Jeong Yeon Hong

Pulmonary edema after da Vinci-assisted laparoscopic radical prostatectomy: a case report.

A 63 year-old man developed sudden pulmonary edema after uneventful robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer despite normal preoperative laboratory findings and appropriate anesthetic management. The pulmonary edema was attributed to prolonged (4 hrs) pneumoperitoneum with concomitant high intraabdominal pressure (15-20 mmHg).

Incidence of venous gas embolism during robotic-assisted laparoscopic radical prostatectomy is lower than that during radical retropubic prostatectomy

BACKGROUNDnRobotic-assisted laparoscopic radical prostatectomy (RALRP) is gaining popularity as a less traumatic and minimally invasive alternative to open radical retropubic prostatectomy (RRP). The aim of this study was to evaluate the incidence and grade of venous gas embolism (VGE) during RALRP compared with those during RRP using transoesophageal echocardiography (TOE).nnnMETHODSnFifty-two patients undergoing RRP (n=26) or RALRP (n=26) were consecutively enrolled. TOE was continuously applied during surgery and VGE was graded by an independent researcher.nnnRESULTSnThe total incidence of VGE (proportion, 95% CI) in the RRP group was higher than that in the RALRP group [20/25 (0.80, 0.60-0.92) and 10/26 (0.38, 0.22-0.58), respectively]. Most VGE in the RALRP group occurred during the transection of the deep dorsal venous complex. There was no difference in the incidence of severe VGE between the two groups. No patients with cardiorespiratory instabilities even with severe VGE were observed in this study.nnnCONCLUSIONSnIn contrast to general belief, VGE occurred less frequently during RALRP. Although the VGE in this study did not cause any cardiorespiratory instability, close monitoring for possibly fatal VGE must be considered during both types of radical prostatectomy because those who undergo radical prostatectomy frequently have cardiopulmonary co-morbidities.

Ultrasound evaluation of the sacral area and comparison of sacral interspinous and hiatal approach for caudal block in children.

Background:Although caudal block via the sacral hiatus is a common regional technique in children, it is sometimes difficult to identify the hiatus. A needle approach via the S2–3 interspace can be used as an alternative to the conventional approach. The authors compared the feasibility and clinical characteristics between the S2–3 approach and hiatal approach, in addition to ultrasound study. Methods:Sacral space depth, dural sac end level, and caudal space depth were evaluated using ultrasound with high-frequency linear probe in the lateral decubitus position in 317 anesthetized children (study 1). In another 162 children who underwent ambulatory urological surgeries, success rate, drug spread, and clinical characteristics were compared between the hiatal and S2–3 approaches (study 2). Results:The dural sac end level was S2U (S3M–L5M). The median depth of the sacral space at the S2–3 level was 7.3 mm, whereas the caudal space depth at the hiatus was 2.9 mm. The overall success rate was 96.3% in both groups. The success rates at the first puncture attempt were 96.2% in the S2–3 group and 77.5% in the hiatus group. Drug spread level and clinical characteristics were similar between the two groups. Conclusions:The S2–3 approach can be applied as a useful fallback method to the conventional landmark approach in children, especially in those older than 36 months who present with difficult identification of the sacral hiatus.

Effects of Thoracic Epidural Analgesia Combined with General Anesthesia on Intraoperative Ventilation/Oxygenation and Postoperative Pulmonary Complications in Robot-Assisted Laparoscopic Radical Prostatectomy

PURPOSEnThe purpose of this study was to evaluate the effects of thoracic epidural analgesia (TEA) on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy requiring high-pressure pneumoperitoneum and the extreme head-down position.nnnMETHODSnSeventy-two patients (age range, 58-76 years) scheduled for elective robot-assisted laparoscopic radical prostatectomy were randomly assigned to receive either TEA combined with general anesthesia (TEA group, n = 36) or general anesthesia (GA group, n = 36). T4-sensory block using 1% lidocaine was continuously provided during surgery in the TEA group but not in the GA group. The mode of ventilation was volume controlled with a linear ramp in the pressure wave. Maximum peak inspiratory pressure was preset at 35 mm Hg, and no positive end-expiratory pressure was administered to the patients. Minute ventilation was adjusted to maintain end-tidal CO(2) between 30 and 35 mm Hg by changing respiratory rate during surgery. Intraoperative ventilatory parameters and blood gas analyses were checked. Clinical and radiological pulmonary complications were observed for 3 days postoperatively.nnnRESULTSnPatients in the TEA group showed significantly lower peak inspiratory pressure and higher dynamic compliance with larger expiratory tidal volume during surgery than those in the GA group. They had significantly better oxygenation and lower concentrations of lactate on arterial blood gas analysis than the GA group. Postoperative clinical and radiological complication rates were not significantly different.nnnCONCLUSIONSnTEA combined with general anesthesia improved intraoperative ventilation/oxygenation. Although clinical and radiologic pulmonary complications were not significantly influenced, TEA can be considered an option for patients with limited reserve capacity or preexisting impairments of visceral blood flow.

Estimating lumbar epidural space depth in infants and children of Korea

BACKGROUNDnLumbar epidural block is now a popular technique for anesthesia and post operative analgesia. It may be helpful for prevention of complication during this procedure to know the depth from the skin to the lumbar epidural space before the procedure. This study was undertaken to evaluate the depth from the skin to the lumbar epidural space and to determine any potential relationship between a patients data (age, weight, and height) and the measured depth in Korean children.nnnMETHODSnWe investigated the electronic records of 662 Korean children who were received urologic surgeries with epidural catheterization for postoperative analgesia. The patients gender, age, weight, height and epidural depth were recorded and analyzed with multiple linear regression test using SPSS 13.0 (SPSS Co., Ilinois, USA).nnnRESULTSnThe patients age and weight were significantly correlated to the skin-epidural space depth in Korean children. Body weight was more significant variable than age on the epidural depth. The empirical formula derived from the results was as follow; epidural depth (mm) = 9 + 0.5 x body weight (kg) - 0.2 x age (months).nnnCONCLUSIONSnWe suggest that the depth of skin-lumbar epidural space can be estimated with the empirical formula based on body weight and age.

Bladder puncture associated with caudal block in a pediatric patient undergoing day surgery - A case report -

Although single-shot caudal blockade is known as a relatively safe procedure, it is not always without complications. We present a case of accidental bladder puncture that was identified with fluoroscopy by chance after single-shot caudal blockade in a 17-months-old, 12 kg boy who underwent inguinal hernioplasty.