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Cardiac arrest with pulseless electrical activity during a robot-assisted distal gastrectomy: A case report.

Younghoon JEON ; Young Hoon PARK ; Doo Youn HWANG ; Seong Wook HONG ; Taeha RYU ; Sung Sik PARK

Anesthesia and Pain Medicine.2012;7(4):329-332.

A 59-year-old woman was scheduled to undergo a robot-assisted distal gastrectomy under general anesthesia. During the operation, the vital signs were maintained in normal range. After 7 hours of surgery, the pulse oxymeter graph became flat and the end tidal CO2 concentration suddenly decreased. Palpation of the carotid artery revealed no heart beat but the EKG continued to show sinus rhythm. Pulseless electrical activity (PEA) was diagnosed. An advanced cardiopulmonary life support protocol for PEA was immediately initiated, which included chest compressions and doses of IV cardiovascular drugs. However, in spite of continuous CPR, the heart wasn't recovered from the arrest. We experienced cardiac arrest for pulseless electrical activity during robot-assisted distal gastrectomy.
Anesthesia, General ; Cardiopulmonary Resuscitation ; Cardiovascular Agents ; Carotid Arteries ; Electrocardiography ; Female ; Gastrectomy ; Heart ; Heart Arrest ; Humans ; Hypovolemia ; Middle Aged ; Palpation ; Peas ; Reference Values ; Thorax ; Vital Signs

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Asystole during manipulation with a curved-blade laryngoscope and tracheal intubation in patient with a history of syncope: A case report.

Chang Hyun PARK ; Young Eun KWON ; Dong Un SONG ; Ki Hyun LEE ; Jae Wook SONG

Anesthesia and Pain Medicine.2012;7(4):325-328.

Vagal reflex during manipulation with a curved-blade laryngoscope and tracheal intubation may result in severe bradycardia and even, asystole. Manipulation with laryngoscope and tracheal intubation leaded to bradycardia and asystole at a 47-year-old woman during induction of anesthesia with propofol, remifentanil and cisatracurium and sevoflurane inhalation. Withdrawal of laryngoscope and atropine 0.5 mg injection, her heart rate was recovered to normal sinus rhythm. Intubation at secondary trial was done with bradycardia and heart rate was returned to normal sinus rhythm soon. She had a history of syncope in interview after surgery and was examined tilt test to find of cause of syncope. Although the result of the test was negative, the bradycardia and asystole seemed to be caused by vagal reflex.
Anesthesia ; Atracurium ; Atropine ; Bradycardia ; Female ; Heart Arrest ; Heart Rate ; Humans ; Inhalation ; Intubation ; Laryngoscopes ; Methyl Ethers ; Middle Aged ; Piperidines ; Propofol ; Reflex ; Syncope

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Comparison of cardioprotection between sevoflurane-remifentanil and midazolam-sufentanil total intravenous anesthesia during off-pump coronary artery bypass surgery.

Nam Su GIL ; Yoon jung SHON ; Jin Young HWANG ; Seung Pyo CHOI ; Sung Eun SIM ; Jin HUH ; Seong Won MIN ; Chong Soo KIM ; Yun Seok JEON ; Sue Young LEE

Anesthesia and Pain Medicine.2012;7(4):320-324.

