Sevoflurane, which has low solubility in blood, facilitates rapid induction and recovery. Sevoflurane is metabolized to hexafluoroisopropanol by cytochrome P450. Hexafluoroisopropanol has significantly less protein binding capability, does not accumulate and rapidly undergoes phase II biotransformation to form Hexafluoroisopropanol glucuronide, which is mostly excreted in the urine within 12 hours. Thus, the hepatotoxic potential of sevoflurane has been considered very low. However, there are many reports about hepatic toxicity after sevoflurane anesthesia. We report a case of a 21-year-old male who had high levels of aspartate transaminase and alanine transaminase with crushing injuries and had low hepatic dysfunction after 29 sevoflurane anesthesia treatments within three months.
Alanine Transaminase ; Anesthesia ; Aspartate Aminotransferases ; Biotransformation ; Cytochrome P-450 Enzyme System ; Humans ; Male ; Protein Binding ; Solubility ; Young Adult

BACKGROUND: The authors hypothesized that the continuous infusion of ramosetron 0.15 mg following a 0.15 mg bolus administration would maintain higher 5-hydroxytryptamine type 3 receptor occupancy levels and be more effective in preventing postoperative nausea and vomiting (PONV) than a 0.3 mg single bolus administration. We conducted a study to compare the efficacy of single bolus ramosetron administration with the combination of continuous infusion following intravenous bolus administration for PONV prophylaxis. METHODS: One hundred and fifty female patients undergoing thyroidectomy were allocated randomly to one of three groups to receive a placebo (Group 1, n = 49), 0.3 mg of IV ramosetron (Group 2, n = 53), or the continuous infusion of 0.15 mg ramosetron following a bolus administration of 0.15 mg of ramosetron (Group 3, n = 48). Anesthesia was maintained with sevoflurane and N2O. The incidence of PONV, nausea severity, and use of rescue antiemetics during the postoperative 24 hours were recorded. RESULTS: Group 1 showed higher incidences of PONV during the postoperative 24 hour than Group 2 (81% vs. 58%, P = 0.02) and Group 3 (81% vs. 48%, P < 0.01), but there was no difference between Groups 2 and 3 (P = 0.39). The use of rescue antiemetics was significantly lower in Groups 2 and 3 than Group 1 during the postoperative 6 to 24 hours. CONCLUSIONS: There were no significant differences of incidence and severity of PONV between ramosetron 0.3 mg single bolus administration and the combination of ramosetron infusion after 0.15 mg bolus administration.
Analgesia, Patient-Controlled ; Anesthesia ; Antiemetics* ; Female ; Humans ; Incidence ; Morphine ; Nausea ; Postoperative Nausea and Vomiting ; Serotonin ; Thyroidectomy

BACKGROUND: We evaluated the efficacy of capsicum plaster, applied to the Chinese acupuncture point (acupoint) Pericardium 6 (P6), in reducing postoperative nausea and vomiting (PONV) in patients who underwent endoscopic sinus surgery (ESS). METHODS: One hundred and fifty patients scheduled for ESS were randomly placed in one of 3 groups. Each group had 50 patients. Inactive tape was affixed at both P6 acupoints and both shoulders in the control (placebo) group. Capsicum plaster was affixed at both P6 acupoints and inactive tape was affixed at both shoulders in the capsicum plaster (P6) group. Capsicum plaster was affixed at both shoulders and inactive tape at both P6 acupoints in the sham group. Plasters and tapes were affixed before the induction and removed 8 hours after surgery. RESULTS: The incidence of PONV and requirement for antiemetics were significantly lower in the P6 group than in the control and sham groups during the 24 hours after surgery. At postoperative 0-24 hour, nausea was 42% in the control group, 2% in the P6 group, and 38% in the sham group. Postoperative vomiting was 28%, 0% and 26%, respectively, and the use of antiemetics was 34%, 0% and 32%, respectively. CONCLUSIONS: Stimulation of the P6 acupoint with capsicum plaster is effective for preventing PONV at postoperative 0-24 hour in patients undergoing ESS.
Acupuncture Points* ; Antiemetics ; Asian Continental Ancestry Group ; Capsaicin ; Capsicum* ; Humans ; Incidence ; Nausea ; Pericardium ; Postoperative Nausea and Vomiting* ; Shoulder

Benedikt syndrome is characterized by ipsilateral ophthalmoplegia with contralateral hemichorea due to a midbrain lesion. A 67-year-old male with Benedikt syndrome underwent corpectomy at L1 and anterolateral interbody fusion at T12-L2 due to pathologic bursting fracture at L1 involving multiple myeloma. He had a history of traumatic subarachnoid hemorrhage and subdural hemorrhage 8 months before surgery. Magnetic resonance image of the brain revealed intracranial hemorrhage from thalamus to midbrain. Target controlled infusion with propofol and remifentanil were administered for anesthetic induction and maintenance and close hemodynamic and neurologic monitoring led to successful anesthetic management.
Aged ; Anesthesia ; Brain ; Hematoma, Subdural ; Hemodynamics ; Humans ; Intracranial Hemorrhages ; Male ; Mesencephalon ; Multiple Myeloma* ; Ophthalmoplegia ; Propofol ; Spine* ; Subarachnoid Hemorrhage, Traumatic ; Thalamus

