BACKGROUND: Intermittent rhythmic delta activity (IRDA) is classified as a nonspecific abnormal EEG pattern. IRDA is clinically associated with alteration of consciousness, hydrocephalus, cerebral edema, deep midline lesions, subcortical lesions, and tumors of the posterior fossa and the third ventricle. Frontal IRDA(FIRDA) is usually seen in patients over age 15 years, whereas occipital IRDA(OIRDA) occurs mainly in children. We have investigated the clinical feature and significance of IRDA in children. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 36 children with IRDA of EEG concerning diagnosis, neurologic examination, classification of epilepsy, and CT & MRI findings. RESULTS: 1) The location of the IRDA was frontal(FIRDA) in 11 of 36(30.5%), occipital(OIRDA) in 20 of 36(55.6%) and mixed in 5 of 36(13.9%) patients. 2) Thirty of 36(83.3%) have epilepsy (including 1 each with MELAS and tuberous sclerosis), 4 of 36(11.1%) have migraine and 2 of 36(11.1%) patients have meningitis. 3) Sixteen of 30(53.3%) have partial or partial with secondary generalized seizure, 10 of 30(33.3%) have generalized seizure and 4 of 30(13.3%) patients with epilepsy have absence seizure. 4) Neuroimaging studies (CT or MRI scan) were performed in 27 cases. Among 27 cases of studies, 6 cases(22.2%) were abnormal including; two cases of infections, and each case of infarction, venous angioma, arachnoid cyst, cortical atrophy, and tuberous sclerosis, respectively. CONCLUSIONS: IRDA may be considered an epileptiform pattern in childhood and FIRDA is frequently seen in children than previous reports.
Arachnoid ; Atrophy ; Brain Edema ; Child* ; Classification ; Consciousness ; Diagnosis ; Electroencephalography ; Epilepsy ; Epilepsy, Absence ; Hemangioma ; Humans ; Hydrocephalus ; Infarction ; Magnetic Resonance Imaging ; Medical Records ; MELAS Syndrome ; Meningitis ; Migraine Disorders ; Neuroimaging ; Neurologic Examination ; Retrospective Studies ; Seizures ; Third Ventricle ; Tuberous Sclerosis

Due to unknown safety concerns, sugammadex should not be administered to patients withend-stage renal disease (ESRD). However, because the supply of benzylisoquinolinium-typeneuromuscular blocking agents (NMBAs) has been discontinued, rocuronium is the onlynon-depolarizing NMBA that can be used in clinical settings in some countries, includingSouth Korea. The administration of sugammadex cannot be avoided to achieve rapid andcomplete neuromuscular recovery in patients with ESRD or renal transplantation after rocuronium administration. Although there has been a limited number of clinical studies involving the use of sugammadex in patients with ESRD, studies have shown that sugammadexcan effectively and safely reverse rocuronium-induced neuromuscular blockade (NMB) inpatients with ESRD, however recovery of neuromuscular function in patients with ESRD isslower than in patients with normal renal function. Nonetheless, safety-concerns are yet tobe addressed. Considering the small number of clinical studies, high heterogeneity amongstudies, and insufficient safety information, more extensive data on the efficacy and safetyof sugammadex in patients with ESRD are needed. In particular, it is important to securedata on safety, including residual NMB after surgery, recurarization and cardiorespiratorycomplications, anaphylactic reactions, and long-term morbidity and mortality. Furthermore,anesthesiologists should remember that performing proper quantitative neuromuscularmonitoring and neuromuscular management based on the monitoring signs are the mostessential requirements when using sugammadex in patients with ESRD.

Nociception monitoring devices using changes in autonomic nervous system activity have been developed in numerous ways. Although there have been few studies conducted on children, compared to the relatively higher number of studies on adults, most of the nociception monitors in children, as in adults, appear to be more useful than the standard clinical practice that uses hemodynamic parameters in the evaluation and treatment of intraoperative nociception (pain) during general anesthesia. Particularly, when monitoring the surgical pleth index (SPI) in anesthetized children, the application of a new target range of SPI values (≤ 40) to the SPI monitoring criteria seems to be necessary for providing a more proper intraoperative analgesia. The analgesia nociception index (ANI) shows promising results in anesthetized adults, and recently, positive results along with cardiorespiratory coherence have been reported in pediatric patients. Newborn infant parasympathetic evaluation (NIPE) could be useful for providing adequate analgesia in newborns, infants, and children under 2 years of age in anesthetized or awake states. In cases of skin conductance and pupillometry, further studies are needed. Understanding the pros, cons, and limitations of these nociception monitoring tools will provide more effective and safe intraoperative analgesia to pediatric patients undergoing general anesthesia, and it may also help to plan and conduct promising research on the use of perioperative nociception monitoring in pediatric patients in the future.
Adult ; Analgesia ; Anesthesia, General ; Autonomic Nervous System ; Child ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Monitoring, Intraoperative ; Nociception ; Pain Measurement ; Skin