BACKGROUND: Volatile agents have been reported to protect myocardium against ischemia. But, there were a few clinical reports about the myocardial protection of inhalation agents. So we investigated the cardiac protection of sevoflurane in comparison with total intravenous anesthesia (TIVA). The study is a retrospective unrandomized study via the medical record review. METHODS: The records of 102 patients who received off-pump CABG were reviewed. One patient group received TIVA by midazolam and sufentanil continuous infusion (TIVA group, n = 68), and the other patient group received an inhalational anesthesia by sevoflurane (sevoflurane group, n = 34). Except maintenance of anesthesia, two groups of patients received an identical surgical, anesthetical, and postoperative care. At arrival in the intensive care unit, and after 1, 2, 3 and 5 days, serum cardiac enzyme levels were measured. RESULTS: All the median values of cardiac enzyme concentrations were lower in the sevoflurane group than TIVA group. Moreover, there were the significant differences between groups at the immediate postoperative CK-MB (median 4.7 ng/ml versus 5.9 ng/ml (P = 0.049)), 1-5 days postoperative LD (1 day 271.5 U/L versus 292 U/L (P = 0.045), 2 day 227.5 U/L versus 270 U/L (P = 0.009), 3 day 215 U/L versus 250 U/L (P = 0.030), 5 day 218 U/L versus 231 U/L (P = 0.005)), and 1, 3 postoperative troponin I level (0.485 ng/ml versus 1.12 ng/ml [P = 0.029], 0.090 ng/ml versus 0.235 ng/ml [P = 0.047] respectively). CONCLUSIONS: Sevoflurane lowered cardiac enzyme levels in comparison with TIVA after off-pump CABG anesthesia. These data suggest a cardioprotective effect of sevoflurane during CABG.
Anesthesia ; Anesthesia, Intravenous ; Coronary Artery Bypass, Off-Pump ; Humans ; Inhalation ; Intensive Care Units ; Ischemia ; Medical Records ; Methyl Ethers ; Midazolam ; Myocardium ; Postoperative Care ; Retrospective Studies ; Sufentanil ; Troponin I

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Total intravenous anesthesia for Kartagener's syndrome: A case report.

Youn Yi JO ; Wol Seon JUNG ; Hong Soon KIM ; Sang Ho BYEN ; Kyung Cheon LEE

Anesthesia and Pain Medicine.2012;7(4):317-319.

Kartagener's syndrome (KGS) is an autosomal recessive disorder which possible to link the occurrence of abnormal ciliary movement and abnormal position of the body organs. Considering the fact that airway ciliary function plays an important role in the primary pulmonary defense mechanism, prevent the ciliodepressant actions are also important for anesthetic management. We described successful anesthetic management of a 44-year-old male scheduled for endoscopic sinus surgery who had a history of frequent epistaxis, anosmia and situs inversus totalis. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion device.
Adult ; Aluminum Hydroxide ; Anesthesia ; Anesthesia, Intravenous ; Carbonates ; Epistaxis ; Humans ; Kartagener Syndrome ; Male ; Olfaction Disorders ; Piperidines ; Propofol ; Situs Inversus

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Comparison of palonosetron with ondansetron in preventing postoperative nausea and vomiting after thyroidectomy during a 48-hour period.

Yu Yil KIM ; Dong Un SONG ; Ki Hyun LEE ; Il Jung LEE ; Jae Wook SONG ; Jin Hun LIM

Anesthesia and Pain Medicine.2012;7(4):312-316.

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after general anesthesia. This study compared the effects of palonosetron and ondansetron in preventing PONV in patients undergoing thyroidectomy. METHODS: 100 non-smoking female subjects were randomly assigned to a palonosetron group (n = 50) or an ondansetron group (n = 50). The patients of each group received 0.075 mg of palonosetron or 8 mg of ondansetron through intravenous bolus injection before induction of general anesthesia. The incidence of nausea and vomiting were monitored at 2 h, 24 h and 48 h after operation. RESULTS: The incidence of PONV during 48 h after operation had no significant differences between the groups. However, the incidence of nausea was lower in the palonosetron group than in the ondansetron group (34% vs. 56%, P = 0.027). No differences were observed in incidences of vomiting, use of antiemetics and adverse events between the groups. CONCLUSIONS: Palonosetron was more effective than ondansetron in preventing nausea for patients undergoing thyroidectomy. However, the effect of palonosetron or ondansetron in preventing PONV was similar.
Anesthesia, General ; Antiemetics ; Female ; Humans ; Incidence ; Isoquinolines ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Quinuclidines ; Thyroidectomy ; Vomiting

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The effect of intravenous dexmedetomidine on the duration of brachial plexus block.