BACKGROUND: Synchrotron small-angle X-ray scattering (SAXS) is a very useful technique for experimental study of the nano-structure of the nervous system of animals. The study was designed to evaluate nerve preservation methods for the measurement of SAXS patterns. METHODS: Normal sciatic nerves extracted from male Sprague- Dawley rats were preserved in saline (N = 2), formalin (N = 2) or liquid nitrogen (N = 2) for 1 day, followed by measurement of SAXS patterns. SAXS patterns of normal sciatic nerves (N = 3) extracted just before the initiation of the experiment were used as controls. The study was carried out using the 4C1 beamline at Pohang Accelerator Laboratory in Korea. Incoming X-rays were monochromatized at 11 keV using a double multilayer (WB4C) monochromator with beam size of approximately 0.5 (V) × 0.8 (H) mm2. The exposure time was set at 60 sec, and 8 to 12 images per sample were acquired at a 0.5 mm interval. RESULTS: The periodic peaks of interfibrillar space between collagen fibrils were undetectable. The periodic peaks of the myelin sheath and collagen fibers were weakly detected or undetected in the nerves preserved in normal saline or formalin. The periodic peaks and intensity of the myelin sheath, collagen fibers, and interfibrillar space between collagens in the nerves preserved in liquid nitrogen were comparable to those of nerves in the ex vivo state. CONCLUSIONS: The study results indicated that preservation of nerves in liquid nitrogen is adequate for measurements with SAXS. However, saline and formalin preservation techniques were inadequate for SAXS measurement.
Animals ; Collagen ; Formaldehyde ; Gyeongsangbuk-do ; Humans ; Korea ; Male ; Methods* ; Myelin Sheath ; Nervous System ; Nitrogen ; Rats* ; Sciatic Nerve* ; Synchrotrons*

Propensity score matching method (PSM) is widely used in observational study to reduce selection bias. Observational study lacks randomization, hence, statistical inferences without bias adjustments usually include observed or unobserved effects of covariates. If a subject with specific characteristics has a higher chance to be selected for a specific treatment, the characteristics have a possible effect on statistical results. PSM is the method for controlling covariate imbalance that produces the selection bias. In this paper, we introduce the basic concepts of PSM and simplified methods of PSM process. However, PSM is a rapidly developing statistical area with many limitations and some disadvantages. These points are described in the concluding section to emphasize the importance of considering the various features of PSM in the study design.
Bias (Epidemiology) ; Methods* ; Observational Study ; Propensity Score* ; Random Allocation ; Selection Bias

In cirrhotic patients undergoing liver transplantation, reperfusion of a liver graft typically increases portal venous blood flow (PVF) because of a decrease in resistance in the liver graft to the PVF and underlying hyperdynamic splanchnic circulation, which develops due to liver cirrhosis complicated by portal hypertension and persists even after successful liver transplantation. If the liver graft has enough capacity to accommodate the increased PVF, the shear stress inflicted on the sinusoidal endothelial cells of the graft promotes hepatic regeneration; otherwise, small-for-size syndrome (SFSS) develops, leading to poor graft function and graft failure. In particular, a partial graft transplanted to patients undergoing living donor liver transplantation has less capacity to accommodate the enhanced PVF than a whole liver graft. Thus, the clinical conditions that the partial graft encounters determine either hepatic regeneration or development of SFSS. Consistent with this, this review will discuss the two conflicting effects of portal hyperperfusion (hepatic regeneration vs. portal hyperperfusion injury) on the partial grafts in cirrhotic patients suffering from hyperdynamic splanchnic circulation, in addition to normal physiology and pathophysiology of hepatic hemodynamics.
Endothelial Cells ; Hemodynamics ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Regeneration ; Liver Transplantation ; Liver* ; Living Donors ; Physiology ; Regeneration* ; Reperfusion ; Splanchnic Circulation* ; Transplants*

BACKGROUND: This study was designed to compare hemodynamic responses and postoperative courses between sevoflurane-remifentanil and sevoflurane-nitrous oxide anesthesia. METHODS: Forty ASA I or II patients undergoing gynecologic surgery were randomly assigned to receive sevoflurane-remifentanil (group R) or sevoflurane-nitrous oxide group (group N). In group R, remifentanil was continuously infused by using target-controlled infusion pump from anesthetic induction (effect-site target concentration: 4 ng/ml) to the end of surgery (1-5 ng/ml). In group N, fentanyl (2microg/kg) was administered before tracheal intubation and 50% N2O was used during anesthesia. In both groups, 2 vol% sevoflurane was used during anesthetic induction and then end-tidal sevoflurane concentrations were controlled between 1 to 3 vol% according to systolic blood pressure. We compared blood pressure (BP) and heart rate (HR) before and after tracheal intubation and frequencies of hemodynamic aberrations between the two groups. Postoperative nausea/vomiting, sedation, pain scores at 2 and 24 hours after operation were also compared. RESULTS: Changes of BP and HR after tracheal intubation were similar in group R and group N, but MAP at 1 and 2 min after intubation was significantly decreased versus baseline MAP in group N. Intraoperative hypertensive episodes (systolic BP > 140 mmHg) were more frequent in group N compared to group R, and hypotensive episodes (SBP < 90 mm Hg) were similar in both groups. There were no differences in postoperative nausea/vomiting, sedation and pain scores. CONCLUSIONS: Sevoflurane/remifentanil anesthesia provided more stable intraoperative hemodynamic status than sevoflurane/N2O and postoperative adverse effects were similar in both groups.
Anesthesia ; Blood Pressure ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Infusion Pumps ; Intubation ; Methyl Ethers ; Nitrous Oxide ; Piperidines