The structure of coxsackievirus and adenovirus receptor's CAR is similar to adhesion molecules. In the adult heart, the majority of CAR localizes at the intercalated disc. Germ line CAR deletion induces embryonic lethality at E11.5 with evidence of a cardiac abnormality. The CAR role as a viral receptor is well known; however, its precise function in the heart for enterovirus infection is not clear. To understand the role of CAR in the cardiac myocyte, we generated cardiac-specific CAR knockout mice using a CAR floxed allele and alpha-MHC-Mer CRE Mer mice. Western blot analysis and immunofluorescent stain of ventricles at 6 weeks after 2 weeks tamoxifen administration, CAR expression was significantly decreased in CAR(f/f) MCM mice but not in CAR(f/f) mice heart. Enterovirus was intraperitoneally infected into CAR(f/f) MCM and CAR(f/f) mice (n=10 each). CAR disruption was dramatically reduced virus infection and replication in the heart but not different in liver, spleen, and pancreas. Cardiac myocyte damage was significantly reduced in the CAR(f/f) MCM mutant mice by evans blue dye stain. In addition, the CAR(f/f) MCM mutant mice heart inflammation and fibrosis were decreased in H&E and trichrome stain compare to CAR(f/f) control mice. CAR expression was required for normal ventricular function, but it is the cause of enterovirus infection. In the adult mice heart, CAR deletion was significantly reduced viral infection, proliferation, and myocarditis. These results suggested that CAR deletion could be useful therapeutic strategy to prevent viral myocarditis.
Adenoviridae ; Adult ; Alleles ; Animals ; Azo Compounds ; Blotting, Western ; Enterovirus ; Enterovirus Infections ; Eosine Yellowish-(YS) ; Evans Blue ; Fibrosis ; Germ Cells ; Heart ; Humans ; Inflammation ; Liver ; Methyl Green ; Mice ; Mice, Knockout ; Myocarditis ; Myocytes, Cardiac ; Pancreas ; Receptors, Virus ; Spleen ; Tamoxifen ; Ventricular Function ; Viruses

OBJECTIVE: Uterine sarcomas are rare and characterized by rapid clinical progression and poor prognosis. The manegement of uterine sarcoma has been challenged. The purpose of this study was to investigate the clinicopathologic findings and outcome of patients with uterine sarcoma METHODS: From Sep. 1990 to July. 1999, 8 patients with histologically proven uterine sarcoma at department of obstetrics and gynecology of Chonbuk University Hospital were evaluated for their clinical profiles and survival retrospectively RESULTS: The age of patients with uterine sarcoma ranged 31 to 60, and the mean age was 46 years. The most common pathologic type of uterine sarcoma was leiomyosarcoma. The common presenting symptom were irregular uterine bleeding, hypermenorrhea and lower abdominal palpable mass. The patients with uterine sarcoma were treated by surgery, post-operative radiotherapy and adjuvant chemotherapy. The mean follow up duration was 34.1 months. The 2 year survival rate was 50%. Distant metastasis were reveled at two patients, and the sites are lung and brain. CONCLUSIONS: Uterine sarcomas are aggressive tumor with a poor prognosis. The Major treatment is surgery and the effect of chemotherapy and radiotherapy were undetermined.
Brain ; Chemotherapy, Adjuvant ; Drug Therapy ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Jeollabuk-do ; Leiomyosarcoma ; Lung ; Menorrhagia ; Neoplasm Metastasis ; Obstetrics ; Prognosis ; Radiotherapy ; Retrospective Studies ; Sarcoma* ; Survival Rate ; Uterine Hemorrhage

The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

BACKGROUND: The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA) with the classic laryngeal mask airway when used by novice personnel. METHODS: There were 114 patients enrolled into this study who underwent general anesthesia were randomly allocated into one of 2 groups; LMA group (n = 57) or SLIPA group (n = 57). After insertion, insertion success rate, insertion time, and hemodynamic responses to insertion were accessed. After surgery, postoperative airway morbidity (sore throat, dysphonia, dysphagia) were evaluated. RESULTS: The SLIPA was successfully inserted in 96% of patients (55/57) and the LMA in 93% (53/57) (P = 0.408). First attempt success rates were 88% (44/57) and 77% (50/57) in the SLIPA and the LMA (P = 0.142). The successful insertion time in SLIPA group (33.4 +/- 11.0 sec) was significantly shorter than that of LMA group (38.8 +/- 16.6 sec) (P = 0.048) and the insertion time at the first attempt was also shorter in SLIPA group (31.0 +/- 6.3 sec) than LMA group (34.7 +/- 8.6 sec) (P = 0.013). There was no statistically significant difference between the two groups in hemodynamic responses and postoperative airway morbidity. CONCLUSIONS: The SLIPA was similar to the LMA in insertion success rate, hemodynamic response, and postoperative airway morbidity by novice personnel. The insertion time at the first attempt and successful insertion time of the SLIPA were significantly shorter than those of the LMA. Therefore, the SLIPA could be a useful alternative to the LMA as primary SGA for novice personnel.
Anesthesia, General ; Dysphonia ; Hemodynamics ; Humans ; Laryngeal Masks ; Pharynx

Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.
Accidents, Traffic ; Adult ; Anesthesia ; Anoxia ; Chest Tubes ; Female ; Humans ; Lacerations ; Lung ; One-Lung Ventilation ; Oxygen ; Pneumothorax* ; Respiration, Artificial ; Thorax ; Ventilation

BACKGROUND: Nitrous oxide (N2O) may increase middle ear pressure during anesthesia, resulting in the displacement of tympanic membrane graft for tympanoplasty.This study was performed to assess the feasibility of remifentanil instead of N2O by comparing hemodynamics, recovery profiles, postoperative analgesia and complications during isoflurane-based anesthesia for tympanoplasty. METHODS: Forty patientsundergoing tympanoplasty were randomly allocated to N2O-isoflurane anesthesia (group N) and remifentanil-isoflurane anesthesia (group R).In group N, N2O was used from induction to 15-30 minutes prior to grafting tympanic membrane and then N2O was changed to air.In group R, remifentanil was infused to the end of surgery.Isoflurane was used in both groups.We compared mean arterial pressure (MAP), heart rate (HR) and recovery times between groups during perioperative period.Postoperative pain, analgesic demand and nausea/vomiting during postoperative period were also compared. RESULTS: MAP and HR were significantly higher in group N than group R at 1 minute, 5 minutes after intubation, skin incision and closure.Hypertensive and tachycardiac events were also more frequent in group N during operation.Time to spontaneous respiration was significantly shorter in group N, but times to eye opening, extubation and recovery of orientation were significantly shorter in group R.There were no significant differences in pain scores, analgesic demand and nausea/vomiting during postoperative period. CONCLUSIONS: Remifentanil can provide more stable hemodynamic status and faster emergence than N2O without significant increase of pain level, analgesic demand and adverse effects in isoflurane-based anesthesia for tympanoplasty.
Analgesia ; Anesthesia ; Arterial Pressure ; Displacement (Psychology) ; Ear, Middle ; Eye ; Heart Rate ; Hemodynamics ; Intubation ; Nitrous Oxide ; Orientation ; Piperidines ; Postoperative Period ; Respiration ; Skin ; Transplants ; Tympanic Membrane ; Tympanoplasty

BACKGROUND: The advantages of addition of epinephrine to local anesthetics during caudal epidural anesthesia are core intense block, prolonged duration of anesthesia and reduction of systemic toxic effect of local anesthetics. The currently recommended concentration of epinephrine is 1 : 200,000, but absorbed epinephrines cause unwanted hemodynamic changes, so we attempted to ascertain the minimum effective concentrations of epinephrine during caudal epidural anesthesia. METHODS: Ninty patients classified ASA physical status I or II scheduled for perianal surgery were studied. These patients were divided into four groups who received 20 ml of 2% lidocaine with epinephrine concentrations of 1 : 100,000, 1 : 200,000, 1 : 400,000 or 1 : 800,000 respectively. Before and during anesthesia, patients' mean arterial pressure (MAP) and heart rate (HR) were measured. Caudal anesthesia was performed with patients in the jack-knife position. A 3 ml test dose was administered initially and then the remaining local anesthetics were injected slowly. The onset of analgesia, duration of analgesia, and other complications were observed. RESULTS: The onset of analgesia was slowest in the 1 : 800,000 group. The duration of analgesia was longest in the 1 : 100,000 group. There were no significant difference in MAP changes, but HR increased significantly in the 1 : 100,000 group compared to the 1 : 200,00 group. There were no systemic toxic symptoms for local anesthetics except that 1 patient, who was in the 1 : 100,000 group, had symptoms of palpitation and headache, considered to be the unwanted pharmacologic effects of epinephrine. CONCLUSION: We concluded that the 1 : 400,000 epinephrine concentration can be used during caudal epidural anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Caudal ; Anesthesia, Epidural* ; Anesthetics, Local ; Arterial Pressure ; Epinephrine* ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine