No abstract available.
Heart Diseases* ; Humans ; Knee* ; Sciatic Nerve*

BACKGROUND: The concept of the effect-site concentration of anesthetic agents is important. The effect compartment model can be explained using the concepts of effect-site concentration and effect-site equilibration rate constant (k e0). This study confirms that the time-to-peak effect (tpe ) can be measured easily in clinical practice by applying a priming dose and train-of-four (TOF) during general anesthesia induction, and k e0 can be calculated from the tpe of the four muscle relaxants that are commonly used in general anesthesia. METHODS: Eighty patients who received general anesthesia were divided into the succinylcholine, rocuronium, atracurium, or vecuronium groups. Priming doses of muscle relaxants were administered. The effects of muscle relaxants were quantified by recording the twitch response of the adductor pollicis muscle after stimulating the ulnar nerve. The tpe was measured at the lowest TOF value. k e0 was calculated from the measured tpe . RESULTS: The k e0 values of the succinylcholine, rocuronium, atracurium, and vecuronium groups were 0.076 (0.030)/min, 0.228 (0.122)/min, 0.062 (0.011)/min, and 0.077 (0.019)/min, respectively. CONCLUSIONS: It is possible to estimate k e0 from the tpe of muscle relaxants using a priming dose and TOF during general anesthesia induction.
Anesthesia, General* ; Anesthetics ; Atracurium ; Humans ; Succinylcholine ; Ulnar Nerve ; Vecuronium Bromide

To determine the effect of the tumor necrosis factor-α (TNF-α) in odontoclast formation, we administrated a TNF-α inhibitor in rats with diabetes rats with periodontitis. The rats included in the study were divided into three groups: control rats without diabetes or periodontitis (the C group), rats with periodontitis and diabetes (the PD group), and rats with periodontitis and diabetes treated by infliximab, the TNF inhibitor (the PD+infliximab group). The PD and PD+ infliximab groups received intravenous administrations of streptozotocin (STZ, 50 mg/kg) to induce diabetes. After 7 days of STZ injections, the mandibular first molars were ligatured to induce periodontitis. The PD+infliximab group was intrapenitoneally administrated by infliximab (5 mg/kg). On days 3 and 20 after the ligature administration, odontoclast formation along root surfaces was evaluated by tartrate resistant acid phosphatase (TRAP) staining and cathepsin K immunohistochemistry. On day 3, the number of TRAP- and cathepsin K-positive cells increased more so in the PD group than in the C group. The PD+infliximab group showed a lower number of positive cells than the PD group. There was no difference in all the groups on day 20. On day 3, the cathepsin-K positive multinucleated and mononucleated cells were higher in the PD group than in the C group. The number of cathepsin-K positive multinucleated cells was lower in the PD+infliximab group than in the PD group. The PD group showed more cathepsin K-positive cells in the furcation and distal surfaces than the c group. The Cathepsin K-positive cells of the PD+infliximab group were lower than that of the PD group in furcation. These results suggest that TNF-α stimulates odontoclast formation in diabetes with periodontitis.
Acid Phosphatase ; Administration, Intravenous ; Animals ; Cathepsin K ; Cathepsins ; Immunohistochemistry ; Infliximab ; Ligation ; Molar ; Necrosis ; Osteoclasts* ; Periodontitis* ; Rats* ; Streptozocin

Purpose: The purpose of this study was to investigate the effectiveness of the elastic compression stockings and Kinesio taping on muscle activity and mechanical properties in healthy women during the heel raise exercise that causes muscle fatigue. Methods: Participants were divided into the elastic compression stockings group (ESG, n= 8), Kinesio taping group (KTG, n= 8), and control group (CG, n= 8). All participants performed the heel raise exercise to cause muscle fatigue. Muscle activity, stiffness, and the muscle tone of the gastrocnemius and tibialis anterior were measured before and after the heel raise exercise. Results: In the gastrocnemius, muscle activity was significantly increased after the heel raise exercise in both the ESG and KTG (p< 0.05).There was a significant difference in the change in the gastrocnemius muscle activity between the groups (p< 0.05). Post hoc analysis showed that the ESG exhibited a significantly greater change in gastrocnemius muscle activity than the CG (p< 0.05). The muscle stiffness of the gastrocnemius was significantly decreased after the heel raise exercise in the ESG (p< 0.05). The muscle tone of the gastrocnemius was significantly increased after the heel raise exercise in the control group (p< 0.05). There were no significant differences in the change in the gastrocnemius stiffness and muscle tone between the groups (p> 0.05). In the tibialis anterior, there were no significant differences in muscle activity, stiffness, and muscle tone between and within the groups (p> 0.05). Conclusion Our findings suggest that the use of elastic compression stockings and Kinesio taping during the heel raise exercise are beneficial and delay muscle fatigue in the gastrocnemius.