BACKGROUND: Cannabinoid receptor agonists can reverse opioidinduced nausea and vomiting in animals, but have not yet been tested against opioid-induced pruritus. This study tests the hypothesis that a cannabinoid receptor agonist will prevent opioidinduced pruritus and evaluates if the use of a cannabinoid receptor agonist will increase the analgesic efficacy of opioids. METHODS: Various doses of fentanyl were injected subcutaneously in mice to obtain a dose-response curve with the use of a writhing test. To observe the analgesic potentiation of the cannabinoid agonist WIN55,212-2 in the writhing test, mice were pretreated with various concentrations of WIN55,212-2 (0.25, 0.5, 1.0, 2.0 mg/kg) 10 min prior to the injection of an ED50 dose of fentanyl, as determined from the dose-response curve. To observe the antipruritogenic effect of WIN55,212-2 in a scratching test, mice were pretreated with WIN55,212-2 (0.25, 0.5 mg/kg) 20 min prior to fentanyl injection. A CB1 receptor selective antagonist, AM251 (3 mg/kg), was used to confirm the cannabinoid receptor selectivity. RESULTS: The ED50 of fentanyl in the writhing test was 0.018 mg/kg (range, 0.011?0.025 mg/kg). A dose of 1 mg/kg WIN55,212-2 increased the analgesic efficacy of fentanyl significantly (P < 0.001), but doses of 0.25 mg/kg and 0.5 mg/kg did not increase the analgesic efficacy. A dose of 0.25 mg/kg WIN55,212-5 reduced the scratching response of fentanyl significantly (P < 0.001) and this action was a cannabinoid receptor selective response. CONCLUSIONS: These results demonstrate that 0.25 mg/kg WIN55,212-2 can prevent opioid-induced pruritus. The antipruritogenic activity of WIN55,212-2 occurs at CB1 receptors even if the analgesic efficacy of fentanyl cannot be increased.
Analgesics, Opioid ; Animals ; Cannabinoid Receptor Agonists ; Fentanyl ; Mice ; Nausea ; Piperidines ; Pruritus ; Pyrazoles ; Receptor, Cannabinoid, CB1 ; Receptors, Cannabinoid ; Vomiting

BACKGROUND: Severe postoperative pain is a well-known problem following shoulder surgery. This study evaluates the clinical efficacy of intermittent interscalene brachial plexus block (ISBPB) compared with that of continuous intraarticular infusion (IAPCA) for the management of postoperative pain after shoulder surgery. METHODS: Fifty seven patients, scheduled for shoulder surgery during general anesthesia, were randomly allocated to one of two groups. Group ISBPB (n = 19) received a preoperative interscalene brachial plexus block using 20 ml of 0.5% bupivacaine followed by insertion of a 20-gauge polyamide catheter. This catheter was connected to a patient-controlled analgesia pump set immediately after surgery to administer a bolus of 0.75% ropivacaine 15 ml at lockout time intervals 8 hours. Group IAPCA (n = 38) received patient- controlled analgesia with 0.2% ropivacaine 100 ml (basal rate 2 ml/hr, bolus 0.5 ml, lockout time 15 min). Both groups received intravascular patient-controlled analgesia with fentanyl 10? 15 microg/ml (basal rate 1 ml/hr, bolus 2 ml, lockout time 15 min). All patients were given pethidine 25 or 50 mg when visual analogue score (VAS) >40 mm. VAS, circulatory and respiratory stress parameter (heart rate, noninvasive blood pressure and respiratory rate) and consumption of pethidine were measured during 72 hours following surgery at intervals of 8 hours. RESULTS: The mean VAS scores in the ISBPB group were significantly lower than in the IAPCA group for 72 hr after surgery (P < 0.01). Pethidine consumption in the ISBPB group was significantly lower than in the IAPCA group (P < 0.01). CONCLUSIONS: We concluded that intermittent interscalene brachial plexus block is an effective method of postoperative analgesia after major shoulder surgery.
Amides ; Analgesia ; Analgesia, Patient-Controlled ; Anesthesia, General ; Blood Pressure ; Brachial Plexus ; Bupivacaine ; Catheters ; Fentanyl ; Humans ; Meperidine ; Nylons ; Pain, Postoperative ; Shoulder