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Bilateral vocal cord palsy in a post-anesthesia care unit after total thyroidectomy: A case report.

Yong Duck PARK ; Min Suk KIM ; Rak Min CHOI ; Jae Hoon NOH

Korean Journal of Anesthesiology.2009;57(4):540-543. doi:10.4097/kjae.2009.57.4.540

A patient had respiratory difficulty and hoarseness following total thyroidectomy due to bilateral vocal cord palsy. The patient was a 60-year-old man who underwent total thyroidectomy for papillary carcinoma of the thyroid. He had no laryngeal symptoms prior to the operation. Anesthesia lasted 3.5 hours and was uneventful. Spontaneous respiration resumed after reversal of the neuromuscular blockade. After arriving at the post-anesthesia care unit, he complained of respiratory difficulty and hoarseness. We confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. It is necessary to perform a complete and thorough search for the underlying cause of vocal cord palsy.
Anesthesia ; Carcinoma, Papillary ; Hoarseness ; Humans ; Laryngoscopy ; Middle Aged ; Neuromuscular Blockade ; Recurrent Laryngeal Nerve ; Respiration ; Thyroid Gland ; Thyroidectomy ; Vocal Cord Paralysis ; Vocal Cords

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Dilutional hyponatremia developed during hysteroscopic myomectomy: A case report.

Jong Taek PARK ; Jae Chan CHOI ; Ji Yeon LEE ; Dea Ja UM

Korean Journal of Anesthesiology.2009;57(4):535-539. doi:10.4097/kjae.2009.57.4.535

Hysteroscopy is a procedure that may appear minimally invasive, but may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for the visualization of the endometrium. Fluid overload due to the absorption of distention media during hysteroscopy can cause mild to severe complications, including hyponatremia, hypoosmolarity, nausea, vomiting, headache, arrhythmia, blindness, confusion, seizure, cerebral edema, brain herniation, and death. We report a case of a 41 year-old female patient who underwent elective hysteroscopic myomectomy under general anesthesia. Approximately 4 hours after the beginning of the surgery, the patient's serum sodium concentration dropped to 109 mM. She was treated with furosemide and recovered without sequelae.
Absorption ; Anesthesia, General ; Arrhythmias, Cardiac ; Blindness ; Brain ; Brain Edema ; Endometrium ; Female ; Furosemide ; Headache ; Humans ; Hyponatremia ; Hysteroscopes ; Hysteroscopy ; Nausea ; Seizures ; Sodium ; Vomiting

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Knotting of a guidewire during internal jugular vein catheterization in an infant: A case report.

Hee Kyung KIM ; Ji Won CHOI ; Jong Hwan LEE ; Ae Ryoung LEE

Korean Journal of Anesthesiology.2009;57(4):531-534. doi:10.4097/kjae.2009.57.4.531

Central venous catheterization has been frequently used in pediatric patients in wide variety of conditions. Several authors have described about various complication of central venous catheterization in pediatric patients and reported complication rates of 3% to 6%. Knotting of guidewire as a complication of central venous catheterization has been reported in adult patients, but knotting of guidewire has not been reported in infants. Therefore we report an infant who experienced a knotting of guidewire during internal jugular vein catheterization which was successfully removed without any adverse events. We suggest that knot formation is possible in infants and there should be a high suspicion if resistance is felt at the time of catheter advancement.
Adult ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Humans ; Infant ; Jugular Veins

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Rhabdomyolysis following posterior lumbar interbody fusion in prone position: report 2 cases: Two cases report.

Hyun Kyoung LIM ; Sang Kyu PARK ; Jong Kwon JUNG ; Choon Soo LEE ; Doo Ik LEE ; Jeong Uk HAN

Korean Journal of Anesthesiology.2009;57(4):528-530. doi:10.4097/kjae.2009.57.4.528

The spine surgery performed in the prone position could cause severe complications such as visual acuity impairment, spinal infarct and rhabdomyolysis. When treating rhabdomyolysis, it is important to prevent acute renal failure from accompanying rhabdomyolysis due to the poor prognosis. We have experienced two cases of rhabdomyolysis after spine surgery where dark urine was present during spine surgery under general anesthesia. Anesthesiologists should pay attention for early diagnosis and treatment of the rhabdomyolysis developing during the spine surgery.
Acute Kidney Injury ; Anesthesia, General ; Early Diagnosis ; Prognosis ; Prone Position ; Rhabdomyolysis ; Spine ; Visual Acuity

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Anesthesia for airway surgeries under the perioperative venovenous extracorporeal membrane oxygenation: Three case reports.

Yong Ki LEE ; Sang Hyun PARK ; Jin Young HWANG ; Choon Gun RYU ; Jin Hee KIM ; Sung Hee HAN

Korean Journal of Anesthesiology.2009;57(4):522-527. doi:10.4097/kjae.2009.57.4.522

The airway management for patients with critical airway problems continues to be a challenge to the anesthesiologist. In general cases, conventional ventilation techniques have been used successfully. These include fiberoptic bronchoscope guided intubation, supraglottic airway, endotracheal or endobronchial intubation at operative field, high frequency jet ventilation, etc. However, patients with near-fatal airway obstruction or severely depressed pulmonary function that is refractory to conventional ventilation methods also present. In these cases, cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO) can be used. Although these situations are uncommon indications for ECMO, ECMO can be a potential option for these life threatening conditions. Especially, venovenous (VV) ECMO can be used for pure pulmonary support. We describe three cases of airway surgery requiring ECMO. VV ECMO was established in all cases. ECMO provided adequate temporary pulmonary support and all patients weaned from ECMO successfully without any complication.
Airway Management ; Airway Obstruction ; Anesthesia ; Bronchoscopes ; Cardiopulmonary Bypass ; Extracorporeal Membrane Oxygenation ; High-Frequency Jet Ventilation ; Humans ; Intubation ; Membranes ; Ventilation

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Stress-induced cardiomyopathy during ophthalmologic surgery: A case report.

