Background: We compare the diversity and niche specificity of the microbiome in the trachea-oropharynx microbiome of malignant breast neoplasm with or without neoadjuvant chemotherapy (NAC) via NGS analysis. Methods: We prospectively collected a total of 40 endotracheal tubes intubated from subjects, of whom 20 with NAC treated breast cancer (NAC group) and 20 with breast cancer without NAC (Non-NAC group). We generated 16S rRNA-based microbial profiles in IlluminaTM platform and alpha diversity indices were compared between groups. For the comparison of taxa abundance, linear discriminant analysis effect size method with Kruskal-Wallis test was used. The distribution of variables between the two groups was compared using the Mann-Whitney test. For beta diversity analysis, PERMANOVA was used. Results: Among the diversity indices, the NAC group showed significantly lower Chao1, Inverse Simpson, and Shannon indices than the Non-NAC group. The three most frequent taxa of all two groups were Streptococcus (20.4%), followed by Veillonella (11.9%), and Prevorella (10.4%). This order was the same in NAC and non-NAC groups. Conclusion: Here, we provide the first comparison data of the respiratory tract microbiome of breast cancer patients with or without NAC via NGS analysis. This study ultimately seeks to contribute to future studies on the lower respiratory tract in cancer patients with cytotoxic chemotherapy by establishing reliable control data.
Breast Neoplasms , Microbiota , Humans , Female , Breast Neoplasms/drug therapy , Trachea/pathology , Neoadjuvant Therapy/adverse effects , RNA, Ribosomal, 16S/genetics , Intubation, Intratracheal , Oropharynx/pathology , Microbiota/genetics
STUDY OBJECTIVE: Although the performance of phase lag entropy (PLE), a new depth-of-sedation monitor based on the diversity of temporal patterns in the phase relationships in electroencephalogram (EEG) data, during propofol sedation has been proven through several studies, since different sedatives have different effects on EEG, we aimed to evaluate the performance of the PLE in comparison with the bispectral index (BIS) during dexmedetomidine sedation. DESIGN: A prospective, observational, and non-inferiority trial. SETTING: Tertiary university hospital operating room. PATIENTS: Forty-two patients aged 20-80 years who were scheduled to undergo elective surgery under spinal anesthesia and had American Society of Anesthesiologists (ASA) physical status I to III were enrolled in this study. INTERVENTIONS: Dexmedetomidine was administered with a loading dose of 0.5-1 µg/kg for 10 min, followed by a maintenance dose of 0.3-0.6 µg/kg/h. MEASUREMENTS: The depth of sedation was assessed using the modified observer's assessment of alertness/sedation (MOAA/S) scale; the data for PLE and BIS were collected; and vital signs, including blood pressure, heart rate, EKG, and pulse oximetry, were evaluated. MAIN RESULTS: 215,082 data points for the MOAA/S score and PLE and BIS values were analyzed. The baseline variabilities of PLE and BIS were 4.53% and 7.02%, respectively. The Spearman correlation coefficients of the MOAA/S score with PLE and BIS were 0.599 and 0.566, respectively. The prediction probabilities of the MOAA/S score with PLE and BIS were 0.647 and 0.636, respectively. When the MOAA/S score was 3 points, the mean (SD) values of PLE and BIS were 68.35 (15.68) and 75.85 (9.81), respectively, However, the mean (SD) values of PLE and BIS for an MOAA/S score of 1 point were 56.08 (12.49) and 68.29 (12.65), respectively. CONCLUSIONS: PLE shows potential as a hypnotic depth indicator during dexmedetomidine sedation, and its performance was not inferior to that of BIS.
