Postoperative residual neuromuscular blockade or residual paralysis in the postanesthesia care unit is associated with postoperative complications such as muscle weakness, difficulty in breathing, airway obstruction, and hypoxemia. Residual paralysis can be defined by inadequate neuromuscular recovery as measured by objective neuromuscular monitoring. The train-of-four ratio threshold less than or equal to 0.9 is considered to indicate inadequate neuromuscular recovery. Careful management of residual paralysis may decrease the occurrence of adverse events associated with residual neuromuscular blockade. In this review, the clinical implications of residual neuromuscular blockade are summarized.
Airway Obstruction ; Anoxia ; Muscle Weakness ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Paralysis ; Postoperative Complications ; Respiration

Hypoxemia is a common and potentially serious postoperative complication. Hypoxic encephalopahty may occur in prolonged hypoxemia. This condition needs brain protection. There are many brain protective methods. The primary cental nervous system protective mechanism of the barbiturates is attributed to their ability to decrease the cerebral metabolic rate, thus improving the ratio of oxygen (O2) supply to O2 demand. The electroencephalogram-derived bispectral index system (BIS) is a promising new method to predict probability of recovery of consciousness. We experienced two cases of hypoxic brain damage in recovery room. The patients were treated with thiopental and monitored with BIS. The use of thiopental as brain protection during complete global ischemia after cardiac arrest was not effective.
Anesthetics ; Anoxia ; Barbiturates ; Brain ; Consciousness ; Heart Arrest ; Humans ; Hypoxia, Brain* ; Ischemia ; Nervous System ; Oxygen ; Postoperative Complications ; Recovery Room ; Thiopental*

Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.
Adolescent ; Anoxia ; Arteriovenous Fistula/etiology ; Biliary Atresia/*diagnosis/etiology ; Cyanosis/complications ; Dyspnea/complications ; Echocardiography, Transesophageal ; End Stage Liver Disease/complications/*surgery ; Female ; Hepatic Artery/abnormalities ; Hepatopulmonary Syndrome/*diagnosis/ultrasonography ; Humans ; *Liver Transplantation ; Osteoarthropathy, Secondary Hypertrophic/complications

No abstract available.
Animals ; Anoxia/*drug therapy ; Diabetes Mellitus, Experimental/*complications ; Diabetic Nephropathies/*drug therapy ; Kidney Tubules/*drug effects ; Male ; Pentoxifylline/*pharmacology ; Phosphodiesterase Inhibitors/*pharmacology

The disorders of cardiac and pulmonary function as complications due to scoliosis have been described by numerous investigators since Hippocrates. The abnormalities of respiratory and cardiovascular function in scoliosis include reduced lung volume and compliance of the total respiratory system, arterial hypoxemia, which may be associated with hypercarbia, imparied chemical regulation of ventilation and increased pulmonary vascular resistance. We recently had six severs scoliotic patients who underwent Cesarean section under balanced anesthesia in Chonbuk National University Hospital. The following conclusions were obtained through our experiences in regards to the anesthetic management. 1) Arterial blood gas must be checked serially. 2) Anesthesiologists must know the degree of abnormality of the spine and the cardiopulmonary dysfunction. 3) During anesthesia intermittent positeve pressure breathing(IPPB) or positive end expiratory pressure(PEEP) is nedded ofr good oxygenation. 4) Length and location of endotracheal tube is very important. 5) For treatment of postoperative complication, digitalizations, hronchodilators and mechanical ventilation may be needed.
Anesthesia ; Anoxia ; Balanced Anesthesia ; Cesarean Section* ; Compliance ; Female ; Humans ; Jeollabuk-do ; Lung ; Oxygen ; Postoperative Complications ; Pregnancy ; Research Personnel ; Respiration, Artificial ; Respiratory System ; Scoliosis ; Spine ; Vascular Resistance ; Ventilation

