Backgroud: In one-lung ventilation using the left-sided double-lumen tube (LDLT), it is important to place the LDLT in correct position to maintain adequate ventilation. We investigated the frequency of and the factors affecting the LDLT malposition in endotracheal intubation. Methods: Ninety one (55 male and 36 female) patients were observed. After endotracheal intubation, using 35 and 37 Fr. sized Robertshaw type LDLT, auscultation and fiberoptic bronchoscope were performed to make sure the correct position of LDLT. The heights, weights, age, and sex were noted. The lengths and diameters of trachea, and the angles and diameters of both bronchi on chest x-ray were measured for comparison. Results: Normal in auscultation and gross malposition were 87.9% and 12.1%. Among those normal in auscultation, normal in bronchoscope, advancing and removing fine malposition were 66.2%, 18.8% and 15.0%, respectively. The angle of left bronchus is 37.71+/-4.60degrees in normal in ausculation and 37.71+/-4.60degrees in gross malposition. The length of trachea is 13.41+/-0.90 cm in normal in bronchoscope, 14.49+/-0.78 cm in advancing fine malposition and 11.86+/-0.35 cm in removing fine malposition. The patient's height is 167.27+/-7.12 cm in normal in brochoscope, 172.45+/-6.67 cm in advancing fine malposition and 163.12+/-6.54 cm in removing fine malposition. Conclusions: The angle of left bronchus is a factor affecting gross malposition. And the length of trachea and the patient's height are factors affecting fine malposition. Thus it is necessary to obtain in advance information on patient's height, length of trachea and angle of left bronchus on chest x-ray, to reduce the occurrence of the LDLT malposition.
Auscultation ; Bronchi ; Bronchoscopes ; Humans ; Incidence* ; Intubation, Intratracheal ; Male ; One-Lung Ventilation ; Thorax ; Trachea ; Ventilation ; Weights and Measures

No abstract available.
Adult* ; Cerebrospinal Fluid* ; Humans

BACKGROUND: Nalbuphine is one of the opioid agonist-antagonists and is used frequently in the anesthetic field. Usage is focused on potent analgesic action and the adjuvant of narcotics because of less complications with preserved analgesia. The most common routes of administration for postoperative pain control are epidural and intravenous, so we compared both pharmacokinetic profiles. METHODS: Twelve patients were randomly divided into two groups. All patients were given a spinal anesthesia with tetracaine hydrochloride. One group (n = 6) received nalbuphine 10 mg via epidural route and another group (n = 6) received the same dose via intravenous route. Venous blood was drawn at 0, 0.25, 0.5, 1, 2, 4, 6 and 8 hours to measure plasma nalbuphine concentrations. Analysis was performed by high performance liquid chromatography with an electrochemical detector. RESULTS: At 0.25 hour, the plasma concentration of nalbuphine was significantly higher in the epidural administration group (49.48 +/- 4.98 ng/ml) than in the intravenous administration group (40.44 +/- 1.64 ng/ml). At 6 and 8 hours, the plasma concentration of nalbuphine was significantly higher in the epidural administration group (5.98 +/- 1.86 ng/ml, 3.85 +/- 0.94 ng/ml) than in the intravenous administration group (3.80 +/- 0.33 ng/ml, 2.43 +/- 0.32 ng/ml). Clearance, elimination half life, volume of distribution and AUC were not significantly different between the two groups. CONCLUSIONS: The plasma concentrations of nalbuphine via epidural route and intravenous route were similar in both groups after 0.25 hour to 6 hours. At 0.25 hour and after 6 hours, the epidural administration group had a higher plasma concentration of nalbuphine than the intravenous administration group.
Administration, Intravenous* ; Analgesia ; Anesthesia, Spinal ; Area Under Curve ; Chromatography, Liquid ; Half-Life ; Humans ; Nalbuphine* ; Narcotics ; Pain, Postoperative ; Plasma* ; Tetracaine

