BackgroundThe authors have performed ultrasound-guided stellate ganglion block (SGB) in our clinic using a lateral paracarotid approach at the level of the 6th cervical vertebra (C6). Although SGB at C6 is a convenient and safe method, there are ongoing concerns about the weak effect of sympathetic blockade in the ipsilateral upper extremity. Therefore, ultrasound-guided SGB was attempted using a lateral paracarotid approach at the level of the 7th cervical vertebra (C7). This prospective study aimed to compare changes in skin temperature after SGB was performed at C6 and C7, and to introduce a lateral paracarotid approach for SGB.MethodsThirty patients underwent SGB twice: once at C6 and once at C7. For every SGB, the skin temperature of the patient’s hypothenar area was measured for 15 min at 1-min intervals. Skin temperatures before and after SGB and side effects were compared between C6 and C7 groups.ResultsThe temperature of the upper extremity increased after SGB was performed at C6 and C7. There were significant differences between mean pre-SGB and the largest increases in post-SGB temperatures (0.50±0.38℃ and 1.41±0.68℃ at C6 and C7, respectively; p<0.05). Significantly increased post-SGB temperatures (difference >1℃) were found in 5/30 (16.7%) and 24/30 (80%) cases for C6 and C7, respectively (p<0.05). There were no significant differences in side effects between SGB performed at C6 or C7 (p>0.05).ConclusionThe lateral paracarotid approach using out-of-plane needle insertion for ultrasound-guided SGB performed at C7 was feasible and more effective at elevating skin temperature in the upper extremity than SGB at C6.

Irritability in children has a broad differential diagnosis, ranging from benign processes to life-threatening emergencies. In children with comorbid conditions and developmental delay, the diagnostic process becomes more challenging. This case report describes a developmentally delayed 14-year-old boy who presented with pain and crying caused by a malfunction of a surgically implanted baclofen pump. We describe recommendations concerning the diagnostic evaluation, medical management, and surgical repair.

Pelizaeus-Merzbacher disease (PMD) is a progressive, degenerative chromosomal disorder of the central nervous system (CNS) caused by defective myelin production. PMD is a variant of leukodystrophy, which is characterized by neuromuscular dysfunctions of the CNS. Thus, the clinical symptoms of PMD arise from widespread hypomyelination of the nervous system and include developmental motor disability, ataxia, choreoathetosis, and cognitive impairment. In addition, an anesthesiologist must consider the possibility of abnormal muscle tone, such as spasticity, airway complications due to pharyngeal muscle weakness, and the risks of aspiration and seizure.Only a few case reports have been published on the anesthetic management of patients with PMD because of its low prevalence [1], which is about 0.13 or 1.45 per 100,000 live births [2,3]. Here we present the case of a 13-year-old girl with PMD who underwent elective ophthalmic surgery under general anesthesia. CASE REPORTA 13-year-old girl required general anesthesia for resection and recession of ocular muscles because of intermittent exotropia. Her mental development was delayed by about five years, and she exhibited snoring while sleeping and mild ataxia. She had been diagnosed with PMD by genetic testing at eight years and had been followed twice per annum at a descriptor hospital. However, she had not been medicated for PMD and experienced hypotonia, spasticity, dystonic posturing, and seizures. She had no history of epilepsy, aspi-