Acute and Critical Care

Case Report

Neurosurgery
Cardiac Arrest from Patient Position Change after Spine Surgery on a Jackson Table: Boohwi Hong, Seok Hwa Yoon, Soo-Yong Park, Seunghyun Song, Ann Youn, Ja Gyung Hwang; Acute Crit Care. 2019;34(1):86-91. Published online February 20, 2017; DOI: https://doi.org/10.4266/acc.2016.00794

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The Jackson table has minimal effects on cardiac function because it does not elevate abdominal and thoracic pressures. In addition, it decreases venous congestion and increases exposure of the surgical field. However, the hips and knees are flexed with inappropriate padding, and venostasis is promoted and increased. Pulmonary thromboembolism (PTE) is fatal; thus immediate diagnosis and treatment are essential. However, clinical signs of intraoperative PTE are difficult to discern. Thrombolytic therapy can be considered as first-line therapy, but bleeding limits its use. The authors report a case of PTE resulting from patient positional change after spine surgery, and the use of immediate postoperative recombinant tissue-type plasminogen activator.

Citations

Citations to this article as recorded by

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions
Lingzhong Meng, Mads Rasmussen, Arnoley S. Abcejo, Deyi M. Meng, Chuanyao Tong, Hong Liu
Anesthesia & Analgesia.2023;[Epub] CrossRef
Perioperative patient positioning following scalp tumor surgery: an anesthetic challenge
Rajnish Kumar, Nishant Sahay, Shagufta Naaz, Ansarul Haq, Rajesh Kumar
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position
DaviBrasil Khouri, MarinaAyres Delgado, JadsonLardy Lemes, MarcelaMorais Afonso Cruz
Saudi Journal of Anaesthesia.2022; 16(4): 485. CrossRef
Pulmonary thromboembolism due to venostasis induced by sitting position during clavicle and pelvic bone fracture surgery
Soomin LEE, Boohwi HONG, Woosik HAN, Man-Shik SHIM, Yoon-Hee KIM, Seok-Hwa YOON
Chirurgia.2021;[Epub] CrossRef

Original Article

Pulmonary
The Usefulness of Intensivist-Performed Bedside Drainage of Pleural Effusion via Ultrasound-Guided Pigtail Catheter: Joo Won Min, Joon Young Ohm, Byung Seok Shin, Jun Wan Lee, Sang Il Park, Seok Hwa Yoon, Yong Sup Shin, Dong Il Park, Chaeuk Chung, Jae Young Moon; Korean J Crit Care Med. 2014;29(3):177-182. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.177

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Abstract PDF: BACKGROUND
There has been little data reporting the usefulness of intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter. The objective of this study is to clarify the usefulness and safety of these methods in comparison with radiologist-performed procedures.
METHODS
Data of patients with pleural effusion treated with US-guided pigtail catheter drainage were analyzed. All procedures were performed from September 2012 to September. 2013 by a well-trained intensivist or radiologist.
RESULTS
Pleural effusion was drained in 25 patients in 33 sessions. A radiologist performed 21 sessions, and an intensivist performed 12 sessions. Procedures during mechanical ventilation were performed in 15 (71.4%) patients by a radiologist and in 10 (83.3%) by an intensivist (p = 0.678). The success rate was not significantly different in radiologist- and intensivist-performed procedures, 95.2% (20/21) and 83.3% (10/12), respectively (p = 0.538). The average duration for procedures (including in-hospital transfer) was longer in radiologist-performed cases (p = 0.001). Although the results are limited because of the small population size, aggravation of oxygenation, CO2 retention, and decrease of mean arterial blood pressure were not statistically different in the groups. Pigtail-associated complications including hemothorax, pneumothorax, hepatic perforation, empyema, kink in the catheter, and subcutaneous hematoma were not found.
CONCLUSIONS
Intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter is useful and safe and may be recommended in some patients in an intensive care unit.

Randomized Controlled Trial

Post-thoracotomy Analgesia & ICU Length of Stay: Comparison of Thoracic Epidrual Morphine Infusion and Lumbar Epidural Plus Intravenous Morphine Infusion: Seok Hwa Yoon, Jung Hyun Lee, Hee Suk Yoon, Yoon Hee Kim, Myung Hoon Na, Seung Pyung Lim; Korean J Crit Care Med. 2007;22(2):77-82.

