BACKGROUND: Endotracheal intubation is accomplished for safe airway establishment, anaesthesia and operation in operating room, intensive care unit and emergency room mostly. Therefore, it will be beneficial that we predict and provide against difficult airway. With this view, our study was planned and carried out. METHODS: For 251 patients with ASA physical status I or II undergoing general aneathesia, the correlation between their age, sex, height, weight, BMI (body mass index), Samsoon & Young classification and laryngoscopic grades by Cormack & Lehane was investigated. RESULTS: Laryngoscopic grades were correlated significantly with patients' age and Samsoon & Young classification. Endotracheal intubation succeeded all, but, 8 patients (3.2%) were difficultly intubated with cricoid cartilage compression and stylet-using. CONCLUSIONS: Before intubating the trachea, it is desirable that patient' age, Samsoon & Young classification and the extent of neck's movement are assessed.
Classification ; Cricoid Cartilage ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intubation, Intratracheal* ; Operating Rooms ; Trachea

BACKGROUND: Mivacurium has a characteristics of rapid onset and the shortest duration of non- depolarizing neuromuscular relaxants and the onset of action could be accelerate more rapidly by using priming principle. The purpose of this study was to compare the onset time of mivacurium by priming principle with succinylcholine during rapid endotracheal intubation. METHODS: 36 patients were randomly divided into 3 groups: mivacurium group by priming principle (Group 1), mivacurium group by bolus injection (Group 2) and succinylcholine group (Group 3). In Group 1, subparalyzing dose of 0.02 mg/kg was administered 2 minutes before principle dose of 0.25 mg/kg was given. Onset time and intubating conditions were observed when twitch tension was reduced by 25% block in each group. RESULTS: The onset of Group 1 (75 sec) was significantly faster than that of Group 2 (90 sec) (p<0.05) but was significantly slower than that of Group 3 (37.5 sec) (p<0.05). Intubating conditions were excellent in all groups. CONCLUSIONS: The attempts of priming principle with mivacurium could accelerate the onset of action of mivacurium compared with that of bolus injection but their onsets were shorter than those produced by succinylcholine.
Humans ; Intubation, Intratracheal* ; Succinylcholine*

BACKGROUND: The implementation of intraoperative normovolemic hemodilution is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential complications. The goal of this study was to evaluate the safety and efficacy of moderate intraoperative normovolemic hemodilution. METHODS: Fifteen patients scheduled for posterolateral spinal fusion underwent intraoperative normovolemic hemodilution with 10% pentastarch to a target hematocrit level of 25% (hemodilution group). All units of blood procured by hemodilution and additional allogeneic blood was transfused in the perioperative period to maintain the hematocrit level of>25%. We investigated the effect of hemodilution on whole blood coagulation as measured by the thromboelastography and, evaluated its efficacy of decreasing the need for allogeneic blood transfusion as compared to the nonhemodilution group, retrospectively. RESULTS: Hemodilution with pentastarch caused a decrease in response and coagulation time (p<0.01) but did not influence on the alpha angle and maximum amplitude on thromboelstogram. Amount of transfusion of allogeneic blood was 4.1 1.7 units for the hemodilution group and 5.0 1.5 units for the nonhemodilution group. Net red blood cell volume ""saved"" from hemodilution was about 120 ml. CONCLUSION: Moderate intraoperative normovolemic hemodilution with pentastarch does not affect the coagulability of whole blood. But its efficacy of decreasing the need for allogeneic blood transfusion is minimal.
Blood Coagulation ; Blood Transfusion ; Erythrocytes ; Hematocrit ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Perioperative Period ; Retrospective Studies ; Spinal Fusion* ; Thrombelastography

