The effect of anticholinergics on memory was studied using 32 male Sprague-Dawley rats. In the control group the trained rats were tested the first performance time of T-maze and the second performance time checked 4-6 hours after injection of 1.0-1.5 mL of normal saline via penile vein. For the experimental groups, after checking the first performance time, 0.1 mg/kg of atropine sulfate in group B, and 1.0 mg/kg in group C was injected via penile vein.And 30 mg/kg injected into intraperitoneal cavity in group D. But for the group E, the mixture of 1.0 mg/kg of atropine and 0.01 mg/kg of neostigmine was injected into the penile vein. 4-6 hours after injection the second performance time was checked and continued these sets of experiment once a day for 6 days. To compare the number of errors (the qualitative effect) the accuracy rate (Number of right trials/Number of total trials x 100) was checked. To eompare the running time (the quantitative effect) the mean performance ratio (II/I x 100) (i.e., I is the score in the first performance time and II is the score in the second performance time) was compared between control and experimental groups. The results were as follows ; 1) The percentage of correct performance was 84.2% in control group, but 86.1% in group B, 91.0% in C, 96.0% in D and 89.6% in E was noted. 2) The performance ratio of control group A was 100.2 but 82.4 in B, 94.7 in C, 83.2 in D and 89.4 in E was recorded. 3) These results suggest that posttraining exposure to atropine sulfate facilitates the accuracy of performance and shortens the running time and no different effect was observed by additional injection of neostigmine in rats.
Animals ; Atropine* ; Cholinergic Antagonists ; Humans ; Male ; Memory* ; Neostigmine* ; Rats* ; Rats, Sprague-Dawley ; Running ; Veins

Airway problems are easiest to manage when they are anticipated. Difficult intubation might, however, occur in patients with no obvious signs or symptoms suggesting airway obstruction. We describe a case of difficult intubation where the laryngeal inlet was obscured by a large epiglottic cyst that was discovered during rapid-sequence induction of general anesthesia. A 3-year-old male weighing 15 kg was admitted for an emergency appendectomy. After preoxygenation, a rapid-sequence induction was carried out. Direct laryngoscopy (Macintosh 1 blade) revealed a large 2-cm cyst arising from the lingual surface of the epiglottis. The cyst completely obstructed the view of the epiglottis and larynx, and several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated without difficulty and oxygen saturation was 98 99%. After a second 10 mg dose of succinylcholine, intubation was attempted using the same laryngoscope blade and a styletted 4.5 mm endotracheal tube by another anesthesiologist as cricoid pressure was maintained. By using the tube to push the cyst upward, intubation of the trachea was performed after a brief view of the arytenoid cartilages. Anesthesia and the operation then proceeded uneventfully. Following an appendectomy, an ENT surgeon removed the cyst.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Appendectomy ; Arytenoid Cartilage ; Bays ; Child, Preschool ; Emergencies ; Epiglottis ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes ; Laryngoscopy ; Larynx ; Male ; Masks ; Oxygen ; Succinylcholine ; Trachea

PURPOSE: We compared the efficacy and patient satisfaction between shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for the treatment of lower ureteral stones. MATERIALS AND METHODS: We reviewed 223 patients who were treated for lower ureteral stones from August 2006 to January 2009. SWL and URS were performed in 47 and 176 patients, respectively. After treatment, the patients' subjective inconvenience/pain and their satisfaction with the treatment process were estimated by questionnaire. We analyzed success rates, complication rates, inconvenience/pain scores, and satisfaction scores for each group of patients. RESULTS: The overall success rates of SWL and URS were 82.9% and 97.7%, respectively (p=0.001). The complication rates of SWL and URS were 8.5% and 10.8%, respectively (p=0.162). The satisfaction scores of SWL and URS were 7.4 and 9.2, respectively (p=0.001). Whereas 87.5% of the URS group preferred the same treatment in case of a recurrence of ureteral stones, only 68% of the SWL group preferred the same treatment in the future (p=0.002). CONCLUSIONS: URS was more successful and satisfactory to the patients with lower ureteral stones. Although both SWL and URS were highly effective for treatment of distal ureteral stones, we believe that URS is the first-line treatment modality for lower ureteral stones.
Humans ; Lithotripsy ; Patient Satisfaction ; Recurrence ; Shock ; Treatment Outcome ; Ureter ; Ureteroscopy

