Interarytenoid adhesion is a rare complication associated with endotracheal intubation. The vocal cord is fixed to arytenoid cartilage and the movement of vocal cord is limited. Its clinical symptoms are dyspnea and hoarseness, so sometimes it is mistaken for bilateral vocal cord palsy because of its clinical features. We have experienced unanticipated failed intubation followed by hypoxia in interarytenoid adhesion who was scheduled for emergency tracheotomy due to bilateral vocal cord palsy. After failure of cricothyroidotomy, patient was successfully ventilated with jet injector and tracheotomy was done without complication.
Airway Management* ; Anoxia ; Arytenoid Cartilage ; Dyspnea ; Emergencies ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Paralysis ; Tracheotomy ; Vocal Cord Paralysis ; Vocal Cords

BACKGROUND: Remifentanil is an ultra-short-acting mu opioid receptor agonist. However, there are few reports of its use in children. Therefore, this study compared propofol-remifentanil anesthesia (PR) with a desflurane-N2O anesthesia (D) in children. METHODS: One hundred children (5-12 years), who were scheduled for a tonsillectomy, were randomly assigned to either Group PR (n=50) or Group D (n=50). After inducing anesthesia with propofol and rocuronium, group PR was maintained with an infusion of propofol and remifentanil. Group D was maintained with desflurane. At the end of surgery all the anesthetics were terminated without tapering. The systolic and diastolic blood pressure, and heart rate were measured upon arrival at the operation room, after induction, after intubation, at the beginning of the operation, 5, 10, 20 minutes after beginning of surgery and the end of anesthesia. RESULTS: There was a significantly lower heart rate in group PR than in group D but there was no significant difference in blood pressure between the two groups. CONCLUSIONS: In children, propofol-remifentanil anesthesia is a well-tolerated method of anesthesia, with a lower heart rate compared with desflurane-N2O based anesthesia.
Anesthesia* ; Anesthetics ; Blood Pressure* ; Child ; Heart Rate* ; Heart* ; Humans ; Intubation ; Propofol ; Receptors, Opioid, mu ; Tonsillectomy*

Uterine rupture is usually associated with previous uterine scar. Although intrapartum rupture of unscarred uterus is very rare, it may cause catastrophic outcomes to both the mother and the newborn infant compared with that of a scarred uterus. The present case describes our experience of anesthesia for an emergency cesarean section due to the arrest of fetal descent in a 36-year-old parturient who had undergone external cephalic version for the breech presentation of her fetus. We detected the rupture of her unscarred uterus during the operation under epidural anesthesia, which was changed to general anesthesia. Despite the uterine rupture the newborn infant survived uneventfully. At the postoperative twelfth day she was discharged from hospital with her baby.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Breech Presentation ; Cesarean Section* ; Cicatrix ; Emergencies ; Female ; Fetus ; Humans ; Infant, Newborn ; Mothers ; Oxytocin ; Pregnancy ; Rupture* ; Uterine Rupture ; Uterus* ; Version, Fetal

Subcutaneous and topical epinephrine are widely used for hemostasis during dermatologic procedure. There was substantial variation in the amount of systemic absorption on the basis of patient's general condition, blood supply of wounds. Increased or unpredictable absorption after topical administration may increase anesthetic and cardiovascular risks. There have been no reports about cardiovascular complications developed during laser resurfacing. We experienced a case of transient hypertension, cardiac arrhythmia and ST-depression during whole face resurfacing by Erbium-Yag laser due to application of high concentration epinephrine gauze on the face. The hypertension and arrhythmia were normalized in 2 minutes, and ST-depression was sustained for about 4 hours.
Absorption ; Acne Vulgaris* ; Administration, Topical ; Arrhythmias, Cardiac* ; Cicatrix* ; Epinephrine ; Hemostasis ; Hypertension* ; Wounds and Injuries

BACKGROUND: Recovery from anesthesia, postoperative pain, nausea and vomiting are very important after pediatric tonsillectomy surgery. We compared the effects of supplemented opioids (remifentanil, meperidine) combined with sevoflurane on the recovery and side effects. METHODS: Patients were randomized to receive meperidine (group M, n = 41) or remifentanil (group R, n = 43). Group R received a bolus dose of normal saline, and group M 1 mg/kg of meperidine. A continuous infusion of normal saline was followed in the group M, and remifentanil 0.25micro/kg/min in the group R. In all patients, signs of inadequate anesthesia were treated with an increase of sevoflurane concentration. Intraoperative hemodynamics, recovery profiles, and side effects were assessed. RESULTS: Supplemented remifentanil resulted in significantly lower systolic blood pressure and heart rate during operation (P < 0.05). The emergence from anesthesia was not different between groups. Although the patients in the group R had early recovery characteristics at recovery room, time to discharge at recovery room was longer in the group R than in the group M (P < 0.05). The incidence of retching and vomiting was not different between groups. Supplemented meperidine resulted in less analgesic requirements than the other group (P < 0.05). CONCLUSIONS: Supplemented remifentanil was associated with hemodynamic stability, however it provided later discharge time at recovery room. Postoperative analgesic requirements were reduced by the supplemented meperidine without increasing postoperative nausea, vomiting.
Analgesics, Opioid ; Anesthesia* ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Meperidine ; Nausea ; Pain, Postoperative ; Pediatrics* ; Postoperative Nausea and Vomiting ; Recovery Room ; Tonsillectomy* ; Vomiting

