Surgical procedures necessitating the prolonged use of the lithotomy position can be associated with neuromuscular dysfunction. Compartment syndrome of the lower leg is a grave complication which, if unrecognized, can lead to either permanent neuromuscular dysfunction or limb loss. We report a case of compartment syndrome of lower leg that occurred in male patient aged 20 years after 380 minutes arthroscopic surgery in the lithotomy position.

BackgroundMany pieces of previous research on measuring blood pressure (BP) using different methods focused on the disparity in the results. However, none of them dealt with the disparity caused by the difference in age and inhalation anesthetics. We attempted to find the variance in accordance with age, body part, and measuring methods (invasive vs noninvasive) and also studied how sevoflurane influences BP as the operation progresses.MethodsIn sixty patients, we measured the arterial BP in the upper and lower limbs by noninvasive methods before inducing anesthesia. After induction, we used sevoflurane to maintain anesthesia, and injected catheters into the radial artery and dorsalis pedis artery to measure arterial pressure at every ten minute by both invasive and noninvasive methods.ResultsThe patients who were 40 or older showed significantly higher values in the systolic BP than the patients younger than 40. The values of systolic and diastolic BP measured by a noninvasive oscillometric method were meaningfully higher than those measured by an invasive method. As the operations progressed, the lower limbs showed higher systolic pressure than the upper limbs regardless of measuring methods, whereas the opposite is true for diastolic pressure.ConclusionsThe values in the arterial BP were measured high by noninvasive method. Systolic BP were estimated significantly high in the older patients and in the lower leg. Due to the effect of sevoflurane, the diastolic BP in the lower limbs becomes lower than that of upper limbs regardless of measuring methods, as the operation progresses.

PurposeThis study set out to identify the association between the intraperitoneal CO2 concentrations and postoperative pain by dividing the participants into a control group and 2 experimental groups receiving irrigation (1 L and 2 L), and directly measuring their intraperitoneal CO2 concentrations with a CO2 gas detector.MethodsA total of 101 patients, American Society of Anesthesiologists physical status classification I and II patients aged 18–65 years were enrolled in the study. Group 1 did not receive irrigation with normal saline, while groups 2 and 3 were administered irrigation with 1 L and 2 L of normal saline, respectively, after laparoscopic cholecystectomy. Intraperitoneal CO2 concentrations were measured with a CO2 gas detector through the port, and postoperative pain was assessed on a visual analogue scale at 6, 12, and 24 hours after surgery.ResultsThe intraperitoneal CO2 concentrations were 1,016.0 ± 960.3 ppm in group 1, 524.5 ± 383.2 ppm in group 2, and 362.2 ± 293.6 ppm in group 3, showing significantly lower concentrations in groups 2 and 3. Postoperative pain was significantly lower in group 3 at 6 hours after surgery, and in groups 2 and 3 at 12 hours after the surgery. However, there was no significant difference between the 3 groups in postoperative pain 24 hours after the surgery.ConclusionThis study found a causal relationship between the amount of normal saline used for irrigation and the intraperitoneal CO2 concentrations in that irrigation with normal saline reduces pain on the day of the surgery.

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BackgroundLaryngopharyngeal reflux (LPR) disease has many symptoms such as globus pharyngeus, excessive throat clearing and hoarseness. The aim of this study was to investigate the effect of stellate ganglion block (SGB) in addition to proton pump inhibitors (PPI) on LPR.MethodsFifty patients complaining of more than 3 typical LPR symptoms for over 3 months were enrolled in the study. The P group took PPI for 8 weeks. The SP group took PPI and interwent a series of 8 SGB procedure once a week during the period of treatment. The blocks were performed one at a time unilaterally on the right and left stellate ganglions by injecting 1% mepivacaine 6 ml. We evaluated the reflux symptom index (RSI) before treatment and following 4 weeks and 8 weeks of treatment in both groups.ResultsAfter 4 weeks of treatment, the RSI of the P group decreased, but not significantly, to 16.6 ± 6.8 compared with the baseline value of 19.2 ± 2.7 (P = 0.093), whereas the RSI of the SP group decreased significantly to 9.8 ± 3.3 compared with the baseline value of 19.0 ± 4.7 (P = 0.000). After 8 weeks of treatment, the RSI of the P group decreased significantly to 13.7 ± 6.7 (P = 0.001) and the RSI of the SP group also decreased significantly to 7.7 ± 3.4 (P = 0.000). There were significant differences in the RSI between the two groups after 4 weeks (P = 0.000) and 8 weeks (P = 0.001) of treatment.ConclusionsThe symptoms of LPR improved earlier when PPI therapy was combined with SGB compared with PPI therapy alone.