BACKGROUND: Emergence agitation (EA) is one of the most common complications after general anesthesia. The goal of this retrospective study was to determine the risk factors of EA in adult patients who underwent general anesthesia. METHODS: We retrospectively investigated the medical records of 5,358 adult patients who stayed in the postanesthesia care unit (PACU) of our hospital after general anesthesia during the 1-year period from January 2014 to December 2014. Psychological and behavioral status in the PACU was determined by the Aono four-point scale. Grade of 3 or 4 were considered as manifestations of EA. Multiple variables assessed EA risk factors. RESULTS: Two-hundred-forty-five patients (4.6%) developed EA. In multivariate analysis, male gender (OR = 1.626, P = 0.001), older age (OR = 1.010, P = 0.035), abdominal surgery (OR = 1.633, P = 0.002), spine surgery (OR = 1.777, P = 0.015), longer duration of anesthesia (OR = 1.002, P < 0.001), postoperative nausea and vomiting (OR = 20.164, P < 0.001) and postoperative pain (OR = 3.614, P < 0.001) were risk factors of EA. CONCLUSIONS: Male gender and older patients were risk factors of EA after general anesthesia in adult patients. Careful attention is needed for patients who receive abdominal or spine surgery, and who receive prolonged anesthesia. Adequate postoperative analgesia and antiemetic therapy should be provided to reduce the incidence of EA.
Adult* ; Analgesia ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, General* ; Delirium ; Dihydroergotamine* ; Humans ; Incidence ; Male ; Medical Records ; Multivariate Analysis ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Retrospective Studies ; Risk Factors* ; Spine

BACKGROUND: In laparoscopic surgical procedures, many clinicians recommend supraglottic airway devices as good alternatives to intubation. We compared the i-gel(R) (i-gel) and LMA Supreme(R) (Supreme Laryngeal Mask Airway, SLMA) airway devices during laparoscopic cholecystectomy regarding sealing pressure and respiratory parameters before, during, and after pneumoperitoneum. METHODS: Following Institutional Review Board approval and written informed consent, 93 patients were randomly allocated into the i-gel (n = 47) or SLMA group (n = 46). Insertion time, number of insertion attempts, and fiberoptic view of glottis were recorded. Oropharyngeal leak pressure (OLP), the use of airway manipulation, peak inspiratory pressure, lung compliance, and hemodynamic parameters were measured before, during, and after pneumoperitoneum. RESULTS: There were no significant differences between the two groups regarding demographic data, insertion time, fiberoptic view of glottis, and the use of airway manipulation. The gastric tube insertion time was longer in the i-gel group (20.4 +/- 3.9 s) than in the SLMA group (16.7 +/- 1.6 s) (P < 0.001). All devices were inserted on the first attempt, excluding one case in each group. Peak inspiratory pressure, lung compliance, and OLP changed following carbon dioxide pneumoperitoneum in each group, but there were no significant differences between the groups. CONCLUSIONS: Both the i-gel and SLMA airway devices can be comparably used in patients who undergo laparoscopic cholecystectomy, and they offer similar performance including OLP.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Ethics Committees, Research ; Glottis ; Hemodynamics ; Humans ; Informed Consent ; Intubation ; Laparoscopy ; Laryngeal Masks ; Lung Compliance ; Pneumoperitoneum

