Efficacy of intrathecal drug delivery system for refractory cancer pain patients: a single tertiary medical center experience.

Background/purpose: Between 10% and 20% of cancer pain patients fail to obtain adequate pain relief despite comprehensive medical management. The totally implantable programmable intrathecal drug delivery system (IDDS) is an attractive option for managing refractory cancer pain. In suitable patients, IDDS can provide reliable long-term analgesia without any permanent nerve or plexus destruction.

Modified lightwand intubation in a child with spondyloepiphyseal dysplasia congenita.

This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia congenita who was successfully intubated with our modified lightwand intubation procedure for general anesthesia to undergo bilateral herniorrhaphy despite the great likelihood of facing a difficult airway because of unstable cervical spine. We bent the pediatric wand after it was encased in an endotracheal (ET) tube of appropriate diameter. The light tip of the wand was let to protrude just out of the bevel of the ET tube.

Iatrogenic left internal iliac artery perforation during lumbar discectomy.

Iatrogenic intra-abdominal vascular injury can result from lumbar discectomy via the posterior approach. Although it is well known and documented in the literature, few anesthesiologists have personal experience with this life-threatening incident. Here, we report a patient who sustained perforation of the left internal iliac artery at the L(4-5) level during posterior lumbar discectomy.

Cervicofacial subcutaneous emphysema following tonsillectomy: implications for anesthesiologists.

Cervicofacial subcutaneous emphysema is an unusual complication following tonsillectomy. We present a 37-year-old male patient who, after receiving tonsillectomy, developed cervicofacial subcutaneous emphysema immediately following endotracheal extubation. Valsalva maneuvers evidenced by coughing and straining of the patient, and positive pressure ventilation by mask to alleviate laryngospasm in an emergency were believed to induce and exacerbate the emphysema.

Application of Pulse Contour Cardiac Output (PiCCO) system for adequate fluid management in a patient with severe reexpansion pulmonary edema.

We report a case of severe reexpansion pulmonary edema that occurred immediately after reinflation of a collapsed lung by rapid negative pressure drainage of prolonged malignant pleural effusion and pneumohemothorax. Although hemodynamic stability was difficult to maintain under aggressive treatment with inhalation of nitric oxide, inotropics and prostacyclin infusion, conventional pulmonary artery catheterization was not adequate for surveillance and adjustment of fluid therapy. For balancing the preload and the extent of pulmonary edema, pulse contour cardiac output monitoring using a single transpulmonary thermal dilution technique was applied to achieve optimal cardiac preload for organ perfusion and to prevent worsening of pulmonary edema from fluid overload.

The optimal injection time of alfentanil for blunting circulatory responses to tracheal intubation.

Background: The aim of this study is to investigate the optimal injection time of alfentanil during induction of anesthesia to blunt the circulatory responses induced by laryngoscopy and tracheal intubation.

Methods: Seventy-five patients of ASA class I or II were randomly assigned to five groups. Group I was the placebo group in which the patients received normal saline 2 ml just before induction.

Intraoperative bronchospasm after intravenous adenosine during general anesthesia.

Adenosine with its rapid onset and brief duration of action has a number of clinical applications including treatment of paroxysmal supraventricular tachycardia and maximal coronary vasodilatation during pharmacologic stress testing. The adverse effects of adenosine include dyspnea, nausea, headache, chest pain, flushing and bronchospasam. Although there were few reports which mentioned the occurrence of bronchospam after administration of adenosine, a number of studies indicated that the use of adenosine was not contraindicated in patients with chronic obstructive pulmonary disease (COPD) or asthma.

Intraoperative TEE monitoring on pulmonary thromboembolectomy--a case report.

We present a successful thromboembolectomy under intraoperative transesophageal echocardiography (TEE) monitoring on a woman with massive pulmonary embolism (PE). Sudden onset of dyspnea happened 7 days after lumbar spine surgery and ventilation/perfusion scan and angiography performed right away were suggestive of PE. Operation was performed 17 days later after invalid anticoagulant treatments and unavailing catheter fragmentation.

General anesthetic management for diagnostic splenectomy in a patient with paraneoplastic pemphigus.

Paraneoplastic pemphigus (PNP) is an autoantibody-mediated mucocutaneous blistering disease that often occurs with confirmed or occult malignancy. It is often accompanied by extensive eruption of respiratory mucosa and can lead to respiratory failure. The indications for anesthetic management in patients with PNP are rare due to the high risk of generating further eruption of respiratory mucosa during intubation, with potentially disastrous consequences.