Excessive peak airway pressure during general endotracheal anesthesia may result from bronchospasm due to light anesthesia or surgical stimulation, bronchial intubation, tension pneumothorax, pulmonary edema, or mechanical obstruction of tube, whether from kinking, inspissated secretions, or overinflation of the cuff. Usually these problems are differentiated with auscultation and drug administration. However, mechanical problems associated with the endotracheal tube may be a cause of increased airway pressure. Reinforced, anode, or armored tubes consist of two coatings of latex or PVC that enclose spiral metal windings. Because of that, the inner layer may peel away, and intraluminally bulge due to nitrous oxide and cause airway obstruction during the course of an anesthetic process. We report a case of intraluminal bulging of the inner layer in a reinforced tube using fiberoptic bronchoscopy during anesthesia.
Airway Obstruction ; Anesthesia* ; Auscultation ; Bronchial Spasm ; Bronchoscopy ; Electrodes ; Intubation ; Latex ; Nitrous Oxide ; Pneumothorax ; Pulmonary Edema ; Wind

BACKGROUND: The use of a low-dose naloxone infusion concomitant with intravenous morphine PCA (patient-controlled analgesia) attenuates opioid-related side effects without reducing analgesic effects. The authors compared the incidence of morphine-related side effects and the quality of analgesia in adding low-dose naloxone, normal saline or droperidol to an IV fentanyl PCA regimen. METHODS: One hundred eight patients undergoing ocular plastic surgery were enrolled in the study. General anesthesia was induced and maintained with propofol TCI (target controlled infusion), vecuronium or pancuronium and nitrous oxide. After intubated, they received intravenous fentanyl as PCA. They were randomized to receive normal saline, droperidol or low-dose naloxone concomitant with IV fentanyl PCA. Verbal rating scores for pain, the degree of patients' satisfaction (1-4), nausea, vomiting, requests for antiemetics, urinary retention, pruritus and respiratory depression were recorded after 24 hours. RESULTS: There was no difference in the VRS (verbal rating score) for pain, degree of the satisfaction and the incidence of nausea, vomiting and requests of antiemetics among the three groups. There was no incidence of pruritus or respiratory depression. One subject developed urinary retention in the control group, and three cases in the droperidol group, but none was developed in the low-dose naloxone group. CONCLUSIONS: There was no difference in the prevention of postoperative nausea, or vomiting among the normal saline, droperidol, and naloxone groups with an IV fentanyl PCA. Low-dose naloxone, however, had a reducing effect on urinary retention; it may become an alternative choice according to the anesthesiologist's preference.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, General ; Antiemetics ; Droperidol ; Fentanyl* ; Humans ; Incidence ; Morphine ; Naloxone* ; Nausea ; Nitrous Oxide ; Pancuronium ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Propofol ; Pruritus ; Respiratory Insufficiency ; Surgery, Plastic ; Urinary Retention ; Vecuronium Bromide ; Vomiting

BACKGROUND: Optimal control for the management of the length of stay in the postanesthesia care unit (PACU) following general anesthesia in adults is an important strategy for surgical patients' care. A model to predict the results of the PACU stays could be used to improve the utilization of the PACU and resources of the operating room through a more efficient arrangement. The purpose of this study was to evaluate the performance of the decision tree based analysis using clinical sets of data from adult patients undergoing general anesthesia. METHODS: The decision tree was trained with 351 clinical sets (86% in 409 data sets) using a Chi-squared automatic interaction detection (CHAID) algorithm and validated through independent testing of 58 cases (14%). Twenty-two independent variables were used to find determinant variables and to predict categorical dependent values (lengths of stay in the PACU). RESULTS: The decision tree based analysis correctly predicted in 68% of real situations and identified influencing variables as intubation state, complication in the PACU, and intraoperative transfusion. CONCLUSIONS: We concluded that the decision tree based analysis could provide a useful predictive and classifying model for the optimization of limited resources of the PACU. The decision tree based analysis is an alternative way of classifying, and a predicting method for developing a model for lengths of stay in the PACU with easy interpretation and clear graphical displays of the structure of variables.
Adult ; Anesthesia, General ; Decision Trees ; Humans ; Intubation ; Length of Stay* ; Operating Rooms

No abstract available.

BACKGROUND: The 5-hydroxytryptamine type 3 (5-HT3) receptor is a member of the Cys-loop superfamily of ligand-gated ion channels (LGICs) and modulated by pharmacologic relevant concentrations of volatile anesthetics or n-alcohols like most receptors of LGICs. The goal of this study was to reveal whether the site-directed single mutations of E-106, F-107 and R-222 in 5-HT3 receptor may affect the anesthetic modulation of halothane known as positive modulator. METHODS: The wild-type and mutant receptors, E106D, F107Y, R222F, R222V, were expressed in Xenopus Laevis oocytes and receptor function was assessed using two electrode voltage clamp techniques. RESULTS: E106D, F107Y, R222F, R222V mutant 5-HT3A receptors were functionally expressed. F107Y mutant 5-HT3A receptors displayed decreased sensitivity to 5-HT compared to the wild type 5-HT3A receptor (P < 0.05). Halothane showed positive modulation in both wild and F107Y mutant 5-HT3A receptors but F107Y mutant 5-HT3 receptor showed greater enhancing modulation comparing to wild-type receptor. Meanwhile, R222F and R222V mutant 5-HT3 receptor lost positive modulation with 1 and 2 MAC of halothane. Most interestingly, positive modulation by halothane was converted into negative modulation in E106D mutant 5-HT3A receptor. CONCLUSIONS: The present study implicate the amino acid residues known for agonist binding and linking agonist binding to channel gating might also have important role for anesthetic modulation in 5-HT3A receptor.
Anesthetics ; Electrodes ; Electrophysiology ; Halothane ; Ligand-Gated Ion Channels ; Oocytes ; Patch-Clamp Techniques ; Receptors, Serotonin, 5-HT3 ; Serotonin ; Xenopus laevis

No abstract available.
Child* ; Humans

Postoperative cognitive dysfunction (POCD) occurs immediately after surgery and is characterized by impairment of memory and changes in cognition. POCD can last for several months or years and have adverse effects including delayed hospital stays, diminished function in daily life, and increased complications and mortality. Despite improvements in surgical technique, anesthesia management, and intensive care, many patients suffer from POCD. POCD is one of the important clinical issues in surgical management and understanding its pathophysiology is necessary. In this review, therefore, we have focused on animal models of POCD and measurements of cognitive ability in preclinical studies, and we have suggested novel approaches for prevention/treatment of POCD. In preclinical studies, major abdominal surgery (laparotomy, hepatectomy, and splenectomy), minor abdominal surgery (laparotomy, probe exploration), and tibial fracture surgery, are used as POCD models. In addition, cognitive function is assessed by Morris water maze, passive avoidance task, elevated plus maze, and T maze test. Neuroinflammation, blood-brain barrier dysfunction, beta amyloid deposition, and tau phosphorylation are suggested as pathological mechanisms of POCD in preclinical studies. Based on several studies of these, we suggest erythropoietin, nuclear factor kappa B, interleukin17A, tumor necrosis factor alpha, and nicotinamide adenine dinucleotide phosphate oxidase 2 as candidates for prevention/treatment of POCD. In the preclinical stage, drug development/exploration and research is being carried out to solve cognitive dysfunction after surgery. Ultimately, based on the results of preclinical studies, we expect to overcome POCD.
Anesthesia ; Blood-Brain Barrier ; Cognition ; Critical Care ; Erythropoietin ; Hepatectomy ; Humans ; Length of Stay ; Memory ; Models, Animal ; Mortality ; NADP ; NF-kappa B ; Oxidoreductases ; Phosphorylation ; Plaque, Amyloid ; Tibial Fractures ; Tumor Necrosis Factor-alpha ; Water

Background: Liver transplantation (LT) may be associated with massive blood loss and the need for allogeneic blood transfusion. Intraoperative blood salvage autotransfusion (IBSA) can reduce the need for allogeneic blood transfusion. This study aimed to investigate the effectiveness of blood salvage in LT. Methods: Among 355 adult patients who underwent elective living-donor LT between January 1, 2019, and December 31, 2022, 59 recipients without advanced hepatocellular carcinoma received IBSA using Cell Saver (CS group). Based on sex, age, model for end-stage liver disease (MELD) score, preoperative laboratory results, and other factors, 118 of the 296 recipients who did not undergo IBSA were matched using propensity score (non-CS group). The primary outcome was the amount of intraoperative allogenic red blood cell (RBC) transfusion. Comparisons were made between the two groups regarding the amount of other blood components transfused and postoperative laboratory findings. Results: The transfused allogeneic RBC for the CS group was significantly lower than that of the non-CS group (1,506.0 vs. 1,957.5 ml, P = 0.026). No significant differences in the transfused total fresh frozen plasma, platelets, cryoprecipitate, and estimated blood loss were observed between the two groups. The postoperative allogeneic RBC transfusion was significantly lower in the CS group than in the non-CS group (1,500.0 vs. 2,100.0 ml, P = 0.039). No significant differences in postoperative laboratory findings were observed at postoperative day 1 and discharge. Conclusions Using IBSA during LT can effectively reduce the need for perioperative allogeneic blood transfusions without causing subsequent coagulopathy.

BACKGROUND: Although the pro-convulsant or anticonvulsant properties of propofol remain a matter of controversy, it is evident that propofol can produce involuntary movement. Such movement is a relatively common side effect, especially in children, and may be dose-related or injection rate-related. The goal of this study was to evaluate the effect of injection rate upon involuntary movement during propofol induction in children. METHODS: Children (age 3-14 yr) undergoing elective Eye and ENT surgery were randomly allocated to one of 4 groups based on the propofol injection rate (A, manual/15 s; B, 360 ml/hr; C, 200 ml/hr, D, 100 ml/hr) using a manual injection method and syringe pumps. No premedication was used. The induction dosage of propofol was 3 mg/kg in all groups. Fentanyl 1mcg/kg and 1% lidocaine 1-2ml were given I.V. before propofol. Involuntary movement was graded 0-2 on severity. The infused dose of propofol at movement was measured. Movement due to pain or mask fitting was not regarded as an involuntary movement. All results were analyzed using the Chi-Square Test and ANOVA. RESULTS: 595 children were studied. Age, gender, and weight were similar in the 4 groups. Involuntary movements were apparent in 179 (30.1%) of the 595 subjects. Movements were significantly less in group A (12.4%) and B (16.4%) compared to group C (46.6%) and D (45.3%). The grades of movement were not different among the 4 groups. The durations of movement in group A and B were significantly short compared to group C and D. The infused dose of propofol (mg/kg) at movement was higher in group C (2.65+/-0.62) than in A (1.99+/-0.62) and B (2.43+/-0.78). There were no significant hemodynamic and SPO2 changes during and after the propofol injection. CONCLUSIONS: We concluded that slow injection may increase the incidence of involuntary movement during propofol induction in children. Since the bolus injection rates are usually slow in most syringe pumps, manual injection for 10 15 s may be a better choice for smoother induction, as it requires fewer interventions to prevent venous catheter displacement in children.
Catheters ; Child* ; Dyskinesias* ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Lidocaine ; Masks ; Premedication ; Propofol* ; Syringes