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Recently, the number of laparoscopic adjustable gastric banding surgery is increasing as is the number of patients with morbid obesity rapidly. However, no anesthetic management including preoperative fasting strategy for patients with laparoscopic adjustable gastric banding exists. Hereby, we report a case of a 22-year-old woman with laparoscopic adjustable gastric banding who suffered pulmonary aspiration during the anesthetic induction for appendectomy, despite a preoperative fasting period longer than 14 h. This case strongly suggests that guidelines for anesthetic management including the appropriate fasting period for patients with laparoscopic adjustable gastric banding are desperately required.
Appendectomy ; Fasting ; Female ; Humans ; Obesity, Morbid ; Patient Safety ; Pneumonia, Aspiration ; Young Adult

BACKGROUND: Emergence agitation (EA) is one of the most common complications after general anesthesia. The goal of this retrospective study was to determine the risk factors of EA in adult patients who underwent general anesthesia. METHODS: We retrospectively investigated the medical records of 5,358 adult patients who stayed in the postanesthesia care unit (PACU) of our hospital after general anesthesia during the 1-year period from January 2014 to December 2014. Psychological and behavioral status in the PACU was determined by the Aono four-point scale. Grade of 3 or 4 were considered as manifestations of EA. Multiple variables assessed EA risk factors. RESULTS: Two-hundred-forty-five patients (4.6%) developed EA. In multivariate analysis, male gender (OR = 1.626, P = 0.001), older age (OR = 1.010, P = 0.035), abdominal surgery (OR = 1.633, P = 0.002), spine surgery (OR = 1.777, P = 0.015), longer duration of anesthesia (OR = 1.002, P < 0.001), postoperative nausea and vomiting (OR = 20.164, P < 0.001) and postoperative pain (OR = 3.614, P < 0.001) were risk factors of EA. CONCLUSIONS: Male gender and older patients were risk factors of EA after general anesthesia in adult patients. Careful attention is needed for patients who receive abdominal or spine surgery, and who receive prolonged anesthesia. Adequate postoperative analgesia and antiemetic therapy should be provided to reduce the incidence of EA.
Adult* ; Analgesia ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, General* ; Delirium ; Dihydroergotamine* ; Humans ; Incidence ; Male ; Medical Records ; Multivariate Analysis ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Retrospective Studies ; Risk Factors* ; Spine

BACKGROUND: Perioperative hypothermia, defined as a core temperature under 36℃, increases the risk of cardiac complication, bleeding and infection. This study aimed to compare the hypothermia-preventing effects of a warming blanket (Ready-heat®) and one-layer cotton blanket in patients undergoing transurethral resection of the bladder (TURBT) under general anesthesia. METHODS: Patients undergoing TURBT under general anesthesia were allocated to the warming blanket (N = 23) or one-layer cotton blanket (N = 23) groups. Ten minutes before induction of anesthesia, warming blanket or one-layer cotton blanket was applied according to the assigned group. Tympanic temperature was measured just before induction of anesthesia. Esophageal temperature and tympanic temperature were measured from 20 min after induction of anesthesia at 10-min intervals. Tympanic temperature was measured at 10-min intervals over a 30-min period in the post-anesthesia care unit (PACU). In addition, the incidence and intensity of shivering and thermal comfort were also measured. RESULTS: The core temperature during general anesthesia showed no significant intergroup difference. The warming blanket group showed a lower incidence of hypothermia at 1 h after induction of anesthesia. Tympanic temperature, the incidence and intensity of shivering, and thermal comfort in the PACU showed no significant intergroup differences. CONCLUSIONS: Application of the warming blanket or one-layer cotton blanket for 10 min before induction of anesthesia showed no hypothermia-preventing effects. However, at one hour after induction of anesthesia, warming blanket application reduced the incidence of hypothermia to a greater degree than one-layer cotton blanket.
Anesthesia ; Anesthesia, General* ; Hemorrhage ; Humans ; Hypothermia* ; Incidence ; Perioperative Period ; Shivering ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND: Baclofen is a gamma-aminobutyric acid B-receptor agonist, which is usually used for patients with spasticity or patients with nerve injury inducing both spasticity and neuropathic pain. Both oral administration and intrathecal injection via a continuous infusion pump are common treatment methods. The aim of this study was to evaluate the effectiveness of a series of three individual injections of intrathecal baclofen for neuropathic pain without spasticity. METHODS: Thirty-one patients with neuropathic pain were treated with a series of three monthly individual injections of intrathecal baclofen without pump implantation A dose of 50 µg of baclofen was used. 10-cm visual analog scale (VAS) scores of spontaneous pain, allodynia, and hyperalgesia were recorded a week after each injection. Vital signs were monitored to detect any hemodynamic changes, and a myelogram was performed to detect any undesirable cerebrospinal fluid leakage. All patients were hospitalized for at least one day following each injection for close observation and to control any adverse effects. RESULTS: VAS scores of spontaneous pain, allodynia, and hyperalgesia decreased significantly (P < 0.001). The major complications were general weakness, sleepiness, and urinary retention; most of these resolved within one day without any further serious symptoms. CONCLUSIONS: A series of three individual intrathecal baclofen injections was effective for those patients who suffered from neuropathic pain without spasticity or dystonia; no serious complications were observed. However, the average satisfaction score recorded for spontaneous pain was lower than those for allodynia and hyperalgesia.
Administration, Oral ; Baclofen* ; Cerebrospinal Fluid Leak ; Dystonia ; gamma-Aminobutyric Acid ; Hemodynamics ; Humans ; Hyperalgesia ; Infusion Pumps ; Injections, Spinal ; Muscle Spasticity ; Neuralgia* ; Urinary Retention ; Visual Analog Scale ; Vital Signs