BACKGROUND: Hemodynamic stability can be achieved using the combination of ketamine and propofol (ketofol). This study was designed to compare the hemodynamic effects of ketofol with different ketamine-propofol ratios versus propofol after induction of general anesthesia with endotracheal intubation. METHODS: A total of 120 American Society of Anesthesiologist physical status I and II patients 20-60 years of age were randomly allocated into one of four groups. The K0 group received only 2 mg/kg propofol. The K0.15 group received 0.15 mg/kg ketamine and 1.85 mg/kg propofol. The K0.3 group received 0.3 mg/kg ketamine and 1.7 mg/kg propofol. The K0.6 group received 0.6 mg/kg ketamine and 1.4 mg/kg propofol. Endotracheal intubation was performed after muscle relaxation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR) and the bispectral index value were recorded. RESULTS: No significant differences were observed in SBP, DBP, MBP, or HR among the groups after endotracheal intubation. However, the number of patients with a decrease of MBP > 20% from baseline after induction was significantly lower in the K0.6 group compared to that in the K0 group (P < 0.05). CONCLUSIONS: The results suggest that ketofol with 0.6 mg/kg ketamine and 1.4 mg/kg propofol can be used as an alternative to 2 mg/kg propofol.
Anesthesia, General ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Intubation, Intratracheal* ; Ketamine ; Muscle Relaxation ; Propofol

BACKGROUND: The clinical features of spinal anesthesia may differ between young and old patients because of the anatomical and physiological changes that occur with an increase in age. This study was performed retrospectively to compare the clinical aspects of spinal anesthesia between the non-elderly and elderly patients. METHODS: We investigated the medical records of 1,180 adult patients who received spinal anesthesia during a one-year period. They were divided into two groups on the basis of 65 years of age; the non-elderly patient group (Y group, n = 813) versus the elderly patient group (E group, n = 367). Pre-, intra-, and postoperative data related to spinal anesthesia were collected. The data about satisfaction and causes of dissatisfaction with the procedure were evaluated. RESULTS: There were significant differences between the two groups in terms of age, height, and weight, except for sex. Significantly more than two attempts at spinal puncture were performed in the E group (37.6%) than in the Y group (21.4%). There were no statistically significant differences in perioperative complications after spinal anesthesia between the two groups. There were no significant differences in the reported causes of dissatisfaction between the two groups. The rate of wanting to undergo spinal anesthesia in the future was 96.4% in the Y group and 97.5% in the E group, which showed no statistically significant difference. CONCLUSIONS: Although the elderly patients had to undergo more spinal puncture attempts, more than 90% of the elderly patients were satisfied with spinal anesthesia and wanted to undergo spinal anesthesia again for similar surgeries in the future.
Adult ; Aged* ; Anesthesia, Spinal* ; Humans ; Medical Records ; Retrospective Studies ; Spinal Puncture

BACKGROUND: This study aimed to retrospectively evaluate the use of sugammadex in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS: Data were obtained from medical record review of patients who underwent VATS lobectomy from January 2013 to November 2014. Fifty patients were divided into two groups: the sugammadex group (group S, n = 19) was administered sugammadex 2 mg/kg, while the pyridostigmine group (group P, n = 31) received pyridostigmine 20 mg with glycopyrrolate 0.2 mg or atropine 0.5 mg. The primary endpoint measure was the overall incidence of postoperative pulmonary complications including prolonged air leak, pneumonia, and atelectasis. The secondary endpoint measures were the length of postoperative hospital stay and duration of chest tube insertion. RESULTS: The overall incidence of postoperative pulmonary complications in patients in group S was significantly lower compared with that of group P (5 [26.3%] vs. 17 [54.8%]; P = 0.049). Also, the durations of chest tube insertion (5.0 [4.0–7.0] vs. 7.0 [6.0–8.0] days; P = 0.014) and postoperative hospital stay (8.0 [8.0–10.0] vs. 10.0 [9.0–11.0] days; P = 0.019) were shorter in group S compared with group P. Administration of sugammadex was associated reduced with postoperative pulmonary complications (OR: 0.22; 95% CI: 0.05–0.87; P = 0.031). CONCLUSIONS: The use of sugammadex, compared with pyridostigmine, showed a significantly reduced overall incidence of postoperative pulmonary complications and decreased duration of chest tube use and postoperative hospital stay in patients undergoing VATS lobectomy, suggesting that sugammadex might be helpful in improving clinical outcomes in such patients.
Atropine ; Chest Tubes ; Glycopyrrolate ; Humans ; Incidence ; Length of Stay ; Lung Neoplasms* ; Lung* ; Medical Records ; Pneumonia ; Pulmonary Atelectasis ; Pyridostigmine Bromide ; Retrospective Studies ; Thoracic Surgery, Video-Assisted

