الملخص
Objective@#Agitation is a common symptom in children undergoing surgery, especially when surgeries are performed under sevoflurane and when patients undergo strabismus surgery. Because agitation can increase the risk of falls and lacerations on surgical sites and can delay discharge from the recovery room, adopting measures to reduce the incidence of agitation is essential. This study aimed to compare the agitation-reducing effects of lidocaine and esmolol administered individually or as a combination. @*Methods@#We included 80 patients scheduled to undergo strabismus surgery. Thiopental and sevoflurane were administered to induce general anesthesia. Group EL received lidocaine (2 mg/kg) right after the end of surgery and esmolol (0.5 mg/kg) immediately after recovery from anesthesia after turning the anesthetic gas off; group L received lidocaine at 2 mg/kg right after the end of surgery and did not receive esmolol, group E did not receive lidocaine at the end of the surgery but received esmolol at 0.5 mg/kg right after recovery from anesthesia, and group C received neither esmolol nor lidocaine. Agitation severity was assessed using the objective pain score, Pediatric Anesthesia Emergence Delirium Scale immediately after recovery from anesthesia and until discharge from the recovery room. @*Results@#Groups L and EL showed significantly lower agitation than groups E and C right after recovery from anesthesia, right after arrival to the recovery room, and 10 minutes after arrival to the recovery room (P 0.05). @*Conclusion@#Compared to the groups without lidocaine administration, groups L and EL, which received 2 mg/kg lidocaine, showed a higher level of reduction in agitation immediately after recovery from anesthesia and right after arrival to the recovery room (P < 0.05).
الملخص
Background@#Lightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation. @*Methods@#The study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The ‘C’ group only received 20 ml of normal saline, while the ‘E0.5’, ‘E1’, and ‘E2’ groups received 20 ml of normal saline containing esmolol—0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients’ blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation. @*Results@#The degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group. @*Conclusions@#1–2 mg/kg of a single esmolol injection prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.
الملخص
A 46-year-old male patient was admitted due to sudden hyperhidrosis of face. His past history was chemotherapy with lung cancer, bone metastasis, and brain metastasis. Horner syndrome, such as ptosis, persisted after stellate ganglion blockade. Compression findings around the ganglion and nerve damage were suspected. No unusual abnormalities were observed. Magnetic resonance imaging of the brain showed pressure on the right side of the oculomotor nerve. Ptosis was improved by radiation therapy.
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Herpes zoster is a disease that involves reactivation of the varicella-zoster virus and induces pain by injuring the nerve ganglia. We present the case of a 52-year-old woman without a notable medical history. She complained of painful itches that were causatively associated with infiltration to the ophthalmic nerve of the trigeminal nerve. Furthermore, the patient did not positively respond to antiviral agents, analgesics, and anticonvulsants. However, after inducing a stellate ganglion block, her Visual Analog Scale for pain and itching reduced from a scale of 8 to 2.
الملخص
BACKGROUND@#Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children.@*METHODS@#Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival.@*RESULTS@#The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0-4), RASS = -4 [(-5)-1]) and were transferred to the recovery room (OPS = 0 (0-8), RASS = -1 [(-5)-3]) (P 0.05).@*CONCLUSIONS@#When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room.@*TRIAL REGISTRATION@#Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532.
الموضوعات
Child , Child, Preschool , Humans , Anesthesia , Methods , Double-Blind Method , Injections, Intravenous , Lidocaine , Pharmacology , Propanolamines , Pharmacology , Sevoflurane , Therapeutic Uses , Strabismus , General Surgery , Wakefulnessالملخص
A 6-year-old male patient underwent general anesthesia for laparoscopic appendectomy. During induction of intubation, metallic intubation stylet was broken. Broken piece was confirmed by bronchoscopy and chest radiography and was rapidly removed using a surgical forceps. The patient was discharged on the fifth postoperative day without any adverse effects.
الموضوعات
Child , Humans , Male , Anesthesia, General , Appendectomy , Bronchoscopy , Foreign Bodies , Intubation , Radiography , Respiratory Aspiration , Surgical Instruments , Thoraxالملخص
PURPOSE: This study set out to identify the association between the intraperitoneal CO₂ concentrations and postoperative pain by dividing the participants into a control group and 2 experimental groups receiving irrigation (1 L and 2 L), and directly measuring their intraperitoneal CO₂ concentrations with a CO₂ gas detector. METHODS: A total of 101 patients, American Society of Anesthesiologists physical status classification I and II patients aged 18–65 years were enrolled in the study. Group 1 did not receive irrigation with normal saline, while groups 2 and 3 were administered irrigation with 1 L and 2 L of normal saline, respectively, after laparoscopic cholecystectomy. Intraperitoneal CO₂ concentrations were measured with a CO₂ gas detector through the port, and postoperative pain was assessed on a visual analogue scale at 6, 12, and 24 hours after surgery. RESULTS: The intraperitoneal CO₂ concentrations were 1,016.0 ± 960.3 ppm in group 1, 524.5 ± 383.2 ppm in group 2, and 362.2 ± 293.6 ppm in group 3, showing significantly lower concentrations in groups 2 and 3. Postoperative pain was significantly lower in group 3 at 6 hours after surgery, and in groups 2 and 3 at 12 hours after the surgery. However, there was no significant difference between the 3 groups in postoperative pain 24 hours after the surgery. CONCLUSION: This study found a causal relationship between the amount of normal saline used for irrigation and the intraperitoneal CO₂ concentrations in that irrigation with normal saline reduces pain on the day of the surgery.
