Sang-Gon Lee

Successful tracheal intubation using fiberoptic bronchoscope via an I-gel™ supraglottic airway in a pediatric patient with Goldenhar syndrome -A case report-

The I-gel™ is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel™ supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel™ supraglottic airway. The authors suggest that I-gel™ is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.

Dexmedetomidine combined with midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia

Background Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation. Methods Ninety patients classified as American Society of Anesthesiologists physical status I–II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused. Results At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively). Conclusions Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia.

Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate -A case report-

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.

Atropine injection followed by coronary artery spasm with ventricular tachycardia during spinal anesthesia -A case report-

Bradycardia may occur during spinal anesthesia with atropine commonly used as a treatment. A 44-year-old female with no known history of any underlying diseases, developed a coronary spasm following ventricular tachycardia when 0.5 mg of atropine was injected intravenously to treat bradycardia during spinal anesthesia. The imbalance caused by atropine in the sympathovagal activity may predispose the coronary artery to develop spasms with ventricular tachycardia. Therefore prudent use of atropine should be accompanied by close monitoring.

Intramuscular hematoma with motor weakness after trigger point injection: A case report

Rationale: Although trigger point injection is known as an easy and low-risk procedure, it is contraindicated to patients with hemorrhagic disorders or who regularly take anticoagulants/antiplatelets. However, taking clopidogrel is not a defined contraindication to this low-risk procedure. Patient concerns: The chief complaint of a 76-year old woman regularly taking clopidogrel was low back and left buttock pain which prolonged for several years. Diagnoses: The patient was diagnosed with L4-5 and L5-S1 spinal stenosis at the orthopedics department and was referred for lumbar spinal epidural steroid injection. Intervention: She was treated with trigger point injection. Outcomes: Three hours after the injection, she complained motor weakness and pain in the injection area. A hematoma on left gluteus medium muscle was detected with ultrasonography and ultrasound-guided needle aspiration was accomplished to relieve the symptom. Lessons: Trigger point injection for patients taking clopidogrel should be done with a caution to prevent such complication.