PURPOSE: Packing the nose is a common procedure after the closed reduction of a nasal bone fracture to prevent postoperative complications, such as bleeding and adhesion formation as well as to stabilize the framework of the nasal bone. On the other hand, it is difficult for a patient to endure nasal packing because of breathing difficulties, headaches, chest discomfort, insomnia, general weakness and hypoxia. This study examined the availability of a bronchodilator to improve the decreased oxygen saturation and postoperative symptoms on nasal packing. METHODS: From February, 2010 to July, 2010, a prospective randomized comparison of the incidence of a range of postoperative signs and symptoms was conducted on 60 patients, who did (n=30) and did not (n=30) undergo bronchodilator infusion (aminophylline 250 mg/10 mL + normal saline 100 mL IV qd) following nasal packing. The postoperative symptoms and oxygen saturation in the two groups were compared. RESULTS: Patients who had infused the bronchodilator showed improved oxygen saturation. Nevertheless, there were no significant differences in the postoperative uncomfortable symptoms (dyspnea, headache, chest discomfort, insomnia, general weakness) between the two groups. CONCLUSION: A bronchodilator after nasal packing improves oxygen saturation by dilating the airway tract but it cannot reduce the uncomfortable symptoms caused by nasal obstruction. Overall, the bronchodilator is a useful medication for improving the level of oxygen saturation.
Anoxia ; Hand ; Headache ; Hemorrhage ; Humans ; Incidence ; Nasal Bone ; Nasal Obstruction ; Nose ; Oxygen ; Postoperative Complications ; Prospective Studies ; Respiration ; Sleep Initiation and Maintenance Disorders ; Thorax

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. If a patient had tachypnea, cold sweating and hypoxemia in postoperative period, PTE must be thought to be one of possible causes of tachypnea. We have experienced one case of PTE after operation. A 40 year-old woman underwent total hystrectomy and partial omentectomy due to huge, bizarre shaped and inflammatory myoma presenting as an abdominal mass with abscess pocket accompanied by severe and adhesion. At the 5 th postoperative day tachypnea and hypoxemia were developed suddenly. PTE was confirmed with lung perfusion scan and leg edema with deep vein thrombosis occurred later. Proper cardiopulmonary support and anticoagulant therapy were done and the patient was recovered and discharged in improved condition.
Abscess* ; Adult ; Anoxia ; Diagnosis ; Edema ; Female ; Humans ; Leg* ; Leiomyoma* ; Lung ; Myoma ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Sweat ; Sweating ; Tachypnea ; Venous Thrombosis*

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. If a patient had tachypnea, cold sweating and hypoxemia in postoperative period, PTE must be thought to be one of possible causes of tachypnea. We have experienced one case of PTE after operation. A 40 year-old woman underwent total hystrectomy and partial omentectomy due to huge, bizarre shaped and inflammatory myoma presenting as an abdominal mass with abscess pocket accompanied by severe and adhesion. At the 5 th postoperative day tachypnea and hypoxemia were developed suddenly. PTE was confirmed with lung perfusion scan and leg edema with deep vein thrombosis occurred later. Proper cardiopulmonary support and anticoagulant therapy were done and the patient was recovered and discharged in improved condition.
Abscess* ; Adult ; Anoxia ; Diagnosis ; Edema ; Female ; Humans ; Leg* ; Leiomyoma* ; Lung ; Myoma ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Sweat ; Sweating ; Tachypnea ; Venous Thrombosis*

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. A 59 year-old woman received cholecystectomy and choledocholithotomy under general anesthesia. At the 9th postoperative day, syncope, hypoxemia and hypotension were developed suddenly and the patient was transfered to intensive care unit. PTE was suspected with hemodynamic monitoring from pulmonary arterial catheter and echocardiography and diagnosed with lung perfusion scan and venogram of lower extremities. Proper cardiopulmonary support was done and the patient was recovered and discharged in improved condition. In conclusion, if a patient have syncopal attack with shock in postoperative period, PTE must be thought to be an one of possible causes of syncope and thoroughly investigated.
Anesthesia, General ; Anoxia ; Catheters ; Cholecystectomy ; Diagnosis ; Echocardiography ; Female ; Hemodynamics ; Humans ; Hypotension ; Intensive Care Units ; Lower Extremity ; Lung ; Middle Aged ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Shock ; Syncope

An 86-year-old female with a history of right rotator cuff injury was admitted for arthroscopic shoulder surgery under general anesthesia. There were no remarkable immediate postoperative complications. However, while recovering in the general ward, she developed dyspnea with hypoxia. She was immediately treated with oxygen, and antibiotics after pneumomediastinum was confirmed on both chest x-ray and chest computed tomography. Subcutaneous emphysema on either face or neck followed by arthroscopic shoulder surgery was common, but pneumomediastinum with hypoxia is a rare but extremely dangerous complication. Thus we would like to report our case and its pathology, the diagnosis, the treatment and prevention, with literature review.
Anesthesia, General ; Anoxia ; Anti-Bacterial Agents ; Arthroscopy ; Dyspnea ; Female ; Humans ; Mediastinal Emphysema ; Neck ; Oxygen ; Patients' Rooms ; Postoperative Complications ; Rotator Cuff ; Shoulder ; Subcutaneous Emphysema ; Thorax