BACKGROUND: The bispectral index, a parameter of electroencephalography (EEG) and a tool for the measurement of sedative state has been used in general anesthesia and for the assessment of sedative degree in intensive care units. The adverse effects of inhalation agents are various although hepatic toxicity, renal toxicity, postoperative nausea, and vomiting have been reported. This study was designed to evaluate the adverse effect of inhalation agents. METHODS: Forty-four adult patients scheduled for thyroidectomy under general anesthesia were randomly assigned to one group with a BIS below 40 (BIS40 group, n = 23) or to a group with a BIS from 50 to 60 (BIS60 group, n = 21). Hgb, WBC count, PLT count, renal function, and liver function were measured pre-and post-operatively (after 24 hrs). The degree of postoperative nausea and vomiting were estimated using the Rhodes Index of Nausea, Vomiting and Retching (RINVR) in postoperative 6 hrs, 12 hrs and 24 hrs. RESULTS: The amount of fentanyl used during the operation were greates in the BIS60 group than in the BIS40 group for adequate analgesia, and the preoperative and postoperative values of Hgb, WBC count, PLT count, AST, ALT, ALP, s-BUN, and s-creatine were not significantly different between the BIS40 and BIS60 groups. 6 hrs, 12 hrs and 24 hrs post-operatively no differences were observed between groups by RINVR in terms of nausea and vomiting. CONCLUSIONS: The adverse effect of an inhalation agent appears not to be related to its concentration when sevoflurane with BIS monitoring are used to reduced the amount of agent inhaled.
Adult ; Analgesia ; Anesthesia* ; Anesthesia, General ; Electroencephalography ; Fentanyl ; Humans ; Inhalation ; Intensive Care Units ; Liver ; Nausea ; Postoperative Nausea and Vomiting ; Thyroidectomy ; Vomiting

OBJECTIVE: The biochemical data of 10 patients admitted with diabetic ketoacidosis(DKA) during the last 2 years were analyzed for the disturbances of serum potassium(K) and acid-base balance with a special interest to look for the underlying causes of potassium(K) disorder, retrospectively. METHODS: Arterial blood gas analysis was done and electrolytes, serum glucose, serum osmolality, BUN, creatinine were checked on admission and recovery in 10 patients with diabetic ketoacidosis. RESULTS: The mean(+/-SE) serum K at diagnosis and on recovery was 4.9+/-0.9mEq/L(range, 3.2-6.5 mEq/L) and 3.8+/-0.2mEq/L(range, 3.0-4.3mEq/L), respectively. Hyperkalemia(>5.0mEq/L) in 30%(3/10) and hypokalemia(<3.5mEq/L) in 10%(1/10) was noted on admission, whereas, on recovery, hyperkalemia in none and hypokalemia in 40%(4/10). Initial K levels showed a negative correlation with pH(gamma= -0.62, P=0.05) but no significant correlation was found between the initial K levels with anion gap (AG), with serum glucose value and with blood osmolality. Only 40%(4/10) had a simple metabolic acidosis while 60%(6/10) had a mixed acid-base disorder DKA with respiratory alkalosis, mostly(5/6). The ratio of delta AG over delta HCO3 was not significantly different between patients with a simple metabolic acidosis(0.95) and with a mixed acid-base disorder(0.92). CONCLUSION: The degree of acidosis must be one of the predominant factors in the pathogenesis of the initial hyperkalemia rather than hyperglycemia resulting from insulinopenia itself. Also, we observed that patients with DKA commonly develop mixed acid- base disorders, and delta AG/delta HCO3 ratio would not be an useful tool to look for a mixed acid-base disorder.
Acid-Base Equilibrium* ; Acidosis ; Alkalosis, Respiratory ; Blood Gas Analysis ; Blood Glucose ; Creatinine ; Diabetic Ketoacidosis ; Diagnosis ; Electrolytes ; Humans ; Hyperglycemia ; Hyperkalemia ; Hypokalemia ; Osmolar Concentration ; Potassium* ; Retrospective Studies

