No abstract available.
Brachial Plexus

No abstract available.
Magnesium ; Perioperative Period

No abstract available.
Magnesium ; Perioperative Period

Post-tetanic count(PTC) was a known monitoring method to evaluate intense neuromuscular blockade of peripheral muscles. It has been reported that intermittent tetanic stimulation(50 Hz for 5 sec.) every 6 to 10 min. during intense nondepolarizing neuromuscular blockade did not influence the recovery of neuromuscular transmission. However, the relatively frequent use of tetanic stimulation might be possible to influence the recovery of neuromuscular blockade and the repeated stimuli might result in a false recovery state. The purpose of this study was to determine the best interval time of tetanic stimulation for evaluation of the correct PTC. Sixty adult patients undergoing stomach operations were randomly allocated to three groups according to the interval of tetanic stimulation ; group 1 (6 min. n=20), group 2 (8 min. n=20) and group 3 (10 min. n=20). In all cases, Anesthesia was maintained with 50% nitrous oxide, 50% oxygen and 1-2% enflurane following induction of anesthesia with thiopental sodium 3-5 mg/kg. Neuromuscular block was achieved by intravenous pancuronium bromide 0.13 mg/kg before application of ulnar nerve stimuli using Myotest MKII. The adduction force of the resultant thumb twitch was measured by the acceleration of a small piezo-electric ceramic wafer with electrodes of Mini-accelograph and recorded by Datascope 2200 I After 1 Hz single twitch stimulation, a tetanic stimulus(50 Hz) was applied for 5 sec. Three seconds later, the single twitch stimulation was again applied for 1 min. followed by 1 min. of TOF stimulation. This pattem of tetanic stimulation was continued by the interval of 6, 8 and 10 min. The results were as follows: 1. The continuance (which was the percentage when PTC was continuously increased, not intermittently reduced) was 73.7% in group 1 and 2, but 100% in group 3 and there were statistically significance. 2. In the regression analysis between FI'C and time from PTC1, we yielded the following equations ; Y=10+3.5X (r(2)=0.71) for group 1, Y=8.6+4.1X (r(2)=0.78) for group 2 and Y=9.8+5.7X (r(2)=0.69) for group 3. The slope and intercept of the line of group 3 showed significantly different to that of group 1 and 2 (p<0.001). The more frequent tetanic stimulation reduced the time to arrive the same PTC. 3. The time from PTCl to TOFl was 51.6+/-3.9 min. in group 1, 65+/-5 min. in group 2 and 69+/-4.3 min. in group 3. There were no statistically significance, but they had trend to reduce by more frequent tetanic stimulation. 4. PTC was 12.9+/-0.9 in group 1, 14.9+/-1.5 in group 2 and 13.2+/-0.8 in group 3 when TOF1 was appeared, and 38.3+/-2.3 in group 1, 33.3+/-2.3 in group 2 and 32.4+/-2.6 in group 3 when the second response to TOF stimulation(TOF2) was recorded(meanSEM). There were no statistically significance. With the above results the authors concluded that 10 min. will be the optimal interval of the tetanic stimulation for the correct PTC, and recognized that the interval of tetanic stimulation was not related to the time from PTC1 or PTC at TOF twitches.
Acceleration ; Adult ; Anesthesia ; Ceramics ; Electrodes ; Enflurane ; Humans ; Muscles ; Neuromuscular Blockade ; Nitrous Oxide ; Oxygen ; Pancuronium ; Stomach ; Thiopental ; Thumb ; Ulnar Nerve

BACKGROUND: The dose-responses of neuromuscular blocking agents may be influenced by many factors including age and inhalation anesthetics. This study was designed to determine the dose-response relationships of a new, short-acting muscle relaxant, mivacurium during nitrous oxide-halothane or nitrous oxide-enflurane anesthesia in two age groups, infants and 1 to 6 years old preschool children. METHODS: Neuromuscular blockade was monitored by recording the accelerographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, 24 infants or children of two anesthetic subgroups for each age group received single bolus doses of 45~100 g/kg of mivacurium. The ED50 and ED95 were estimated from linear regression plots of log-dose vs probit of twitch depression. The lag time, onset time and maximal depression of twitch height for the selective medium dose were mesured. RESULTS: The ED50 and ED95 for the infants group were 38.2 and 53.3 g/kg during halothane anesthesia, and 29.8 and 48.6 g/kg during enflurane anesthesia, respectively. And, those for preschool children group were 49.4 and 90.7 g/kg during halothane anesthesia, and 32.3 and 81.4 g/kg during enflurane anesthesia, respectively. There was a parallelism of the dose-response curve between halothane and enflurane anesthesia in either age group. Also, there was statistically significant difference in the maximal twitch depression for the selective medium dose of mivacurium between halothane and enflurane anesthesia in either group. CONCLUSIONS: The potency of mivacurium during enflurane anesthesia is higher than that during halothane anesthesia in infants and preschool children, and during either inhalation anesthesia the dose of mivacurium is less required in infants than preschool children.
Anesthesia* ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; Child ; Child, Preschool* ; Depression ; Enflurane* ; Halothane* ; Humans ; Infant* ; Linear Models ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Ulnar Nerve

