No abstract available.
Intubation, Intratracheal*

Postoperative brain damage is one of most serious complications of cardiopulmonary bypass (CPB). To prevent brain damage during CPB, adequate cerebral perfusion for cerebral oxygen demand should be maintained. This study monitored jugular venous oxyhemoglobin saturation (SjO₂), which reflects the overall balance of cerebral oxygen supply and demand, intermittently in 10 patients undergoing cardiac surgery. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, SjO₂ did not change, and it was stable during the hypothermic period of CPB. But a significan reduction in SjO₂ was observed during the rewarming period, and SjO₂ had an inverse linear correlation with esophageal temperature. Furthermore, the percent decrease of SjO₂ was related to rewarming speed. Therefore, therapeutic approaches for SjO₂ desaturation include slower rewarming, increasing cerebral blood flow, decreasing the cerebral metabolic rate for oxygen, increasing oxygen content, and increasing perfusion flow rate.
Arterial Pressure ; Brain ; Cardiopulmonary Bypass ; Cerebrovascular Circulation ; Humans ; Oxygen ; Oxyhemoglobins* ; Perfusion ; Rewarming ; Thoracic Surgery

BACKGROUND: In previous our retrospective study, we concluded that administered fluid volume, duration of operation, operative procedures and anesthetic techniques were the major factors of postoperative urinary retention. However, the administered fluid volume, age, types and duration of the operation confined to hemorrhoidectomy was questioned as a precipitating factor. The high retention rate in spinal anesthesia is also questioned. METHODS: We investigated these possible precipitating factors of urinary retention in healthy patients (n=154) undergoing hemorrhoidectomy. The patients were randomly divided into three different anesthetic techniques: caudal (2% lidocaine 300 mg with 1 : 200,000 epinephrine), spinal (0.5% tetracaine 5 mg with epinephrine 0.1 mg or 5% lidocaine 40 mg) and general (enflurane, N2O, vecuronium). Urinary retentin was searched according to above factors following surgery. RESULTS: The overall urinary retention rate was 46.1%. The retention rate in patients with spinal anesthesia was higher than that in those with other anesthetic techniques (p<0.05). There was no significant difference between patients with lidocaine and tetracaine spinal anesthesia in urinary retention rate. The administered fluid volume in patients with urinary retention was significantly higher than that of patients without retention (p<0.05). Age, duration and types of hemorrhoidectomy did not significantly affect urinary retention rate. CONCLUSIONS: Restriction of fluid administration and avoidance of spinal anesthesia are necessary in reducing postoperative urinary retention following hemorrhoidectomy.
Anesthesia, Spinal ; Epinephrine ; Hemorrhoidectomy* ; Humans ; Lidocaine ; Precipitating Factors ; Retrospective Studies ; Surgical Procedures, Operative ; Tetracaine ; Urinary Retention*

To identify the epidural space various methods have been recommended and the methods are divided into two major categories, either loss of resistance or negative pressure technics. A s#yringe technic to feel loss-of-resistanse is now widely used clinically due to its reliability and simplicity. However, in some instances, it is very difficult to recognize the epidural space despite using the above methods so that the need for a more safe and easier one is required. After the patient is placed in a sitting flexed position, an 18 gauge Tuohy needles is inserted epidurally at the lumbar area with a saline filled CVP manometer connected via a 3-way stopcock, then a sudden drop of pressure is usually observed and a fluctuation of the pressure can be observed in the water column of the manometer according to the changes in positions, respiration and heart beat. Although this method can be criticized because the technique is somewhat cumbersome and is difficult for retrial when the dura has been punctured, the authors appreciate the experimental values of the technic and suggest its aduantanges as follows: 1) it is a visual thchnic. 2) the measurement of epidural pressure is possible. 3) it prevents back-drip of local anesthetic solution with a 3-way stopcock. 4) it is useful as an index for determination of local anesthetic volume to be injected.
Epidural Space* ; Heart ; Humans ; Needles ; Respiration ; Water