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Abstract PDF: BACKGROUND
Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group).
METHODS
Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed.
RESULTS
There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital.
CONCLUSIONS
Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.

Case Reports

A Case of Pulmonary Edema which Developed after Difficult Endotracheal Intubation of Hunter Syndrome: A Case Report: Ha Jin Kim, Seok Hwa Yoon, Yoon Hee Kim, Hee Suk Yoon; Korean J Crit Care Med. 2005;20(2):187-191.

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Abstract PDF: Hunter syndrome is one of the mucopolysaccharidoses, characterized by abnormal accumulation and deposition of mucopolysaccharides in the tissues of several organs which are known to complicate anaesthetic and airway management. We experienced a case of pulmonary edema which developed during induction of general anesthesia of Hunter syndrome after several attempts of intubation and airway obstruction.

A Case of Pulmonary Aspiration during the Anesthetic Induction in the Post Total Gastrectomy Patient: Yoon Hee Kim, Sang Soo Kim, Moon Hee Park, Seok Hwa Yoon; Korean J Crit Care Med. 1998;13(1):85-90.

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Abstract PDF: Pulmonary aspiration of gastric contents is a feared complication of anesthetic procedures. But aspiration of intestinal contents is rare, the influences of the aspirated contents and/or the consequnt events in the airway have not been fully settled in its provacative role for causing an acute pulmonary reaction. We experienced a case of pulmonary aspiration of intestinal content. The patinet who had undergone previous total gastrectomy was planed emergency operation due to intestinal obstructon. Aspiration during anesthetic induction occurred accidentally. Immediate endotracheal intubation and suction were followed. Right chest breathing sound was coarse and then it was getting better. Although supplement of O2 by Y-piece, arterial blood gas analysis of patient revealed pH 7.30, PaCO2 36 mmHg, PaO2 58 mmHg after emegence from anesthesia in the recovery room. Chest X-ray showed the focal air space consolidation in right lower lung and ill defined pulmonary opacity in left mid lung and retrocardiac area. The measured pH of aspiration content was 7.8 and nonpathogenic Gram negative bacilli species were cutured. Frequent suction, encouraging expectoration, antimicrobial agents therapy and O2 supplementation by Y-piece were performed in the ICU. Patient normalized following 24 hrs after the episode of aspiration.

Original Article

The Effects of Lipopolysaccharide on the Reactivity of Isolated Rat Trachea with or without Epithelium: Hyo Chul Shin, Yoon Hee Kim, Dong Sik Hur, Seok Hwa Yoon, Yong Sup Shin, Sae Jin Choi; Korean J Crit Care Med. 1998;13(1):25-32.

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Abstract PDF: BACKGOUND: Gram negative bacterial lipopolysaccharide (LPS) induces increase in the production of nitric oxide (NO), or a related substance derived from L-arginine in the animal tissue. Recent evidence indicates that airway epithelium may secrete NO or a related compound. It has multiple regulatory roles in the airways. In vitro, the effects of lipopolysaccharide (LPS) on the reactivity of rat' tracheal wall with or without epithelium were examined.
METHODS
Tracheas were removed from Sprague Dawley rats. Preparations were mounted for isometric recording in 20ml organ baths at 37degrees C containing Tis-buffered Tyrode solution continuously gassed with 100% O2. Tensions were measured with force displacement transducers and responses were recorded on a polygraph. Cummulative concentration-response curves were constructed for acetylcholine (Ach) in the tracheal strips with or without preincubation of Escherichia coli LPS (100 mcg/ml, 5hrs). And then effects of NO synthase inhibitors and removal of epithelium were examined.
RESULTS
In isolated perfused tracheas preincubated by LPS, both removed epithelium and intact epithelium of rat tracheal rings showed decreased Ach-induced contraction. In intact epithelium group, 10 (-5)M L-NAME (N-nitro-L-arginine methyl ester), 10 (-5)M L-arginine or dexamethasone pretreatment was restored in Ach-induced contraction response. But in the removed epithelium group, Ach-induced contraction was potentiated by L-arginine pretreatment and was not restored by the pretreatment of L-NAME and dexamethasone.
CONCLUSIONS
The results suggest that nitric oxide synthase is induced by endotoxin in the tracheal epithelium, resulting in inhibition of the contractile response.

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