Jun Rho Yoon

Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy

Background Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques. Methods Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation. Results The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05). Conclusions The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.

Thiopental-induced burst suppression measured by the bispectral index is extended during propofol administration compared with sevoflurane.

Background: Thiopental is used to suppress cerebral metabolism during temporary clip ligation of the cerebral arteries. Electroencephalogram (EEG) can measure intraoperative burst suppression as evidence of cerebral metabolic suppression, but EEG is not always available during clip ligation. This study was conducted to compare the effect of propofol-based total intravenous anesthesia (TIVA) with sevoflurane-based inhalational anesthesia on thiopental-induced burst suppression during aneurysm surgery. The effect of thiopental was measured by burst suppression ratio (BSR) using the bispectral index (BIS) monitor. Methods: Forty-six patients who underwent temporary clipping during aneurysm surgery were randomized into 2 groups. The inhalation group (n=21) received sevoflurane-N2O anesthesia and the TIVA group (n=25) received propofol-remifenatanil-N2O anesthesia. The anesthesia level maintained a BIS value between 40 and 55. Pharmacological burst suppression was induced with bolus administration of thiopental (5 mg/kg) before temporary clipping. The BIS number, BSR values, the onset time and duration of BSR, and hemodynamic variables were recorded every minute in both groups. Results: There were no significant differences between groups in the onset time of burst suppression (P=0.394) and BIS changes (P=0.878). However, statistically significant longer duration (P<0.001) and significantly higher degree of burst suppression (P=0.006) were observed in the TIVA group compared with the inhalation group. Conclusions: Our results suggest that at equivalent BIS values TIVA with propofol anesthesia provides longer duration and greater cerebral metabolic suppression compared with sevoflurane-N2O inhalation anesthesia. BIS may be an acceptable alternative to standard EEG monitoring when assessing burst suppression during temporary clipping.

Rhabdomyolysis after laparoscopic radical nephrectomy -A case report-

Rhabdomyolysis is a rare but potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. This devastating disease could be due to muscle compression caused by urologic positioning for a lengthy nephrectomy. In this regard, laparoscopic renal surgery may be a risk for the development of rhabdomyolysis. This phenomenon of massive muscle necrosis can produce secondary acute renal failure. The risk factors have to be managed carefully during anesthetic management. Here, we report a case of a patient with rhabdomyolysis that developed in the flexed lateral decubitus position during laparoscopic nephrectomy.

Anesthetic experience of a patient with hereditary factor XI deficiency (Hemophilia C) - A case report -

Factor XI deficiency (also called Hemophilia C) rarely occurs among ethnicities other than Ashkenazi Jews. A boy was scheduled for frontoethmoidectomy due to bilateral chronic rhinosinusitis. He was incidentally found to have factor XI deficiency due to prolonged aPTT on preoperative laboratory finding. His medical history reveals frequent epistaxis 2 or 3 times per day and his factor XI and XII activity were 17% (normal; 60-140%) and 34% (normal; 60-140%), respectively on furthermore laboratory evaluation. He was diagnosed as hereditary factor XI deficiency. He underwent the operation with administration of the fresh frozen plasma without complication.

Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period

Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.

Anesthetic experience of patients with Fournier's syndrome

Fournier’s syndrome is defined as a suppurative bacterial infection of the perineal, genital, or perianal regions. Those conditions often lead to thrombosis of subcutaneous vessels and with infection, resulting in the development of gangrene of the overlying skin and subcutaneous tissue [1]. This rare syndrome is a rapidly progressive and potentially lethal necrotizing fasciitis caused by invasive infections of the lower part of the genitourinary tract, anorectal soft tissue, and genital skin [1,2]. The devastating rapidity is typical, as evidenced by the fact that the mean duration of symptoms to become the target of emergency operation is just a few days, and a majority of patients are seriously ill at the time of admission. Anesthetic management of patients with this syndrome is often difficult, due to its devastating nature as well as significant comorbid diseases. However, because of the infrequency of the syndrome, there is limited information regarding the anesthetic management of this disease. We recently encountered the anesthetic management in three cases of patients with Fournier’s syndrome. There were three initial emergency and six additional elective operations under general anesthesia, except one spinal anesthesia in an elective case. Therefore, we report these cases and review the relevant literatures. Immediate and, if required, repetitive operation is important for saving lives in patients with this syndrome [1-3]. Fournier’s syndrome is frequently associated with certain diseases and conditions. Diabetes mellitus is probably the most common comorbid disease, as evidenced by our cases [1]. Even when the patient has diabetes, as in our two patients, Fournier’s syndrome might be the first clinical disease to be detected. The second common condition is alcoholism, such as in all our patients, because any disorder that compromises the immunity

Anesthetic management in an angiographic suite: a retrospective review of 88 cases

BACKGROUND Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.