Search

Background Various methods have been used to reduce postoperative pain after thoracic surgery. However, these methods may affect the patient's respiratory response and delay recovery from anesthesia. We aimed to evaluate the effects of fentanyl and remifentanil during extubation after video-assisted thoracic surgery (VATS). Methods This study included 45 randomly-selected male patients who underwent VATS for pneumothorax between July 2011 and August 2012. We divided the participants into 3 groups: the F group, which received a bolus injection of 1.0 μg/kg of fentanyl; the R1 group, which received a 0.04 μg/kg/min remifentanil infusion; and the R2 group, which received a 0.08 μg/kg/min remifentanil infusion. Hemodynamics, pain, cough, consciousness level, and nausea were assessed for each group. Results The number and severity of coughs were lower in the R1 and R2 groups than in the F group, and there were no differences between the R1 and R2 groups. Respiratory depression and loss of consciousness were not observed in any of the patients, and there were no differences in hemodynamics. Conclusion In comparison with fentanyl, remifentanil did not result in a wide fluctuation of blood pressure and heart rate upon emergence from general anesthesia. Moreover, remifentanil contributed to cough suppression and postoperative pain control. Remifentanil seems to be a safe and effective analgesic after VATS.

Purpose: This randomized noninferiority trial aimed to evaluate whether combined suprascapular, axillary nerve, and the articular branch of lateral pectoral nerve block (3NB) is noninferior to interscalene nerve block (ISB) for pain control after arthroscopic rotator cuff repair (ASRCR). Materials and Methods: Eighty-five patients undergoing ASRCR were randomized to either 3NB (n = 43) or ISB (n = 42) group. We used 5 and 15 ml of 0.2% ropivacaine for each nerve in the 3NB and ISB groups, respectively. The primary outcome was the visual analog scale (VAS) pain score at 4 h postoperatively measured assessed on an 11-point scale (ranging from 0 = no pain to 10 = worst pain) that was analyzed using noninferiority testing. The secondary outcome was VAS pain scores in the recovery room and at 8, 12, 24, 36, 48, and 72 h postoperatively. Rebound pain, IV-PCA usage during 48 h, dyspnea, muscle weakness, and satisfaction were evaluated. Results: Regarding the primary outcome, the mean difference in VAS pain scores between the 3NB (2.5 ± 1.6) and ISB (2.2 ± 2.3) groups at 4 h postoperatively was 0.3, with a 95% confidence interval (CI) of −0.56 to 1.11. The upper limit of 95% CI is lower than the noninferiority margin of 1.3 ( p < 0.001). At all other time points, except in the recovery room, 3NB showed noninferior to ISB. Rebound pain, IV-PCA usage during the second 24 h, and muscle weakness were lower in the 3NB group (all p < 0.005). The satisfaction was similar in both groups ( p = 0.815). Conclusion: Combined 3NB is noninferior to ISB in terms of pain control after ASRCR; and is associated with low levels of rebound pain, IV-PCA usage, and muscle weakness. Level of evidence: Randomized controlled trial, Level I.

Forearm disabilities can result from a number of diseases or injuries, such as stroke, spinal cord injuries (SPI), and acquired/traumatic brain injuries (ABI/TBI). Patients with forearm disabilities suffer from daily activities and follow-up care and rehabilitation are critical to recovery of the patients in this case. However, they have to make personal trips to clinics or hospitals for follow-up treatments since most of existing devices available are bulky, heavy and even expensive in general, discouraging the patients from having them home. This paper proposes a pneumatic inflatable rehabilitation device designed with bio-inspiration. The device is lightweight, safe, and affordable compared to conventional devices. When the actuators of the device are inflated, the contractions of the actuators mimic the motions of the human muscles of the forearm, assisting pronation and supination. The actuators are made of heat-sealable fabrics using a custom-built patterning system. This system facilitates rapid fabrication of repetitive and complex sealing patterns. Also, the proposed rehabilitation device, which can be conjointly used with typical clothing materials, provides comfort for the user by easily conforming the three-dimensional geometries of the forearm. To characterize the system, the angles and the torques of the wrist generated by the device were measured. The result of simple closed-loop control using a vision feedback was also presented.

