RESUMEN
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.
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Humanos , Colecistectomía Laparoscópica , Clasificación , Dolor Postoperatorio , Aguas SalinasRESUMEN
BACKGROUND: Laryngopharyngeal reflux (LPR) disease has many symptoms such as globus pharyngeus, excessive throat clearing and hoarseness. The aim of this study was to investigate the effect of stellate ganglion block (SGB) in addition to proton pump inhibitors (PPI) on LPR. METHODS: Fifty patients complaining of more than 3 typical LPR symptoms for over 3 months were enrolled in the study. The P group took PPI for 8 weeks. The SP group took PPI and interwent a series of 8 SGB procedure once a week during the period of treatment. The blocks were performed one at a time unilaterally on the right and left stellate ganglions by injecting 1% mepivacaine 6 ml. We evaluated the reflux symptom index (RSI) before treatment and following 4 weeks and 8 weeks of treatment in both groups. RESULTS: After 4 weeks of treatment, the RSI of the P group decreased, but not significantly, to 16.6 +/- 6.8 compared with the baseline value of 19.2 +/- 2.7 (P = 0.093), whereas the RSI of the SP group decreased significantly to 9.8 +/- 3.3 compared with the baseline value of 19.0 +/- 4.7 (P = 0.000). After 8 weeks of treatment, the RSI of the P group decreased significantly to 13.7 +/- 6.7 (P = 0.001) and the RSI of the SP group also decreased significantly to 7.7 +/- 3.4 (P = 0.000). There were significant differences in the RSI between the two groups after 4 weeks (P = 0.000) and 8 weeks (P = 0.001) of treatment. CONCLUSIONS: The symptoms of LPR improved earlier when PPI therapy was combined with SGB compared with PPI therapy alone.
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Humanos , Ronquera , Reflujo Laringofaríngeo , Mepivacaína , Faringe , Inhibidores de la Bomba de Protones , Ganglio EstrelladoRESUMEN
BACKGROUND: Many pieces of previous research on measuring blood pressure (BP) using different methods focused on the disparity in the results. However, none of them dealt with the disparity caused by the difference in age and inhalation anesthetics. We attempted to find the variance in accordance with age, body part, and measuring methods (invasive vs noninvasive) and also studied how sevoflurane influences BP as the operation progresses. METHODS: In sixty patients, we measured the arterial BP in the upper and lower limbs by noninvasive methods before inducing anesthesia. After induction, we used sevoflurane to maintain anesthesia, and injected catheters into the radial artery and dorsalis pedis artery to measure arterial pressure at every ten minute by both invasive and noninvasive methods. RESULTS: The patients who were 40 or older showed significantly higher values in the systolic BP than the patients younger than 40. The values of systolic and diastolic BP measured by a noninvasive oscillometric method were meaningfully higher than those measured by an invasive method. As the operations progressed, the lower limbs showed higher systolic pressure than the upper limbs regardless of measuring methods, whereas the opposite is true for diastolic pressure. CONCLUSIONS: The values in the arterial BP were measured high by noninvasive method. Systolic BP were estimated significantly high in the older patients and in the lower leg. Due to the effect of sevoflurane, the diastolic BP in the lower limbs becomes lower than that of upper limbs regardless of measuring methods, as the operation progresses.
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Humanos , Anestesia , Anestesia General , Anestésicos por Inhalación , Presión Arterial , Arterias , Presión Sanguínea , Catéteres , Pierna , Extremidad Inferior , Éteres Metílicos , Arteria Radial , Extremidad SuperiorRESUMEN
Surgical procedures necessitating the prolonged use of the lithotomy position can be associated with neuromuscular dysfunction. Compartment syndrome of the lower leg is a grave complication which, if unrecognized, can lead to either permanent neuromuscular dysfunction or limb loss. We report a case of compartment syndrome of lower leg that occurred in male patient aged 20 years after 380 minutes arthroscopic surgery in the lithotomy position.
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Anciano , Humanos , Masculino , Artroscopía , Síndromes Compartimentales , Extremidades , Pierna , OrtopediaRESUMEN
H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation.
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Adulto , Humanos , Masculino , Persona de Mediana Edad , Anestesia General , Capnografía , Esófago , Hematoma , Intubación , Boca , Parto , Tórax , Fístula Traqueoesofágica , VentilaciónRESUMEN
BACKGROUND: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. METHODS: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n = 30), 0.15% ropivacaine + fentanyl 4 microg/ml] or IV-PCA [Group IV-PCA (n = 30) fentanyl 20 microg/kg + ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C)7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. RESULTS: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV- PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. CONCLUSIONS: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction.
