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The effect of pulsed radiofrequency (PRF) for the treatment of supraorbital neuropathic pain: A report of three cases.

Hyun Min BAE ; Young Hoon KIM ; Sang Wook KIM ; Dong Eon MOON

Anesthesia and Pain Medicine.2012;7(2):117-120.

Historically, peripheral neuropathic pain has occasionally been difficult to treat. Both a systematic review of the evidence as well as clinical experience have demonstrated that treatment options including polypharmacy provide effective pain relief in only half of the patients with neuropathic pain. After peripheral nerve injury, the incidence of degenerative alterations in the spinal cord and central pathologic sensitization are possible. Due to this observation, It may be difficult to treat this group of patients with peripheral neuropathic pain by therapeutic intervention of the peripheral nerve. Pulsed radiofrequency (PRF) has several benefits for treatment of this condition including, accuracy and safety, and the elimination of thermal lesions due to the reduction in the target tissue temperature (below 42 degrees). We treated three cases of supraorbital neuropathic pain using PRF, and discovered that two of the patients had significant pain relief at the six month time point.
Central Nervous System Sensitization ; Humans ; Incidence ; Neuralgia ; Peripheral Nerve Injuries ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Polypharmacy ; Spinal Cord

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Pulsed radiofrequency lesioning of the median nerve in a patient with bilateral carpal tunnel syndrome: A case report.

Il Bong PARK ; Yu Yil KIM ; Jun Hak LEE ; Dong Un SONG ; Jae Wook SONG

Anesthesia and Pain Medicine.2012;7(2):114-116.

Carpal tunnel syndrome, compression of the median nerve in the carpal tunnel at the wrist, is the most common entrapment syndrome of peripheral nerve. It is characterized by sensory and motor symptoms and signs in the distribution of the median nerve. Radiofrequency thermocoagulation is a neuroablative treatment for various chronic pain disorders, but is associated with neural injury, neuritis, and occasional neuroma. Unlike RF, pulsed radiofrequency, the use of the high current intensity and electrical fields, has been proposed for the modulation of the excited nervous system pathway of pain without neuro-destruction and other potential complications. We report a case of bilateral carpal tunnel syndrome that was relieved after PRF lesioning of both median nerves.
Carpal Tunnel Syndrome ; Chronic Pain ; Electrocoagulation ; Humans ; Median Nerve ; Nervous System ; Neuritis ; Neuroma ; Peripheral Nerves ; Wrist

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Pain managements in pancreatic cancer patient with opioid-induced hyperalgesia: A case report.

Jung Hyun PARK ; Dae Hwan LIM ; Young Hoon KIM ; Keon Hee RYU ; Dong Eon MOON

Anesthesia and Pain Medicine.2012;7(2):110-113.

Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.
Abdominal Pain ; Analgesia ; Analgesics ; Analgesics, Opioid ; Catheters ; Celiac Plexus ; Female ; Humans ; Hyperalgesia ; Middle Aged ; Pain Management ; Pancreatic Neoplasms ; Stress, Psychological

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Low-flow anesthesia in children: theory and clinical practice.

Kyoung Ok KIM

Anesthesia and Pain Medicine.2012;7(2):103-109.

There has been increased interest recently in low-flow anesthesia to minimize wastage of expensive volatile anesthetics and reduce atmospheric pollution. With the help of modern anesthetic apparatus and the availability of comprehensive gas monitoring, low-flow anesthesia can be performed safely in children. However, pediatric anesthesiologists have been more reluctant to adopt low-flow techniques. In this review article, the safety and efficacy of low-flow anesthesia will be discussed to help the anesthesiologists who want to employ this technique in children.
Anesthesia ; Anesthetics ; Child ; Humans

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Anesthetic Management for Abdominal Aortic Aneurysm Surgey without Homologous Blood Transfusion in Adult Jehovah'sWitness : A case report.

Ji Yeon JEONG ; Won Seok HUR ; Jeong Rim LEE ; Chul Woo JUNG ; Kook Hyun LEE

Anesthesia and Pain Medicine.2006;1(1):68-72.

