Septic embolism and stroke are serious complications in patients with sepsis and often necessitate urgent surgical intervention to control the source of infection. A 69-year-old man presented with severe pain in his back and left thigh. MRI revealed extensive posterior epidural or subdural abscesses extending from the cervical to the lumbar level, as well as an abscess in the iliopsoas muscle. The patient underwent urgent drainage of the abscesses and decompression of the lumbar spine. Postoperatively, he developed sudden-onset atrial fibrillation and altered mental status. Brain CT showed multiple embolic infarctions. His condition deteriorated due to persistent infection, leading to disseminated intravascular coagulation, acute kidney injury, and septic shock. This case highlights the risk of cerebral embolism and hemorrhagic complications in patients with sepsis who undergo surgery. Early recognition of individuals at high risk and comprehensive perioperative management are critical to reducing the likelihood of such complications.
This study was performed to assess the factor affecting the distance from skinto epidural space.
The distance from the skin to epidural space(DSES) was measured in 105 patients who received lumbar epidural anesthesia. The relationship between patient factors [age, weight, height, body mass index(BMI : weight/height2), pregnancy] and technical factor(posture) versus DSES was investigated using multiple regression analysis.
The mean DSES was 4.5±0.7cm. DSES correlated positively with weight and BMI in non-obstetrics(including male), and BMI in obstetrics. But, DSES did not correlated with posture.
The patient's weight and BMI in non-obstetrics and BMI in obstetrics but posture during epidural needle placement are important factors influencing DSES.
, Eun Chi Bang, Eun Ah Yang, Hyun Sook Lee, Yong In Kang, Kyung Sook Cho, Su Yeon Kim To compare the clnical data of general and regional anesthesia for cesarean section in patients with systemic hypertension.
We conducted a retrospective survey with the medical records of the patients with hypertensive disorders in pregnancy, who under went cesarean section from January 1998 to December 2012. We collected data including patients' demographics, anesthesia and maternal and neonatal outcome. According to anesthetic method, the subjects were divided into general anesthesia and regional anesthesia group and the clinical outcome were compared. We reclassified the patients according to the use of magnesium sul fate (MgSO4) and compared the clinical outcomes.
Of the 1,050 hypertensive parturients, 848 (80.8%) patients went through cesarean section. Three hundred and sixty three patients (42.8%) underwent epidural anesthesia, general and spinal anesthesia were used in 268 (31.6%), and 217 (25.6%) patients, respectively. There was no significant difference in maternal and neonatal outcome according to anesthetic method. In the patients administered MgSO4, 1 minute Apgar score was lower and maternal gestational age and birth weight were less than the patients not receiving MgSO4.
Anesthetic methods did not have effect on outcome of cesarean section of the patients with hypertensive disorder of pregnancy.
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, Yong Jae Cho, Do Sang Cho, Myung Hyun Kim, Eui Kyo Seo, Sang Jin Kim Inflammatory response may play role in symptomatic nerve irritation that is associated herniated disc. Steroids decrease neurogenic inflamation, inhibit phospholipase A2 and produce membrane stabilization that result in pain relief. Local anesthetics are believed to break the cycle of pain that exists between local pain and a secondary muscle spasm. Epidural block with steroid combined with local anesthetics(EBSL) are recommended in patients with sign and symptoms of nerve root irritation. The purpose of this study was to asses of ESBL.
A retrospective study undertaken of 20 patients who received ESBL from May 2004 to November 2005 at the pain clinic of Mokdong Hospital Ewha Womans Medical Center. The mean age of the patients was 52, with range from 18-82 years. Nine patients was male, eleven were female. The etiologies of the pain were low back strain(3 patients), bulging disc(9 patients), degenerative disc(4 patients), lumbar stenosis(2 patients) and spondylolisthesis(2 patients). Diagnostic workouts were history, physical and neurologic examinations, and labo-rative studies including simple X-ray and magnetic resonance image. The steroid preparation usedis methylprednisolone and the use of dilute local anesthetics Is mepibacaine. The method of technique of EBSL was median approach with loss of resistance technique. The clinical responsefall into four categories, 6 months follow up after therapy. An excellent response was defined ascomplete resolution of presenting symptoms. A good response was judged to greater than 75%improvement in symptoms with full resumption of the patients life style. A fair response was defined as improvement in the patients condition, whereas a poor response indicated little or noimprovement. The total numbers of blocks were 48 in 20 patients and 2.4/per patient. The duration symptoms within one month were 8 patients and the other 12 patients over one month.
A detailed follow-up of 20 patients with EBSL showed a successful rate(good to excellent) 65%, fair 25%, and poor 10%. The effective responses of EBSL were depend on the etiologies, duration of pains and patients age. All patients of low back strain with one month duration or less have a response rate of very successful excellent. Also all patient with bulging disc who present with pain within one month have a response rate of excellent 3(60%), good 2(40%) and the patient who present with pain of over one month or more have a response rate excellent 1(25%), fair 2(50%) and poor 1(25%). All patients of degenerative disc present with pain of over one month have 50% relative success rate and good 2 patients. The response rate of two patients of spinal stenosis and two patients of spondylolisthesis present pain of long time(2-6 months) and response rate showed fair 3, poor 1, and 0% of successful rate.
EBSL can safely performed and its efficacy has been established in patients with low back strain and bulging disc. The success of this therapeutic procedure depends on attention to selected of patient etiologies and concomitant therapies. In addition, well controlled studics are needed to evaluate any effectivness of EBSL on back pain and radiculopathy.
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