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Femenino , Humanos , Amidas , Analgesia , Analgesia Epidural , Analgesia Controlada por el Paciente , Analgésicos , Anestesia General , Presión Sanguínea , Mama , Catéteres , Fentanilo , Frecuencia Cardíaca , Incidencia , Ketorolaco , Mamoplastia , Mastectomía , Dolor Postoperatorio , Anafilaxis Cutánea PasivaRESUMEN
Corticosteroid preparations have anti-inflammatory and immunosuppressive properties and are used widely for the treatment of allergic disorders and asthma. Steroids themselves, however, can induce hypersensitivity reactions. In this study, we report the case of a 66-year-old man with chronic obstructive pulmonary disease who exhibited an allergic reaction (rash, bronchospasm, bradycardia, severe hypotension and cardiac arrest) immediately after the intravenous injection of methylprednisolone sodium succinate. Despite cardiopulmonary resuscitation, sinus rhythm was not restored. The anesthesiologist should be aware that allergic reactions to corticosteroids can occur.
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Anciano , Humanos , Corticoesteroides , Asma , Bradicardia , Espasmo Bronquial , Reanimación Cardiopulmonar , Hipersensibilidad , Hipotensión , Inyecciones Intravenosas , Hemisuccinato de Metilprednisolona , Enfermedad Pulmonar Obstructiva Crónica , EsteroidesRESUMEN
BACKGROUND: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. METHODS: Twenty eight patients were assigned to receive diagnostic laparoscopy (n = 12) or laparoscopic surgery (n = 16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. RESULTS: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P < 0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P < 0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P < 0.05). CONCLUSIONS: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children.
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Niño , Humanos , Presión Arterial , Frecuencia Cardíaca , Insuflación , Laparoscopía , Neumoperitoneo , Frecuencia Respiratoria , Volumen de Ventilación PulmonarRESUMEN
The general anesthesia combined with epidural anesthesia have many advantages, which are including early recovery, postoperative analgesia, and less requirement of inhalation anesthetic. But the complications of epidural anesthesia such as total spinal anesthesia, respiratory depression, myocardial ischemia, and local anesthetic toxicity can lead to cardiac arrest. We report a case of acute myocardial infarction in a 74-year-old female patient receiving general anesthesia combined with epidural anesthesia. The profound hypotension without bradycardia and ST-segment elevation in lead II occurred 1 hour after local anesthetic injection and cardiac arrest followed. After the injection of atropine, epinephrine and dopamine, and external cardiac massage, sinus rhythm was restored. Postoperative serial examinations of ECG showed ST-segment elevation in leads II, III, aVF and serum enzymes such as CPK, CK-MB, and Troponin T were elevated. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.
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Anciano , Femenino , Humanos , Analgesia , Anestesia Epidural , Anestesia General , Anestesia Raquidea , Angioplastia Coronaria con Balón , Atropina , Bradicardia , Dopamina , Electrocardiografía , Urgencias Médicas , Epinefrina , Paro Cardíaco , Masaje Cardíaco , Hipotensión , Inhalación , Infarto del Miocardio , Isquemia Miocárdica , Insuficiencia Respiratoria , Troponina TRESUMEN
BACKGROUND: The popularity and the demand for Nuss procedure have increased dramatically. Many pediatric surgeons became familiarized with Nuss procedure and have applied it to a large number of patients. But the intraoperative and the postoperative complications have not been defined yet. METHODS: 630 patients, who underwent the Nuss procedure between August 1999 and December 2006, were studied retrospectively. Risk factors and complications were obtained from chart review and anesthesia records, and analyzed statistically. RESULTS: Complication rates were 127/630 (20.1%) in total patients. Frequent complications were arrhythmia 37 (5.8%), pneumothorax 29 (4.6%), pleural effusion 15 (2.4%), wound infection 14 (2.2%), bar displacement 13 (2%) and pericarditis 9 (1.3%) in order. Resk factors are severity of pectus excavatum and lack of surgeon's experience (P < 0.05). CONCLUSIONS: Nuss procedure has evolved into an effective method of pectus excavatum repair. To reduce the complications, there must be precise preoperative assessment of computed tomography index (CTI) and intensive postoperative management in the operative day.
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Humanos , Anestesia , Arritmias Cardíacas , Desplazamiento Psicológico , Tórax en Embudo , Pericarditis , Derrame Pleural , Neumotórax , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Infección de HeridasRESUMEN
Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view and improvement of the pulmonary function, but the complications such as heart injury, bar displacement, hemothorax, pneumothorax and tension pneumothorax sometimes occur. We experienced a 12 year-old female, who showed profound hypotension with a bradycardia and severe reduction in oxygen saturation followed by the tension pneumothorax after the operation by the Nuss method. The patient was treated with the immediate thoracostomy and recovered without any other problem. In anesthetic management of the pectus excavatum repair by the Nuss method, we should always pay attention to the possible occurrence of tension pneumothorax.
