[Show abstract][Hide abstract] ABSTRACT: An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction. A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age. From anesthesiologists' point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern. Unexpectedly, it can cause difficult airway such as 'cannnot intubate' or 'cannot intubate and cannot ventilate' situation during anesthesia. Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation. He was discharged 10 days later with no harmful events.
[Show abstract][Hide abstract] ABSTRACT: The estimation of plasma hemoglobin concentration (Hb) is among one of the daily activities in the practice of clinical anesthesiology. The near-infrared spectroscopy of the brain (rSO(2)) represents a balance between cerebral oxygen delivery and consumption. This study was designed to assess the value of rSO(2) in the prediction of the Hb level while other variables were mathematically controlled. Thirty healthy adult patients undergoing spine surgery, expected to have a moderate degree of intraoperative bleeding, were enrolled in this study. General anesthesia was given and ventilation was mechanically controlled. Measurement of Hb and PaCO(2) were performed at random periods of time. We obtained a total of 97 data combinations for the 30 study patients. The Hb was regressed by independent variables including rSO(2) and PaCO(2). A multilinear regression analysis was performed and the final regression equation was expressed only with statistically significant variables. The measured Hb was tightly regressed with three variables. The final regression equation was Hb=+8.580+0.238.rSO(2)-0.338.PaCO(2)-0.004.anesthetic exposure duration (Tmin) (p=0.000, r(2)=0.809). Near-infrared spectroscopy was shown to be a valuable predictor of plasma Hb in the clinical anesthesiology setting.
Journal of Korean Medical Science 09/2008; 23(4):674-7. · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many reports with hypnotics and opiates have been published for nonrelaxant tracheal intubation. In addition to its immediate onset and short duration time, remifentanil can well prevent responses against short and strong stimulation like tracheal intubation. However, the high concentration of remifentanil for nonrelaxant tracheal intubation can cause hemodynamic instability, thus we tried to estimate the predicted effect-site concentration of remifentanil for smooth intubation and provoking hypotension.