Chang Jae Kim

Effect of High-Dose Vitamin C on Oxygen Free Radical Production and Myocardial Enzyme after Tourniquet Ischaemia–Reperfusion Injury during Bilateral Total Knee Replacement

This study investigated the effects of high-dose vitamin C on oxygen free radical production and cardiac enzymes after tourniquet application and ischaemia–reperfusion injury during bilateral total knee replacement (TKR) in elderly patients. In the vitamin C (VC) group (VC group, n = 16), during surgery, patients received a priming bolus of 0.06 g/kg vitamin C with 100 ml saline followed by 0.02 g/kg vitamin C mixed with 30 ml saline, intravenously. The control group (n = 16) received no intra-operative vitamin C. In the VC group, malondialdehyde levels were lower, and arterial oxygen tension and mean blood pressure were higher, than in controls after post-operative deflation of both knee tourniquets. Troponin I levels were lower in the VC group than in controls 8 h post-operation. Administering high-dose vitamin C during bilateral TKR could prevent oxygen free radical production and a decline in arterial oxygen tension and mean blood pressure induced by ischaemia–reperfusion injury, thereby protecting the myocardium.

Airway fire injury during rigid bronchoscopy in a patient with a silicon stent -A case report-

Therapeutic bronchoscopy is widely employed as an effective first-line treatment for patients with central airway obstructions. Airway fires during rigid bronchoscopy are rare, but can have potentially devastating consequences. Pulmonologist and anesthesiologist undertaking this type of procedure should be aware of this serious problem and be familiar with measures to avoid this possibly fatal complication. We report the case of a 24-year-old patient with a silicone stent who experienced an electrocautery-induced airway fire during rigid bronchoscopy.

Successful airway management with combined use of McGrath ® MAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter -a case report

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.

Hemoptysis during general anesthesia in a diabetic patient with healed tuberculosis: a case report

Hemoptysis is a common complication of pulmonary tuberculosis. Most of the cases of hemoptysis originate from hypertrophied bronchial arteries. Also, diabetes induces pulmonary vascular abnormalities such as endothelial dysfunction, inflammatory infiltration and pulmonary vascular remodeling. A 27-year-old male, with diabetes and a history of tuberculosis, underwent the procedure of pars plana vitrectomy under general anesthesia. After an uneventful intra-operative period, he had hemoptysis prior to extubation. Emergency fiberoptic bronchscopy showed blood plugs and spotted fresh blood at the right upper lobar bronchus. After successful embolization of the bronchial artery, the patient made a recovery and was discharged without experiencing any complication. Predisposing factors of hemoptysis in this case are presumed to be tuberculosis and diabetes. The bleeding might had been caused by the rupture of a weakened artery within the cavity in the right upper lobe, through expansion of the lung during manual ventilation by positive pressure.

Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report.

Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.

Tracheal granuloma after thyroidectomy with difficult intubation.

Tracheal complications after endotracheal intubation or tracheostomy include tracheal stenosis, ulcers, granulomas and tracheomalacia [1]. Of these, tracheal granuloma is a rare complication, and common on the anterior wall of the subglottis [2]. We experienced a case in which a patient with symptoms of airway obstruction due to tracheal granuloma after total thy roidectomy underwent resection of a tracheal granuloma and anastomosis under general anesthesia after bronchoscopy. A 55-year-old male patient had undergone total thyroid ectomy due to thyroid cancer. However, symptoms of upper respiratory infection, cough and sputum, continued after discharge. After 4 months, stridor and dyspnea developed, and flexible bronchoscopy was performed to assess. A granuloma about 1 cm × 1 cm in size was found 3 cm below the vocal cords on fiberoptic bronchoscopy. The patient was transferred to our hospital for diagnosis and treatment using interventional rigid bronchoscopy. According to the history of the first operation, the patient was 166 cm tall and, weighed 73 kg, with a body mass index of 26, classified as, mildly overweight. He had had predictive signs of difficult intubation: short neck, Mallampati class III, thyromental distance of 2 fingerbreadths. He had not had any respiratory symptoms. A 1.5 cm × 1.0 cm-sized thyroid cancer was founded, but no abnormal findings at any other sites were noted on neck computed tomography (CT) scan. On laryngoscopy, the patient’s airway was classified as CormackLehane grade IIIa. His trachea was intubated using an ID 6.5 mm endotracheal tube with stylet after trials with an ID 8.0 mm reinforced an endotracheal tube and an ID 7.0 mm plain endotracheal tube with inserted stylet. The cuff volume was about 5 cc. Anesthesia was adequately maintained with N2O-O 2sevoflurane at bispectral index 44 -58 during the thyroidectomy. The surgeon placed a 10 cm high pillow under the shoulder and extended the neck simultaneously for the thyroid surgery. The operating time for the thyroidectomy was 84 minutes. In our hospital, CT scan revealed a polypoid mass about 1 cm in length with erosion of cartilage in the right lateral aspect of the upper trachea, along with tracheal stenosis (Fig. 1A). To facilitate the performance of rigid bronchoscopy, propofol and remifentanil were used with rocuronium as anesthetic agents. However, the rigid bronchoscopy could not be performed because the patient had a short neck and limited neck extension. Therefore, the tracheal granuloma was inspected by flexible bronchoscopy instead of rigid bronchoscopy (Fig. 1B), and the trachea was intubated by guided flexible bronchoscopy using an ID 6.5 mm endotracheal tube. The decision was made to perform surgery on the patient in the Department of Thoracic Surgery on the following day. During the second operation, the tracheal region including the granuloma was resected and the trachea was anastomosed under general anesthesia using N2O-O 2-sevoflurane. A 1.0 cm × 1.0 cm-sized granuloma was located on the lower cricoid car tilage and stenotic change was observed around the granuloma. As a result of this tissue biopsy, the mass was diagnosed as a typical granuloma with ulcer and sclerosis. Because this patient had undergone thyroidectomy due to thyroid cancer, we assumed that a mass in the trachea might be caused by extended cancer. However, the mass was located at the region of the tube-tip and had a yellowish and smooth sur

The effects of callander modification of laryngoscopic blade on hemodynamic changes according to the degree of difficult airway

BACKGROUND Laryngoscopy and tracheal intubation are known to have profound cardiovascular effects. The Callander modification of Macintosh blade is associated with greater field of laryngoscopic view and decreased risk of dental contact. The purpose of this study was to compare the hemodynamic responses to laryngoscopy and tracheal intubation according to the degree of difficult airway, and to evaluate the usefulness of Callander modification of Macintosh blade for attenuating the hemodynamic responses. METHODS One hundred, forty-eight patients scheduled for elective surgery were divided into Easy group and Difficult group by Wilsons risk sum score. Laryngoscopy was performed using either an ordinary Macintosh No. 3 blade or the modified Macintosh blade. The modification consisted of reducing the height of the flange by partial removal, as described by Callander et al. Hemodynamic variables (systolic, diastolic, mean blood pressure, heart rate and rate pressure product) were noted before induction (baseline) and immediately after intubation. RESULTS The hemodynamic changes after tracheal intubation in Difficult group were significantly greater than those in Easy group (P < 0.05). When using the modified blade, systolic, diastolic and mean blood pressure after tracheal intubation were lower than those using the conventional blade regardless of Wilsons risk sum score, but no statistical significances could be found. CONCLUSIONS The hemodynamic changes after tracheal intubation increased as the degree of airway difficulty increased. Laryngoscopy with the Callanders modified blade did not reduce the degree of hemodynamic stimulation compared with the conventional Macintosh blade.