A hiccup is the involuntary and sudden contraction of the diaphragm and intercostal muscles, followed by abrupt glottic closure, generating the characteristic sound. Hiccups are usually common, transient, and self-limited [1,2]. However, if the condition persists longer than days or months, it can negatively impact a patient's quality of life, possibly leading to dehydration, exhaustion, fatigue, malnutrition, insomnia, weight loss, depression, anxiety, and rarely death due to ventricular dysrhythmia [3,4]. Moreover, persistent or intractable hiccups make it difficult to maintain the body motionless, and thus interrupt radiologic imaging examinations such as magnetic resonance imaging (MRI) and positron emission tomography -computed tomography (PET-CT) scans.A wide range of pharmacological and non-pharmacological treatments has been used for the management of persistent or intractable hiccups. Drugs commonly recommended for persistent or intractable hiccups have included chlorpromazine, metoclopramide, baclofen, gabapentin, carvedilol, 5-hydroxytryptamine (5-HT) agonists, olanzapine, midazolam, and amantadine [1,2]. In addition, in cases of intractable hiccups that are resistant to pharmacological therapy, various alternative non-pharmacological procedures have been applied. These procedures include phrenic or vagus nerve block, phrenic and/or vagus nerve stimulation, ultrasound-guided pulsed radiofrequency ablation of the phrenic nerve, acupuncture, and cervical epidural block [5][6][7]. Unfortunately, however, despite numerous attempts to develop treatments for persistent or intractable hiccups, including pharmacologic or non-pharmacologic methods, the optimal treatment has not been established because of the low incidence of hiccups, which makes case reports or randomized controlled trials relatively rare.We experienced a case of remission of hiccups following repetitive stellate ganglion block (SGB) in a patient who was

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

Study Design. This is an anatomic study using cadaveric material. Objective. To provide anatomic descriptions of the normal lumbar sublaminar ridge in the lateral recess and its potential to impact on the exiting nerve root there, with implications to surgical technique in lumbar spinal stenosis. Summary of Background Data. The lateral extent of the sublaminar ridge-the bony, superior insertion site of the ligamenta flava-and its topological relationship to the nerve root are not described in the literature. In the setting of degenerative lumbar stenosis this structure can hypertrophy and impinge the nerve root within the lateral recess even after excision of the corresponding ligamentum flavum. Failure to address this may contribute to failed lateral recess decompression. Methods. Fifteen lumbar vertebrae, not obviously degenerated, were resected en bloc from three fixed adult human cadavers and then transected through the pedicles, leaving the posterior column and neural elements intact and articulated. The shape of the sublaminar ridge in the lateral recess and its relationship to the exiting nerve root were carefully examined. Results. The exiting nerve root consistently crosses the sublaminar ridge immediately inferior to the mid-pedicle, lateral to the subarticular gutter, and on the medial aspect of the true intervertebral foramen. A hypertrophic ridge can compress the exiting root by elevating the nerve root superiorly against the bony underside of the pedicle or displacing it anteriorly against the disc or vertebral body. Conclusion. The sublaminar ridge in the lateral recess may contribute to degenerative lumbar stenosis. Comprehensive appreciation of this anatomy may facilitate thorough lateral recess decompression.