BACKGROUND: The pro's and con's of pulsatile versus nonpulsatile perfusion during acute and chronic mechanical circulatory support is a longstanding controversial issue, some investigators have suggested that the simplest explanation for this controversy is a failure to quantitate adequately the pulsatile components of flow in studies. The aim of this study was to examine the pulsatility generated by centrifugal pump (CP) and a pulsatile extracorporeal life support (twin pulse life support, T-PLS) in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE). METHODS: In each of the 5 cardiac arrested pigs, the outflow cannula of the CP or T-PLS was inserted into the ascending aorta, and the inflow cannula of the CP or T-PLS was placed in the right atrium. Extracorporeal circulation was maintained for 30 minutes using a pump flow of 75 ml/kg/min by CP or T-PLS, respectively. Pressure and flow were measured in the right internal carotid artery. RESULTS: No statistical difference was observed between CP and T-PLS in terms of mean carotid artery pressure. However, pulse pressure, the percent change from mean arterial pressure to EEP, and SHE in T-PLS were higher than CP (pulse pressure: 36.1 +/- 3.6 mmHg vs 9.1 +/- 1.3 mmHg, P < 0.05, the percent change from mean arterial pressure to EEP: 19.8 +/- 6.2% vs 0.2 +/- 0.3%, P < 0.05). CONCLUSIONS: In a cardiac arrested animal model, CP revealed nonpulsatility and pulsatility generated by T-PLS was effective in terms of EEP and SHE.
Aorta ; Arterial Pressure ; Blood Pressure ; Carotid Arteries ; Carotid Artery, Internal ; Catheters ; Extracorporeal Circulation ; Heart Arrest ; Heart Atria ; Hemodynamics ; Humans ; Life Support Systems* ; Models, Animal ; Perfusion ; Research Personnel ; Swine

Endoscopic thyroidectomy has been increasingly used because it is minimally invasive, provides better cosmetic results as well as less, post-operative pain. However, the technique is associated with complications that, include subcutaneous emphysema, hypercarbia and pneumothorax. We treated a 45 year-old female patient who had subcutaneous emphysema, hypercarbia and increased peak inspiratory airway pressure due to carbon dioxide administered during the endoscopic thyroidectomy. After the above problems occurred, we increased the minute ventilation with 100% O2. The operation was over after about one hundred twenty minutes and ventilation was adequate so that arterial blood gas findings returned to the normal range in the recovery room. The patient was treated conservatively with oxygen and recovered completely at the time of discharge from the Hospital
Carbon Dioxide ; Female ; Humans ; Middle Aged ; Oxygen ; Pneumothorax ; Recovery Room ; Reference Values ; Subcutaneous Emphysema* ; Thyroidectomy* ; Ventilation

BACKGROUND: Pediatric tonsillectomy may be associated with a high incidence of emergence agitation. The aim of this study was to determine the appropriate dose of remifentanil continuously administered in the postanesthetic care unit (PACU) to reduce the incidence of emergence agitation and side effects after total intravenous anesthesia (TIVA). METHODS: Sixty children aged from 4 to 12 years undergoing tonsillectomy were randomly assigned to 3 groups. Anesthesia was induced with 1.5 mg/kg of propofol, 1microg/kg of remifentanil and was maintained with continuous infusion of propofol 100microg/kg/min, remifentanil 0.25microg/kg/min. At the end of surgery, each group received 0.025 (group 1), 0.05 (group 2), or 0.1 (group 3)microg/kg/min of remifentanil, respectively and the infusion was discontinued at 10 min before PACU discharge. Duration of anesthesia and emergence time were evaluated at the operating room. Agitation score, the time of stay in PACU and postoperative side effects were evaluated at the PACU. RESULTS: The emergence time and the time of stay in PACU were prolonged in the group 3 compared to the other groups (P < 0.05). The Group 2 and 3 had lower agitation score in comparison with that of the group 1 in the PACU (P < 0.05). CONCLUSIONS: For reducing emergence agitation after TIVA, we recommend infusion dose of remifentanil 0.05microg/kg/min.
Anesthesia ; Anesthesia, Intravenous* ; Child ; Dihydroergotamine* ; Humans ; Incidence ; Operating Rooms ; Propofol ; Tonsillectomy*

BACKGROUND: Laryngoscopy and tracheal intubation often cause hemodynamic changes such as hypertension and tachycardia. This study was carried out to determine the optimal dose of sufentanil for attenuating the hemodynamic changes that occur during the induction of anesthesia with propofol. METHODS: The authors examined 100 ASA class 1-2 patients, who were scheduled for elective surgery anddivided randomly into 4 groups. Anesthesia was induced with propofol (5.0microg/kg target controlled infusion). Three minutes later, rocuronium 1.2 mg/kg was administered. Group 1 (CON group) received no sufentanil, and groups 2, 3 and 4 (SO3, SO5, SO7 groups) received 0.3, 0.5, 0.7 microg/kg, sufentanil, respectively. The hemodynamic changes and BIS were measured at preinduction, 1 and 3 minutes after propofol infusion, and 1 and 3 minutes after sufentanil infusion, intubation, and post-intubation period for 10 minutes. RESULTS: In the SO3, SO5, SO7 groups, the systolic and diastolic and mean arterial pressure did notincrease compared with that at preinduction. However, in the SO7 group, the systolic and diastolic and mean arterial pressure decreased significantly 1 minute after intubation. In the SO3 group, the heart rate increased significantly after intubation compared with preinduction. On the other hand, the heart rate did not increase after intubation in the SO5 and SO7 groups. CONCLUSIONS: When anesthesia is induced with propofol TCI (5.0 microg/ml, the authors suggest that the recommended dosage of sufentanil for attenuating the hemodynamic changes accompanying a laryngoscopy and tracheal intubation be approximately 0.5microg/kg.
Anesthesia ; Arterial Pressure ; Hand ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Propofol ; Sufentanil* ; Tachycardia