BACKGROUND: Ideal condition of endotracheal intubation after administration of non-depolarizing muscle relaxants like vecuronium is the time when the diaphragm and upper airway muscles are completely relaxed. But these muscles are difficult to determine the degree of relaxation. Neuromuscular response of these muscles are similar to that of orbicularis oculi (OO), but adductor pollicis (AP) is different. However, it is sometimes difficult to monitor OO response. The purpose of this study was to monitor the upper airway muscle relaxation using AP other than OO. METHODS: Fourty-four adult patients of ASA class 1 schaduled for elective surgery under general anesthesia were examined. Anesthesia was induced with fentanyl 2 mcg/kg, and 2 minutes later followed by thiopental sodium 5 mg/kg. After supramaximal stimulation for control twitch height, vecuronium 0.1 mg/kg was intravenously injected and applied continuous train-of-four (TOF) facial nerve stimuli. The TOF response of OO was closely observed with examiner's naked eyes. When complete relaxation of OO achieved, TOF ratio of AP and the time after vecuronium injection were recorded. Thereafter, tracheal intubation was performed and the intubating condition scores was recorded. Ulnar nerve stimuli were continuously applied until complete relaxation of AP was achieved. The time of complete relaxation of AP after vecuronium injection was also recorded. RESULTS: The onset time of complete relaxation was significantly faster in OO (181.3+/- 47.4 secs) as compared with that of AP (265.0+/-67.8 secs). The average TOF ratio of AP was 47.3+/-17.2% and the condition of intubation performed after complete relaxation of OO was satisfied. CONCLUSION: The optimal time for endotracheal intubation was about 3 min after vecuronium 0.1 mg/kg injection, when TOF ratio of AP was about 50%.
Adult ; Anesthesia ; Anesthesia, General ; Diaphragm ; Facial Nerve ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Muscle Relaxation ; Muscles ; Neuromuscular Nondepolarizing Agents ; Relaxation ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

Lung lavage is an accepted modality for treatment of pulmonary alveolar proteinosis. The procedure can be accomplished by the use of double lumen endobronchial tube, with lavaging of one lung while the other is ventilated. As lung lavage is an intentional drowning, particular attention must be paid to potentially serious complications such as severe hypoxemia. We report a case of lung lavage in a patient with secondary pulmonary alveolar proteinosis performed safely by careful monitoring of oxygenation and hemodynamics.
Anoxia ; Bronchoalveolar Lavage* ; Drowning ; Hemodynamics ; Humans ; Lung ; Oxygen ; Pneumoconiosis* ; Pulmonary Alveolar Proteinosis*

Airway management for patients who have suffered multiple facial fractures and skull base fractures is complicated. Nasal intubation can interfere with centralization and stabilization of nasal fractures and may lead to cranial intubation. Restoring the dental occlusion by means of intraoperative maxillo- mandibular fixation is a prerequisite to the corrrect anatomical reduction of multiple facial fractures. This fixation precludes oral endotracheal intubation. In the past, it has been overcome by a tracheostomy. Complications of a tracheostomy include infection, hemorrhage, subcutaneous emphysema, pneumothorax, pneumomediastinum, recurrent laryngeal nerve damage, tracheal stenosis, and tracheoesophageal fistula. The technique of submental intubation was originally described by Altemir. This technique provide secure airway, an unobstructed intraoral airway field. and allows maxillomandibular fixation while avoiding the drawbacks and complications of naso-endotracheal intubation or tracheostomy. With this technique, the multiple facial fractures were corrected successfully.
Airway Management ; Dental Occlusion ; Hemorrhage ; Humans ; Intubation* ; Intubation, Intratracheal ; Jaw Fixation Techniques ; Mediastinal Emphysema ; Pneumothorax ; Recurrent Laryngeal Nerve ; Skull Base ; Subcutaneous Emphysema ; Surgery, Oral* ; Tracheal Stenosis ; Tracheoesophageal Fistula ; Tracheostomy

Though anticoagulant therapy has been shown to improve outcomes dramatically, pulmonary embolism is a potentially fatal disease. A 82 years old female underwent elective operation for left femur neck fracture under general anesthesia. At the twenty-two postoperative days, she suddenly developed cyanosis with hypotension. She was transferred to intensive care unit and pulmonary embolism was diagnosed by pulmonary perfusion scan and echocardiography. Despite of diagnosis and treatment of pulmonaly embolism, she expired 29 hours after onset of symptom.
Aged, 80 and over ; Anesthesia, General ; Arthroplasty, Replacement, Hip* ; Cyanosis ; Diagnosis ; Echocardiography ; Embolism ; Female ; Femoral Neck Fractures ; Humans ; Hypotension ; Intensive Care Units ; Perfusion ; Pulmonary Embolism* ; Thromboembolism

