BACKGROUND: Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it.CASE: We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature.CONCLUSIONS: There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.
Edema ; Granulation Tissue ; Granuloma, Laryngeal ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Ischemia ; Laryngeal Mucosa ; Neck ; Osteotomy ; Surgery, Oral ; Ulcer ; Vocal Cord Paralysis

Stellate ganglion block (SGB) is an effective method that is used by pain clinicians to treat patients who have pain in the head, neck and arm area. SGB acts mainly by increasing regional blood flow via peripheral vasodilation and decreasing pain sensation by reducing the afferent sensory signals of the sympathetic nervous system in the region. This patient had received more than 450 sessions of left SGB continually for the past 6 years to relieve her left-sided facial pain caused by facial trauma. Out of our curiosity, we tried to obtain some objective dermatological measurements like skin elasticity, water content, and hair follicle density on her scalp and we found that the values were different between the left side of her face and the right side of her face. Here, we report the results and we want pain clinicians to know that repeated SGBs may improve skin elasticity, water content in the skin, and increase the number of hair follicles on the scalp.
Arm ; Elasticity ; Exploratory Behavior ; Facial Pain ; Hair Follicle ; Head* ; Humans ; Methods ; Neck ; Regional Blood Flow ; Scalp ; Sensation ; Skin* ; Stellate Ganglion* ; Sympathetic Nervous System ; Vasodilation ; Water

Stellate ganglion block (SGB) is an effective method that is used by pain clinicians to treat patients who have pain in the head, neck and arm area. SGB acts mainly by increasing regional blood flow via peripheral vasodilation and decreasing pain sensation by reducing the afferent sensory signals of the sympathetic nervous system in the region. This patient had received more than 450 sessions of left SGB continually for the past 6 years to relieve her left-sided facial pain caused by facial trauma. Out of our curiosity, we tried to obtain some objective dermatological measurements like skin elasticity, water content, and hair follicle density on her scalp and we found that the values were different between the left side of her face and the right side of her face. Here, we report the results and we want pain clinicians to know that repeated SGBs may improve skin elasticity, water content in the skin, and increase the number of hair follicles on the scalp.
Arm ; Elasticity ; Exploratory Behavior ; Facial Pain ; Hair Follicle ; Head* ; Humans ; Methods ; Neck ; Regional Blood Flow ; Scalp ; Sensation ; Skin* ; Stellate Ganglion* ; Sympathetic Nervous System ; Vasodilation ; Water

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

A 26-year-old male who had no underlying disease, including coagulopathy, underwent thoracotomy and bleeding control due to hemothorax. On the fifth postoperative day, paralysis of both lower limbs occurred. Urgent spine magnetic resonance imaging showed a massive anterior spinal epidural hematoma from C2 to L1 level with different signal intensities, which was suspected to be staged hemorrhage. Hematoma evacuation with decompressive laminectomy was performed. The patient's neurologic deterioration was recovered immediately, and he was discharged without neurological deficits. A drug history of naftazone, which could induce a drug-induced platelet dysfunction, was revealed retrospectively. To our knowledge, this is the first report of whole spontaneous spinal epidural hematoma in a young patient, with a history of hemorrhoid medication.
Adult ; Blood Platelets ; Hematoma ; Hematoma, Epidural, Spinal* ; Hemorrhage ; Hemorrhoids ; Hemothorax ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Paralysis ; Retrospective Studies ; Spine ; Thoracotomy

A 26-year-old male undergoing thoracotomy and bleeding control received a preoperative thoracic epidural for postoperative analgesia. On the fifth postoperative day, paralysis of both lower limbs occurred and urgent magnetic resonance imaging showed massive anterior epidural hematoma. During laminectomy and decompression, platelet dysfunction was diagnosed and preoperative non-steroidal anti-inflammatory drugs medications were supposed to the cause of platelet dysfunction. After infusion of ten units of platelet concentrate, coagulopathy was improved. We should be more careful to drugs with antiplatelet effect when using regional analgesia.
Adult ; Analgesia ; Analgesia, Epidural* ; Blood Platelets ; Decompression ; Hematoma* ; Hemorrhage ; Humans ; Ketorolac* ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Mefenamic Acid* ; Paralysis ; Thoracotomy

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. RESULTS: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
Anesthesia, General ; Brachial Plexus ; Forearm ; Hand ; Humans ; Mepivacaine ; Needles

BACKGROUND: The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. METHODS: One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. RESULTS: The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 +/- 6.9 min, 13.6 +/- 4.5 min, 16.7 +/- 4.6 min, and 16.5 +/- 3.7 min, respectively. There were no significant differences. Horner's syndrome was higher in Group 35 (P < 0.05). CONCLUSIONS: In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block.
Anesthetics, Local ; Horner Syndrome ; Humans ; Mepivacaine ; Nerve Block

Epiglottic tuberculosis without pulmonary involvement is an uncommon disease that has rarely been described in Korea. We report here a case of a 36 year-old man with a recurrent tuberculosis abscess in his thigh. He had been treated with steroids for systemic lupus erythematosus, and he suffered from recurrent tuberculosis abscess in the thigh where he had received total hip replacement arthroplasty. When inducing general anesthesia for incision and drainage, we noticed a destroyed epiglottis. After consultation with an otolaryngologist, we concluded that the patient has had epiglottic tuberculosis and precautions against tuberculosis infection were taken. The surgery ended without event. The patient recovered safely and was transferred from the operating room directly to the general ward. In this paper, we also discussed the epiglottic tuberculosis and precautions that were taken to prevent tuberculosis infection of the healthcare workers in the operating theater.
Abscess ; Anesthesia, General ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Delivery of Health Care ; Drainage ; Epiglottis ; Humans ; Korea ; Lupus Erythematosus, Systemic ; Operating Rooms ; Patients' Rooms ; Steroids ; Thigh ; Tuberculosis

Intracerebral hemorrhage (ICH) is one of very dangerous complications of preeclampsia/eclampsia. We experienced postoperative ICH in a 39-year-old woman with preeclampsia and HELLP syndrome. The paturient complained severe headache and upper abdominal pain with nausea and vomiting. Her initial blood pressure was 190/120 mmHg and her heart rate was 80 beat/min. The diagnosis of preeclampsia with HELLP syndrome was confirmed by the severe hypertension and the laboratory findings. She was drowsy at the emergency room but she lost consciousness when transferring to the operation room. Caesarean section was done under general anesthesia. After the operation she could not recover self-respiration and consciousness. Her brain CT showed ICH in the basal ganglia with intraventricular hemorrhage and severe brain edema. She expired one the 5 th post operative day due to brain death and multiple organ failure. Early diagnosis is the key to treating ICH.
Abdominal Pain ; Adult ; Anesthesia, General ; Basal Ganglia ; Blood Pressure ; Brain ; Brain Death ; Brain Edema ; Cerebral Hemorrhage ; Cesarean Section ; Consciousness ; Early Diagnosis ; Emergencies ; Female ; Headache ; Heart Rate ; HELLP Syndrome ; Hemorrhage ; Humans ; Hypertension ; Multiple Organ Failure ; Nausea ; Pre-Eclampsia ; Pregnancy ; Vomiting