Liver ischemia/reperfusion has been shown to result in injury of remote organs such as the heart and lungs. Whether or not acute liver injury also results in kidney injury has so far not been adequately addressed. In anesthetized Wistar rats, partial (70%) normothermic hepatic ischemia was applied for 75 min. After 24 h of reperfusion, renal injury was assessed by histology, creatinine and blood urea nitrogen (BUN) serum concentrations, renal expression of proinflammatory genes [quantitative real-time polymerase chain reaction (qRT-PCR)], caspase-3 activation (Western blot), and neutrophil accumulation (myeloperoxidase assay). Twenty-four hours after hepatic ischemia, creatinine (0.57+/-0.06 vs. 0.32+/-0.04 mg/dL) and BUN (40.7+/-15.3 vs. 14.3+/-2.0 mg/dL) were increased when compared to sham. qRT-PCR revealed higher renal intercellular adhesion molecule-1 gene expression following hepatic ischemia (166+/-45% when compared to sham) but no differences in renal monocyte chemoattractant protein-1, macrophage inflammatory protein-2, and inducible NO synthase expression. In both groups, kidneys showed no morphological damage and no increase in caspase-3 and myeloperoxidase activity. Severe hepatic ischemia results in a moderate impairment of renal function in rats but does not trigger an inflammatory response in the kidney and does not result in morphological damage of the kidney.

We report a case of Baker's cyst that induced compression of both the tibial and common peroneal nerves. The patient presented with calf atrophy and foot drop over a 6-month period. These signs and symptoms could have been mistaken for those of spinal origin. Based on an electrodiagnostic study and magnetic resonance imaging, compression of nerves by an asymptomatic Baker's cyst measuring 6x4 cm was confirmed. This cyst communicated with the articular joint which was also associated with a medial meniscal lesion. We treated the patient arthroscopically by performing partial medial meniscectomy, and through the posterolateral and the posteromedial portal, decompression of the Baker's cyst was performed. Approximately 6 weeks after the arthroscopic decompression, the cyst recurred. Therefore open resection was performed. At 1-year follow-up, the patient had considerable improvement in motor as well as sensory function and showed no evidence of recurrence. Although the electrodiagnostic studies showed an improvement in symptoms, the patient continued to complain of lower leg weakness owing to delayed diagnosis and cyst decompression. We believe that Baker's cysts should also be considered in the differential diagnoses of patients who present with neuromuscular dysfunction in the calf and leg.

Objectives: To determine the effect of a single dose of methylphenidate on the cognitive performance of patients with traumatic brain injury (TBI), and particularly on working memory and visuospatial attention. Design: A double-blind placebo-controlled study. The subjects were randomly divided into an experimental group taking methylphenidate and a control group taking a placebo. Setting: The Department of Rehabilitation Medicine of a university hospital. Subjects: Eighteen subjects with TBI (16 male and two female) were enrolled. Interventions: The patients were given 20 mg methylphenidate or a placebo. Cognitive assessments were performed at three times: before the medication as a baseline, 2 h after medication and at follow-up (48 h later). Main measures: Cognitive assessments consisted of working memory tasks and endogenous visuospatial attention tasks designed using SuperLabPro 2.0 software. Response accuracy and reaction time were measured. Results: There were significant improvements in response accuracy in the methylphenidate group compared with the placebo group for both the working memory and visuospatial attention tasks. A significant decrease in the reaction time was also observed in the methylphenidate group only for the working memory task. Conclusions: The administration of single-dose methylphenidate has an effect in improving cognitive functioning following a TBI. The effects were most prominent regarding the reaction time of the working memory.