BACKGROUND: Neuromuscular ultrasound has emerged over the last decade as a useful tool for diagnosing peripheral neuropathy. Because nerve enlargement is the most important diagnostic marker of an abnormal nerve, quantification of nerve size is essential. METHODS: We included 80 healthy volunteers aged 21-60 years. The nerve cross-sectional area (CSA) was measured in all participants at the following common compressive sites: bilateral median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head and popliteal fossa, and tibial nerve at the popliteal fossa. Anatomical variants were also evaluated, including a bifid median nerve and persistent median artery. RESULTS: The CSAs were 9.58+/-1.55, 6.87+/-1.61, 4.72+/-0.91, 6.64+/-1.33, 6.48+/-1.68, 12.35+/-3.55, and 26.98+/-6.92 mm2 (mean+/-SD) for the median nerve at the carpal tunnel and forearm, ulnar nerve at the wrist and medial epicondyle, radial nerve at the spiral groove, peroneal nerve at the fibular head, and tibial nerve at the popliteal fossa, respectively. The nerve CSA was significantly larger in men than in women and was correlated with body mass index, weight, and height. A bifid median nerve and persistent median artery were seen in 12 (7.5%) and 4 (2.5%) of 160 hands, respectively. CONCLUSIONS: The information produced in this study can serve as reference data when evaluating these nerve sites using ultrasound.
Arteries ; Body Mass Index ; Female ; Forearm ; Hand ; Head ; Healthy Volunteers ; Humans ; Male ; Median Nerve ; Nerve Compression Syndromes ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Radial Nerve ; Reference Values* ; Tibial Nerve ; Ulnar Nerve ; Ultrasonography ; Wrist

No abstract available.
Humans ; Longitudinal Ligaments* ; Magnetic Resonance Imaging* ; Spine*

No abstract available.
Compartment Syndromes*

BACKGROUND: The acute physiology and chronic health evaluation (APACHE) II score is considered to be a precise predictor of mortality and a useful basic research tool. A lower APACHE II score means a better prognosis of patients, which means that these relatively low risk patients are more likely to benefit from the improved patient management than the higher predicted mortality admissions. Therefore, these patients are obvious targets for intensive care and for decreasing the level of intensive care unit (ICU) mortality. METHODS: This study reviewed the medical records of 729 patients, whose APACHE II scores on the ICU admission day were 10 or less, from June 1, 2001 to May 31, 2002 in University Hospital. The data of the patient's age, gender, disease category, first admission or readmission, APACHE II score, length of stay at the ICU and the hospital were reviewed. RESULTS: The average mortality rate of the patients who had an APACHE II score of 10 or less was 4.1%. The mortality of the cancer patients (8%) was significantly higher than the other disease groups. The mortality of the readmitted patients was significantly higher than the mortality of the patients who were admitted to the ICU for the first time. CONCLUSIONS: Among the patients in the ICU with a low APACHE II score, the mortality of cancer patients was high. The mortality of the readmitted patients was significantly higher than in those on the first admission.
APACHE* ; Humans ; Intensive Care Units ; Critical Care* ; Length of Stay ; Medical Records ; Mortality ; Prognosis

OBJECTIVE: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy. METHODS: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured. RESULTS: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3. CONCLUSION: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.
Adult ; Cadaver ; Ganglia, Sympathetic ; Head ; Humans ; Muscles ; Ribs ; Spine ; Sympathectomy ; Thoracic Cavity ; Thoracic Vertebrae ; Thoracoscopy