Jehovah's Witnesses present a challenge for the anesthesia professionals on account of their refusal to accept blood and blood products. Therefore, anesthesiologists must be able to individualize their treatment depending on the patients' condition. We report a case of a stent removal and aorto-biiliac bypass surgery in a Jehovah's Witness. A 69 year-old, hypertensive man presented with claudication of both lower extremities due to the distal migration of an endoaneurysmal stent. According to his previous medical history, he had a lacunar infarction in the right middle cerebral artery territory, ischemic coronary artery disease with a stent in situ, and a stent inserted for an abdominal aortic aneurysm by radiological intervention. Because he strongly refused a transfusion, human recombinant erythropoietin was used before surgery. After the erythropoietin treatment, hemoglobin level increased to 14.8 g/dl (hematocrit 47.6%). During the operation, closed-circuit cell saver was used and transfused autologous blood was saved by acute normovolemic hemodilution. The patient recovered uneventfully from the anesthesia and was transferred to the intensive care unit. He was discharged on the ninth postoperative day without complications with a hematocrit level of 28.9%.
Adult* ; Aged ; Anesthesia ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Blood Transfusion* ; Coronary Artery Disease ; Disulfiram ; Erythropoietin ; Hematocrit ; Hemodilution ; Humans ; Intensive Care Units ; Jehovah's Witnesses ; Lower Extremity ; Middle Cerebral Artery ; Stents ; Stroke, Lacunar

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An Anesthetic Experience for Russell-SilverSyndrome : A case report.

Tae Joong YOO ; Sang Seok LEE ; Yeun Hee LIM ; Byung Hoon YOO ; Seung Hoon WOO

Anesthesia and Pain Medicine.2006;1(1):64-67.

We present a 4-years-old Russell-Silver syndrome patient who underwent surgical correction of left auricular abnormality. He had a triangular face with hypoplastic mandible. Because of facial manifestations of this syndrome, the anesthesiologist should prepare for a difficult endotracheal intubation and mask fitting. These patients may be prone especially to hypoglycemia and hypothermia during intraoperative period, therefore close monitoring and appropriate care for hypoglycemia and hypothermia is required. In this case, gentle direct laryngoscopy was performed to assess the airway. Hypoglycemia and hypothermia was not observed. We discuss anesthetic considerations in management.
Anesthesia ; Humans ; Hypoglycemia ; Hypothermia ; Intraoperative Period ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Mandible ; Masks ; Silver-Russell Syndrome

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The Effects of Remifentanil to Prevent the Hemodynamic Changes to Mouth Gag Insertion in Tonsillectomy.

Tae Hun AN ; Jong Dal JUNG ; In Ho YANG

Anesthesia and Pain Medicine.2006;1(1):61-63.

BACKGROUND: The insertion of a mouth gag causes acute hemodynamic changes such as hypertension and tachycardia. Several adjuvant drugs have been used to attenuate such responses. The aim of this study was to determine the effects of remifentanil in preventing the hemodynamic changes associated with the insertion of mouth gag after a remifentanil injection. METHODS: Thirty children, ASA1 or 2, who were scheduled for elective surgery, were divided randomly into two groups; group I (placebo; normal saline 0.05 ml/kg, n = 15), and group II (remifentanil 0.05microg/kg, n = 15). After inducing general anesthesia with thiopental sodium (5 mg/kg) and rocuronium (0.06 mg/kg), anesthesia was maintained by the inhalation of sevoflurane 2 vol% in N2O/O2 (50/50) via an endotracheal tube. The patients in group I and II received normal saline 0.05 ml/kg, and remifentanil 0.05microg/kg 1 minute before inserting the mouth gag, respectively. The patients' blood pressure heart rate were measured before and after inserting mouth gag. RESULTS: The hemodynamic changes in group I were minimal after inserting the mouth gag compared with group II. CONCLUSIONS: Remifentanil is effective in attenuating the increase in blood pressure and heart rate after inserting a mouth gag.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Child ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Inhalation ; Mouth* ; Tachycardia ; Thiopental ; Tonsillectomy*

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Comparison of Remifentanil-Propofol and Remifentanil-Sevoflurane Anesthesia for Pediatric Tonsillectomy.

Chan Jong CHUNG ; Jung Moo LEE ; So Rhon CHOI ; Young Jhoon CHIN

Anesthesia and Pain Medicine.2006;1(1):56-60.