Anesthesia, Spinal , Dexmedetomidine , Propofol , Dexmedetomidine/pharmacology , Electroencephalography , Entropy , Humans , Hypnotics and Sedatives , Prospective Studies
BACKGROUND: Differences in the effects of propofol and dexmedetomidine sedation on electroencephalogram patterns have been reported previously. However, the reliability of the Bispectral Index (BIS) value for assessing the sedation caused by dexmedetomidine remains debatable. The purpose of this study is to evaluate the correlation between the BIS value and the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale in patients sedated with dexmedetomidine. METHODS: Forty-two patients (age range, 20-80 years) who were scheduled for elective surgery under spinal anesthesia were enrolled in this study. Spinal anesthesia was performed using 0.5% bupivacaine, which was followed by dexmedetomidine infusion (loading dose, 0.5-1 µg/kg for 10 min; maintenance dose, 0.3-0.6 µg/kg/h). The MOAA/S score was used to evaluate the level of sedation, and the Vital Recorder program was used to collect data (vital signs and BIS values). RESULTS: A total of 215082 MOAA/S scores and BIS data pairs were analyzed. The baseline variability of the BIS value was 7.024%, and the decrease in the BIS value was associated with a decrease in the MOAA/S score. The correlation coefficient and prediction probability between the two measurements were 0.566 (P < 0.0001) and 0.636, respectively. The mean ± standard deviation values of the BIS were 87.22 ± 7.06, 75.85 ± 9.81, and 68.29 ± 12.65 when the MOAA/S scores were 5, 3, and 1, respectively. Furthermore, the cut-off BIS values in the receiver operating characteristic analysis at MOAA/S scores of 5, 3, and 1 were 82, 79, and 73, respectively. CONCLUSION: The BIS values were significantly correlated with the MOAA/S scores. Thus, the BIS along with the clinical sedation scale might prove useful in assessing the hypnotic depth of a patient during sedation with dexmedetomidine.
BACKGROUND: This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. METHODS: The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. RESULTS: Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 µg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 µg, P < 0.001, P = 0.003, respectively). CONCLUSIONS: Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.
BACKGROUND: Higher levels of anxiety increase the risks of surgery, including morbidity and mortality. The objectives of this study were to measure anxiety and depression during the preoperative period and to identify the degree of knowledge and concerns of older patients and their family protectors regarding anesthesia, and the causes of these concerns. METHODS: We administered a questionnaire to older patients scheduled to undergo surgery and their family protectors one day prior to the surgery. The questionnaire included tools for quantifying anxiety and depression (Anxiety-Visual Analogue Scale, the Amsterdam Preoperative Anxiety and Information Scale, State-Trait Anxiety Inventory Korean YZ Form, and Short Form Geriatric Depression Scale). We also asked about the concrete causes of anxiety using pre-created forms. RESULTS: There were 140 older patients and family protectors who participated in the study. The majority of older patients (n = 114, 81.4%) undergoing surgery and their family protectors (n = 114, 81.4%) indicated that they were anxious. Most of the older patients and their family protectors responded that they had insufficient knowledge about anesthesia, and they were mostly worried about failure to awaken following surgery, and postoperative pain. Older patients with higher anxiety scores showed higher depression scores. There were significant differences in depression scores depending on the presence of cohabitating family members. CONCLUSIONS: It is important to remember that older patients with higher depression scores have higher anxiety during the preoperative period.
BACKGROUND: Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. METHODS: We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. RESULTS: The mean age of patients with VCP was 51.3 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. CONCLUSIONS: We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.
