Brugada syndrome is characterized by right bundle branch block, ST segment elevation in the precordial leads and sudden death caused by ventricular fibrillation. We present two successful anaesthetic management cases in patients with Brugada syndrome. Accepted for publication 8 May 2004Key words: Brugada syndrome; complications; electrocardiography; sudden death.# Acta Anaesthesiologica Scandinavica 48 (2004) I N 1992 a new syndrome was described consisting of syncope or sudden death in patients with a structurally normal heart and an electrocardiogram (ECG) characteristic of right bundle branch block with ST segment elevation in leads V 1 to V 3 . This condition was named 'Brugada syndrome' (1). The syndrome is genetically determined and caused by mutations in the gene SCN5A on chromosome 3, encoding the human cardiac sodium channel (2).There are few reports of anaesthetic management of patients with Brugada syndrome, and especially regional anaesthesia of patients with Brugada syndrome. Therefore, we report one case of regional anaesthesia and one case of general anaesthesia in patients with Brugada syndrome. Case report Case 1A 33-year-old man was presented for an emergency orthopaedic operation due to open fracture of the patella. One year ago, before admission, Brugada syndrome was diagnosed in routine cardiologic evaluation. He had no past history of syncope and there was no family history of sudden death. On admission, a physical examination revealed no abnormal findings except ECG findings showing the coved-type ST segment elevation in leads V 1 to V 3 with a right bundle branch block (Fig. 1). Echocardiography showed a normal heart with an ejection fraction of 60%. Electrophysiology study revealed normal sinus node function, but non-sustained ventricular tachycardia was induced by electric ventricular stimulation.Having been informed of the associated risks, the patient was taken to the operating room and routine monitors were applied. A radial arterial cannula was inserted under local anaesthetic. Prior to the induction of anaesthesia, an external defibrillator was prepared. Spinal tapping was carried out at the L4/5 space in right lateral position. Afterwards, 0.5% bupivacaine hydrochloride 10 mg was injected intrathecally and satisfactory spinal block was achieved up to the T 10 dermatome.During the operation, ECG and continuous blood pressure were monitored and showed no abnormalities.After a 2-h operation, the patient was transferred to the post anaesthetic care unit (PACU) and postoperative pain was controlled with intravenous patientcontrolled analgesia (PCA) using opioids and NSAID. Postoperative recovery was uneventful. Case 2A 56-year-old male with L 1 vertebral body compression fracture scheduled for spine fusion under general anaesthesia. His preoperative 12-lead ECG showed a complete right bundle branch block and ST segment elevation (Fig. 2). There was no family history of sudden death. Several years ago, before admission, he had one history of syncope attack. Echocardiogram showed no s...

McGrath VL provides better laryngeal views and lower IDS but similar intubation times and success rates compared with the Macintosh laryngoscope in children with normal airway.

During laparoscopic hepatic resection, an abrupt decrease in FE'CO 2 (from 28 mmHg to 9 mmHg) associated with near cardiac arrest occurred concomitantly with hepatic vein laceration and the use of an argon beam coagulator system. During venous gas embolism, transesophageal echocardiography (TEE) proved the transpulmonary passage of the gas. In the post-operative period, the patient developed pulmonary edema and made a full recovery after 5 days. This is a case report of a possible paradoxic carbon dioxide (CO 2 ) and argon gas embolism by transpulmonary passage during laparoscopic hepatic resection. Accepted for publication 19 April 2007Key words: Venous gas embolism; Argon beam coagulation system; laparoscopy. used in laparoscopic procedures, there is a risk of CO 2 and/or argon gas embolism (1-3). During venous gas embolism, systemic embolization by transpulmonary passage is a rare occurrence; however, it can occur when the filtering capacity of the lungs for venous gas embolism is impaired (4-7). To the best of our knowledge, this is a rare case of CO 2 and argon gas systemic embolization by transpulmonary passage which was proved by transesophageal echocardiography (TEE). Case reportA female patient (61 years, 62 kg, ASA II) underwent resection of the left lobe of the liver for a stone in the intrahepatic duct. She had no specific medical illness on routine laboratory testing. The patient was premedicated with glycopyrrolate [0.2 mg intravenously (i.v.)]. Anesthesia was induced with thiopentone and was maintained with 1.0-2.0 vol% isoflurane in 50% oxygen with air. The fresh gas flow was 4 l/min. Muscle relaxation was carried out with rocuronium. Ventilation was mechanically controlled and adjusted to maintain an end-tidal concentration of carbon dioxide (FE' CO2 ) between 35 and 45 mmHg throughout surgery with a positive end-expiratory pressure (PEEP) of 5 cm H 2 O. Arterial blood pressure was monitored invasively from the right femoral artery, and oxygen saturation with a pulse oximeter (SpO 2 ). Central venous pressure (CVP) was measured intermittently through an indwelling catheter. After the induction of anesthesia, arterial blood gas analysis was normal. Four trocars were inserted and connected to the carbon dioxide source and were insufflated into the abdomen. Intra-abdominal pressure was regulated to less than 12 mmHg. The operation was performed in the head-up position. During dissection, the surgeon used an ABC system (Force Argon TM II; Valleylab TM , Boulder, CO). Three hours after the start of the operation, an abrupt decrease in FE'CO 2 (from 28 mmHg to 9 mmHg) and SpO 2 (from 100% to below 50%) was noted. After a few seconds, systolic blood pressure decreased from 120 mmHg to near zero, and heart rate fell from 75 beats/min to near zero. A gas embolism was suspected, and the surgeon was informed. They acknowledged the laceration of the left hepatic vein. The CO 2 gas was disconnected and 0.4 mg of atropine and 1 mg of epinephrine were given through the CVP catheter. For a moment, the lungs wer...

Systemic venous air embolism is a serious complication in patients with chronic liver disease having liver surgery. Intrapulmonary arteriovenous shunting can permit air emboli to pass into the systemic circulation. We describe a case of paradoxical air embolism detected by transoesophageal echocardiography in a patient with cirrhosis who was having a hepatic resection.

Background: Buckwheat¯our (BF) is known as a potent food allergen. Sensitization to it usually occurs by ingestion but also by inhalation in occupational or domestic exposure. Buckwheat chaff-stuffed pillows (BCP) can be contaminated with BF during the process of pilling, and many Korean children and adults use BCP for health reasons. Methods and Results: We here present three cases of BF allergy in children using BCP, who had been treated as nonatopic asthmatics after undergoing the routine allergy skin tests and serologic tests. We took careful clinical histories, and performed skin prick tests (SPT), the radioimmunoassay (RIA) for speci®c IgE, the BCP-elimination test, the BF bronchial provocation test, and IgE Western blot. All three children showed positive skin reactions to BF, but none of them had positive reactions to house-dust mites. Nocturnal asthmatic symptoms were improved during 7 days of BCP elimination, and asthmatic responses were observed by bronchial provocation tests with homemade BF extract. Serum BFspeci®c IgE antibodies and several IgE-binding proteins were detected by RIA and Western blot analysis, respectively. Conclusions: Thus, a small amount of BF attached to BCP can induce BF sensitization, and BCP should be considered a main cause of childhood nocturnal asthma in those asthmatics exposed to these pillows.