BACKGROUND: Motor weakness occurs frequently after piriformis injection and it could put patients at risk of falls. We investigated the appropriate concentration and volume of ropivacaine required to minimize motor dysfunction. METHODS: A total of 120 patients who received piriformis injection were included in this study. Piriformis injections of triamcinolone 10 mg in various concentrations (0.1%, 0.075%) and volumes (8, 10, 12 ml) of ropivacaine were administered in 20 patients, respectively. One hour after the injection, we compared motor function according to the concentrations and volumes of ropivacaine. RESULTS: There were significant differences (P < 0.05) in the occurrence of motor dysfunction according to body mass index (BMI) and the concentration of ropivacaine. No significant differences were found in terms of gender, age, weight, height, or the volume of ropivacaine. Logistic regression analysis showed that the likelihood of motor dysfunction with administration of 0.1% ropivacaine was 58.249 times greater than that with administration of 0.075% concentration (P < 0.001), while BMI did not have a significant effect on motor dysfunction. CONCLUSIONS: According to the results of this study, 0.075% ropivacaine rather than 0.1% ropivacaine is appropriate in terms of reducing motor dysfunction after piriformis injection.
Accidental Falls ; Body Mass Index ; Humans ; Logistic Models ; Piriformis Muscle Syndrome ; Triamcinolone

A 77-year-old woman was scheduled for a coronary artery bypass graft. Her preoperative transthoracic echocardiographic (TTE) examination revealed an enlarged left atrium with reduced systolic dysfunction (ejection fraction: 38%), moderate global hypokinesia of the left ventricle, and moderate mitral and tricuspid regurgitation. No thrombus was visualized on the preoperative TTE. However, the intraoperative transesophageal echocardiography performed before the cardiopulmonary bypass revealed a thrombus of approximately 1.3 × 1.8 cm in the left atrial appendage (LAA). The LAA thrombus was removed, an internal suture was placed on the LAA before the coronary artery bypass grafting, and the main operation was performed successfully. The patient was transferred to the intensive care unit to receive postoperative care. She was extubated 4 h after the surgery and was transferred to the general ward on postoperative day 3 without any neurological sequelae.
Aged ; Atrial Appendage* ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Atria ; Heart Ventricles ; Humans ; Hypokinesia ; Intensive Care Units ; Patients' Rooms ; Postoperative Care ; Sutures ; Thrombosis* ; Transplants ; Tricuspid Valve Insufficiency

Polyuria is occasionally observed after general anesthesia with sevoflurane. Usually the onset of polyuria is abrupt and remission is spontaneous, so it's not so easy to do detailed investigation. The authors came across with two cases of polyuria during general anesthesia with sevoflurane which occurred so early around one hour after induction of anesthesia. Both cases revealed no special problem like central diabetes insipidus.
Anesthesia ; Anesthesia, General ; Diabetes Insipidus, Neurogenic ; Polyuria*

BACKGROUND: Elevated blood pressures during emergence from general anesthesia in patients with hypertension often result in undesirable complications such as myocardial ischemia, intracranial hemorrhages. The aim of this study was to assess the effect of intracuff 4% lidocaine on the dosage of nitroglycerine required to maintain the stable blood pressure during peri-extubation period in patients with hypertension. METHODS: Forty-nine patients scheduled for elective surgery were randomly allocated to group 1 and 2. We filled endotracheal tube's cuff with normal saline for group 1 and with 4% lidocaine for group 2. Blood pressures and heart rates were recorded before operation, during emergence, and after extubation. Nitroglycerine infusion was adjusted to maintain systolic blood pressure below 150 mmHg. Total infused dosages of nitroglycerine were recorded during operation and after stop of inhalational anesthetics for comparison of both groups' hemodynamic stability. RESULTS: Mean infused volume (microg/kg/min) of nitroglycerine during peri-extubation period was less in the group 2 than group 1. CONCLUSIONS: Intra-cuff 4% lidocaine in patients with hypertension during emergence from general anesthesia reduces the nitroglycerine dosage required to maintain hemodynamic stability.
Anesthesia, General ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Intracranial Hemorrhages ; Lidocaine* ; Myocardial Ischemia ; Nitroglycerin*

BACKGROUND: Backache is a common complication following anesthesia and surgery. Previous studies indicated that the use of a lumbosacral wedge was effective in reducing the incidence of postoperative backache. We investigated the effective inflation pressure of an inflatable wedge in preventing postoperative backache following spinal anesthesia and surgery in the lithotomy position. METHODS: A pilot study established a mean comfortable pressure for the wedge when used to support the lumbar curvature. In males and females, the mean pressure values were 23.6 +/- 3.1 mmHg and 18.9 +/- 3.7 mmHg, respectively. The design of the main study was a randomized, controlled trial involving the use of a wedge intra-operatively in patients undergoing spinal anesthesia and urological surgery in the lithotomy position. Fifty male and 50 female patients were included in the main study and randomly allocated to the control or study group. In the study group, the wedge was inserted immediately after the induction of anesthesia and maintained during surgery. On the first day after surgery, all patients were asked whether they had backache. If there was backache, the degree of pain was noted using the numeric rating scale (NRS). RESULTS: In the study and control groups of male patients, the incidence of backache was 16% and 24%, respectively. There was no significant difference between the two groups. In the study and control groups of female patients, the incidence of backache was 20% and 52%, respectively (P < 0.05). Where backache occurred, there was no significant difference in its severity between the study and control groups. CONCLUSIONS: The effective pressure value of an inflatable wedge in preventing postoperative backache following spinal anesthesia and surgical operation in lithotomy position was 19 mmHg in female patients.
Anesthesia ; Anesthesia, Spinal ; Back Pain* ; Female ; Humans ; Incidence ; Inflation, Economic ; Male ; Pilot Projects