Acute urinary retention is a common complication following anorectal surgery. However, the cause of this complication is poorly understood. We investigated the influence on postoperative urinary retention of age, sex, premedicants, intraoperative fluid volume administered, surgeon, operating time, type of operation, anesthetic technique in 278 patients undergoing elective surgery for benign anorectal disease by a review of the charts. The results were as follows. The overall urinary retention rate was 31.7%. Age, sex, premedicants (narcotics, anticholinergics), surgeon did not correlate with urinary retention. Increasing age was associated with a relatively high incidence of urinary retention, but the difference did not reach statistical significance (P=0.054). The variables of intraoperative fluid volume administered (>200 ml), anesthetic technique (spinal anesthesia vs. general or caudal anesthesia), type (hemorrhoidectomy, especially including multiple mucosal ligation or sphincterotomy) of the operation, and operating time (>30 min) correlated significantly with retention (P<0.05). Urinary retention was 2, 7 and 3 times more likely to occur in patients who had duration of operation more than 30 minutes, hemorrhoidectomy, and spinal anesthesia respectively. After all above variables were controlled for, duration and type of the procedure and anesthetic technique remained significantly correlated with retention (P<0.05). We concluded that operating time of more than 30 minutes, hemorrhoidectomy (especially using multiple mucosal ligations or sphincterotomy), and spinal anesthesia were significant precipitating factors, but could not determine whether age and intraoperative fluid volume administered were associated with urinary retention with this retrospective study.
Anesthesia ; Anesthesia, Spinal ; Hemorrhoidectomy ; Humans ; Incidence ; Ligation ; Precipitating Factors ; Retrospective Studies ; Urinary Retention*

BACKGROUND: Lidocaine sprayed down the endotracheal tube (ETT) before extubation and during ETT removal was reported to prevent increases in blood pressure and heart rate during and after extubation. We hypothesized that lidocaine administered via this route would suppress the cough reflex associated with tracheal extubation. METHODS: Eighty-five patients requiring intubation in the supine position were studied. All patients received a standardized anesthetic protocol. At the end of surgery, the patients were randomly divided into three groups and given no drug (group 1-control), given 1 mg/kg 2% lidocaine sprayed down the ETT 5 minutes prior to extubation (group 2), or given intravenous lidocaine (IVL) 1 mg/kg 3 minutes prior to extubation (group 3). Extubation was performed when the patients met the criteria of extubation. Number of coughs was recorded from 5 minutes before until 5 minutes after extubation. Each value was compared among the three groups. RESULTS: Seventy-five patients completed this study (n = 25 for each group). The incidence of patients experiencing coughing was decreased in group 2 (P = 0.03), compared with group 3 or the control. Number of coughs per patient was significantly less in group 2 (P = 0.00). IVL did not significantly diminish the incidence or the amount of coughing compared with the control. CONCLUSIONS: Lidocaine sprayed down the ETT suppresses cough reflex and is more effective than IVL in blunting the cough reflex. This study indicates that lidocaine sprayed down the ETT has a topical anesthetic effect suppressing the cough reflex.
Airway Extubation ; Anesthetics ; Blood Pressure ; Cough* ; Heart Rate ; Humans ; Incidence ; Intubation ; Lidocaine* ; Reflex* ; Supine Position

BACKGROUND: Rocuronium is suitable for short operations and rapidly controlling the airway on account of its rapid onset and intermediate action. However, the intravenous administration of rocuronium can cause pain and withdrawal movement in children. This study evaluated the effect of diluting rocuronium from 10 mg/ml to 1 or 0.67 mg/ml with 0.9% NaCl on the withdrawal response associated with the intravenous administration of rocuronium with the intubation dose. METHODS: Ninety pediatric patients undergoing general anesthesia were randomized into one of three groups; Group OR (only rocuronium 0.6 mg/kg, n = 30), Group SR10 (rocuronium 0.6 mg/kg diluted with 0.9% NaCl to 1 mg/ml, n = 30), Group SR15 (rocuronium 0.6 mg/kg diluted with 0.9% NaCl to 0.67 mg/ml, n = 30). After the loss of consciousness by a thiopental sodium 5 mg/kg injection, the patients from each group received the 0.6 mg/kg premixed rocuronium, respectively. Patients' withdrawal response to the injection were graded using a 4-point scale (Grade 0, 1, 2, 3). RESULTS: The incidence and the intensity of the withdrawal response were significantly lower in the SR10 and SR15 groups than in the OR group (P < 0.05). In the SR15 group, the intensity of the withdrawal response was under grade 2 in all patients. CONCLUSIONS: Diluting rocuronium to 0.67 mg/ml is a simple and effective method for preventing withdrawal movements during an intravenous rocuronium injection.
Administration, Intravenous ; Anesthesia, General ; Child ; Humans ; Incidence ; Intubation ; Thiopental ; Unconsciousness

