-
A Case of Spontaneous Intracranial Hypotension with Headache and Tinnitus Treated with Epidural Blood Patch : A Case Report
-
Bong Jae Lee
-
Korean J Crit Care Med. 2006;21(2):126-130.
-
-
-
 Abstract
 PDF
- Spontaneous intracranial hypotension (SIH) is a syndrome of low cerebrospinal fluid pressure characterized by postural headaches in patients without any history of dural puncture, back trauma, operative procedure, or medical illness. The clinical spectrum of SIH is quite variable and includes headache, neck stiffness, nausea, horizontal diplopia, dizziness, tinnitus, visual blurring, radicular arm pain.
When the headache persists or more incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is used in the management of SIH and highly effective. I experienced a case of 39 year old female with postural headache and tinnitus who was diagnosed as having SIH and successfully treated with epidural blood patch.
-
Effect of Positive End-Expiratory Pressure on the Concentration of Sodium and Potassium in Plasma and Urine, Plasma Creatinine and Urine Output in Mechanically Ventilated Patients
-
Bong Jae Lee, Kyu Suk Suh, Dong Ok Kim, Dong Soo Kim
-
Korean J Crit Care Med. 1999;14(2):154-160.
-
-
-
Abstract
PDF
- BACKGOUND: It has been suggested that the addition of positive end-expiratory pressure (PEEP) to the patients with ventilator support leads to an impairment on renal hemodynamics and water- and sodium-retaining hormonal systems, such as plasma renin activity (PRA), plasma aldosterone, urinary antidiuretic hormone (ADH).
METHODS
To evaluate the effects of 5 cmH2O and 10 cmH2O PEEP on renal function, we measured the plasma concentration of sodium (Na+), potassium (K+) and creatinine, urinary excretion of Na+, K+ and urine output in eight normovolemic male patients requiring ventilator support. Also changes in mean arterial pressure, pulse rate, arterial oxygen tension (PaO2) and carbon dioxide tension (PaCO2) during the experimental period were measured in these patients.
RESULTS
Both 5 and 10 cmH2O PEEP showed no significant effect on the mean arterial pressure, heart rate, PaO2, and PaCO2. Both 5 and 10 cmH2O PEEP showed no significant effect on the plasma concentration of sodium, potassium and creatinine. 5 cmH2O PEEP showed no significant effect on the urinary excretion of sodium, potassium and urine output, but 10 cmH2O PEEP showed significant effect on the urinary excretion of sodium (19% decrease, p<0.05), and urine output (12.5% decrease, p<0.05) respectively.
CONCLUSIONS
10 cmH2O PEEP was revealed to decrease urinary sodium excretion along with urinary output and this phenomenon was likely to relate with water- and sodium-retaining hormonal systems. These results suggested that it was preferable to apply high PEEP cautiously in patients with impaired renal function.
-
Misconception of Bilateral Vocal Cord Paralysis as Laryngeal Spasm after Endotracheal Extubation
-
Bong Jae Lee, Jae Yong Jeong, Doo Ik Lee, Dong Soo Kim
-
Korean J Crit Care Med. 1999;14(1):47-51.
-
-
-
Abstract
PDF
- We recently experienced an unexpected episode of bilateral vocal cord paralysis following endotracheal extubation after uvulopalatopharyngoplasty and tonsillectomy in 64-year-old man. The patient had no any other clinical manifestations regarding larynx or vocal cord except sleep apnea syndrome prior to this operation. The surgical procedure lasted almost 120 minutes and surgery and anesthesia was uneventful. After restoration of his spontaneous respiration, we tried extubation as usual method. Regardless his effort of spontaneous respiration for several times, he was suddenly apneic and showed declining of arterial oxygen saturation on the pulse oximeter (SpO2). Then we tried reintubation as a decision of laryngeal spasm. This alternative episode of extubation and reintubation was tried again and the causative factor of this respiratory impairment was confirmed as bilateral vocal cord paralysis by fiberoptic bronchoscopic examination in the operating room. Almost two thirds of vocal cord function was restored after six months of operation.
|
KSCCM