BACKGROUND: Postoperative sore throat (POST) is a complication that decreases patient satisfaction and increases postoperative complaints. The present study was conducted to investigate effects of gargling with dexamethasone, intravenous dexamethasone injection and the combination of the two on the incidence and severity of POST. METHODS: Study participants were 96 patients who had undergone laparoscopic cholecystectomy, randomly allocated into three groups. Group G gargled with 0.05% dexamethasone solution and were infused intravenous 0.9% normal saline before general anesthesia; group I gargled with 0.9% normal saline and were infused intravenous 0.1 mg/kg dexamethasone; group GI gargled with 0.05% dexamethasone solution and were infused intravenous 0.1 mg/kg dexamethasone. The incidence and severity of POST, hoarseness and cough were evaluated and recorded at 1, 6, and 24 h after the surgery. RESULTS: There were no significant differences in the total incidence of POST up to 24 postoperative hours among Group G, Group I and Group GI (P = 0.367, Group G incidence = 34.38%, [95% confidence interval, 95% CI = 17.92-50.83], Group I incidence = 18.75%, [95% CI = 5.23-32.27], Group GI incidence = 28.13%, [95% CI = 12.55-43.70]). The other outcomes were comparable among the groups. CONCLUSIONS: In patients who had undergone laparoscopic cholecystectomy, gargling with 0.05% dexamethasone solution demonstrated the same POST prevention effect as intravenous injection of 0.1 mg/kg dexamethasone. The incidence and severity of POST were not significantly different between the combination of gargling with 0.05% dexamethasone solution and intravenous injection of 0.1 mg/kg dexamethasone and use of each of the preventive methods alone.
BACKGROUND: Postoperative sore throat (POST) is a complication that undermines patient satisfaction and increases discomfort in the postoperative period. The present study examined the effects of dexamethasone gargle and endotracheal tube cuff soaking on the incidence and severity of POST. METHODS: Ninety patients undergoing laparoscopic cholecystectomy were randomly allocated into three groups: 0.9% normal saline gargling and tube soaking (group C), 0.05% dexamethasone solution gargling and 0.9% normal saline tube soaking (group G), 0.9% normal saline gargling and 0.05% dexamethasone tube soaking (group S). The incidence and severity of POST were then assessed and recorded at 24 hours after surgery. RESULTS: The total incidence of POST was significantly different among the groups (P < 0.05), and group S exhibited a significantly lower incidence of POST than group C (P < 0.0167). In addition, the POST intensity of group G and group S was less severe than those of group C (Both P < 0.0167). CONCLUSIONS: Among patients undergoing laparoscopic cholecystectomy, those who gargled with 0.05% dexamethasone solution exhibited lower severity of POST than the control group, and those whose endotracheal tube cuff was soaked in the dexamethasone solution before intubation exhibited significantly lower incidence and severity of POST than the control group.
BACKGROUND: Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. METHODS: Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. RESULTS: The initial body temperatures were 36.5 ± 0.3â vs. 36.4 ± 0.4â in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3â vs. 34.9 ± 0.3â; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3â vs. 35.2 ± 0.2â in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. CONCLUSIONS: The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.
BACKGROUND: Sugammadex is a novel neuromuscular reversal agent, but its associated hypersensitivity reaction and high cost have been obstacles to its widespread use. In the interest of reducing the necessary dosage of sugammadex, the reversal time of the combined use of sugammadex and neostigmine from moderate neuromuscular blockade were investigated. METHODS: The patients enrolled ranged in age from 18 to 65 years old with American Society of Anesthesiologists class 1 or 2. The subjects were randomly assigned into one of the four groups (Group S2, S1, SN, and N; n = 30 per group). The reversal agents of each groups were as follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1 mg/kg + neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg, N - neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg. The time to recovery of the train-of-four (TOF) ratio was checked in each group. RESULTS: The time to 90% recovery of TOF ratio was 182.6 ± 88.9, 371.1 ± 210.4, 204.3 ± 103.2, 953.2 ± 379.7 sec in group S2, S1, SN and N, respectively. Group SN showed a significantly shorter recovery time than did group S1 and N (P < 0.001). However, statistically significant differences between the S2 and SN groups were not be observed (P = 0.291). No hypersensitivity reactions occurred in all groups. CONCLUSIONS: For the reversal from rocuronium-induced moderate neuromuscular blockade, the combined use of sugammadex and neostigmine may be helpful to decrease the recovery time and can also reduce the required dosage of sugammadex. However, the increased incidence of systemic muscarinic side effects must be considered.