BACKGROUND: The stellate ganglion block controls the pain and the vascular insufficiency in the innervating regions. Recently, the therapeutic indications of the stellate ganglion block are widely extended to the psychosomatic disorder. Therefore, this study was designed to observe the effect of the stellate ganglion block on stress using the Porsolt's behavioral despair model of rats. METHODS: Fifty-five male Sprague-Dawley rats were given five forced-swimming tests at 24-hour intervals. The first test through which rats learn helplessness lasted 15 minutes and following four tests given 30 minutes after every superior cervical ganglion block lasted 5 minutes respectively. The superior cervical ganglion block was achieved by using 0.2 ml of 1% lidocaine in the experimental group(n=30), and 0.2 ml of normal saline instead of lidocaine in the control group(n=25). The duration of mobility was measured during the first 5 minutes in all tests. RESULTS: A difference was found between the control and the experimental group in the performance ratios after the superior cervical ganglion block(P<0.01), but the number of trials of the superior cervical ganglion block did not effect the duration of mobility. CONCLUSIONS: These results suggest that the superior cervical ganglion block reduces the duration of immobility independently of the number of trials of the superior cervical ganglion block.
Animals ; Humans ; Lidocaine ; Male ; Psychophysiologic Disorders ; Rats* ; Rats, Sprague-Dawley ; Stellate Ganglion ; Superior Cervical Ganglion* ; Sympathetic Nervous System

BACKGROUND: The development of so-called "Point-of-care" (POC) devices for blood or urine analysis has resulted in many systems that are widely used at home or at the bedside. We evaluated the performance of the I-STAT portable clinical analyzer for measuring blood gases (pH, PCO2, PO2) and whole blood electrolytes (sodium, potassium and ionized calcium) with reference to a conventional blood gas analyzer (Chiron 348 pH/ blood gas/electrolytes). METHODS: Thirty samples from the arterial blood were simultaneously analyzed with I-STAT system and with Chiron 348 pH/blood gas/ electrolytes analyzer. Differences between results of two methods were analyzed by paired t-test (p<0.05). RESULTS: PO2, PCO2 and Na measured with I-STAT system and Chiron 348 PH/ blood gas/ electrolytes analyzer showed no significant differences. pH, calculated HCO3, K and Ca measured by two methods showed significant difference, but observed differences would not affect clinical decisions except ionized calcium. CONCLUSIONS: This study shows that blood gas and electrolyte analysis using the I-STAT portable device is comparable with that performed by a conventional Chiron 348 pH/blood gas/ electrolytes analyzer except ionized calcium.
Calcium ; Electrolytes ; Gases ; Hydrogen-Ion Concentration ; Potassium

Awake craniotomy is indicated for tumor resection involving eloquent cortex. It allows the operator to perform appropriate cortical mapping during surgery and facilitate maximum tumor resection while minimizing neurologic deficit. Therefore anesthesia should provide adequate analgesia and sedation but also importantly a full consciousness and cooperation for neurologic testing. This case reports the use of target-controlled infusion (TCI) and monitoring of sedation and anesthetic depth through bispectral index (BIS), providing good control of sedation and analgesia to meet frequent changes throughout the different levels of the procedure while maintaining good condition for intraoperative brain mapping. We propose that TCI of propofol and remifentanil in combination may be a useful alternative for awake craniotomy requiring intraoperative brain mapping surgery.
Analgesia ; Anesthesia ; Brain Mapping ; Conscious Sedation ; Consciousness ; Craniotomy ; Neurologic Manifestations ; Piperidines ; Propofol