No abstract available.
Coronary Artery Disease* ; Coronary Vessels*

A 6-year old female, who was operated on for tracheoesophageal fistula at the time of birth, was diagnosed with recurrent TEF, and it was decided to undergo endoscopic management, using cyanoacrylate under general anesthesia. After cuffing, the endotracheal tube was located at the level of the fistula, and endoscopic management was undertaken through the esophagus, using cyanoacrylate. The peak inspiratory pressure was shown to have increased from 18 to 28 cmH2O. We observed partial obstruction of the endotracheal tube end, and partial attachment of the cyanoacrylate to the tracheal wall. The patient's symptoms gradually improved, and no other particular finding was observed during the following two months. We suppose that the cyanoacrylate has been ventilated, and gradually excreted. In manipulation that may cause changes in the tube position, it is recommended to check ventilation via the fistula, and to recheck the tube position.
Anesthesia, General ; Cyanoacrylates ; Esophagus ; Female ; Fistula ; Humans ; Parturition ; Tracheoesophageal Fistula ; Ventilation

Pneumocephalus can be developed after a dural puncture, which occurs in association with epidural procedures. A 37-year-old, gestational age 40 weeks, pregnant woman was admitted for vaginal delivery. She asked for epidural analgesia when she suffers with labor pain. Epidural anesthesia was done at the L3-L4 interspace with the loss of resistance technique, using air. During the identification of the epidural space, an accidental dural puncture was diagnosed by observing a free flow of CSF, through the needle. The patient developed headache 2 hours later. She was treated with hydration, oxygen, analgesics and the autologus blood patch procedure was done, at the L4-L5 interspace. Despite these measures, the patient's symptoms worsened with nausea and vomiting. A brain CT scan showed the presence of pneumocephalus. After 100% oxygen therapy and metoclopramide injection, she was discharged on postpartum 2 days, without any complications.
Adult ; Analgesia, Epidural ; Analgesics ; Anesthesia, Epidural ; Brain ; Epidural Space ; Female ; Gestational Age ; Headache ; Humans ; Labor Pain ; Metoclopramide ; Nausea ; Needles ; Oxygen ; Pneumocephalus ; Postpartum Period ; Pregnancy ; Pregnant Women ; Punctures ; Vomiting

BACKGROUND: Spinal anesthesia for cesarean section is widely used technique for rapid induction, high success rate and excellent intraoperative and postoperative analgesia. Potentiating the effect of intrathecal local anesthetics by addition of opioid for cesarean section is well known. In this study, we compared the clinical effects when different doses of fentanyl were combined with intrathecal hyperbaric bupivacaine. METHODS: Ninety six healthy term parturients were randomly divided into four groups: Group C (control), : Group F10 (fentanyl 10 microg), : Group F15 (fentanyl 15 microg), F: Group F20 (fentanyl 20 microg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS: There were no significant differences between four groups in maximal level and recovery rate of sensory and motor block. Quality of intraopertive analgesia and muscle relaxation was increasing by increasing dosage of intrathecal opioids. Duration of effective analgesia was significantly prolonged in Group F15 and F20 than Group C and F10, but there were no differences between Group F15 and F20. And the frequencies of side effects such as hypotension, max sedation level were increasing by increasing dosage of intrathecal opioids. The Apgar scores were normal, and there were no differences between the four groups. CONCLUSIONS: The addition of fentanyl 15 microg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia without significant adverse effects.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Cesarean Section ; Female ; Fentanyl ; Humans ; Hypotension ; Muscle Relaxation ; Pregnancy

BACKGROUND: We studied the hemodynamic changes associated with steep Trendelenburg position and prolonged pneumoperitoneum during robot-assisted laparoscopic prostatectomy in elderly patients with cardiac diseases. METHODS: Hemodynamic variables were measured at baseline supine position, at 30 min, 1, 2, 3 and 4 h during CO2 insufflation in post-Trendelenburg position, and after deflation in the supine position. RESULTS: In comparison with normal subjects, the cardiac index and systemic vascular resistance index of patients with cardiac diseases were significantly affected by the Trendelenburg position and pneumoperitoneum (P < 0.001). However, other variables of heart rate, mean arterial pressure and central venous pressure were not differed between the groups. CONCLUSIONS: We conclude that attention should be paid to maintain adequate hemodynamic status during prolonged pneumoperitoneum in the Trendelenburg position, and which is unfeasible in patients with severe heart failure and unstable angina.
Aged ; Angina, Unstable ; Arterial Pressure ; Central Venous Pressure ; Head-Down Tilt ; Heart Diseases ; Heart Failure ; Heart Rate ; Hemodynamics ; Humans ; Insufflation ; Pneumoperitoneum ; Prostatectomy ; Supine Position ; Vascular Resistance