Degenerative disc disease of the lumbar spine caused leg pain with associated calf weakness and atrophy. However, an unusual case of leg pain and calf atrophy due to neural compression is reported. We reported a rare case of a Baker's cyst causing common peroneal nerve and tibial nerve entrapment neuropathy. Initially, after arthroscopic menisectomy and cyst decompression, Baker's cyst was recurred and then open excision was done. Until 1 year after surgery, the cyst was not recurred, increased muscle bulk was noted and EMG showed improved findings. But she continued to complain of lower leg weakness and sole paresthesia owing to delayed diagnosis and cyst decompression.

Background: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. Methods: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients’ requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. Results: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. Conclusions: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.

Background: The carbon dioxide () insufflation and lithotomy-Trendelenburg position are required in the laparoscopic gynecologic surgery. However, they can change the distance from the upper incisor to the carina. This may increase the risk of endobronchial intubation. Methods: Nineteen patients, aged 29-50 yr, who were undergoing laparoscopic surgery were enrolled. We measured the distance from the upper incisor to the carina of them with fiberoptic bronchoscope. Measurements were taken in the each point of lithotomy position, lithotomy-Trendelenburg position, and lithotomy-Trendelenburg position after insufflation. Results: The average distance from the upper incisor to the carina was 23.1 1.4 cm in the lithotomy position () and was significantly decreased to 22.6 1.4 cm in the lithotomy-Trendelenburg position () (P insufflation into the abdominal cavity, the mean distance in the lithotomy-Trendelenburg position () was significantly decreased to 22.11.4 cm (P insufflation decrease the distance from the upper incisor to the carina.

Adenotonsillectomy is one of the most common operations being performed in children. Fortunately, pulmonary edema is an infrequent perioperative complication, but pulmonary edema complicting adenotonsillectomy has been reported to occur mainly during the induction of anesthesia or immediately after extubation of endotracheal tube. The etiology of pulmonary edema in these cases is presumed to be the sudden relief of chronic airway obstruction or acute upper airway obstruction (UAO), such as post-extubation laryngospasm and laryngeal edema. The purpose of this paper is to report the occurrence of pulmonary edema during the adenotonsillectomy, which is both rare and unpredictable, especially at 40 to 50 minutes after endotracheal intubation. In addition, we describe its clinical course.

Background: Arterial pressure measured in a peripheral artery sometimes underestimates central arterial pressure after discontinuation of cardiopulmonary bypass (CPB) for reasons that are still unclear. Therefore, the sideport of the aortic cannula is often used for measurement of central pressure because it is accessible and is near the ascending aorta. This study was designed to assess whether blood pressure measured at the sideport of the aortic cannula mirrors blood pressure measured within the ascending aorta. Methods: Blood pressure was compared in 21 patients 5 minute after discontinuation of CPB at two sites: at the tip of the 23-gauge needle that points distally at a 25 to 30 angle to the blood flow within the ascending aorta and at the sideport of the aortic cannula. The effects on the sideport-to-aorta pressure differences and wave contour were tested by placing a clamp at the proximal and distal end of the arterial line (aortic cannula sideport-oxygenator tube) of the CPB circuit. Results: There were no statistical differences between systolic, diastolic and mean blood pressure measured at the sideport and ascending aorta when the clamp was applied to the proximal end. The average sideport-to-aorta systolic pressure differences (0.3 3.1 mmHg ranged from -5 to 6 mmHg), diastolic pressure differences (-0.9 2.1 mmHg ranged from -4 to 4 mmHg) and mean pressure differences (-0.5 1.0 mmHg ranged from -2 to 2 mmHg) were not significantly different. No statistical differences were noted between pressures measured at the two sites when the clamp was applied to the distal end of the arterial line. Conclusions: It is concluded that the pressure measured at the sideport of the aortic cannula reflects the pressure in the ascending aorta after discontinuation of CPB.