Ji Woong PARK ; Jeong Uk HAN ; Helen Ki SHINN ; Jong Kwon JUNG ; Young Deog CHA ; Sung An KANG ; Jang Ho SONG

Anesthesia and Pain Medicine.2012;7(4):307-311.

BACKGROUND: Dexmedemomidine, a highly selective alpha-2 adrenoreceptor agonist has an analgesic and sedative effect without causing respiratory depression. In this study, we compared the duration of brachial plexus block (BPB), the time at which the patient first feels pain after performing BPB, the need for use of analgesics, and the occurrence rate of complications while continuous infusion with dexmedetomidine was used for sedation in patients undergoing BPB, to a control group, who were only infused with normal saline. METHODS: BPB was performed in 48 patients scheduled for upper limb surgery. Infraclavicular approach was provided with 40 ml of 1.5% mepivacaine and 200 microg of epinephrine using nerve stimulator. After verification of successful block, dexmedetomidine group received dexmedetomidine (loading dose 0.1 microg/kg/min for the first 10 minutes followed by a maintenance dose of 0.005 microg/kg/min as required to maintain bispectral index 60-80). In the control group, normal saline was infused at a rate of 10 ml/hr. The duration of BPB, the time at which the patient first feels pain after performing BPB, frequency of complication, and the use of analgesics of the both groups were checked. RESULTS: The motor and sensory block duration, and the time at which the patient first feels pain after BPB were longer in the dexmedetomidine group compared to the control group. And the need for analgesics were less in the dexmedetomidine group. CONCLUSIONS: Intravenous administration of dexmedetomidine prolongs the duration of BPB.
Administration, Intravenous ; Analgesics ; Brachial Plexus ; Dexmedetomidine ; Epinephrine ; Humans ; Hypnotics and Sedatives ; Mepivacaine ; Respiratory Insufficiency ; Upper Extremity

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The effect of sex on drug consumption and recovery time in Entropy-monitored propofol-remifentanil anesthesia.

Ji Na OH ; Chan Jong CHUNG ; Ji Yeon LEE ; Sang Won PARK ; Ho Jin SHIN ; Jong Hwan LEE

Anesthesia and Pain Medicine.2012;7(4):301-306.

BACKGROUND: It has been shown sex-related differences for propofol consumption and recovery time in general anesthesia. Recently, Entropy has been promoted as a monitor for anesthetic depth. This study investigated the effects of sex on drug consumption and recovery time in Entropy-monitored propofol-remifentanil anesthesia. METHODS: Sixty-eight females and sixty-eight males, ASA physical status class 1 or 2, who were scheduled to undergo elective laparoscopic cholecystectomy were included. Anesthesia was induced and maintained with target-controlled infusion of propofol and remifentanil. Effect-site concentration (Ce) of propofol and remifentanil were adjusted according to the state entropy (SE) and hemodynamic parameters, respectively. Heart rate, blood pressure, response entropy (RE), SE, Ce of propofol, and Ce of remifentanil were measured during anesthesia. The time from stop of propofol until eye opening was compared between the females and males. RESULTS: No significant differences existed between the females and males with respect to age, body mass index, duration of surgery, and duration of drug infusion. There were no significant differences between the females and males in the changes of blood pressure, heart rate, RE, SE, and Ce of propofol and remifentanil during anesthesia. Remifentanil consumption was similar between the females and males. Significantly higher amount of propofol was consumed in the females compared to the males (0.170 +/- 0.028 vs. 0.159 +/- 0.026 mg/kg/min, P < 0.05). The females woke significantly faster than the males (9.2 +/- 2.8 vs. 11.5 +/- 3.3 min, P < 0.05). CONCLUSIONS: With Entropy guidance, mean propofol consumption and recovery time were sex-dependent in propofol-remifentanil anesthesia.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Body Mass Index ; Cholecystectomy, Laparoscopic ; Entropy ; Eye ; Female ; Heart Rate ; Hemodynamics ; Humans ; Male ; Organothiophosphorus Compounds ; Piperidines ; Propofol

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Effect-site target-controlled infusion of propofol: comparison of Schnider and modified Marsh models.

