Seok Kon Kim

The effect of additional propofol on intubation conditions

STUDY OBJECTIVE To evaluate whether an additional dose of propofol prior to intubation improves intubation conditions. DESIGN Prospective, randomized, double-blinded clinical study. SETTING Operating room in university hospital. PATIENTS 102 ASA physical status I and II patients undergoing elective surgery with general anesthesia. INTERVENTIONS Patients received different doses of propofol (Groups A and B, 1.5 mg/kg; Group C, 2 mg/kg) preceded by fentanyl (1.5 μg/kg). In Group B, additional propofol (0.5 mg/kg) was administered 45 seconds after rocuronium. Intubation was performed 90 seconds after administration of rocuronium 0.6 mg/kg. Intubation conditions and hemodynamic variables were compared among the three groups. MEASUREMENTS AND MAIN RESULTS Intubation conditions were acceptable in 61.8% of Group A patients, 58.8% of Group C patients, and 91.1% of Group B patients (P = 0.005). Mean arterial pressure (MAP) three minutes after intubation was significantly lower in Group C (P = 0.006 vs. Groups A and B), while MAP did not differ between Group A and Group B. CONCLUSIONS Administration of an additional dose of propofol (0.5 mg/kg) prior to intubation may significantly improve intubation conditions without increasing the frequency of hypotension.

Effect on bone formation of the autogenous tooth graft in the treatment of peri-implant vertical bone defects in the minipigs

BackgroundThe aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs.Material and MethodsSix minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge 3.0x10mm fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation.ResultNBF were 48.15 ± 18.02%, 45.50 ± 28.37%, and 77.13 ± 15.30% in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed 37.00 ± 11.53%, 32.25 ± 26.99%, and 1.33 ± 2.31% in 4,8,12 weeks, respectively. BIC ratio were 53.08 ± 19.82%, 45.00 ± 28.37%, and 75.13 ± 16.55% in 4,8,12 weeks, respectively. Those for the control groups were 38.33 ± 6.43%, 33.50 ± 29.51 %, and 1.33 ± 2.31% in 4, 8, 12 weeks, respectively.ConclusionAutogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.

Comparison of ultrasound-guided supraclavicular block according to the various volumes of local anesthetic

Background The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. Methods One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. Results The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 ± 6.9 min, 13.6 ± 4.5 min, 16.7 ± 4.6 min, and 16.5 ± 3.7 min, respectively. There were no significant differences. Horners syndrome was higher in Group 35 (P < 0.05). Conclusions In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block.

Dyspnea after supraclavicular brachial plexus block in a morbidly obese patient due to phrenic nerve block - A case report -

A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block.

Fiberoptic bronchoscope and C-MAC video laryngoscope assisted nasal-oral tube exchange: two case reports

In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device. We report a successful airway conversion under the aid of both, a fiberoptic bronchoscope and a C-MAC video laryngoscope.

Anesthetic Considerations in Pediatric Patients with Epidermolysis Bullosa: A Case Report

Epidermolysis bullosa (EB), a rare genetic disorder with abnormal fragility of skin and mucous membranes, is characterized by blister formation, either spontaneously or following a minor friction. In addition to the skin, it often involves other epithelial-lined organs requiring profound considerations in the anesthetic management related to some comorbidities. Monitoring, difficult airway, positioning, nutritional deficiencies and poor immunity can be challenging for the anesthesiologist in perioperative management. The authers described an experience of a 3-year-old male child with a dystrophic type of EB since birth who underwent hernioplasty. Perioperative careful management and minimal mandatory monitoring might be needed to minimize mechanical injury to the skin and mucous membranes.