BACKGROUND: Ketamine and dexmedetomidine are commonly used for sedation and analgesia in patients. We tried to compare the effects of intravenous ketamine and dexmedetomidine infusion on spinal block with bupivacaine. METHODS: Ninety American Society of Anesthesiologists physical status class I or II patients, who were scheduled to spinal anesthesia were randomly assigned to one of three groups (n = 30). Normal saline 10 ml, 5 ml/hr (loading dose for 10 minutes, infusion) (Group NS), dexmedetomidine 1 µg/kg, 0.5 µg/kg/hr (Group DEX), or ketamine 0.2 mg/kg, 0.5 mg/kg/hr (Group KET) was infused intravenously before spinal anesthesia. We recorded the time to highest sensory block level, sensory and motor regression, and hemodynamic changes. RESULTS: Patients in Groups KET had a significantly faster onset time of sensory block than patients in Group NS. The highest sensory block levels were not significantly different between groups. Average time of sensory regression and knee flexion, was significantly longer in the Group KET and Group DEX than the Group NS. CONCLUSIONS: Intravenous dexmedetomidine and ketamine were found to have a similar synergistic effect with intrathecal bupivacaine. Hemodynamic stability showed better results in Group KET.
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease. Gallium nitrate has been reported to reserve immunosuppressive activities. Therefore, we assessed the therapeutic effects of gallium nitrate in the mouse model of developed type II collagen-induced arthritis (CIA). CIA was induced by bovine type II collagen with Complete Freund's adjuvant. CIA mice were intraperitoneally treated from day 36 to day 49 after immunization with 3.5mg/kg/day, 7mg/kg/day gallium nitrate or vehicle. Gallium nitrate ameliorated the progression of mice with CIA. The clinical symptoms of collagen-induced arthritis did not progress after treatment with gallium nitrate. Gallium nitrate inhibited the increase of CD4(+) T cell populations (p<0.05) and also inhibited the type II collagen-specific IgG2a-isotype autoantibodies (p<0.05). Gallium nitrate reduced the serum levels of TNF-α, IL-6 and IFN-γ (p<0.05) and the mRNA expression levels of these cytokine and MMPs (MMP2 and MMP9) in joint tissues. Western blotting of members of the NF-κB signaling pathway revealed that gallium nitrate inhibits the activation of NF-κB by blocking IκB degradation. These data suggest that gallium nitrate is a potential therapeutic agent for autoimmune inflammatory arthritis through its inhibition of the NF-κB pathway, and these results may help to elucidate gallium nitrate-mediated mechanisms of immunosuppression in patients with RA.
Anti-Inflammatory Agents/therapeutic use , Arthritis, Experimental/drug therapy , Gallium/therapeutic use , Animals , Ankle Joint/drug effects , Ankle Joint/metabolism , Ankle Joint/pathology , Anti-Inflammatory Agents/pharmacology , Arthritis, Experimental/chemically induced , Arthritis, Experimental/immunology , Arthritis, Experimental/pathology , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/immunology , Collagen Type II , Foot/pathology , Gallium/pharmacology , Immunoglobulin G/blood , Interferon-gamma/blood , Interferon-gamma/genetics , Interleukin-6/blood , Interleukin-6/genetics , Male , Matrix Metalloproteinase 2/genetics , Matrix Metalloproteinase 9/genetics , Mice, Inbred DBA , NF-kappa B/antagonists & inhibitors , NF-kappa B/immunology , Spleen/cytology , Spleen/drug effects , Spleen/immunology , Tumor Necrosis Factor-alpha/blood , Tumor Necrosis Factor-alpha/genetics
BACKGROUND: The main disadvantage of rocuronium is the pain associated with vascular injection. We evaluated the efficacy of palonosetron for reducing pain after rocuronium injection. METHODS: EIGHTY PATIENTS SCHEDULED FOR ELECTIVE SURGERY WERE RANDOMLY DIVIDED INTO TWO GROUPS: Group C (normal saline 1.5 ml, n = 40) and Group P (palonosetron 0.075 mg, n = 40). Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds. Thirty seconds after the injection of the test drug, rocuronium 0.6 mg/kg was injected over 30 seconds and the response was recorded. Injection pain was graded using a 4-point scale. The grade was 0 points for no movement, 1 point for wrist movement, 2 points for elbow or shoulder movement, and 3 points for whole body movement. Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection. RESULTS: There was no significant difference in the grade 1 response between the two groups; however, the grade 2 and 3 responses in Group P were 5 (12.5%) and 4 (10%), respectively, which were significantly lower than in Group C, with 13 (32.5%) responses for each grade. There were no significant differences in hemodynamic changes within each group. However, the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P. CONCLUSIONS: Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration.