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Niño , Femenino , Humanos , Bradicardia , Tórax en Embudo , Lesiones Cardíacas , Hemotórax , Hipotensión , Oxígeno , Neumotórax , Acero Inoxidable , ToracostomíaRESUMEN
BACKGROUND: Thoracic paravertebral blockade (TPVB) can be effective in many clinical settings. However, many clinicians are reluctant to use this technique due to its adverse effects such as pneumothorax. The aim of this study was estimate the appropriate depth and width for safe needle positioning. METHODS: The depth from skin to the paravertebral space (PVS) and the width from the spinous process (SP) to the PVS and the lateral tip of the transverse process (LTTP) were measured in all available sections from 84 patients examined by chest computed tomography (CT). The correlation between age, gender, body mass index (BMI) and each measured value was analyzed. RESULTS: All 828 sections from the 84 patients aged between 19 and 65 years old were evaluated. The minimum and maximum values of the mean depth from the skin to PVS were 40.3-52.4 mm in men and 41.2-55.9 mm in women. The minimum and maximum values of the mean width from the SP to LTTP were 29.2-34.6 mm in men and 23.7-31.0 mm in women. At every thoracic level, the depth to PVS was similar in both genders but the width from the SP to the NEP in men was significantly higher than in women. Weight significantly influenced the width from the SP to LTTP in men but height and BMI did not. Also weight and BMI significantly influenced the depth from skin to PVS in almost all of the thoracic region at both sex, but height did not influence the depth from skin to PVS in both sex. CONCLUSIONS: We report clinically useful estimates that may be used to help avoid side effects such as pneumothorax and achieve a successful thoracic paravertebral blockade.
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Anciano , Femenino , Humanos , Masculino , Índice de Masa Corporal , Agujas , Neumotórax , Piel , TóraxRESUMEN
Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration.
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Humanos , Bradicardia , Puente Cardiopulmonar , Tórax en Embudo , Atrios Cardíacos , Hemotórax , Hipotensión , Laceraciones , Pulmón , Derrame Pericárdico , Pericardiectomía , Pericarditis Constrictiva , NeumotóraxRESUMEN
A 6-year-old-man with a severe pectus excavatum and marfanoid feature was admitted for the correction of pectus excavatum. Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view. This method is that convex steel bar is inserted under the sternum through small bilateral thoracic incisions, and when it is in position, the bar is turn over, thereby correction the deformity. We experienced a case of the cardiac arrest during the rotation of a stainless steel bar. After the injection of atropine, epinephrine and the closed cardiac massage, sinus rhythm was restored. A vasovagal reflex due to the operation could be considered the possible etiology.
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Humanos , Atropina , Anomalías Congénitas , Epinefrina , Tórax en Embudo , Paro Cardíaco , Masaje Cardíaco , Reflejo , Acero Inoxidable , Acero , EsternónRESUMEN
Goldenhar syndrome is a rare congenital disorder of hemicraniofacial and vertebral defects related to the abnormal development of the first and second branchial arches. In some infants, congenital heart disease, and pulmonary and renal defects are also present. Goldenhar syndrome commonly involves an airway which is difficult to manage. Tracheal intubation may be difficult due to a combination of retrognathia, micrognathia, mandibular hypoplasia, palatal defects and vertebral abnormities. We experienced the anesthetic management of an 8-month-old boy with Goldenhar syndrome who received excision and biopsy for conjunctival dermoid and ureteral reimplantation for vesicoureteral reflux under general anesthesia. Airway management, with thiopental, rocuronium and sevoflurane, and tracheal intubation were accomplished successfully in the patient. Surgery was performed uneventfully and the patient was discharged without complication.
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Humanos , Lactante , Masculino , Manejo de la Vía Aérea , Anestesia General , Biopsia , Región Branquial , Enfermedades y Anomalías Neonatales Congénitas y Hereditarias , Quiste Dermoide , Síndrome de Goldenhar , Cardiopatías Congénitas , Intubación , Reimplantación , Retrognatismo , Tiopental , Uréter , Reflujo VesicoureteralRESUMEN
BACKGROUND: A prospective study was performed to evaluate the preventive effect of intravenous (IV) ondansetron on postoperative nausea and vomiting (PONV) due to epidural morphine for postoperative pain control after major abdominal surgery. METHODS: One hundred patients undergoing elective major abdominal surgery were randomly devided into two groups, group O (n = 50) receiving IV ondansetron and group C (n = 50) receiving IV saline. After bolus epidural morphine were injected to all patients thirty minutes before the end of surgery, group O received ondansetron 8 mg and group C received normal saline intravenously. Incidence and severity of nausea, episodes of vomiting, patient's satisfaction, side effects such as pruritus, headache, dizziness related to epidural morphine were checked at 6, 24 hours after operation. RESULTS: The incidence and severity of nausea were significantly decreased in group O than group C during the first 24 hours after surgery. There were no significant differences in postoperative pain scores and patient's satisfaction between groups. The patients who didn't experienced PONV were significantly more satisfied than those who experienced PONV after surgery. CONCLUSION: Ondansetron decrease the incidence and severity of nausea in patients receiving epidural morphine for postoperative pain control after major abdominal surgery.