BACKGROUND: Patients receiving an elective total knee replacement (TKR) are frequently older and immobilized. The related decline in respiratory function and structural changes may place these patients at an increased risk of perioperative pulmonary complications. METHODS: This study reviewed the data of 239 consecutive procedures performed by a single surgeon. The data examined included the patient's characteristics (age, gender, height, weight and body mass index [BMI]); concurrent pulmonary comorbidity (presence vs. absence); anesthetic techniques (general vs. spinal); types of operation (unilateral vs. bilateral); duration of operation (< 4 vs. > or = 4 hr); duration of tourniquet inflation (< 2 vs. > or = 2 hr); number of perioperative transfusions (< or = 4 vs. > or = 5 units); and American society of anesthesiologists (ASA) physical status. Pulmonary complications were grouped together as a single outcome. A Chi-square test and multiple logistic regression analysis were used to identify the risk factors. A P value < 0.05 was considered significant. RESULTS: Pneumonia, pulmonary edema, pulmonary congestion, atelectasis and pulmonary embolism were the pulmonary complications (n = 28; 11.7%) examined. Age, gender, BMI, pulmonary comorbidity, type and duration of surgery, duration of tourniquet inflation, anesthetic technique and ASA physical status were not associated with pulmonary complications. Only the number of packed cells transfused (> or = 5 units) was found to be associated with the pulmonary complications (odds ratio 5.21; P = 0.015). In particular, transfusions were related to pneumonia, pulmonary edema, pulmonary congestion and pulmonary embolism (P < 0.01). However, atelectasis was not related to any of the potential risk factors including the anesthetic technique. CONCLUSIONS: Transfusion requirements may be an important risk factor of the early postoperative pulmonary complications in patients receiving a TKR.
Arthroplasty, Replacement, Knee* ; Body Mass Index ; Comorbidity ; Estrogens, Conjugated (USP) ; Humans ; Inflation, Economic ; Logistic Models ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Pulmonary Embolism ; Risk Factors* ; Tourniquets

BACKGROUND: During laryngoscopy, force applied to the soft tissue are assumed to cause circulatory response. The aim of the study was to evaluate this circulatory response and to analyze the relationship between the intensity of the force and the magnitude of the associated circulatory responses. METHODS: Sixty-three healthy patients, aged 17 to 29 years, were randomly allocated to one of three groups according to the three different subjective forces applied intentionally. Subjects in group 1 received minimal force enough to stimulate circulatory response, but not enough to expose the glottis. Group 2 received the optimal force necessary to expose the glottic opening. Group 3 received excessive force to expose the glottic opening. The axial forces of the laryngoscope handle with a Macintosh blade were measured during a ten-second laryngoscopy, and peak force, mean force, and area under the curve were calculated. Then, arterial pressure and heart rate were recorded after the laryngoscopy at 30 seconds intervals for 3 minutes. The data was compared among groups and with the baseline post-induction values. RESULTS: No significant difference was found in heart rate and blood pressure at each interval among the three groups, with increasing arterial pressure and heart rate after the laryngoscopy. Blood pressure and heart rate were maintained high, being progressively higher in the groups receiving a higher force. CONCLUSIONS: We conclude that little association was found between the force and the magnitude of circulatory response although higher forces cause longer circulatory responses.
Arterial Pressure ; Blood Pressure ; Glottis ; Heart Rate ; Humans ; Intention ; Laryngoscopes ; Laryngoscopy*

BACKGROUND: During laryngoscopy, force applied to the soft tissue are assumed to cause circulatory response. The aim of the study was to evaluate this circulatory response and to analyze the relationship between the intensity of the force and the magnitude of the associated circulatory responses. METHODS: Sixty-three healthy patients, aged 17 to 29 years, were randomly allocated to one of three groups according to the three different subjective forces applied intentionally. Subjects in group 1 received minimal force enough to stimulate circulatory response, but not enough to expose the glottis. Group 2 received the optimal force necessary to expose the glottic opening. Group 3 received excessive force to expose the glottic opening. The axial forces of the laryngoscope handle with a Macintosh blade were measured during a ten-second laryngoscopy, and peak force, mean force, and area under the curve were calculated. Then, arterial pressure and heart rate were recorded after the laryngoscopy at 30 seconds intervals for 3 minutes. The data was compared among groups and with the baseline post-induction values. RESULTS: No significant difference was found in heart rate and blood pressure at each interval among the three groups, with increasing arterial pressure and heart rate after the laryngoscopy. Blood pressure and heart rate were maintained high, being progressively higher in the groups receiving a higher force. CONCLUSIONS: We conclude that little association was found between the force and the magnitude of circulatory response although higher forces cause longer circulatory responses.
Arterial Pressure ; Blood Pressure ; Glottis ; Heart Rate ; Humans ; Intention ; Laryngoscopes ; Laryngoscopy*