Background: Propofol often causes pain when injected into small peripheral veins, but the pain can be minimized by using a larger vein. This study was designed to determine whether local warming of the injection site and forearm before propofol injection is effective in reducing pain. Methods: Sixty adult patients undergoing general anesthesia for an elective surgery were randomly allocated to one of two groups. All were unpremedicated and had an 18-gauge cannula inserted into a cephalic vein on the wrist. Patients in group 1 (n = 30) received 1% propofol at room temperature. Patients in group 2 (n = 30) received 1% propofol after local warming (36-37oC) of the injection site and forearm using a forced-air warming system (Bair Hugger). For each patient, the pain during injection of the propofol solution was graded as none, mild, moderate, or severe. Results: Overall the incidence of pain was significantly reduced in group 2 (36.7%) compared with group 1 (66.7%). No patients complained of pain at the injection site and forearm in group 2. However, there was no significant difference in the incidence or severity of pain on the elbow and axilla between the two groups. Conclusions: We found that local warming applied to the injection site (wrist) and forearm before propofol injection is significantly effective in reducing pain at the injection site and forearm, but there was no improvement of pain on the elbow and axilla when injecting.

It is difficult to determine respiratory criteria of fitness for surgery and anesthesia in patients with intractable chronic obstructive pulmonary disease (COPD), who have high mortality and morbidity in the perioperative period. Also, it is commonly assumed that general anesthesia carries a greater risk of perioperative pulmonary complications than regional anesthesia in patients with COPD. A 79-yr-old COPD female patient complaining of right hip pain due to fracture of right femur neck and dyspnea on rest was admitted for surgery. Even after aggressive medical management for COPD during the preoperative period, dyspnea on rest and expiratory wheezing were not improved. The results of the pulmonary function test and the immediate preoperative arterial blood gas analysis were as follows: FVC 0.97 L, FEV1 0.38 L, FEF25-75% 0.11 L/sec, PaO2 47.6 mmHg, and PaCO2 68 mmHg. We report the anesthetic considerations for the epidural block for the severe COPD patient associated with hypoxemia and hypercarbia. (Korean J Anesthesiol 1999; 36: 540∼546)

Background : The clinicians frequently use crystalloid solutions to manage inpatients and outpatients. Recently Normosol becomes available but there is little understanding of Normosol. So we surveyed residents to assess the level of knowledge about three crystalloid solutions. Methods : The respondents were 46 residents of internal medicine, general surgery, pediatrics, and anesthesiology. The questionnaire asked for the following information: To list the constituents and their concentrations in each 1 litre of normal saline, Hartmann's solution, and Normosol; to match correct pH and osmolality to each solutions; to describe the metabolism and role of lactate in Hartmann's solution. Results : All 46 (100%) knew that both sodium and chloride ions were present in normal saline. Twenty six (57%) of them knew correct concentration of sodium and chloride. The presence of sodium ion in Hartmann's solution was known by 44 (96%) and its concentration was recognized by 20 (43%). Chloride ion and potassium ion in Hartmann's solution were recognized by 43 (93%) and 42 (91%), respectively. Fifteen (33%) knew correct constituents of Hartmann's solution. Only three (7%) knew correct constituents and their concentration of Hartmann's solution. Thirty six (76%) knew that bicarbonate is formed by metabolism of lactate. No one accurately recorded the correct constituents of Normosol. Conclusions : The constituents and their concentrations of normal saline are well known to residents but those of Hartmann's solution and Normosol are not. Our survey reveals that there was little understanding of the reasons for including lactate in Hartmann's solution and even less of presence of acetate in Normosol. (Korean J Anesthesiol 1998; 34: 403∼408)

Background: Endobroncheal intubation or extubation may occur accidentally when the patient''s neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient''s neck is extended or flexed. Methods: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient''s displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student''s paired t-test. Results: The endotracheal tube moved away from the carina when the patient''s neck was extended, while it moved toward the carina when flexed in all cases. When the patient''s neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. Conclusions: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea. (Korean J Anesthesiol 1997; 33: 839∼843)