Quadriplegia after parathyroidectomy in a hemodialysis patient.

We present a case of post-operative iatrogenic quadriplegia, which occurred after subtotal parathyroidectomy. This patient was on long-term hemodialysis for 7 years. The need of prolonged neck extension for this procedure was probably the main risk factor for the spinal cord injury.

Botulinum toxin A relieved neuropathic pain in a case of post-herpetic neuralgia.

Botulinum toxin type A (BTX-A) has been widely used in many clinical disorders including migraine, cervical dystonia, etc. The use of BTX-A in neuropathic pain, however, is uncommon, and the application of the anti-nociceptive effect of botulinum toxin is emerging. Here we report a case of an 80-year-old man who suffered from severe pain of post-herpetic neuralgia which was refractory to the usual therapies.

Intraoperative latrogenic superior vena cava syndrome complicated by ensuing insidious critical airway--a case report.

Superior vena cava (SVC) syndrome mostly presents the typical and unmistakable symptoms and signs, such as edema and venous distension of the face, neck, arms, and upper chest wall. Dyspnea and symptoms of airway obstruction are often the complaints of conscious patients. However, SVC syndrome if develops intraoperatively may become indistinguishable in view of the lack of utterable complaints of the patient and variable degrees of clinical presentation.

Efficacy and adverse effects of patient-controlled epidural or intravenous analgesia after major surgery.

Background: The purpose of this retrospective study was to determine whether epidural fentanyl-bupivacaine patient-controlled analgesia (PCA) was more efficacious and had fewer adverse effects than epidural or intravenous morphine PCA.

Methods: We retrospectively retrieved data from 859 patients (mean age 64+/-7 years) who received continuous epidural medication, either morphine or fentanyl-bupivacaine PCA, or intravenous morphine PCA for postoperative pain control after major elective surgery from 1999 to 2000. Pain was assessed postoperatively using a verbal analogue pain scale (VAS, 0-10) during rest, mobilization, and coughing.

Paraplegia after delayed detection of inadvertent spinal cord injury during thoracic epidural catheterization in an anesthetized elderly patient.

We report a case of permanent paraplegia in an 81-yr-old patient who had thoracic epidural catheterization performed under general anesthesia for abdominal surgery. The epidural needle was introduced at the T9-10 interspace, and 3 passes were made to locate the epidural space with the loss-of-resistance-to-air technique. During the postoperative epidural pump infusion, the patient was unaware of the progressive motor and sensory impairment.

Desflurane accelerates patient response during the wake-up test for scoliosis surgery.

Purpose: To evaluate if desflurane possesses a shorter wake-up onset time and less incidence of recall than fentanyl-based anesthesia.

Methods: Forty ASA class I-II adolescents, were enrolled into either a desflurane (DES) group, or a fentanyl (FEN) group for scoliosis surgery. Bispectral index (BIS) was monitored continuously in all patients throughout the procedure; the relationship between the wake-up time and BIS value was evaluated.

Myofascial pain syndrome induced by malpositioning during surgery--a case report.

It is a real challenge to the anesthesiologists to differentiate brachial plexus injury (BPI) from myofascial pain syndrome (MPS). The possibility of MPS should be suspected in a patient with complaints of pain and dysfunction of the upper arm immediately after surgery. Here we report a case of gallstone with cervical ankylosing spondylitis who sustained myofascial pain syndrome (MPS) immediately after open cholecystectomy.