Symptomatic hepatic cysts are infrequently seen. A 82-year-old woman was admitted because of growing abdominal mass and pain. On admission, the mass was palpated on right upper quadrant of the abdomen. Ultrasonography and computed tomography disclosed a huge cystic lesion of the liver. It measured 22.5 x 19.0 x 18.0 cm and had a thick wall that was irregular. Because of the patient's symptoms and the radiologic findings, the decision was made to aspirate the cyst percutaneously under fluoroscopic guidance. Percutaneous drainage yielded approximately 3300 cc of yellow brownish fluid. A cytologic evaluation of the fluid was negative for malignant cells, and a fluid analysis was described as predominantly inflammatory in nature. Cultures revealed a growth of Klebsiella oxytoca. After drainage of the cystic fluid, we instilled contrast medium. No communication between the cyst and bile ducts was seen. Seven days later, the patient was discharged. Four months after treatment, no reaccumulated fluid was observed by ultrasonography. Ten months after treatment, the patient is healthy without abdominal discomfort. We report a case of the infected huge hepatic cyst successfully treated with fluoroscopic-uided percutaneous drainage.
Abdomen ; Aged, 80 and over ; Bile Ducts ; Drainage* ; Female ; Humans ; Klebsiella oxytoca ; Liver ; Ultrasonography

A 26-year-old male patient presented for stump revision of an amputated right 3rd finger and neurorrhaphy for a lacerated right 2nd finger. An axillary brachial plexus block was performed using the transarterial technique. Postoperatively, the patient demonstrated signs and symptoms of brachial plexus injury. He exhibited paresthesia in the distribution of the ulnar nerve and motor weaknesses the wrist, elbow, and shoulder. On the 18th postoperative day, nerve conduction and electromyographic studies were performed, which revealed possible right radial neuropathy and axillary neuropathy, or right brachial plexopathy with posterior cord involvement. After seven months of medical and physical treatment, the pain subsided but slight paresthesia and muscle weaknesses still remained. We describe a case of postoperative neuropathy, which is believed to be caused by a direct nerve injury after an axillary brachial plexus block with persistent signs and symptoms over a considerable period.
Adult ; Brachial Plexus Neuropathies ; Brachial Plexus* ; Elbow ; Fingers ; Humans ; Male ; Muscle Weakness ; Neural Conduction ; Paresthesia ; Radial Neuropathy ; Shoulder ; Ulnar Nerve ; Wrist

A 74-year-old male patient receiving ventilatory support due to aspiration pneumonia developed bilateral pneumothorax, pneumopericardium, pneumomediastinum, pneumo-retroperitoneum, and subcutaneous emphysema, after manual ventilation while being transferred from the intensive care unit (ICU) to the operating room (OR). These complications were assumed to be secondary to inappropriate manual ventilation of the intubated patient. In addition, it is likely that the possible migration of an already marginally acceptable endotracheal tube (ETT) position during transport was the cause of these complications. Finally, aggravation of a latent pneumothorax might have contributed to these complications.
Aged ; Barotrauma ; Humans ; Intensive Care Units ; Male ; Mediastinal Emphysema ; Operating Rooms ; Pneumonia, Aspiration ; Pneumopericardium ; Pneumothorax ; Subcutaneous Emphysema ; Ventilation

BACKGROUND: The bispectral index (BIS) has been used as a monitor measuring hypnotic level of anesthesia or sedation. Recently EEG-entropy (M-Entropy(TM), S/5(TM) Entropy Module) has been provided and started to use domestically. This study was designed to compare the measured values between EEG-entropy and BIS monitor on general anesthesia and sedation. METHODS: Thirty patients undergoing total hysterectomy were anesthetized with propofol target controlled infusion (TCI), fentanyl, rocuronium and BIS, RE (response entropy), SE (state entropy), and hemodynamic variables were measured at the effect site concentration of 1.5-10.0 microgram/ml (P15-P100). On the other hand, fifteen patients undergoing breast biopsy were sedated with propfol TCI and BIS, RE and SE were measured at 0.9-2.3 microgram/ml (P09-P23). RESULTS: During general anesthesia, SE values were significantly lower than BIS or RE at baseline. But RE alone at P15, RE and SE at P20 were significantly higher than BIS. During sedation, SE values were significantly lower than BIS or RE at baseline-P09 and significantly lower than RE alone at P10-P15, and RE were significantly higher than BIS at P13-P20. After P21, RE and SE values fell abruptly and approached to BIS. CONCLUSIONS: EEG-entropy reflected hypnotic level well equal to BIS during general anesthesia. However, EEG-entropy did less reflected the hypnotic level than BIS during sedation.
Anesthesia ; Anesthesia, General* ; Biopsy ; Breast ; Entropy ; Fentanyl ; Hand ; Hemodynamics ; Humans ; Hysterectomy ; Propofol