BACKGROUND: The effects of a muscle relaxant may differ in elderly compared with young adult patients for a variety of the pharmacokinetic and pharmacodynamic reasons. Atracurium is eliminated by nonorgan dependent pathway, Hofmann elimination and ester hydrolysis. So there are some arguments for age-related differences. The purpose of this study was to compare the differences of the onset and duration of atracurium in young and elderly. METHODS: Eighteen young adults (21-54 yr) and 18 elderly (>65 yr) patients anesthetized with nitrous oxide and enflurane. Atracurium (0.5 mg/kg) was given and then intubation was performed after T1 response was blocked more than 80%. Neuromuscular relaxation was measured by the first twitch of train-of-four (T1) response at the adductor pollicis after supramaximal stimulation of ulnar nerve at 2Hz every 12 sec. The onset (disappearance of T1) and duration of 5, 25, 50, 75% recovery time of T1 and recovery index (time for 25-75% recovery of T1) were recorded. RESULTS: Onset of block was not significantly different between the young and elderly. Recovery time of 5, 25, 50, 75% and recovery index were not prolonged in elderly compared with young adults. CONCLUSIONS: There were no significant differences between young and elderly adults in onest time, recovery time of 5, 25, 50, 75% and recovery index when atracurium is used in a single bolus dose. The results suggest that atracurium in elderly patients has similar onset and action duration compared with younger patients.
Adult ; Aged* ; Atracurium* ; Enflurane ; Humans ; Hydrolysis ; Intubation ; Nitrous Oxide ; Relaxation ; Ulnar Nerve ; Young Adult

A case of difficult intubation is described in which the problem was overcome by use of the laryngeal mask airway (LMA). The patient had difficulty in mouth opening due to severe burn scar contracture around the mouth and limited access prevented tracheal intubation. The use of LMA is shown to have obviated the need for tracheal intubation in the case of a patient whose injuries would have made this technique difficult.
Adult ; Cicatrix/complications ; Contracture/etiology ; Face ; Female ; Humans ; *Intubation, Intratracheal ; *Laryngeal Masks

Sodium thiopental is a popular intravenous anesthetic that has been used extensively throughout the world. The rare adverse reactions to thiopental consist mainly of anaphylactic shock, bronchospasm, and local thrombophlebitis. The reported incidence of presumed anaphylactic reaction (Type l hypersensitivity) to thiopental are extremely rare. Although the mechanism of these adverse reactiona is unclear, the clinical features (generalized erythema, hypotension, edema and bronchspasm) are thought to result from massive discharge of histamine and other vasoactive substance from basophils and mast cells. Since such reactions are life threatening, they must be recognized immediately and the appmpriate treatment given. The successful management of anaphylaxis requires a thorough understanding of this syndrome and the application of therapeutic agents. The authors report a case of anaphylactoid response to thiopental in a 34 years old healthy male patient and briefly review the literature.
Adult ; Anaphylaxis ; Basophils ; Bronchial Spasm ; Edema ; Erythema ; Histamine ; Humans ; Hypotension ; Incidence ; Male ; Mast Cells ; Sodium ; Thiopental* ; Thrombophlebitis

Laryngeal mask airway(LMA) is a new type of airway, which may be used as an alternative to either the endotracheal tube or the face-mask with either spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. LMA have many advantages of easy intubation without laryngoscope and muscle relaxants, decreasing damages of larynx and pharynx., and also useful in difficult intubation or emergency airway care. Recently its interesting has been increased. Clinical studies of LMA was done in 242 patients, about hemodynamic changes, volume and pressure changes of cuff, problems and complications during insertion and maintaining of LMA. The results were as follows: 1) The average time taken to insert the laryngeal mask airway was 9.9sec(range:5~60sec), and 43 cases were correct placement at the second attempt. And the total insertion time was 103 min(range:15~355min). 2) Total ari volume of cuff was 20.5ml(range:15~35ml) in LMA No 3, 28.1 ml(range:25~60ml) in LMA No 4. The least volume of cuff without air leakage was 15ml in LMa No 3 and 25ml in LMA No 4. During positive pressure ventilation the peak airway pressure was 20 cmH2O(15mmHg). 3) In hemodynamic changes, blood pressure was increased about 27.5 mmHg in systolic, 21.2 mmHg in diastolic, and 22.4 mmHg in mean arterial pressure after LMA insertion. 4) Cuff pressure was increased from 70.5mmHg at insertion to 98.9mmHg after 1hours with use of N2O for anesthesia and more increased than without N2O. 5) LMA was used 229 patients in supine position and 5 patients in lateral position. In 8 cases was failed to insertion of LMA. 6) Compilcations were 3 cases of gastric distention, 1 case of difficult nasogastirc tube insertion, and 1 case of severe sore throat with mucosal bleeding on pharyax. Sor throat was complained 26.9% without regard to severity.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Emergencies ; Esophagus ; Hemodynamics ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Pharyngitis ; Pharynx ; Positive-Pressure Respiration ; Supine Position

