Rationale:Although persistent postoperative hiccups can cause various problems (such as sleep disorders, depression, fatigue) for the patient, there has been little research on this topic. The purpose of this study is to determine the effectiveness of treating persistent postoperative hiccups with a stellate ganglion block (SGB), an injection of local anesthetic in the sympathetic nerve tissue of the neck.Patient concerns and diagnoses:Three patients each developed persistent hiccups within 3 days of abdominal surgery, lasting for 3 to 6 days. The patients were diagnosed as having persistent hiccups based on the hiccup duration.Interventions and outcomes:The 3 patients were treated with an SGB. After the procedure, the frequency and intensity of hiccups decreased and then the hiccups stopped completely.Conclusion:An SGB is an effective method that can be considered in conjunction with other treatments for persistent hiccups. Clinicians should be mindful of the negative effects that persistent hiccups can exert on patients.

Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient's symptoms improved without the occurrence of any complications.

Rationale:Thrombosis is a major cause of morbidity in the perioperative period. Although many risk factors are known, activated protein C resistance is a prominent risk for thrombosis. Activated protein C resistance frequently occurs with recurrent thromboembolism.Patient concerns:A 59-year-old Korean woman patient with hypertension was admitted due to dysarthria and left side motor weakness.Diagnosis and interventions:Magnetic resonance imaging showed subacute cerebral infarction with right frontoparietal lobe and stenosis at the right internal carotid artery. She underwent right carotid endarterectomy under general anesthesia. However, recurrent thrombosis on postoperative day 1 was noted at patient's right carotid artery, which prompted emergency surgery. Additional preoperative laboratory review revealed findings for activated protein C resistance, low protein S activity, antinuclear antibody (>1:160), anti-cardiolipin IgM antibody (16.6), and thrombocytosis, Janus kinase and factor V Leiden mutations. At the intensive care unit, heparin was continually infused until postoperative day 12 and was then switched to warfarin.Outcomes:Patient was discharged at postoperative day 21 without any event. Patient had no signs of recurrence within the 3-year follow-up period, and she is still on oral warfarin and clopidogrel.Lessons:Screening test for hypercoagulability can be used to identify patients at higher risk of postoperative complications. If hypercoagulability state is confirmed by laboratory testing, a suitable anticoagulant treatment plan should be made within the perioperative period.