Central venous catheterization by Seldinger's technique uses a guidewire which may cause complications such as kinking, knotting and fracture. Fractured guidewire may lead to severe outcomes such as embolization, and removal of it may also cause problems such as vessel damage. We experienced a case of right internal jugular venous catheterization complicated by guidewire fracture entrapped in the central venous catheter, and its successful removal under fluoroscopic guidance using snare-loop. The patient recovered without any complications. When resistance is felt during insertion or withdrawal of the guidewire, force should not be applied to the guidewire and care should also be exercised when passing the tissue dilator over the guidewire. Clinicians should be aware of this rare complication and snare-loop technique could be considered as one of the methods for removal of the fractured guidewire.

BackgroundA decrease in core body temperature caused by heat distribution depends on the anesthetic agent used. The purpose of this study is to investigate the effects of sevoflurane and propofol on core temperature during laparoscopic major abdominal surgery requiring pneumoperitoneum of more than 90 min.MethodsFifty adult patients undergoing laparoscopic major abdominal surgery were randomly assigned to either a sevoflurane group (n = 25) or a propofol group (n = 25). In the sevoflurane group, anesthesia was induced with propofol 2 mg/kg, remifentanil 1.0 µg/kg, and maintained with 0.8-2.0 vol% sevoflurane and 0.1-0.2 µg/kg/min remifentanil. In the propofol group, anesthesia was induced with the effect-site concentration of propofol of 5.0 µg/ml and remifentanil 4 ng/ml, and maintained with the effect-site concentration of propofol of 2-3.5 µg/ml and remifentanil 3-5 ng/ml. Core body temperature was measured with an esophageal stethoscope with a temperature sensor after the start of the pneumoperitoneum (baseline) and at 15-min intervals until completion of surgery.ResultsDuring the study period, core temperature was comparable between the two groups. When compared with baseline values, core temperatures in both groups were significantly decreased 45 min after pneumoperitoneum.ConclusionsThis study demonstrated that in patients undergoing prolonged laparoscopic surgery, a decrease in core body temperature during sevoflurane-remifentanil anesthesia was not different than propofol-remifentanil anesthesia, and the incidence of hypothermia of the two groups did not differ.