Tae Kwan Kim

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.

Comparison of the Predictive Power of the LODS and APACHE II Scoring Systems in a Neurological Intensive Care Unit

OBJECTIVE: A prospective study to compare the power of the Logistic Organ Dysfunction System (LODS) and the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring systems to predict survival, in patients admitted to the neurological intensive care unit (NICU). METHODS: Clinical data from 521 consecutive NICU patients were collected during the first 24 h of admission and were used to compare the predictive power of both scoring systems. RESULTS: The observed mortality rate was 10.0% compared with predicted mortality rates of 7.2% and 4.8% according to LODS and APACHE II, respectively. Both scoring systems had excellent discrimination but LODS had superior calibration. CONCLUSION: The LODS scoring system was more stable than the APACHE II scoring system in the NICU setting.

The effect of thioctic acid on allodynia in a rat vincristine-induced neuropathy model

Objective To investigate the antiallodynic effects of thioctic acid in vincristine-induced neuropathy in rats. Methods Neuropathy was induced in Sprague–Dawley rats via vincristine intraperitoneal injection. After 15 days, rats were investigated for the presence of mechanical and cold allodynia, and those with allodynia received intraperitoneal injection with normal saline or 1, 5, or 10 mg/kg thioctic acid. Mechanical and cold allodynia were assessed before treatment and at 15, 30, 60, 90, 150 and 180 min after treatment. Results Mechanical and cold allodynia were reduced by thioctic acid injection. The duration of effect increased with thioctic acid dose. Conclusion Thioctic acid may be an effective treatment for vincristine-induced neuropathy.

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.

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