BACKGROUND: This study compared the hemodynamic response and recovery profile of remifentanil-sevoflurane anesthesia for a pediatric tonsillectomy with that of remifentanil-propofol anesthesia. METHODS: Fifty healthy children (4-10 yr) undergoing a tonsillectomy were randomly assigned to one of two groups. Anesthesia was induced with remifentanil 1 mcg/kg over 1 min, propofol 2 mg/kg, and rocuronium 0.8 mg/kg. Anesthesia was maintained with remifentanil 0.25 mcg/kg/min and propofol 6 mg/kg/h, or remifentanil 0.25 mcg/kg/min and sevoflurane 1.0 vol%. The propofol and sevoflurane dose was kept unchanged, and remifentanil was titrated according to the hemodynamic response. The perioperative hemodynamics, recovery time, and side effects were assessed. RESULTS: Remifentanil-based anesthesia with propofol or sevoflurane resulted in stable hemodynamics, but sevoflurane was associated with a significantly lower systolic blood pressure. The recovery times were similar for spontaneous ventilation, extubation, eye opening, orientation, and full recovery in both groups. The incidence of side effects was similar in both groups. CONCLUSIONS: Remifentanil/sevoflurane is as equally effective as remifentanil/propofol in pediatric patients. The hemodynamic stability is appropriate and the recovery from anesthesia is rapid.
Anesthesia* ; Blood Pressure ; Child ; Hemodynamics ; Humans ; Incidence ; Propofol ; Tonsillectomy* ; Ventilation

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Anesthetic Management of Cesarean Section in Human Immunodeficiency Virus (HIV)Positive Pregnant Woman : A case report.

Jong Taek PARK ; Jae Myoung KIM ; Dae Ja UM

Anesthesia and Pain Medicine.2006;1(1):53-55.

Anesthesiologists are encountering an increasing number of human immunodeficiency virus (HIV) infections in pregnant women. In HIV infected patients, the history should include an evaluation of opportunistic infections, malignancies and treatments with antiretroviral drugs. The anesthesiologist should be aware of the possible toxic side effects or interactions between the antiretroviral drugs and anesthetics. In addition, a HIV infection passing from patient to physician can occur. Therefore, safety measures must be taken when handling body fluid or blood. We report the anesthetic management of an elective cesarean section in a HIV positive pregnant woman who was treated with antiretroviral drugs to decrease the possibility of vertical transmission.
Anesthetics ; Body Fluids ; Cesarean Section* ; Female ; HIV Infections ; HIV* ; Humans* ; Opportunistic Infections ; Pregnancy ; Pregnant Women*

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The Maternal and Neonatal Effect of Remifentanil in General Anesthesia for Cesarean Section.

Eui Min LEE ; Dong Yeon KIM ; Rack Kyung CHUNG ; Guie Yong LEE

Anesthesia and Pain Medicine.2006;1(1):48-52.

BACKGROUND: In case of general anesthesia for cesarean section, giving remifentanil has been described, but its maternal and neonatal effects and safety have not been investigated by a controlled study. METHODS: 20 healthy women undergoing elective cesarean section under general anesthesia at term were allocated randomly to receive remifentanil as effect site concentration of 3.0 ng/ml (R group, n = 10) and same amount of normal saline (C group, n = 10) just before endotracheal intubation. Each group was assessed for bispectral index (BIS), blood pressure, and heart rate at preinduction, arrival to target concentration, intubation, and 1 and 3 minutes after intubation and delivery. Neonatal effect was assessed by Apgar score at 1 and 5 minutes. RESULTS: The BIS of remifentanil group was lower than that of control group at 1 min after intubation (P < 0.05). The systolic blood pressure of remifentanil group were lower than those of control group at immediately after intubation (P < 0.05) and 1 min after intubation (P < 0.01). There were no significant differences in heart rate between two groups. CONCLUSIONS: We found that infusing remifentanil just before tracheal intubation was effective and safe to both mother and neonate.
Anesthesia, General* ; Apgar Score ; Blood Pressure ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Infant, Newborn ; Intubation ; Intubation, Intratracheal ; Mothers ; Pregnancy

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