Ri Na CHANG ; Hee Jung BAIK ; Dong Yeon KIM ; Guie Yong LEE ; Rack Kyung CHUNG ; Heeseung LEE

Anesthesia and Pain Medicine.2012;7(4):293-300.

BACKGROUND: We investigated effect-site concentrations of propofol, changes in blood pressure and heart rate, time to loss of consciousness, time to loss of eyelid reflex and awakening time during anesthesia using effect-site target-controlled infusion, to compare the differences between Schnider and modified Marsh model. METHODS: Forty American Society of Anesthesiologists (ASA) physical status I or II patients between the ages of 18 and 55 years old and who were scheduled for elective surgery under general anesthesia were enrolled in this study. The patients were randomized into two groups: one group using modified Marsh model (Group 1) and the other group using Schnider model (Group 2). Effect-site concentrations of propofol, blood pressure, heart rate and BIS at each anesthetic stage were recorded. Time to loss of consciousness, time to loss of eyelid reflex and awakening time were measured. RESULTS: Group 1 showed shorter time to loss of consciousness and eyelid reflex at the lower effect-site concentration of propofol than Group 2 (P < 0.05). The effect-site concentrations of Group 1 were higher than those of Group 2 at eye opening and extubation (P < 0.05). CONCLUSIONS: Induction of anesthesia is achieved at lower effect-site concentration of propofol and more rapidly in the modified Marsh model than in the Schnider model. However the effect-site concentrations of propofol for awakening are higher in the modified Marsh model than in the Schnider model.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Eye ; Eyelids ; Heart Rate ; Humans ; Propofol ; Reflex ; Unconsciousness ; Wetlands

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An experience of increased pain in patient with postherpetic neuralgia who had skin excision: A case report.

Ki Tae JUNG ; Keum Young SO ; Sang Hun KIM

Anesthesia and Pain Medicine.2012;7(4):289-292.

Surgical excision or undermining of the affected skin in patients with postherpetic neuralgia (PHN) has been introduced as an optional treatment when other treatment failed to reduce the pain. Such peripheral operation is rarely performed due to its limited effects and invasiveness. There were few reports about long-term outcome regarding surgical excision of PHN skin. We had experienced a case of PHN patient, who underwent surgical excision 10 years ago and suffered with returned pain and severe allodynia. The pain subsided markedly after a treatment with intercostal nerve block and topical lidocaine patch.
Humans ; Hyperalgesia ; Intercostal Nerves ; Lidocaine ; Neuralgia, Postherpetic ; Skin ; Surgical Procedures, Minor

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Thoracic epidural anesthesia for modified radical mastectomy in a patient with diffuse systemic sclerosis: A case report.

Kyu Yong JANG ; Jong Taek PARK ; Woo Young PARK ; Jong Hyuk LEE

Anesthesia and Pain Medicine.2012;7(4):286-288.

Systemic sclerosis is a systemic autoimmune disease. It is characterized by deposition of collagen in skin, blood vessels and internal organs. Systemic sclerosis can cause skin, cardiovascular, pulmonary, gastrointestinal, renal and other complication. A 42 year old woman with systemic sclerosis and breast cancer was scheduled for modified radical mastectomy under thoracic epidural anesthesia because of exertional dypnea, decreased diffusion lung capacity and Raynaud's phenomenon. There was no dyspnea or significant hemodynamic change during operation under epidural anesthesia. She discharged 12 days after operation without complications.
Anesthesia, Epidural ; Autoimmune Diseases ; Blood Vessels ; Breast Neoplasms ; Collagen ; Diffusion ; Dyspnea ; Female ; Hemodynamics ; Humans ; Lung Volume Measurements ; Mastectomy, Modified Radical ; Scleroderma, Systemic ; Skin

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