No abstract available.
Cactaceae* ; Dermatitis* ; Humans ; Leprosy*

No abstract available.

The most frequently reported neurological complication of a wasp sting is ischemic stroke. We treated a patient with wasp sting with unusual complications. A 52-year-old man was hospitalized for anaphylactic shock after multiple wasp stings. Although the patient recovered consciousness after 2 days, he had global aphasia and right hemiparesis. Brain magnetic resonance imaging and angiography revealed high-intensity signals in the left basal ganglia and cerebral cortex and stenosis of the left middle cerebral artery. After 2 days, the middle cerebral artery stenosis improved. After 5 days, diffusion-weighted imaging showed an enlarged lesion in the left frontal cortex. The infarct in this case was due to a predominantly unilateral vasoconstrictive hypoxic brain injury from wasp stings.
Brain Injuries

Methazolamide is a sulfonamide derivative and carbonic anhydrase inhibitor used to lower intraocular pressure in glaucomatous eyes. Stevens-Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) associated with methazolamide treatment has been reported in Korean and Japanese patients. We report two cases of SJS-TEN associated with methazolamide treatment. The result of HLA typing of our two patients was a positive reaction for HLA-B59, which is specific to Koreans and Japanese. This suggests a possible relationship between genetic background and SJS-TEN associated with methazolamide treatment. Therefore, methazolamide should be prescribed with caution to Korean or Japanese patients.
Asian Continental Ancestry Group ; Carbonic Anhydrases ; Histocompatibility Testing ; Humans ; Intraocular Pressure ; Methazolamide* ; Stevens-Johnson Syndrome*

BACKGROUND: Maintenance of normal arterial carbon dioxide tension (PaCO2) is not generally a problem if the same tidal volume can be maintained when changing from two-lung(TLV) to one-lung ventilation(OLV). However, there have been a few studies on the use of capnography in monitoring the adequacy of ventilation during one-lung anesthesia. We have therefore studied how closely end-tidal PCO2 (PETCO2) values reflect changes in PaCO2 in patients undergoing thoracoscopic sympathectomy during TLV and after transition to OLV. METHODS: We have measured arterial oxygen tension(PaO2), PaCO2, PETCO2, and (PaCO2-PETCO2) in 24 adult, either sex, patients by infra-red spectrometry. They were measured after induction of anesthesia, in supine position(TLVsup), after a lateral decubitus position(TLVlat), at 15 minutes after left OLV(OLVLt), after right OLV(OLVRt), and at 10 minutes in the supine position re-positioned at the end of the operation(TLVrep). Data were analyzed with a one-way analysis of variance with repeated measures followed by multiple comparision. The correlation between PaCO2 and PETCO2 were tested using linear regression. RESULTS: PaCO2 did not significantly change, whereas PETCO2 significantly decreased at OLVLt, OLVRt compared with TLVsup value (OLVLt, 29.7 mmHg OLVRt, 30.5 mmHg and TLVsup, 33.6 mmHg; P< 0.05). Compared with TLVsup(0.2 mmHg), (PaCO2-PETCO2) significantly increased at OLVLt, OLVRt, TLVrep(3.7 mmHg, 2.3 mmHg, 3.5 mmHg). The correlation between PaCO2 and PETCO2 in these series is consistent. (r>0.65, P<0.0006) CONCLUSIONS: In the patients undergoing thoracoscopic sympathectomy with TLV or OLV in the lateral decubitus position, PETCO2 is a reliable estimate of the PaCO2. However, when the operative time is prolonged the arterial PCO2 may be more reliable than PETCO2.
Adult ; Anesthesia ; Capnography ; Carbon Dioxide ; Humans ; Linear Models ; One-Lung Ventilation* ; Operative Time ; Oxygen ; Spectrum Analysis ; Supine Position ; Sympathectomy ; Thoracoscopy* ; Tidal Volume ; Ventilation