Ultrasonography*

Lowe syndrome is a rare genetic condition that involves three major organs: eyes, brain, and kidney. Anesthetic management can be challenged by problems associated with high ocular pressure, mental retardation, and renal tubular dysfunction. We report a case of a 17 year-old boy with Lowe syndrome accompanied by end-stage renal disease who underwent general anesthesia for arteriovenous fistula formation. The Anesthetic implications of this syndrome are also described.
Anesthesia ; Anesthesia, General ; Arteriovenous Fistula ; Brain ; Eye ; Humans ; Intellectual Disability ; Kidney ; Kidney Failure, Chronic ; Oculocerebrorenal Syndrome ; Quaternary Ammonium Compounds

A 27-year-old man underwent excision of a mediastinal mass using video-assisted thoracoscopic surgery (VATS) performed in the right lateral position. Postoperatively, he complained of pain in the left upper arm and chest wall, limitation of the left shoulder joint, allodynia, hyperalgesia, spontaneous pain in left finger, edema, hypohidrosis, and change of skin color of the left hand. We diagnosed the patient with complex regional pain syndrome (CRPS) by using the proposed modified International Association of the Study of Pain (IASP) research diagnostic criteria, and initiated treatment through medication and interventional management. After 3 months of treatment, the pain intensity reduced to below 2 cm on the VAS. In this study, we describe a case of postoperative CRPS, which is believed to have been caused by excessive stretching of the brachial plexus. Careful positioning of patients on the operating table with proper padding will reduce injuries to the peripheral nerves.
Adult ; Arm ; Brachial Plexus ; Brachial Plexus Neuropathies ; Edema ; Fingers ; Hand ; Humans ; Hyperalgesia ; Hypohidrosis ; Operating Tables ; Peripheral Nerves ; Shoulder Joint ; Skin ; Thoracic Surgery, Video-Assisted ; Thoracic Wall

BACKGROUND: Preoxygenation with tidal volume breathing for 3 min is a standard technique using 100% oxygen for prevention of hypoxia during the induction of general anesthesia. The measurement of end tidal oxygen concentration is useful in preoxygenation monitoring. The aim of the study was to determine the effects of preoxygenation in pediatric patients during 3 min with tidal volume breathing. METHODS: Sixty patients who were scheduled for general surgery were divided into 0-6 yr old children (Group I, n = 20), 7-15 yr old children (Group II, n = 20) and adults (Group III, n = 20). Patients with an inflatable mask connected to an anesthesia machine breathed 100% oxygen spontaneously for 3 min with tidal volume in all three groups. End tidal oxygen concentration, end tidal carbon dioxide concentration and respiratory rate were measured simultaneously for 3 min. RESULTS: Group I and II showed significantly higher end tidal oxygen concentrations than Group III from 10 sec to 160 sec with 3 min tidal volume breathing (P < 0.05). The mean time required for end tidal oxygen concentration of 90% was 85.5 +/- 18.5 sec for Group I, 101.5 +/- 21.5 sec for Group II and 148.0 +/- 24.0 sec for Group III. Therefore, Group I and II showed a significantly shorter time than Group III (P < 0.05). CONCLUSIONS: Pediatric patients showed a significantly shorter time to obtain the required preoxygenation.
Adult ; Anesthesia ; Anesthesia, General ; Anoxia ; Carbon Dioxide ; Child ; Humans ; Masks ; Oxygen ; Respiration ; Respiratory Rate ; Tidal Volume

BACKGROUND: Recently, the value of routine preoperative screening tests has been questioned, especially in healthy children scheduled for elective minor surgery. We have assumed that sufficient history taking and physical examination could replace these tests. We prepared child health check lists for the parents to answer. Then, we compared the usefulness between preoperative screening tests and child health check lists. METHODS: Group A included 67 children, the parents of whom had answered the child health check list, and group B included 63 children who underwent routine preoperative screening tests. Each group was divided into ambulatory surgery patients (groups A1, B1) and patients admitted for surgery (group A2, B2). Comparison values between the two groups included preoperative evaluation time, operation time, anaesthesia time and recovery time. Also, clinical side effects were evaluated. RESULTS: The operation time, anaesthesia time and recovery time in each group showed no statistical differences. However, there were statistical differences of preoperative evaluation time. Preoperative evaluation time was significantly decreased in groups A1 (4.0 +/- 1.2), and A2 (5.4 +/- 1.3) compared to groups B1 (7.6 +/- 1.7), and B2 (8.6 +/- 1.8). CONCLUSIONS: The use of a child heath check list saved time in the preoperative evaluation and saved the effort of the anaesthesiologist. It also decreased the discomfort of the children by omitting the invasive procedure and it reduced the medical costs.
Ambulatory Surgical Procedures ; Child ; Child Health ; Humans ; Mass Screening ; Parents ; Physical Examination ; Surgical Procedures, Minor

Achondroplasia is the most common non-lethal skeletal dysplasia. Underdevelopment and premature ossification of bones result in characteristic craniofacial and spinal abnormalities. Achondroplastic dwarfs have low fertility rates and require delivery by cesarean section due to their cephalo-pelvic disproportion. Controversy exists regarding the ideal anesthesia for an achondroplastic parturient dwarf for urgent cesarean section. Anesthesia, whether general or regional, presents many potential problems during cesarean section. We report the experience of the epidural anesthesia in an achondroplastic dwarf undergoing elective cesarean section.
Achondroplasia ; Anesthesia ; Anesthesia, Epidural ; Birth Rate ; Cesarean Section ; Female ; Pregnancy