BACKGROUND: Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We evaluated the analgesic effect of perioperative dexmedetomidine infusion during laparoscopic cholecystectomy with multimodal analgesia. METHODS: Forty-two patients aged 20 to 60 years old were allocated randomly into one of 2 groups (n = 21, in each). All patients underwent laparoscopic cholecystectomy under multimodal analgesia. The patients in group P received dexmedetomidine 1 µg/kg during 10 min before induction and then 0.5 µg/kg/h continuously until the removal of the gall bladder while the patients in the group C received saline by the same methods as group P. Total analgesic consumption and VAS score were recorded for the first 24 hr. RESULTS: There were no significant differences in VAS scores between group P and group C during 24 hr after laparoscopic cholecystectomy. VAS scores of group P were lower than that of group C during the 1st hr after operation. The amount of ketorolac required during the 24 hr after the operation was significantly less in group P compared to group C. CONCLUSIONS: The administration of dexmedetomidine during laparoscopic cholecystectomy with multimodal analgesia has minimal benefits on the reduction of the postoperative pain score. The amount of ketorolac requirements during 24 hr after the operation showed significant difference. Dexmedetomidine might be helpful for the postoperative pain after laparoscopic cholecystectomy with multimodal analgesia.
BACKGROUND: Reduction of intraoperative bleeding is necessary to achieve the ideal surgical field for the endoscopic sinus surgery (ESS). Intraoperative intra nasal bleeding is influenced by various anesthetics. This study compared surgical field condition between propofol/remifentanil (PR) based anesthesia and desflurane/remifentanil (DR) based anesthesia. METHODS: American Society of Anesthesiologists physical status class I or II patients undergoing ESS were randomly assigned to group PR (n = 36) or group DR (n = 32). The extent of the preoperative surgical lesion was classified as high (> 12) and low (≤ 12) Lund-Mackay (LM) scores according to the computed tomography findings. The target mean blood pressure was maintained at 70-80 mmHg. Only one surgeon was involved in rating the visibility of the surgical field on a numeric rating scale (NRS) every 10 minutes. RESULTS: There was a different surgical field grade from PR to DR. The mean (SD) surgical field score of NRS for the PR and DR was 2.3 (0.57) and 2.7 (0.67), respectively (P = 0.006). Especially in the high-LM score patients, the mean (SD) of surgical field score for the PR and DR was 2.4 (0.67) and 3.0 (0.63), respectively (P = 0.012). CONCLUSIONS: In the high-LM score patients, PR based anesthesia resulted in better surgical field condition for ESS than DR based anesthesia. In ESS, PR based anesthesia is considered to be helpful.
BACKGROUND: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. METHODS: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. RESULTS: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). CONCLUSIONS: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.
Intraoperative formation and management of a thrombus in right atrium has been reported occasionally. Nevertheless, it is rare that a right atrial thrombus with unstable hemodynamic changes detected by transesophageal echocardiography is resolved spontaneously. We report upon the 44-year-old woman, who had a right atrial thrombus detected by transesophageal echocardiography during laparoscopic assisted vaginal hysterectomy and resolved during thromboembolectomy.