The common carotid artery is an artery which supplies the head and neck with oxygenated blood. Although unilateral common carotid artery occlusion or bilateral internal carotid artery occlusion have been reported, the incidence of both common carotid artery occlusion is very rare. As previous report which reviewed 5400 carotid duplex ultrasonograms, 2.5% of internal carotid artery occlusion, 0.24% of unilateral common carotid artery occlusion and none of bilateral common carotid artery occlusion were reported. Common carotid and subclavian arteries are important in the blood supply to the vasculatures of head and upper extremities. Bilateral common carotid artery occlusion might be a cause of stroke, transient ischemic attack or other neurologic sequalae. Cerebral oximetry is a simple method of measuring regional cerebral oxygen saturation (rSO2), which appears to reflect changes in cerebral perfusion and it has been increasingly applicated in many clinical situations such as vascular surgeries involving head/ neck and operations adopting cardiopulmonary bypass. This case describes a successful anesthetic management in a patient with occlusion of bilateral common carotid and subclavian arteries using continuous cerebral oxygenation monitoring during laparoscopic cholecystectomy.
Anesthesia ; Arteries ; Cardiopulmonary Bypass ; Carotid Artery, Common ; Carotid Artery, Internal ; Cholecystectomy, Laparoscopic ; Equipment and Supplies ; Head ; Humans ; Incidence ; Ischemic Attack, Transient ; Neck ; Oximetry ; Oxygen ; Perfusion ; Stroke ; Subclavian Artery ; Upper Extremity

Spinal gabapentin and adenosine have been known to display an antinociceptive effect. We evaluated the nature of the interaction between gabapentin and adenosine in formalin-induced nociception at the spinal level. Male Sprague-Dawley rats were prepared for intrathecal catheterization. Pain was evoked by injection of formalin solution (5%, 50 microliter) into the hindpaw. After examination of the effects of gabapentin and adenosine, the resulting interaction was investigated with isobolographic and fractional analyses. Neither gabapentin nor adenosine affected motor function. Gabapentin or adenosine decreased the sum of the number of flinches during phase 2, but not during phase 1 in the formalin test. Isobolographic analysis, in phase 2, revealed an additive interaction between gabapentin and adenosine. Taken together, intrathecal gabapentin and adenosine attenuated the facilitated state and interacted additively with each other.
*Adenosine/administration & dosage/metabolism/therapeutic use ; *Amines/administration & dosage/metabolism/therapeutic use ; *Analgesics/administration & dosage/metabolism/therapeutic use ; Animals ; *Cyclohexanecarboxylic Acids/administration & Dose-Response Relationship, Drug ; Formaldehyde/*toxicity ; Injections, Spinal ; Male ; Motor Activity/physiology ; Pain Measurement ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; *gamma-Aminobutyric Acid/administration & dosage/metabolism/therapeutic

BACKGROUND: Propofol has a high incidence of pain when administered by intravenous injection. Among the many different methods available, lidocaine is used most frequently to minimize this pain. Propofol also has a depressant action on hemodynamics, especially in the elderly. The present study was aimed to examine whether lidocaine affects hemodynamic changes associated with propofol injection and endotracheal intubation, and whether it attenuates propofol-induced pain. METHODS: Eighty patients, over 60 years old, ASA physical status I and II, were randomly divided into four groups of 20 each according to lidocaine dosage mixed with 2 mg/kg of propofol given over 30 seconds during the induction of anesthesia; 0 mg (control group), 20 mg, 40 mg and 80 mg. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index scale (BIS) were measured before anesthetic induction (baseline value), 1 minute after the start of induction, immediately before endotracheal intubation, and then every minute for 5 minutes. Injection pain was scored as none, mild, moderate, or severe. RESULTS: MAP decreased significantly following the propofol injection and then increased after endotracheal intubation in all four groups, the magnitude of this decrease did not differ among the groups. HR increased after the propofol injection and then decreased. It increased again after intubation in all four groups. BIS was decreased by the induction of anesthesia, but was not affected by endotracheal intubation in any group. The three lidocaine groups had a lower incidence and severity of propofol-induced pain than the control group, and the effect were comparable among the lidocaine-treated groups. CONCLUSIONS: Our results indicate that lidocaine 20, 40 or 80 mg mixed with propofol does not affect the hemodynamic changes associated with propofol and endotracheal intubation, but that they similarly attenuate the injection pain associated with propofol.
Aged* ; Anesthesia* ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Lidocaine* ; Middle Aged ; Propofol