A 41-year-old man with a 12-year history of urinary incontinence and frequency was presented our hospital. He had a spinal cord injury after fell down from a utility pole. Spastic neurogennic bladder and detrusor external sphincter dyssynergia was diagnosed and augmentation cystoplasty was performed. And we performed additional external sphincterotomy to avoid intrmittent self catheterization. He can retain as much as 800m1 of urine without urinary incontinence and voids with abdominal pressure and retains little residual urine. We report the good result of additional external urethral sphincterotomy after augmentation cystoplasty.
Adult ; Ataxia ; Catheterization ; Catheters ; Humans ; Muscle Spasticity* ; Spinal Cord Injuries ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Incontinence

PURPOSE: To compare the clinical and anterior segment anatomical features in primary angle closure sub-groups based on configurations of iris root insertion. METHODS: Primary angle closure patients were imaged using anterior segment optical coherence tomography. Anterior chamber depth, iris curvature, iris thickness (IT) at the scleral spur and 500, 750, and 1,500 µm from the scleral spur (IT(0), IT(500), IT(750), and IT(1500)), lens vault, iris area, angle opening distance (AOD(500)), angle recess area (ARA(750)), and trabecular iris space area (TISA(750)) were measured. Iris root insertion was categorized into a non-basal insertion group (NBG) and basal insertion group (BG). RESULTS: In total, 43 eyes of 39 participants belonged to the NBG and 89 eyes of 53 participants to the BG. The mean age of participants was greater in the NBG than the BG (62.7 ± 5.7 vs. 59.8 ± 7.3 years, p = 0.043), and the baseline intraocular pressure was higher in the BG than the NBG (16.4 ± 4.4 vs. 14.9 ± 3.3 mmHg, p = 0.037). The BG showed a greater IT(0) (0.265 ± 0.04 vs. 0.214 ± 0.03 mm, p < 0.001) and iris area (1.59 ± 0.24 vs. 1.52 ± 0.27 mm2, p = 0.045), lower ARA(750) (0.112 ± 0.08 vs. 0.154 ± 0.08 mm2, p = 0.017) and AOD(500) (0.165 ± 0.07 vs. 0.202 ± 0.08 mm, p = 0.014) compared to the NBG. CONCLUSIONS: The BG had a narrower anterior chamber angle, thicker peripheral iris, and higher pretreatment intraocular pressure.
Anterior Eye Segment/*diagnostic imaging ; Female ; Glaucoma, Angle-Closure/diagnosis/physiopathology/*surgery ; Gonioscopy ; Humans ; *Intraocular Pressure ; Iridectomy/*methods ; Iris/diagnostic imaging/*surgery ; Lens, Crystalline/diagnostic imaging ; Male ; Middle Aged ; Prospective Studies ; Tomography, Optical Coherence/*methods

Estrogen may promote osteoblast/osteocyte viability by limiting apoptotic cell death. We hypothesize that hsp27 is an estrogen- regulated protein that can promote osteoblast viability by increasing osteoblast resistance to apoptosis. The purpose of this study was to determine the effect of estrogen treatment and heat shock on TNF alpha- induced apoptosis in the MC3T3-E1 cell line. Cells were treated with 0 - 100 nM 17betaestradiol (or ICI 182780) for 0 - 24 hours before heat shock. After recovery, apoptosis was induced by treatment with 0 - 10 ng/ml TNF alpha. Hsp levels were evaluated by Northern and Western analysis using hsp27, hsp47, hsp70c and hsp70i - specific reagents. Apoptosis was revealed by in situ labeling with Terminal Deoxyribonucleotide Transferase (TUNEL). A 5 - fold increase in hsp27 protein and mRNA was noted after 5 hours of treatment with 10 - 20 nM 17beta estradiol prior to heat shock. Increased abundance of hsp47, hsp70c or hsp70i was not observed. TUNEL indicated that estrogen treatment also reduced (50%) MC3T3-E1 cell susceptibility to TNF alpha-induced apoptosis. Treatment with hsp27-specific antisense oligonucleotides prevented hsp27 protein expression and abolished the protective effects of heat shock and estrogen treatment on TNF alpha-induced apoptosis. Hsp27 is a determinant of osteoblast apoptosis, and estrogen treatment increases hsp27 levels in cultured osteoblastic cells. Hsp27 contributes to the control of osteoblast apoptosis and may be manipulated by estrogenic or alternative pathways for the improvement of bone mass.
Apoptosis* ; Cell Death ; Cell Line ; Estradiol ; Estrogens* ; Hot Temperature ; HSP27 Heat-Shock Proteins ; In Situ Nick-End Labeling ; Indicators and Reagents ; Oligonucleotides, Antisense ; Osteoblasts* ; RNA, Messenger ; Shock ; Transferases ; Tumor Necrosis Factor-alpha

We report a case of cervical spinal epidural abcess due to Salmonella group D. A 58-year-old man complained of progressive neck pain and right arm weakness with fever. Clinical and radiographic findings including cervical magnetic resonance(MR) image showed paraspinal soft tissue inflammation of neck and abcesses in prevertebral and epidural space at C3-5 level. The patient underwent a C4 corpectomy and adjacent diskectomy and continous irrigation suction drainage. A MR image taken at second postoperative day revealed diffuse cord swelling from C2 to T1 suggesting edema and/or myelitis and then laminectomy from C3 to C6 was performed immediately to decompress the spinal cord. The patient recovered excellently and the abscess culture revealed Salmonella group D.
Abscess ; Arm ; Diskectomy ; Edema ; Epidural Abscess* ; Epidural Space ; Fever ; Humans ; Inflammation ; Laminectomy ; Middle Aged ; Myelitis ; Neck ; Neck Pain ; Salmonella* ; Spinal Cord ; Suction

PURPOSE: To compare the radiographic results of unicompartmental knee arthroplasty using a navigation system with those using a manual alignment system. MATERIALS AND METHODS: The results of 50 cases (46 patients) of unicompartmental knee arthroplasty using a navigation system (24 patients, 25 cases) and using a manual alignment system (22 patients, 25 cases) were evaluated. Knee anteroposterior, lateral, and weight-bearing full-length lower extremity radiographs before and after the arthroplasty were used for the measurements. RESULTS: The mean postoperative femorotibial alignment was 3.6 degrees of valgus in the manual alignment group and 5.4 degrees of valgus in the navigation group. The postoperative mechanical axis measured using Kennedy and White's method was located at zone 1 in 4 cases (16%), at zone 2 or C in 21 cases (84%) in the manual group, and at zone C for all cases in the navigation group (p=0.001). In the coronal axis of the femoral component, 11 cases (44%) were excellent, 7 cases (28%) were good and, 7 cases (28%) were poor in the manual alignment group. In the navigation group, 15 cases (60%) were excellent and 10 cases (40%) were good and there were no poor results (p<0.05). In the coronal axis of the tibial component, 22 cases (88%) showed excellent results and 3 cases (12%) showed poor results in the manual alignment group. In the navigation group, all cases were showed excellent results (p>0.05). In the sagittal axis of the tibial component, 9 cases (36%) showed poor results in manual group and there were no poor results in the navigation group (p<0.05). CONCLUSION: Unicompartmental knee arthroplasty using navigation produced better results in restoring the alignment of the prosthesis and the mechanical axis of the lower extremity than that using manual alignment.
Arthroplasty* ; Axis, Cervical Vertebra ; Humans ; Knee* ; Lower Extremity ; Prostheses and Implants ; Weight-Bearing