Laryngeal mask airway (LMA) is an adjunctive airway device composed of a tube with a cuffed mask-like projection on the distal end, which is more practical than a face mask and less invasive than an endotracheal tube. It has the great economical advantage of being reusuable. Even though the LMA withstands a large number of sterilization cycles without undergoing damage, these sterilization cycles make the tear strength of the LMA lower. And it can be easily damaged during anesthesia or sterilization. We report a case of a fracture of the LMA during anesthesia probably caused by teeth as well as prolonged and repeated use.
Anesthesia ; Anesthesia, General* ; Laryngeal Masks* ; Masks ; Sterilization ; Tooth

BACKGROUND: Laryngeal mask airway (LMA) is a useful instrument for routine anesthesia. It permits spontaneous or positive pressure ventilation but its use in obstetric anesthesia has not been described. In this study, we evaluated the effectiveness and the side effects of the LMA during elective cesarean sections. METHODS: Institutional approval and patients' permission were obtained. One thousand sixty-seven patients scheduled for elective an cesarean section, that have been NPO for more than 6 (6-48) hours were evaluated. They were premedicated with an H2 receptor blocker (ranitidine 50 mg i.m.) 1 hour before the operation. They were anesthetized with penthotal sodium (3-4 mg/kg), vecuronium (1 mg/10 kg i.m.) and then a 3 or 4 LMA was inserted after the mask ventilation with 100% oxygen for 1 min. The cuff was inflated with air 15.3 +/- 2.6 ml. On auscultation, air entry was good in both lungs. Anesthesia was maintained by 50% oxygen in N2O with 0.7 - 1.0% enflurane. Analgesics (tramadol 30 mg i.v.) was given incrementally after delivery of the baby. Manual assisted ventilation was used throughout the procedure. The number of insertion attempts, cuff volume and the incidences of complications were evaluated. RESULTS: In 1051 patients, the LMA was inserted on the first attempt. In 16 patients more than 2 attempts were needed and change to endotracheal intubation were needed in 7 cases. The mean cuff volume was 15 +/- 2.6 ml at insertion and increased to 18.5 +/- 3.2 ml after removal. The average airway pressure was 20 cmH2O during positive pressure ventilation, above that pressure air leakage was detected in 16 cases. Complications noted were mild sore throat in 5 cases, and blood tinged after removal of LMA in 3 cases but gastric distention was not detected. No incidence of aspiration was noted. CONCLUSIONS: In this study, the LMA proved to be a useful tool for the management of patients presenting for elective an cesarian section. There is the remote possibility of aspiration which did not happen in our study.
Analgesics ; Anesthesia ; Anesthesia, Obstetrical ; Auscultation ; Cesarean Section* ; Enflurane ; Female ; Humans ; Incidence ; Intubation, Intratracheal ; Laryngeal Masks* ; Lung ; Masks ; Oxygen ; Pharyngitis ; Positive-Pressure Respiration ; Pregnancy ; Sodium ; Tolnaftate ; Vecuronium Bromide ; Ventilation

BACKGROUND: Phantom limb sensation is an unusual position sense of the extremity during nerve block that the position of extremity is misinterpreted as being flexed, or elevated, when actually they are in neutral position. Whether it is from the fixation of proprioceptive input at the time of motor blockade or from unmasking of the pattern which has been already present in the CNS is still controversial. We perfomed this study under the assumption that phantom limb sensation can still be reproduced without the influence of position at the time of nerve blockade. METHODS: Thirty-six patients scheduled for elective orthopedic surgery were randomly assigned. For 26 patients, spinal anesthesia was performed with hyperbaric 0.5% tetracaine or bupivacaine at lateral decubitus position and the position was changed to supine immediately. Existence of phantom limb sensation and the level of anesthesia was recorded at 10 and 20 minutes after injection of local anesthetics. For 10 patients, same local anesthetics were injected after patient's legs were straightened in lateral decubitus position. RESULTS: Forteen out of 26 patients whose position were changed to supine immediately after the injection of local anesthetics experienced phantom limb sensations. Five out of 10 patients whose legs were kept straight before the injection of local anesthetics experienced phantom limb sensations. Previous history of trauma was positively related to the expression of phantom limb sensation. CONCLUSION: Our data showed that the expression of phantom limb sensation is reproducible. And this was not related to the position at the time of spinal anesthesia. Trauma seems to be an important factor related to the expression of phantom limb sensation.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine ; Extremities ; Humans ; Leg ; Nerve Block ; Orthopedics ; Phantom Limb* ; Proprioception ; Sensation* ; Tetracaine