Acute and Critical Care

Surgery
Iatrogenic Intramural Dissection of the Esophagus after Insertion of a Laryngeal Mask Airway: Hee Young Kim, Seung-Hoon Baek, Yong Hoon Cho, Joo-Yun Kim, Yun Mi Choi, Eun Ji Choi, Jung Pil Yoon, Jung Hyun Park; Acute Crit Care. 2018;33(4):276-279. Published online June 30, 2017; DOI: https://doi.org/10.4266/acc.2016.00829

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In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an i-gel^® (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an i-gel^® . However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.

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Yin-Xiao Chen, Jie Lin, Xian-Hua Ye, Xian-Da Zhao, Qun-Xin Yan
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Hypertensive Crisis during Removal of Retroperitoneal Mass in a Patient with Undiagnosed Paraganglioma - A Case Report -: Hee Young Kim, Joo Yun Kim, Hae Kyu Kim, Seung Hoon Baek; Korean J Crit Care Med. 2013;28(1):64-66.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.64

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Abstract PDF: Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient's hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.

Bronchospasm during Minimally Invasive Cardiac Surgery in a Patient with a Mosaic Attenuation Pattern on Lung Computed Tomography: A Case Report: Eun Soo Kim, Hyeon Jeong Lee, Sung Chun Park, Hee Young Kim, Hyung Gon Je, Jung Min Hong; Korean J Crit Care Med. 2010;25(1):48-51.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.48

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Severe bronchospasm during cardiac surgery is an uncommon, but serious problem. A 52-year-old woman with a mosaic attenuation pattern on the whole lung field was scheduled for repair of an atrial septal defect under minimally invasive cardiac surgery. Bronchospasm developed intraoperatively, but the underlying ventilatory impairment, poor performance of one-lung ventilation and initiation of cardiopulmonary bypass delayed diagnosing and treating the bronchospasm. The bronchospasm induced severe pulmonary edema that required postoperative ventilatory care.

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Pulmonary Edema in Severe Bronchospasm
Charles Her
The Korean Journal of Critical Care Medicine.2010; 25(3): 203. CrossRef

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