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.
Anesthesia, Spinal ; Aneurysm, False* ; Aorta, Thoracic ; Chest Pain* ; Diagnostic Tests, Routine ; Prostate* ; Thorax*

BACKGROUND: Buprenorphine is more potent and has less side effects than morphine. Therefore it can be used instead of morphine in cancer or postoperative pain contol. The aim of this study was to find an effective low dose of buprenorphine in epidural administration for pain control after obstetric-gynecologic surgery. METHODS: Epidural catheters were placed at L2-3 or L3-4 epidural space in all groups. Sixty nine patients were randomized to three epidural infusion group M, B1 and B2. Each group was 23. Group M: 3 mg morphine with 0.5% bupivacaine 10 ml as bolus, morphine 7 mg in 0.125% bupivacaine 100 ml in infusor; group B1: 0.068 mg buprenorphine with 0.5% bupivacaine 10 ml as bolus, buprenorphine 0.17 mg in 0.125% bupivacaine 100 ml in infusor; group B2: 0.11 mg buprenorphine with 0.5% bupivacaine 10ml as bolus, buprenorphine 0.24 mg in 0.125% bupivacaine 100 ml in infusor. Pain score, side effects and frequency of adjuvant analgesics were recorded at postoperative 1, 2, 6, 12, 24 and 48 hours. RESULTS: There was statistically significant difference of pain score at postoperative 1, 2 and 12 hrs in group B1 (p<0.05). Frequency of adjuvant analgesic was significantly increased in group B1. But there was no significant difference between group M and B2 in pain score. CONCLUSIONS: Our results suggest that buprenorphine 0.11 mg as bolus and 0.24 mg for 2 days are the optimal dose in continuous epidural administration for postoperative pain contol.
Analgesics ; Bupivacaine ; Buprenorphine* ; Catheters ; Epidural Space ; Humans ; Infusion Pumps ; Morphine ; Pain, Postoperative*

BACKGROUND: A hypertensive response is seen when a skull pin is inserted for a craniotomy. The risk of morbidity and mortality is high in patients with intracranial pathology. Many methods have been introduced to overcome the problem. We compared the hemodynamic effects and changes of intracranial pressure when we used lidocaine or fentanyl for blunting the hypertensive response. METHODS: Thirty-two patients scheduled for a craniectomy were divided into two groups: an IV (intravenous) bolus of fentanyl (2micro gram/kg) group or lidocaine (1.5 mg/kg) group. An anesthesia was induced with fentanyl (2micro gram/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg) and vecuronium (0.1 mg/kg), and was maintained with isoflurane 1 MAC (minimum alveolar anesthetic concentration) in nitrous oxide 50% and oxygen. After induction of anesthesia, a lumbar subarachnoid catheter was inserted for CSFP (cerebrospinal fluid pressure) measurement. An IV bolus of either fentanyl (2micro gram/kg) or lidocaine (1.5 mg/kg) was administered prior to insertion of the skull pin by a randomized method. CSFP, MAP (mean arterial pressure), and HR (heart rate) were measured before and 5 min after induction of anesthesia, immediately before and each mininute for five measurements after skull pin insertion. RESULTS: There were no intergroup differences in the values of CSFP and HR. The MAP increased 9+/-14 (mean+/-SD) mmHg and 4+/-12 (mean+/-SD) mmHg 1 min after the skull pin insertion compared with immediately before skull pin insertion in the fentanyl group and lidocaine group respectively. The MAP recovered 2 min after the skull pin insertion in both groups. CPP (cerebral perfusion pressure) recovered 3 min and 2 min after the skull pin insertion in the fentanyl group and lidocaine group respectively. CONCLUSIONS: An IV bolus of either fentanyl or lidocaine before skull pin insertion resulted in a stable value of CSFP, CPP and HR.
Anesthesia ; Catheters ; Cerebrospinal Fluid Pressure* ; Cerebrospinal Fluid* ; Craniotomy ; Fentanyl* ; Hemodynamics ; Humans ; Intracranial Pressure ; Isoflurane ; Lidocaine* ; Mortality ; Nitrous Oxide ; Oxygen ; Pathology ; Perfusion* ; Skull* ; Thiopental ; Vecuronium Bromide