was performed for the treatment of a ruptured cerebral aneurysm. Then, the over-ballooning of an endotracheal tube cuff and deep intubation were observed on a chest X-ray. So, the tube was re-ballooned and re-positioned before surgery. Five hours after extubation in the intensive care unit at postoperative 5 days, a perforation of the tracheal diverticulum wall, leading to subcutaneous emphysema around her neck and pneumomediastinum, was diagnosed using CT and bronchoscopy. The cause of the tracheal diverticulum was suspected over-ballooning of the endotracheal tube cuff because the diverticulum site and size were the same as those of the over-ballooning cuff.
Bronchoscopy ; Diverticulum* ; Embolization, Therapeutic ; Emergencies ; Female ; Humans ; Intensive Care Units ; Intracranial Aneurysm ; Intubation* ; Mediastinal Emphysema ; Middle Aged ; Neck ; Subcutaneous Emphysema ; Thorax ; Trachea
Bronchoscopy ; Diverticulum* ; Embolization, Therapeutic ; Emergencies ; Female ; Humans ; Intensive Care Units ; Intracranial Aneurysm ; Intubation* ; Mediastinal Emphysema ; Middle Aged ; Neck ; Subcutaneous Emphysema ; Thorax ; Trachea
Anesthesia and Pain Medicine.2015;10(1):27-31. doi:10.17085/apm.2015.10.1.27
BACKGROUND: The goal of this prospective study was to determine the effect of midazolam pretreatment on the desflurane requirement for blunting the sympathetic response after surgical incision (minimum alveolar concentration blockade of adrenergic responses, MAC(BAR)) when desflurane is combined with a target-controlled concentration of remifentanil at 1 ng/ml. METHODS: Sixty-five patients aged 30 to 60 years with American Society of Anesthesiologists physical status of I or II who were undergoing general anesthesia for thyroidectomy were registered for this study. The patients were randomly allocated to receive either 30 microg/kg of midazolam (Group M) or isovolemic saline (Group C) intravenously before anesthetic induction. All patients were anesthetized with propofol, rocuronium, desflurane and remifentanil at a target-controlled effect-site concentration of 3 ng/ml at intubation followed by 1 ng/ml throughout the study. Sympathetic responses to surgical incision were determined 10 minutes after stabilization of end-tidal desflurane and target-controlled remifentanil concentrations. The predetermined end-tidal desflurane concentrations and MAC(BAR) for each group were determined using an up-and-down sequential allocation technique. RESULTS: The MAC(BAR) of desflurane with 1 ng/ml remifentanil concentration was 7.1 and 6.8% without and with midazolam pretreatment, respectively, using Dixon's up-and-down method (P = 0.755). CONCLUSIONS: Midazolam administered intravenously before anesthetic induction does not impact the MAC(BAR) of desflurane with an effect-site concentration of remifentanil 1.0 ng/ml.
Anesthesia, General ; Humans ; Intubation ; Midazolam* ; Propofol ; Prospective Studies ; Thyroidectomy
Anesthesia, General ; Humans ; Intubation ; Midazolam* ; Propofol ; Prospective Studies ; Thyroidectomy
Anesthesia and Pain Medicine.2015;10(1):21-26. doi:10.17085/apm.2015.10.1.21
BACKGROUND: An electrical patient-controlled analgesia (PCA) pump enabled us to collect infusion history of opioid analgesic and other efficacy parameters of PCA, including delivery-to-attempt (D/A) ratio. This study evaluated the effectiveness of PCA in a large population of surgical patients using numerical rating scale (NRS) for pain and D/A ratio. METHODS: A total of 6,847 patients were enrolled in this study. All patients received intravenous bolus of fentanyl (0.2 microg /kg) one hour before the end of the surgery. Basal infusion rate, demand bolus, and lockout time of the PCA pump was set as 1 ml/h, 1 ml, and 15 minutes, respectively. The concentration of fentanyl in the analgesic solution was 15 microg/ml. RESULTS: NRS scores for pain and D/A ratios for the first 6 hours after operations were as follows (median, 25-75%): open colorectal surgery (NRS: 6.5, 5.0-8.0; D/A: 62.5, 46.2-77.8%), laparoscopic colorectal surgery (NRS: 6.0, 4.5-7.0; D/A: 69.2, 50.0-81.9%), open hepato-biliary-pancreas surgery (NRS: 6.0, 4.5-7.0; D/A: 59.2, 38.7-75.0%), open stomach surgery (NRS: 5.0, 4.0-6.7; D/A: 58.1, 41.2-75.0%), open abdominal vascular surgery (NRS: 5.0, 3.5-6.5; D/A: 58.3, 40.0-81.3%), laparoscopic stomach surgery (NRS: 5.0, 4.0-6.0; D/A: 63.6, 45.5-80.0%), laparoscopic hepato-biliary-pancreas surgery (NRS: 5.0, 4.0-6.0; D/A: 66.7, 50.0-80.8%), vascular bypass surgery (NRS: 4.0, 3.0-6.0; D/A: 64.5, 42.7-84.0%), anal surgery (NRS: 4.0, 3.0-5.8; D/A: 71.4, 60.0-100%), and breast surgery (NRS: 3.0, 3.0-4.0; D/A: 86.6, 67.2-100%). CONCLUSIONS: Mean D/A ratios for the first 6 hours after all operations except anal and breast surgeries were below 70%, suggesting that a higher amount of fentanyl should be administered during this period.
Analgesia, Patient-Controlled* ; Breast ; Cohort Studies* ; Colorectal Surgery ; Fentanyl ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies* ; Stomach
Analgesia, Patient-Controlled* ; Breast ; Cohort Studies* ; Colorectal Surgery ; Fentanyl ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies* ; Stomach
Country
Republic of Korea
Publisher
Korean Society of Anesthesiologists
ElectronicLinks
Editor-in-chief
Abbreviation
Anesth Pain Med
Vernacular Journal Title
ISSN
1975-5171
EISSN
2383-7977
Year Approved
2009
Current Indexing Status
Currently Indexed
Start Year
2006
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