PURPOSE: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples. METHODS: We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14). RESULTS: Mean operation time was 265.3 +/- 21.3 minutes (mean +/- standard deviation) in the individual group and 170 +/- 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 +/- 1.6 and 2.6 +/- 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 +/- 1.1 and 9.4 +/- 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups. CONCLUSION: LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.
Drainage ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Retrospective Studies ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Sutures

BACKGROUND: Optiscope™ is a semi-rigid fiberscope for endotracheal intubation. A camera attached to the distal end of the stylet shows the laryngeal view through an adjustable LCD-monitor attached at the handle. The aim of this study was to evaluate the learning curve of skilled anesthesiologists in the use of Optiscope™. METHODS: Eighty-patients with normal airways were randomly assigned to four anesthesiologists, who did not have previous experience of intubation with Optiscope™. After induction of general anesthesia, the four investigators performed 20 intubations each, using the Optiscope™. Time to intubation (TTI), number of intubation attempts, and reasons of prolonged TTI were evaluated. RESULTS: The success rate of intubation was 98.8%. The TTI was significantly faster in 16th–20th patients (35.0 s, interquartile range 27.3–41.4) than in the first 10 patients (54.1 s, interquartile range 31.2–75.5) (P = 0.006). All patients after the 16th intubation were intubated at the first attempt. Frequent problems encountered were difficulty in getting the stylet tip under the epiglottis, and mucous secretion obscuring the laryngeal anatomy. CONCLUSIONS: Optiscope™ is an effective device for endotracheal intubation. About 15 intubations in patients with normal airways provided clinically adequate experience to the skilled anesthesiologists. Additional maneuver of airway opening such as jaw thrust and sufficient removal of oral secretion, are suggested to reduce TTI.
Airway Management ; Anesthesia, General ; Epiglottis ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Learning Curve* ; Learning* ; Research Personnel

BACKGROUND: Optiscope™ is a semi-rigid fiberscope for endotracheal intubation. A camera attached to the distal end of the stylet shows the laryngeal view through an adjustable LCD-monitor attached at the handle. The aim of this study was to evaluate the learning curve of skilled anesthesiologists in the use of Optiscope™. METHODS: Eighty-patients with normal airways were randomly assigned to four anesthesiologists, who did not have previous experience of intubation with Optiscope™. After induction of general anesthesia, the four investigators performed 20 intubations each, using the Optiscope™. Time to intubation (TTI), number of intubation attempts, and reasons of prolonged TTI were evaluated. RESULTS: The success rate of intubation was 98.8%. The TTI was significantly faster in 16th–20th patients (35.0 s, interquartile range 27.3–41.4) than in the first 10 patients (54.1 s, interquartile range 31.2–75.5) (P = 0.006). All patients after the 16th intubation were intubated at the first attempt. Frequent problems encountered were difficulty in getting the stylet tip under the epiglottis, and mucous secretion obscuring the laryngeal anatomy. CONCLUSIONS: Optiscope™ is an effective device for endotracheal intubation. About 15 intubations in patients with normal airways provided clinically adequate experience to the skilled anesthesiologists. Additional maneuver of airway opening such as jaw thrust and sufficient removal of oral secretion, are suggested to reduce TTI.
Airway Management ; Anesthesia, General ; Epiglottis ; Humans ; Intubation ; Intubation, Intratracheal* ; Jaw ; Laryngoscopes ; Learning Curve* ; Learning* ; Research Personnel

BACKGROUND: The objective of this study was to compare the frequency of hypotension and immediate hemodynamic changes induced by unilateral and bilateral spinal anesthesia in hypertensive elderly patients. METHODS: Forty hypertensive elderly patients undergoing lower leg surgery were randomly allocated into unilateral (group US) and bilateral spinal anesthesia (group BS). After intrathecal bupivacaine injection, patients in group US were kept in the lateral position for 10 min while patients in group BS were immediately placed in the supine position. Hemodynamic parameters were measured for 20 min by non-invasive cardiac output monitor based on bioreactance. RESULTS: In both groups, mean arterial pressure was significantly decreased after spinal anesthesia compared to the baseline value. However, frequency of hypotension requiring vasoactive drug was significantly lower in group US (5%) than in group BS (35%) (P = 0.044). The dermatom of sensory block on the operated limb was significantly lower in group US [T10 (10–10)] than in group BS [T8 (7.5–10)] (P = 0.013). In comparison within the group, changes of cardiac index were similar as the baseline value in both groups, although total peripheral resistance index was constant in group US but significantly decreased in group BS. CONCLUSIONS: Unilateral spinal anesthesia effectively reduced the frequency of hypotension requiring vasoactive drug and affected hemodynamic performance less than bilateral spinal anesthesia.
Aged ; Anesthesia, Spinal ; Arterial Pressure ; Bupivacaine ; Cardiac Output ; Extremities ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Leg ; Supine Position ; Vascular Resistance

No abstract available.
Dermatofibrosarcoma* ; Nose*