, In-Young Yoon, Dong Yeon Kim, Sooyoung Cho OxyMask, a novel product, has recently been used to administer oxygen postoperatively to patients who have undergone general anesthesia. This study aimed to evaluate the incidence of hypoxia in patients under general anesthesia upon arrival to the post-anesthesia care unit (PACU) using arterial blood gas analysis, and to compare the effectiveness of OxyMask with a non-rebreathing oxygen mask for oxygen administration.
We retrospectively investigated anesthesia-related data from the electronic medical records of 460 patients treated from April to November 2021. We analyzed patients aged 20 years or older who had undergone general anesthesia and whose perioperative arterial blood gas analysis results were available upon arrival to the PACU. These patients were grouped into the non-rebreathing oxygen mask (n=223) and OxyMask (n=237) groups, and statistical analysis was performed utilizing their anesthesia records.
No patients exhibited hypoxia upon arrival to the recovery room. The oxygen concentration increased after oxygen administration; its concentration during the recovery room period (Δ2 PaO2) was 10.7±42.3 and 13.9±38.5 mmHg in the non-rebreathing oxygen mask and OxyMask groups, respectively. This difference was not statistically significant. Moreover, the arterial oxygen saturation between the end of surgery and upon arrival to the PACU (Δ1 SaO2) and the arterial oxygen saturation 20 minutes after oxygen administration at the PACU (Δ2 SaO2) did not significantly differ between the groups.
OxyMask was not superior to a non-rebreathing oxygen mask in terms of the effectiveness of oxygen supply.
, Sooyoung Cho, Dong Yeon Kim, Seung Hee Yoo Variant angina, which is associated with coronary artery spam, is difficult to recognize on routine preoperative evaluation. Coronary spasm results in myocardial ischemia and even lethal arrhythmia in severe cases. Since patients are unconscious and cannot complain of symptoms during general anesthesia, early detection of such an event is difficult, and it could lead to severe bradycardia or cardiac arrest. We report a case of a patient with previously undiagnosed variant angina who experienced severe hypotension and ventricular fibrillation during general anesthesia.
Citations
, Heeseung Lee, Soo In Kim, Dong Yeon Kim, Hee Jung Baik, Rack Kyung Chung Some patients with depression require electroconvulsive therapy performed under general anesthesia. This requires rapid loss of consciousness, with minimal interference from seizure activity, appropriate muscle relaxation status, prevention of hyperdynamic responses to the electrical stimulus, and proper recovery of spontaneous ventilation and consciousness. The authors report the first case of electroconvulsive therapy performed with the patient under general anesthesia at the Ewha Womans University Medical Center, Korea.
, Jun Seop Lee, Jong Hak Kim, Youn Jin Kim, Jae Hee Woo, Dong Yeon Kim, Jeong Jeong The phase of the menstrual cycle was demonstrated to have an influence on the incidence of postoperative nausea and vomiting (PONV) after gynecologic laparoscopic surgery, but little was known for breast surgery, which was shown to have relatively higher incidence of PONV, >60%. We performed this study to investigate the influence of the phase of menstrual cycle on PONV after breast cancer surgery.
A total of 103 patients, who were scheduled for breast cancer surgery under general anesthesia, were recruited, and patients with irregular menstrual cycles, history of previous history of PONV were excluded. Groups were divided in two ways as follows: 1) gynecologic classification: premenstrual and menstrual (days 25 to 6), follicular (days 8 to 12), ovulation (days 13 to 15), and luteal phase (days 20 to 24); 2) menstrual classification: menstrual (days 1 to 8) and non-menstrual (days 9 to 28). PONV were recorded using Rhodes index of nausea, vomiting and retching at postoperative 6 and 24 hours.
The overall incidence of PONV during postoperative 24 hours was 35.4%. At the menstrual classification, the incidence of PONV at postoperative 24 hours was higher in the menstrual group than that in the non-menstrual group (16.7% vs. 4.2%, P=0.057). The severity of PONV, measured with Rhodes index of nausea, vomiting and retching was significantly different between menstrual and non-menstrual groups (P=0.034).
The duration and severity of the PONV after breast cancer surgery were demonstrated to be prolonged and aggravated during menstruation, respectively. Therefore, consideration of menstrual cycle for scheduling breast cancer surgery could effectively prevent the PONV and reduce medical cost.
Citations
, Youn Jin Kim, Jae Hee Woo, Rack Kyung Chung, Dong Yeon Kim, Ji Seon Chae We present an uncommon case of hypoesthesia in the posterior and upper third of the superior area on the left ear auricle, after arthroscopic surgery of the shoulder in the lateral position under general anesthesia with ultrasound guided-interscalene brachial plexus block. A 65-year-old man underwent arthroscopic rotator cuff repair of the left shoulder in the right lateral decubitus position. Two days after operation, he complained of numbness around the left auricle; his symptoms persisted until 6 weeks after surgery. Audiometry and sensory examinations were normal. He recovered naturally by 6 months postoperatively. Postoperative neurological deficits that may not be block-related can be attributed to a combination of factors, such as patient-, anesthesia-, and surgery-related factors, including direct trauma, positioning, and retraction. Anesthesiologists should be aware that the injury may not be block-related and consider other possible causes.
Citations
, Youn Jin Kim, Jong Hak Kim, Dong Yeon Kim, Guie Yong Lee, Chi Hyo Kim Vasovagal syncope is one of the most common causes of transient syncope during anesthesia for elective surgery in patients with a history of syncope and requires special attention and management of anesthetics. The causes and pathophysiological mechanism of this condition are poorly understood, but it has a benign clinical course and recovers spontaneously. However, in some cases, this condition may cause cardiovascular collapse resulting in major ischemic organ injury and be life threatening. Herein we report a case and review literature, regarding completing anesthesia safely during an elective surgery of a 59-year-old female patient with history of loss of consciousness due to suspected vasovagal syncope followed by cardiovascular collapse and cardiac arrest, which required cardiopulmonary resuscitation and insertion of a temporary pacemaker and intra-aortic balloon pump immediately after a fine-needle aspiration biopsy of a lung nodule located in the right middle lobe.
, Guie Yong Lee, Jong In Han, Dong Yeon Kim, Rack Kyong Chung, Jong Hak Kim, Chi Hyo Kim, Choon Hi Lee Preoxygenation is recommended in order to prevent hypoxemia with hypoventilation or apnea during induction of anesthesia. The purpose of this study was to determine the duration of preoxygenation required to achieve an end-tidal oxygen fraction(FE'O2) of 0.9 in children and adults.
In 24 healthy children and adults breathing 100% oxygen, end tidal oxygen and carbon dioxide concentration have been measured at 15 seconds interval from the start of liter per minute. The gas sampling line of the Capnomac II(Datex, Helsinki, Finland) was placed in the nasal cavity.
The study showed that all children attained an FE'O2 of 0.9 within 75s of preoxygenation, but adults had not reached an FE'O2 of 0.9 within 180s.
More oxygen wash-in would be expected in children. We suggested that at least 3 min of preoxygenation should be performed before intravenous induction of anesthesia in children.
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