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We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.

A 38-year-old woman underwent a 4-hour operation in the prone position for a laminectomy at C4-7 and posterior cervical decompressive fusion at C7-T1 under general anesthesia. After undraping at the end of surgery, considerable swelling with many blisters of the left forearm and hand was observed. The chest roll at the left side had moved cephalad into the axilla and compressed the axillary structures. An emergency fasciotomy to decompress the compartments of the forearm and dorsal surface of the hand was performed. In the post anesthesia care unit, the radial pulse of the left hand was palpable and the level of oxygen saturation was normal. Forearm and hand edema subsided gradually over several days and the patient was discharged with full function of her left arm. This compartment syndrome suggests careful attention should be paid to the position of the chest roll when the prone position is established for a long duration.

We report a case of Rumpel-Leede (RL) phenomenon, - acute dermis capillary rupture, secondary to noninvasive blood pressure (NIBP) monitoring in a patient with type 2 diabetes mellitus (DM) and hypertension. The first most likely cause is vascular fragility in microangiopathy as a result of DM and chronic steroid use. The second is the increased venous pressure during cycling of the blood pressure cuff in a hypertensive state. Anesthesiologists need to be aware that acute dermal capillary rupture, although rare, can occur in patients with long-standing DM, hypertension and chronic steroid use.

Background: Postoperative pain degree is variable according to the site, type, and method of operation. This study compared the pain degree and amount of analgesics required among 3 types of operation. Methods: Ninety patients were selected that cesarean section (Group I, n = 30), open total hysterectomy (Group II, n = 30), laparoscopic total hysterectomy (Group III, n = 30) were scheduled. Patients received PCA with basal rate 2 ml/h, bolus 1 ml, lockout interval 5 min using fentanyl and ketorolac. We evaluated VAS at 30 min, 2, 6, 12, 18, 24, 36, 48 h postoperatively, demand of button and attempt of button, 6 hourly used amount of analgesics; side effects and degree of satisfaction after 24, 48 h postoperatively. Results: The rest VAS decreased below 30 at 6 hr in group I & II and at 2 hr in group III. More analgesics were needed for the first 6 hr compared with remained time in 3 groups (group I vs. group II vs. group III, P ＜ 0.05). Total amount of analgesics including loading dose were fentanyl 1,536 ± 342μg, ketorolac 167 ± 34 mg for group I; 1,212 ± 215μg, 132 ± 30 mg for group II; 866 ± 125μg, 97 ± 27 mg for group III (group I vs. group II vs. group III, P ＜ 0.05). Conclusions: The postoperative pain was painful as order of cesarean section, open total hysterectomy, and laparoscopic total hysterectomy. The pain was reduced 6 hr in laparotomy and 2 h in laparoscopy. (Korean J Anesthesiol 2007; 52: 166～71)