Awareness of intraoperative events in patients under general anesthesia is rare, but awareness during anesthesia is a serious complication that leads to anxiety and post-traumatic stress disorder. The Bispectral Index (BIS) has generally been accepted as a measurement of hypnosis under anesthesia. It is derived from a processed electroencephalogram and computer algorithm that assigns a numerical value based on the probability of consciousness. A 46-year-old, 65-kg male without underlying disease underwent elective surgery for ventral hernia. The patient in this case was administered an anesthetic that we frequently use and then average BIS value are 35. But he experienced awake during general anesthesia. We describe the first case of intraoperation awake under BIS 40 using desflurane.
Anesthesia ; Anesthesia, General ; Anxiety ; Consciousness ; Consciousness Monitors ; Electroencephalography ; Hernia, Ventral ; Humans ; Hypnosis ; Intraoperative Awareness ; Intraoperative Complications ; Isoflurane ; Male ; Mental Recall ; Stress Disorders, Post-Traumatic

OBJECTIVE: To investigate the incidence of awareness during general anesthesia in patients undergoing surgery. METHODS: A total of 1,800 patients who underwent the selected and acute surgery with general anesthesia were enrolled. Brain function monitors were not used. Patients were interviewed twice during 24 h and 96 h postoperatively to determine intraoperative awareness. RESULTS: Of all the inpatients, 13 (0.72%) reported clear awareness and never forgot anything during the operation; 145 (8.1%) reported dreaming during anesthesia with doubtful intraoperative recollection. Among the 145 patients, 108(74.5%) were females and 114(78.6%) received propofol anesthesia. CONCLUSION Intraoperative recollections are rare complication of general anesthesia, and are associated with the increased ASA physical status. Age and sex do not influence the incidence of awareness. Dreaming during anesthesia is related to younger females and propofol maintenance.
Adult ; Anesthesia, General ; adverse effects ; Awareness ; physiology ; China ; epidemiology ; Female ; Humans ; Intraoperative Complications ; epidemiology ; Intraoperative Period ; Male ; Mental Recall ; physiology ; Middle Aged ; Surveys and Questionnaires

OBJECTIVE: To investigate the incidence of awareness during general anesthesia and analyze the risk factors in anesthetic practice and patient populations. METHODS: A total of 2 300 patients who underwent general anesthesia were included. Perioperative data and anesthetic drugs were collected prospectively. Patients were interviewed twice postoperatively with the same structured questionnaire. Each patient was classified into categories as no awareness, possible awareness, and awareness. RESULTS: Twenty-one patients (0.91%) definitely reported awareness, and another 205 (8.91%) reported possible awareness. Few of the patients with awareness required psychological intervention. ASA physical status III-IV and propofol maintenance were associated risk factors of awareness. CONCLUSION The incidence of intraoperative awareness is high in the clinical practice in major medical centers.
Adult ; Anesthesia, General ; adverse effects ; Anesthetics, Intravenous ; adverse effects ; Awareness ; China ; epidemiology ; Female ; Humans ; Incidence ; Intraoperative Complications ; epidemiology ; Male ; Middle Aged ; Propofol ; adverse effects ; Risk Factors

The neck is a geometric region that can be studied and operated using anatomical triangles. There are many triangles of the neck, which can be useful landmarks for the surgeon. A better understanding of these triangles make surgery more efficient and avoid intraoperative complications. Herein, we provide a comprehensive review of the triangles of the neck and their clinical and surgical applications.
Intraoperative Complications ; Neck

In order to evaluate the effects of the postoperative astigmatism control, we compared 20 eyes measuring astigmatism at the end of operation with the Zeiss surgical keratometer and then had received loosening or tightening of sutures(keratometer group), with 20 eyes that were operated without the keratometer(control group). The mean cylindrical power of the keratometer group was lower than the control group at early postoperative period(P<0.001), but there was no statistical difference between both group at one or two months after operation. However the amount of cylinder was smaller in the keratometer group than in the control group. 19 of 20 eyes(95%) had less than 2D of astigmatism in the keratometer group, but in the control group 15 of 20 eyes(75%) had less than 2D of astigmatism at postoperative 60 days. 4 cases of posterior capsule rupture as intraoperative complication occured in the keratometer group. The posterior capsule rupture was caused by the decrease of surgical field clarity due to farther working distance by 17.5cm through attaching the Zeiss surgical keratometer to the operating microscope. From this study, Zeiss surgical keratometer seems to useful to reduce the early postoperative astigmatism but the intraoperative difficulty because of occupying space and decreasing clarity of surgical field is observed. The posterior capsule rupture as intraoperative complication occurs more frequently due to the disadvantages of this instrument.
Astigmatism* ; Cataract* ; Intraoperative Complications ; Rupture

