Postoperative nausea and vomiting were compared in 54 patients who underwent gynecologic surgery under propofol (P) or inhalation anesthetics (I: sevoflurane/nitrous oxide) combined with epidural anesthesia. At the end of the operation, 4 to 8ml 0.25% bupivacaine either with morphine (2mg) or buprenorphine (0.2mg), or only bupivacaine was administered through the epidural catheter for postoperative pain relief, followed by continuous infusion of 0.25% bupivacaine at a rate of 2ml•h-1 for 24h. The incidence of postoperative nausea and vomiting (PONV)was lower in group P than group I on discharge (P=0.01). In the ward, however, there were no significant differences between the two groups in respect of postoperative pain, PONV, or itching up to the 2nd postoperative day. We conclude that propofol anesthesia can relieve PONV only in the immediate postoperative period in patients undergoing gynecologic surgery.

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To clarify the effect of mild hypothermia for ruptured aneurysm surgery, perioperative factors, intraoperative hemodynamic parameters and prognosis were compared between patients managed under normothermia and mild hypothermia.
There were no differences in age, sex, preoperative Hunt and Hess grade, location of aneurysms and duration of temporary occlucsion. Cardiac index (normothermia: mild hypothermia, 3.8±0.6: 2.9&plusmn;0.9l&bull;min-1•m-2, p<0.01) and oxygen saturation in jugular bulb (61±6.8:55±7.1%, p<0.05) were lower in mild hypothermic group. There was no difference in neurological outcome.
Protective effect of mild hypothermia was not confirmed in this study. Poorer systemic and cerebral circulation in hypothermic group may contribute the negative results.

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This report describes an unusual complication during attempted central venous catheterization. Using the carotid arterial pulsation as landmark, right internal jugular venipuncture was done with 14G needle with free aspiration of venous blood. Because it was impossible to insert the catheter though the needle, a guidewire was used to assist the catheter placement. The guidewire was inserted with a little resistance, and the catheter was inserted over the guidewire without difficulty. After removal of the guidewire, we found the catheter tip was in the intrathecal space, confirmed by aspiration of cerebrospinal fluid. We speculate that the needle tip was in the vertebral vein, and the guidewire penetrated the venous wall and the dura into the intrathecal space. After the operation, the patient complained pain in right neck and upper extremity. Although the symptom was fully recovered within two weeks, we must acknowledge the possibility of permanent neurological complications. The misplacement occurred because of erroneous judgement of anatomical landmarks. To avoid this complication, when difficulty of puncture or insertion of catheter is exist, we should confirm the anatomical landmarks again by palpating the carotid artery or by ultrasound imaging.

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A 21-year-old woman with intermittent Wolff-Parkinson-White (WPW) syndrome was scheduled for scar revision of the right thigh. On arrival to the operating room, the electrocardiogram (ECG) showed normal sinus rhythm and a narrow QRS complex. Anesthesia was maintained with nitrous-oxide and sevoflurane in oxygen. When we began to decrease the administration of sevoflurane before the end of surgery, the ECG showed that the narrow QRS complex converted to a wide and slurring QRS complex which was characteristic of WPW syndrome. We intravenously administered 1mg•kg-1 propofol to provide adequate depth of anesthesia. One minute after the propofol administration, the slurring QRS complex was normalized. Nitrous-oxide and sevoflurane were then discontinued with termination of surgery. A few minutes later, the wide and slurring QRS complex was returned. The patient was administered 1mg•kg-1 propofol followed by a continuous infusion of 3mg•kg-1•h-1 propofol. The QRS complex was normalized immediately. Propofol was then discontinued in a stepwise fashion and the ECG remained normal during emergence from anesthesia. This observation raises the possibility that propofol may depress velocity of antegrade conduction through accessory pathway in the patient with intermittent WPW syndrome.

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Sympathetic ganglion block with alcohol is very useful nerve block, but the technique of this block without complication is not so easy even for expert hands, because of difficulty of steering of needle and penetration of alcohol into undesirable part of body.
However if we apply radiofrequency thermocoagulation with a curved needle for this block instead of alcohol, we might be able to place a needle tip on the proper surface of vertebra easily and to avoid any complications. We think that radiofrequency thermocoagulation with a curved needle is a new alternative method for lumbar sympathetic ganglion block.

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