- Suddenly fixed upward ocular deviation under general anesthesia
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Won Jae Kim, Sang Jin Park, Myung Mi Kim
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Yeungnam Univ J Med. 2017;34(2):290-292. Published online December 31, 2017
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DOI: https://doi.org/10.12701/yujm.2017.34.2.290
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- Various changes in ocular position are possible during general anesthesia as opposed to the awakening state. However, unexpected ocular deviation under general anesthesia is a disconcerting event as it can lead to difficult complications intraoperatively. To date, sudden fixed upward ocular deviation has been rarely reported previously. This phenomenon was observed in an 8-year-old boy during strabismus surgery. Suddenly fixed upward ocular deviation occurred when the speculum was inserted into the right eye. When the eyeball was pulled down, using forceps, there was some resistance, such as contracture of superior rectus. The eyeball sprang back into the upward position when the forceps was released. These changes could hamper the good exposition of the surgical field, leading to significant intraoperative difficulties and complications. Surgeons should be aware of this possibility, despite general anesthesia; if it occurs, proceed with the surgery as planned preoperatively, and both ophthalmic and anesthetic interventions should be used to solve this problem.
- Medial malleolar fracture associated with deltoid ligament rupture following ankle pronation injury
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Chan Ho Park, Jae Woo Park, Chul Hyun Park, Sang Jin Park
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Yeungnam Univ J Med. 2017;34(1):146-148. Published online June 30, 2017
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DOI: https://doi.org/10.12701/yujm.2017.34.1.146
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- Concurrent injury of medial malleolus and deltoid ligament is difficult to occur considering the injury mechanism. When the concurrent injury comes about, the deltoid ligament injury could be missed and it may lead to medial ankle instability. There are few reported cases of the concurrent injury and domestic case of concurrent failure of both structures over the medial side has been reported just once; however, the injury mechanism is different from this case. The authors report a case of medial malleolus fracture with deltoid ligament rupture following pronation injury with a review of necessity of repairing deltoid ligament for ankle stability.
- A comparison of 0.075% and 0.15% of ropivacaine with fentanyl for postoperative patient controlled epidural analgesia after laparoscopic gynecologic surgery
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Hyun Chul Jung, Hyo Jung Seo, Deok Hee Lee, Sang Jin Park
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Yeungnam Univ J Med. 2017;34(1):37-42. Published online June 30, 2017
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DOI: https://doi.org/10.12701/yujm.2017.34.1.37
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- BACKGROUND
A motor blockade of lower limbs interferes with early ambulation and limits the usefulness of patient-controlled epidural analgesia (PCEA). The concentration of local anesthetic solution is a major determinant for motor block with PCEA. We compared the effects of epidural infusion of 0.075% ropivacaine with 0.15% epidural ropivacaine on postoperative analgesia, motor block of lower limbs, and other side effects. METHODS: A total of 70 patients undergoing laparoscopic gynecologic surgery received epidural infusions (group R1, 0.15% ropivacaine with fentanyl; group R2, 0.075% ropivacaine with fentanyl). Pain score, motor block, and side effects (hypotension, nausea, vomiting, pruritus, urinary retention, dizziness, and numbness) were measured. RESULTS: There were no significant differences in the demographic profiles between the groups. Pain scores of the group R1 and the group R2 were not significantly different. Motor block was more frequent in the group R1 (0.15% ropivacaine with fentanyl) than in the group R2 (0.075% ropivacaine with fentanyl). CONCLUSION: Lower concentration of ropivacaine (0.075%), when compared with higher concentration of ropivacaine (0.15%), seemed to provide similar analgesia with less motor blockade of the lower limbs for the purpose of PCEA.
- Exacerbation of spasticity in ipsilateral shoulder after right brachial plexus block in a patient with right hemiplegia.
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Sang Jin Park, Jong Yoon Baek
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Yeungnam Univ J Med. 2015;32(1):22-25. Published online June 30, 2015
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DOI: https://doi.org/10.12701/yujm.2015.32.1.22
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- Spasticity is a common impairment in patients with central nervous system disease. Clinical observation has demonstrated that spasticity can be aggravated by various factors such as emotional state as well as noxious stimuli. A 51-year-old male patient was scheduled for arteriovenous fistula surgery. He had right hemiplegia including motor weakness and spasticity. It was decided that the surgery would be performed under an axillary brachial plexus block (BPB). He appeared nervous when blockade was terminated. The spasticity of the right shoulder increased after ipsilateral BPB. However, when we administered sedative drugs and performed interscalene BPB 2 days later, spasticity did not occur. Exacerbation of spasticity might be evoked by an anxious emotional state. Thus, it seems to be good to consider removing of anxiety and using an appropriate approach when it is tried to perform nerve blocks in individuals with spasticity.