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Humanos , Mareo , Cefalea , Incidencia , Morfina , Náusea , Ondansetrón , Dolor Postoperatorio , Náusea y Vómito Posoperatorios , Estudios Prospectivos , Prurito , VómitosRESUMEN
Hiccups are due to an intermittent clonic spasm of the diaphragm. In most cases, hiccups are self-limiting disease, but persistent hiccups may be related to the presence of serious underlying systemic disease. Two patients who had persistent hiccups that were not controled by conventional methods and medications were referred to the pain clinic. We administered a single oral medication of gabapentin, and then the hiccups disappeared in both cases. We concluded that gabapentin should be considered as an alternative therapy to control persistent or intractable hiccup. It could be particularly useful for those patients with solid malignancies, either alone or as an "add-on therapy" with other oral agents.
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Humanos , Diafragma , Hipo , Clínicas de Dolor , EspasmoRESUMEN
BACKGROUND: Many factors cause postoperative hepatic dysfunction, and anesthetic agents and type of surgery are belived to contribute to hepatic dysfunction. The authors planned this study to evaluate the effect of different anesthetic agents (sevoflurane, desflurane, enflurane or propofol) on liver enzymes in the patients who undergone laparoscopic cholecystectomy. METHODS: 80 patients were randomly selected from among those who had undergone cholecystectomy and divided into 4 groups; an enflurane group (n = 20), a sevoflurane group (n = 20), a desflurane group (n = 20) and a propofol group (n = 20). Preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those on postoperative days 1 and 3 in all groups. RESULTS: In all groups, ALT and AST were significantly elevated after operation, and then showed a decrease 3 days after operation, but remainrd of above preoperative levels (P < 0.05). However, no differences were observed between the 4 groups (P < 0.05). CONCLUSIONS: We consider that propofol, sevoflurane, desflurane and enflurane are equally usable and that they have little effect on liver function after laparoscopic cholecystectomy.
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Humanos , Alanina Transaminasa , Fosfatasa Alcalina , Anestesia , Anestésicos , Aspartato Aminotransferasas , Colecistectomía , Colecistectomía Laparoscópica , Enflurano , Hígado , PropofolRESUMEN
Involvement of the peripheral nerveous system by diabetes is referred to as diabetic neuropathy. The frequency of diabetic neuropathy ranges from 5% to 60% and the pain management is one of the greatest problem. The patient was a 57-year-old man who has been treated with diabetes(DM type IIa) for about 12 years. The symmetrical pain, swelling and sensory loss on feet were started 3 months before admission and the burning pain was intensified at night with resultant insomnia. The systoms were aggravated 1 month ago and they were not relieved by any medication and physical therapy. We attempted lumbar epidural block to the patient and the result was good. So we performed a permanent lumbar sympathetic ganglion block with neurolytics(99.9% alcohol) for the long term relief of pain. The patient was satisfied with the result of the block and discharged.
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Humanos , Persona de Mediana Edad , Quemaduras , Neuropatías Diabéticas , Pie , Ganglios Simpáticos , Metabolismo , Manejo del Dolor , Trastornos del Inicio y del Mantenimiento del Sueño , Sistema Nervioso SimpáticoRESUMEN
Numerous neuropathologic sequelae of cardiopulmonary bypass have been reported. These include embolism, cerebral infarction, neuronal degeneration, subarachnoid hemorrhage and intracranial hemorrhage. These sequelae may account for the neurologic and behavioral desorders in the postoperative period. We report a case of intracranial hematoma following total correction of TOF. An emergency craniotomy was performed to evacuate the hematoma, but the patient failed to regain consciousness following surgery and expired on the 17th postoperative day. In this patient, two factors responsible for the pathogensis of intracranial hemorrhage anre postrulated. First, in the pressence of intraoperative heparin administration, significant hematoma formation may result from damage to the bridging during vein from minor head trauma or alterations in cerebral volume from fluid shift, which may occur during bypass. Second, preexisting arterivenous malformation may be a source of hemorrhage under heparin administration. These hematoma are potentially reversible, so early diagnosis and therapy is extremely improtant.