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: Two patients who underwent thoracic epidural neurolysis after titration using local anesthetic are reported. Case 1 suffered serious back and epigastric pain arising from metastasis of lung cancer and Case 2 was not relieved right chest pain by costal metastasis from urethral cancer only by morphine. Block therapies improve the patients' quality of life if these underwent in opioid resistant pain or moving pain. Among them subarachnoid neurolytic blockage or epidural continuous blockage are usually selected in terminal stage. Subarachnoid blockage is potent but usually induces paresthesia and hypesthesia and patient has to keep lateral position under affected site intraoperatively. Epidural block is easy to treat but is difficult to continue because of infection and decrement of efficacy attributed adhesion of epidural space, stress arose from immobilization. We operate epidural neurolytic blockage for these patients and they were relieves from pain without suffer from the side effect.

Background We experienced the critical aspiration pneumonia during induction of anesthesia in elective abdominal surgery which standard fasting period was complied with. Case presentation A 64-year-old male was scheduled for gastrojejunostomy because of gastrointestinal obstruction. He fasted from the night before surgery. General anesthesia was induced, and cricoid pressure was applied during intubation. However, he vomited huge amount of gastric contents. The scheduled surgery was performed without surgical complications, and postoperatively respiratory management, including mechanical ventilation with prone positioning, was performed in high care unit. He was extubated on postoperative day 2. He was discharged from the hospital on POD 25. Conclusion The standard fasting period can prevent aspiration pneumonia in most cases. However, even in elective cases without abdominal symptoms, we consider that massive-volume gastric residual contents, especially in susceptible cases. We suggest that point-of-care gastric ultrasonography be performed in suspicious cases before induction of anesthesia.

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