الموضوعات
Humans , Cholecystectomy, Laparoscopic , Classification , Pain, Postoperative , Saline Watersالملخص
BACKGROUND: Herpes Zoster is a disease that occurs after the virus is reactivated due to infection of the varicella virus in childhood. Risk factors are advanced age, malignant neoplasm, organ transplantation, immunosuppressive agents taking are known. The purpose of this study was to investigate the relationship between the seasonal effect and other risk factors on the incidence of herpes zoster. METHODS: The medical records of 1,105 patients admitted to the outpatient diagnosed with herpes zoster were retrospectively examined. The patients' sex, age, dermatome, onset, underlying disease, residential areas were collected. RESULTS: The incidence of women outnumbered men and increased for those above the age of 50. The number of occurrences of herpes zoster patients was higher in the spring and summer than in winter. Unlike men, women had the most frequent outbreaks in March. The most common occurrence of dermatome is in the thoracic region. The number of occurrence was similar on the left as the right. CONCLUSIONS: In this study, herpes zoster occurs more often in women than in men and more frequently occurs in women in the spring and summer.
الموضوعات
Female , Humans , Male , Chickenpox , Disease Outbreaks , Epidemiologic Studies , Epidemiology , Herpes Zoster , Immunosuppressive Agents , Incidence , Medical Records , Organ Transplantation , Outpatients , Retrospective Studies , Risk Factors , Seasons , Transplantsالملخص
BACKGROUND: Vancomycin is frequently used as a prophylactic antibiotic in patients undergoing cardiac and orthopedic surgical procedures. However, the interactions of vancomycin with non-depolarizing muscle relaxant have not yet been reported on. Therefore, we studied the effects of vancomycin on the neuromuscular block of vecuronium, rocuronium and atracurium in vitro. METHODS: Square wave, 0.1 Hz supramaximal stimuli were applied to the phrenic nerve-hemidiaphragm preparation of the rat and the twitch height response was recorded. We measured cumulative concentration response curves of vecuronium, rocuronium or atracurium, respectively, and also those of the rats that were pretreated with vancomycin (20 microgram/ml). The EC50 and EC95 of these muscle relaxants alone and those of the rats pretreated with vancomycin were calculated with using an inhibitory sigmoid Emax model. RESULTS: Vancomycin alone did not depress the twitch height. The pretreated vancomycin (20 microgram/ml) did not affect the EC50 and EC95 of vecuronium or rocuronium, but it significantly reduced the EC50 and EC95 of atracurium (P < 0.05). CONCLUSIONS: Vancomycin itself does not have neuromuscular blocking properties. Vancomycin does not affect the neuromuscular blockade induced by vecuronium or rocuronium, but it significantly enhances the neuromuscular blockade induced by atracurium.
الموضوعات
Animals , Humans , Rats , Atracurium , Colon, Sigmoid , Drug Interactions , Neuromuscular Blockade , Orthopedic Procedures , Vancomycin , Vecuronium Bromideالملخص
Although benign, endometriosis possesses the unique ability to invade tissue and to disseminate or metastasize by hematogeneous, lymphatic route, or direct implantation. Scar from operations are occasionally the site of endometriosis implatation. A case of endometriosis in the abdominal scar following cesarean section was experienced and treatd with complete surgical excision. We reported this case with brief review of the literature.
الموضوعات
Female , Pregnancy , Cesarean Section , Cicatrix , Endometriosisالملخص
Until recently, the cervical pregnancy have been treated with surgery, usually hy- sterectomy, because of uncontrollable heavy vaginal bleeding. The development of sophisticated ultrasound which allows early diagnosis of cervical pregnancy and methotrexate chemotherapy opened up new therapeutic options in the management of this unusual but potentially life threatening complication of pregnancy which have been always a nightrnare for the gynecologist. We are reporting a case of cervical pregnancy diagnosed in 12 weeks of gestation. The patient was successfully treated with alternative administration of methotrexate (1 mg/kg, intramuscularly) and leucovorin (0.1 mg/kg, intramuscularly) without surgical intervention, in order to preserve both the uterus and fertility. Follow up was done with serum beta hCG and pelvic ultrasonography. Complete resolution of the cervical pregnancy was obtained at 50 days after starting methotrexate treatment. This case gave us the opportunity to review the recent literature on cervical pregnancy.