Kyu Han LEE ; Jong Hwan LEE ; Soo Il LEE ; Seung Cheol LEE ; So Ron CHOI

Korean Journal of Anesthesiology.2009;57(4):518-521. doi:10.4097/kjae.2009.57.4.518

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is a recently described clinical entity which is associated with a chest pain occurring during a stress, an abnormal ECG and/or an increase in the troponin blood level and a transient left ventricular dysfunction. Transient left ventricular dysfunction generally involves the midsection and the apex of the heart with an akinesis. We reported a case of a 55-year-old female patient who developed a stress-induced cardiomyopathy after local epinephrine use during ophthalmologic surgery.
Cardiomyopathies ; Chest Pain ; Electrocardiography ; Epinephrine ; Female ; Heart ; Humans ; Middle Aged ; Takotsubo Cardiomyopathy ; Troponin ; Ventricular Dysfunction, Left

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Phrenic nerve palsy following coracoid infraclavicular brachial plexus block.

Hong Sik LEE ; Jae Hak LEE ; Young Deog CHA ; Sang Kyu PARK ; Chu Hwan SEO ; Jeong Uk HAN

Korean Journal of Anesthesiology.2009;57(4):515-517. doi:10.4097/kjae.2009.57.4.515

Various methods of infraclavicular brachial plexus block have been introduced in the past, of which Wilson's coracoid infraclavicular brachial plexus block, a more lateral approach, consequently thought to be easier and safer. While only a few cases of transient ipsilateral phrenic nerve palsy after infraclavicular brachial plexus block have been reported, we describe a rare case of phrenic nerve palsy after Wilson's coracoid infraclavicular brachial plexus block.
Brachial Plexus ; Paralysis ; Phrenic Nerve

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Dyspnea after supraclavicular brachial plexus block in a morbidly obese patient due to phrenic nerve block: A case report.

Jae Gyok SONG ; Seok Kon KIM ; Dae Geun JEON ; Min A KWON ; Jin Hee YOO

Korean Journal of Anesthesiology.2009;57(4):511-514. doi:10.4097/kjae.2009.57.4.511

A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block.
Anesthesia, General ; Brachial Plexus ; Carpometacarpal Joints ; Chest Pain ; Dyspnea ; Female ; Humans ; Ligaments ; Mepivacaine ; Middle Aged ; Needles ; Obesity, Morbid ; Oxygen ; Phrenic Nerve ; Risk Factors ; Tendons

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Anesthetic experience for orthopedic surgery on a patient with Glanzmann's thrombasthenia refractory to platelet transfusion: A case report.

Jung Bok PARK ; Yang Sik SHIN ; Soo Hwan KIM

Korean Journal of Anesthesiology.2009;57(4):507-510. doi:10.4097/kjae.2009.57.4.507

Glanzmann's thrombasthenia is an autosomal recessive bleeding disorder caused by qualitative or quantitative abnormalities of the platelet glycoprotein IIb/IIIa (GP IIb/IIIa), which can lead to excessive bleeding. Glanzmann thrombasthenia is associated with clinical variability, with some patients only having minimal bruising and others having frequent, severe and potentially fatal hemorrhages. Platelet transfusions, which used to be the standard treatment, may lead to the development of antibodies to HLA and/or GPIIb/IIIa, thereby rendering future transfusions ineffective. Glanzmann's thrombasthenia can be a severe hemorrhagic disease; however, the prognosis is excellent with careful supportive care. In this case, administering allogenic plateletpheresis to patients with Glanzmann's thrombasthenia who were refractory to platelet transfusions was found to be successful during bone surgeries.
Anesthesia, General ; Antibodies ; Blood Platelets ; Glycoproteins ; Hemorrhage ; Humans ; Orthopedics ; Platelet Transfusion ; Plateletpheresis ; Prognosis ; Thrombasthenia

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Asystole induced by laryngosopy and tracheal intubation after induction of general anesthesia: A case report.

Dae Hee KIM ; Sung Yong PARK ; Kyu Dong KYOUNG ; Jin Soo KIM ; You Sun HONG ; Yong Woo HONG

Korean Journal of Anesthesiology.2009;57(4):503-506. doi:10.4097/kjae.2009.57.4.503

Vagal reflex during laryngosopy and tracheal intubation may result in cardiac arrhythmia such as bradyarrhythmia and asystole. A 66-year-old woman, scheduled for coronary artery bypass surgery, received intravenous bolus of midazolam 2 mg, sufentanil 50 microgram, and vecuronium 10 mg for induction of general anesthesia. After two minutes of manual ventilation, tracheal intubation was attempted and the patient became asystolic during laryngoscopic manipulation. The laryngoscope was immediately withdrawn, and the patient returned to normal sinus rhythm. Ten minutes later, more experienced practitioner performed the second laryngoscopic intubation, but it eventually induced asystole again. External cardiac massage was commenced and normal sinus rhythm retuned at a rate of 60 beats/min after 1-2 minute later.
Aged ; Anesthesia, General ; Arrhythmias, Cardiac ; Bradycardia ; Coronary Artery Bypass ; Female ; Heart Arrest ; Heart Massage ; Humans ; Intubation ; Laryngoscopes ; Laryngoscopy ; Midazolam ; Reflex ; Sufentanil ; Vecuronium Bromide ; Ventilation

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