BACKGROUND: In anemic patients, it has been usually traditional practice to correct the anemic state with preoperative blood transfusion. But now, there is an increasing tendency of refusing blood transfusion due to the transfusional complications, especially AIDS etc. The purpose of this study is to survey the effects of anesthesia in anemic patients with normal cardiopulmonary function compared to non-anemics. METHOD: 40 patients with uterine myoma were divided into two groups, an experimental group of 20 patients with hemoglobin concentration of 8~10 gm% and a control group of 20 patients with hemoglobin concentration higher than 10 gm%, and their blood pressure, pulse rate and arterial oxygen saturation were monitored and compared. RESULTS: There were no significant differences between two groups in blood pressure, pulse rate and arterial oxygen saturation. CONCLUSION: Preoperative blood transfusion, in patients with moderate anemia, does not seem to be a mandatory practice.
Anemia ; Anesthesia ; Blood Pressure ; Blood Transfusion* ; Heart Rate ; Humans ; Leiomyoma* ; Oxygen

It is a common knowledge to anesthesiologists that bleeding can eventually lead to shock and it is a mandatory task of anesthesiologists to monitor and prepare for postoperative bleeding. We have experienced at recovery room a case of cardiac arrest due to massive bleeding after a spinal surgery in a 62-year-old lady weighing 60 kg with no specific abnormalities in both history and physical examination. Immediate intervention with CPR, DC shock and administration of blood and fluids revived her and a subsequent surgical procedure was performed for bleeding control. The major common cause of cardiac arrest associated with operation/anesthesia are cardiovascular failure and respiratory failure. Postoperative bleeding, therefore, warrants close and careful monitoring in order that immediate and optimal care can be provided.
Cardiopulmonary Resuscitation ; Heart Arrest* ; Hemorrhage ; Humans ; Middle Aged ; Physical Examination ; Recovery Room ; Respiratory Insufficiency ; Shock

BACKGROUND: With recently increase in geriatric population, hip surgery of the aged is increasing likewise as one of the major surgical procedures for orthopedic surgeons. It is the purpose of this paper to study the effects of combined spinal epidural anesthesia on blood pressure, heart rate, pulse oxygen saturation, level of blockade, postoperative pain control and complication in geriatric hip surgery. METHODS: Combined spinal epidural anesthesia was performed with a 27G Whitacre spinal needle through a 18G Weiss epidural needle in 30 patients undergoing elective hip surgery of geriatric patients. 0.5% heavy bupivacaine 2 ml (10 mg) was injected intrathecally. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Onset of sensory anesthesia and motor blockade were measured at frequent intervals. Blood pressure, heart rate and pulse oxygen saturation were checked in preoperative state, 1, 2, 3, 4, 5, 7, 9, 11, 13, 15 minute after injection, and then every 3 minute until the operation was finished. 0.125% bupivacaine 110 ml with morphine 3 mg was provided by Baxter infusor (Baxter Healthcare CO. Deerfield, USA) for postoperative pain control. RESULTS: All 30 patients had adequate anesthesia. Sensory block level was at least above T10 dermatome and motor blockade of lower extremity was Bromage 3 in all patients. Systolic blood pressure and diastolic blood pressure were significantly different (P<0.05) after 3 minutes compared to preoperative state, but any patient had no specific problem. Postoperative pain control was excellent with no significant complication. CONCLUSIONS: Combined spinal epidural anesthesia provided reliable anesthesia for hip surgery of geriatric patients without significant complication.
Aged* ; Anesthesia ; Anesthesia, Epidural* ; Blood Pressure ; Bupivacaine ; Catheters ; Delivery of Health Care ; Heart Rate ; Hip* ; Humans ; Infusion Pumps ; Lower Extremity ; Morphine ; Needles ; Orthopedics ; Oxygen ; Pain, Postoperative

BACKGROUND: Meperidine, having intermediate lipid solubility, permits postthoracotomy analgesia. The aim of this study is to compare the analgesic efficacy, side effects, and patient satisfactions of istered thoracic versus lumbar epidural route anesthesia during the first 48 hours postthoracotomy. METHODS: A prospective randomized study was conducted for 48 hours after thoracotomy with ridine administered 50 mg as a bolus and continuously at 0.21 mg/kg/hr via either a thoracic (group T), or a lumbar (group L) epidural catheter at the end of the operation. Postoperative pain was assessed 2, 8, 24, 48 hours after the operation on a visual analog scale (VAS). Side effects and levels of patient ction of the epidural analgesia were assessed. RESULTS: There were no significant intergroup differences in heart rate, blood pressure, pain score, side effects and levels of patient satisfaction with analgesia. CONCLUSIONS: We conclude that there is no difference between thoracic and lumbar epidural eridine analgesia for postthoracotomy pain relief.
Analgesia* ; Analgesia, Epidural ; Anesthesia ; Blood Pressure ; Catheters ; Heart Rate ; Humans ; Meperidine* ; Pain, Postoperative ; Patient Satisfaction ; Prospective Studies ; Solubility ; Thoracotomy* ; Visual Analog Scale

Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.
Anesthesia, General ; Anoxia ; Ascites* ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Colon ; Female ; Head-Down Tilt* ; Humans ; Lung ; Ovarian Neoplasms* ; Ovary ; Pleural Effusion* ; Round Ligament of Uterus ; Thorax ; Uterus

BACKGROUND: Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. METHODS: Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. RESULTS: No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 +/- 8.5 ml vs. 16.6 +/- 12.0 ml, P = 0.013). CONCLUSIONS: Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Dizziness ; Female ; Fentanyl* ; Gynecologic Surgical Procedures* ; Humans ; Hysterectomy ; Oxycodone* ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Period

BACKGROUND: Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation. METHODS: Ninety patients classified as American Society of Anesthesiologists physical status I–II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused. RESULTS: At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively). CONCLUSIONS: Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia.
Anesthesia, Spinal* ; Anoxia ; Blood Pressure ; Bradycardia ; Dexmedetomidine* ; Heart Rate ; Humans ; Hypotension ; Methods ; Midazolam* ; Prevalence

Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.
Anesthesia ; Anesthesia, Spinal ; Carotid Artery, Internal ; Cesarean Section ; Displacement (Psychology) ; Ephedrine ; Female ; Hemodynamics ; Humans ; Hypotension ; Moyamoya Disease ; Phenylephrine ; Postoperative Complications ; Pregnancy

Herpes zoster is viral infection that presents unilateral skin rash or vesicle along the sensory nerve. It is known that pediatric herpes zoster rarely occurs and usually not so severe when it developed, except in immunocompromised children. We report an uncommon case of herpes zoster ophthalmicus in a 9-year-old boy. He presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid. He was treated with oral acyclovir and stellate ganglion block, with complete resolution without sequelae. In addition, we also review the literature on herpes zoster in childhoods.
Acyclovir ; Child ; Exanthema ; Eyelids ; Forehead ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Stellate Ganglion

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.
Anesthesia, General ; Felodipine ; Fentanyl* ; Meperidine* ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin Syndrome* ; Serotonin*