- An Unexpected Vapor Leakage from Locked Vaporizer.
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Hyun Seok Seong, Sang Jin Park, In Seong Kim
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Yeungnam Univ J Med. 2011;28(1):94-98. Published online June 30, 2011
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DOI: https://doi.org/10.12701/yujm.2011.28.1.94
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- One of the most popular types of vaporizer mounting sytems is Selectatec, as it possesses a simple detachment mechanism. Detachable units can loosen between the vaporizer and anesthetic machine, which can cause vapor leakage. A locking system was subsequently developed to prevent this issue; however, we report a case of an unexpected vapor leakage from a locked vaporizer.
- Anesthetic Management of a Patient with Kimura's Disease.
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Eun Ji Choi, Sang Jin Park
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Yeungnam Univ J Med. 2009;26(1):38-43. Published online June 30, 2009
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DOI: https://doi.org/10.12701/yujm.2009.26.1.38
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- Kimura's disease is an idiopathic chronic condition, associated with a high-titer of IgE and peripheral eosinophilia. It frequently presents as a solitary or multiple lesions in the head and neck area. During the perioperative period, anesthesiologists should understand the anatomical structures of the patient who has Kimura's disease involvement of the head and neck, especially the airway. It is important to pay attention to the occurrence of signs and symptoms of acute allergic reactions related to a high-titer of IgE and eosinophilia. We report our experience with anesthetic management in an 18-year-old patient with multiple neck masses due to Kimura's disease.
- Hemothorax after Central Venous Catherization Failure through the Subclavian Vein.
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Dae Young Kim, Dae Woo Kim, Hee Won Son, Sang Jin Park, Deok Hee Lee
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Yeungnam Univ J Med. 2008;25(2):175-181. Published online December 31, 2008
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DOI: https://doi.org/10.12701/yujm.2008.25.2.175
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- Central venous catheterization via an internal jugular vein or subclavian vein has become a common procedure in monitoring CVP and managing severely ill patients. However, there have beennumerous reports of complications associated with central venous catheterization. These include vessel injury, pneumothorax, hemothorax, nerve injury, arrhythmias, arteriovenous thrombosis, pulmonary embolism, and infection at the insertion site. We report a case of hemothorax after subclavian vein catheterization failure, along with successful treatment.
- General Anesthesia for Extracorporeal Shockwave Lithotripsyin Child with Lesch-Nyhan Syndrome.
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Sang Jin Park, Il chi Kwon, Won Ki Lee, Deok Hee Lee
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Yeungnam Univ J Med. 2008;25(1):78-83. Published online June 30, 2008
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DOI: https://doi.org/10.12701/yujm.2008.25.1.78
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- Lesch-Nyhan syndrome is an inborn error of purine metabolism resulting from hypoxanthine-guanine-phosphoribosyltransferase (HGPRT) deficiency and leading to excess purine production and uric acid over-production. It is a very rare X-linked recessive disorder, characterized by movement disorder, cognitive deficits, and self-injurious behavior. However, because of the high incidence of calculi, patients may present for surgery of urinary tract, and have increased risk of difficult intubation, aspiration pneumonia, renal insufficiency or sudden death. We report the case of a 5-year-old boy with Lesch-Nyhan syndrome who underwent successive extracorporeal shockwave lithotripsy under general anesthesia.
- Ventilation Impairment During Anesthesia in Patients with Anterior Mediastinal Mass.
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Kibum Bum Park, Sang Jin Park, Dae Lim Jee, Bo Hyun Lee
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Yeungnam Univ J Med. 2005;22(1):104-112. Published online June 30, 2005
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DOI: https://doi.org/10.12701/yujm.2005.22.1.104
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- Because of location, a mediastinal mass may cause complications such as a major airway obstruction, a superior vena caval obstruction, and cardiac compression during general anesthesia. The patient's condition need to be assessed by several methods to predict the risks associated with general anesthesia. The authors took computed tomographs for a preoperative evaluation of two patients with an anterior mediastinal mass, and the risk of perioperative complications was predicted by measuring the tracheal area. The patients were managed according to the preoperative evaluation but severe ventilation impairments were encountered during anesthesia. In one patient, stable ventilation could not be maintained until spontaneous breathing appeared. The operation was cancelled and the patient was brought into the ICU. In the other patient, a tracheal tube was inserted deeper in an attempt to pass the narrowed tracheal portion due to mediastinal tumor compression resulting in improved ventilation
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