Hip fracture patients preoperative and postoperative exist hidden blood loss which often affect patients' wound healing, increase the probability of infection, prolong rehabilitation exercise, influence postoperative effect. At the same time, the body's blood loss increase the activation of the blood clotting mechanism, promote the incidence of deep vein thrombosis, bleeding and deep vein thrombosis has become the main causes of high risk in hip operation. It is very important to stop bleeding, anticoagulation should not be ignored, so how to effectively deal with the prominent contradiction between the postoperative anticoagulation and bleeding or looking for a best balance has become a intractable problems in hip fracture treatment.
Anticoagulants ; therapeutic use ; Blood Loss, Surgical ; prevention & control ; Hip Fractures ; complications ; surgery ; Humans ; Intraoperative Complications ; drug therapy ; etiology ; prevention & control

Trichiasis is usually associated with congenital entropion or conjunctival destruction from disease or injuries. Cicatricial entropion follows scarring of the palpebral conjunctiva, which may be caused by chemical injuries, surgical procedures, trauma and infections. Numerous surgical procedures have been described for correction of trichiasis and cicatricial entropion in accordance with the severity and location of the condition. We have treated partial trichiasis in 2 cases(4 lids),(one involving nasal one forth of the upper lid with corrected congenital ptosis and the other in temporal one forth of the upper lid with narrow palpebral fissure) and cicatricial entropion on the middle one forth of the upper lid in 3 cases(3 lids) with transposition of skin flaps. The resuits were satisfactory.
Cicatrix ; Conjunctiva ; Entropion* ; Intraoperative Complications ; Skin* ; Trichiasis*

BACKGROUND: Percutaneous vertebroplasty (PV) is a minimally invasive, image-guided therapy used to relieve pain from osteoporotic vertebral compression fractures. Venography before injection of bone cement has been advocated as a means of identifying sites of potential venous leakage during the procedure. However, venography has been used only in selected situations, and its need is debatable. We aimed to analyze the usefulness of venography with percutaneous vertebroplasties for osteoporotic compression fractures and to report our recent experiences in treating such patients. METHODS: One hundred PVs performed on 93 patients were evaluated. To identify the usefulness of venography, our cases were divided into 2 groups. Group A patients had venographies before the PVs, whereas Group B patients were treated without venography. We analyzed their clinical status, pain status, and complications linked to leakage of bone cement. RESULTS: There were no significant differences in any of the collected data for the two groups. CONCLUSION: Our results indicate that PVs can be performed safely without venography beforehand. However, venography may be beneficial for less experienced physicians or trainees.
Fractures, Compression ; Humans ; Intraoperative Complications ; Phlebography ; Vertebroplasty

BACKGROUND: Percutaneous vertebroplasty (PV) is a minimally invasive, image-guided therapy used to relieve pain from osteoporotic vertebral compression fractures. Venography before injection of bone cement has been advocated as a means of identifying sites of potential venous leakage during the procedure. However, venography has been used only in selected situations, and its need is debatable. We aimed to analyze the usefulness of venography with percutaneous vertebroplasties for osteoporotic compression fractures and to report our recent experiences in treating such patients. METHODS: One hundred PVs performed on 93 patients were evaluated. To identify the usefulness of venography, our cases were divided into 2 groups. Group A patients had venographies before the PVs, whereas Group B patients were treated without venography. We analyzed their clinical status, pain status, and complications linked to leakage of bone cement. RESULTS: There were no significant differences in any of the collected data for the two groups. CONCLUSION: Our results indicate that PVs can be performed safely without venography beforehand. However, venography may be beneficial for less experienced physicians or trainees.
Fractures, Compression ; Humans ; Intraoperative Complications ; Phlebography ; Vertebroplasty

BACKGROUND AND OBJECTIVES: Dacryocystorhinostomy is commonly performed through an external incision. Several transnasal approach were described earlier in this century but they failed to gain popularity probably because of difficult exposure. Whether the endoscopic laser dacryocystorhinostomy improved intranasal visualization and decreased intraoperative complications than external incision. MATERIALS AND METHODS: During recent 3 years, we performed endoscopic laser dacryocytorhinostomy about 10 cases at Joong Ang Gil Hospital. RESULTS: Success rate of revision groups (3 cases) was very good. CONCLUSION: Small-diameter endoscope with angled field of view provides excellent intranasal visualization. Endoscopic laser dacryocystorhinostomy avoids the possibility of pathologic scar formation and injury to the medial canthus. Endoscopic laser dacryocystorhinostomy appears to be the safe treatment especially for revision procedure.
Cicatrix ; Dacryocystorhinostomy* ; Endoscopes ; Endoscopy ; Intraoperative Complications