BACKGROUND AND OBJECTIVES: Pseudo-labyrinthine symptom without any other accompanying neurologic symptoms or signs occur with cerebellar infarction. The prognosis and management of cerebellar infarction differ from those of vertigo associated with unilateral vestibulopathy. The objective of study was to analyze the clinical symptoms of cerebellar infarction mimicking unilateral vestibulopathy according to the infarction territory. MATERIALS AND METHOD: Among 273 patients who showed pseudo-labyrinthine symptoms or signs, 28 patients were diagnosed cerebellar infarction on MRI between January 2003 and October 2006. Out of the 28 patients, 9 patients accompanying with focal neurologic symptoms or signs in early stage were excluded, and a retrospective analysis of total 19 patients was done through chart reviews. Using diffusion-weighted imaging, we divided 19 patients into two groups, AICA and PICA territory infarction. Clinincal features, outcome of audiologic and vestibular function test were compared between the groups. RESULTS: Among the 19 subjects, 10 were males and 9 were females, the mean age was 63.1+/-.0. On MRI, 5 (26.3%) subjects showed infarction in unilateral AICA territory, 14(73.7%) in unilateral PICA territory. In the patients with AICA territory infarction, audiological tests confirmed unilateral sensorineuronal hearing loss in all 5 subjects. On V-ENG, 4/5 (80%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 4/5 (80%) had a canal paresis to caloric stimulation. In several days of hospital stay, 3/5 (60%) showed new neurologic signs, facial numbness. In the patients with PICA infarction, there was no hearing change. On V-ENG, 12/14(85.7%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 7/14 (50%) had a canal paresis to caloric stimulation. In several days of hospital stay, 10/14 (71.4%) accompanied with cerebellar ataxia. CONCLUSION: Cerebellar infarction simulating unilateral vestibulopathy is more common than previously thought. Early recognition of the cerebellar infarction showing pseudo-vestibular symptom may allow specific management. Also taking into account that clinical features differ by infarction territory will assist in determining the patient's status of the disease.
Cerebellar Ataxia ; Cerebellum ; Female ; Hearing ; Hearing Loss ; Humans ; Hypesthesia ; Infarction* ; Length of Stay ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Paresis ; Pica ; Prognosis ; Retrospective Studies ; Vertigo ; Vestibular Function Tests

BACKGROUND: Previous studies have shown that morphine in intravenous PCA provides effective pain control in the postoperative patient, but many patients received morphine have complained side effects. Many studies have suggested that meperidine is less common than morphine in side effects, especially nausea and vomiting. We studied morphine and meperidine in intravenous PCA to compare analgesic effects and side effects in both drugs. METHODS: 100 ASA class I patients undergoing cesarean section were chosen and randomly divided into two groups. Group I (n=50) received morphine (initial 0.1 mg/kg, maintenance 12.5~62 microgram/kg/hr) and group II (n=50) received meperidine (initial 1 mg/kg, maintenance 0.15~0.75 mg/kg/hr). We compared the analgesia and side effects of group I to those of group II for 2 days. We used Basal-Bolus Infusor R (15 minutes lock-out interval, 0.5 ml/hr, 0.5 ml/one push module, Baxter Healthcare Corporation, USA)) for intravenous PCA. RESULTS: There were no significant differences in effects of analgesia between both groups. Nausea was more in group I. There were no significant differences in patient's comfort between both groups. CONCLUSIONS: We concluded that meperidine is more useful than morphine in PCA intravenously for post-operative analgesia after cesarean section because there were no significant differences in analgesic effects between both groups but nausea was less in group received meperidine.
Analgesia ; Cesarean Section* ; Delivery of Health Care ; Female ; Humans ; Infusion Pumps ; Meperidine* ; Morphine* ; Nausea ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Vomiting

BACKGROUND: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A randomized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. METHODS: Forty-nine patients (ASA I-II) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupivacaine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. RESULTS: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean SD) was 18.9 7.0 minutes and 187.5 34.6 minutes respectively for ropivacaine, and was 15.2 8.8 minutes and 187.8 40.0 minutes respectively for bupivacaine. Maximum block height (mean SD) was T6.5 2.0 for ropivacaine and T6.4 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12/20 for bupivacaine. CONCLUSIONS: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine.
Analgesia ; Anesthesia ; Blood Pressure ; Bupivacaine* ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Lower Extremity*

BACKGROUND: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A randomized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. METHODS: Forty-nine patients (ASA I-II) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupivacaine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. RESULTS: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean SD) was 18.9 7.0 minutes and 187.5 34.6 minutes respectively for ropivacaine, and was 15.2 8.8 minutes and 187.8 40.0 minutes respectively for bupivacaine. Maximum block height (mean SD) was T6.5 2.0 for ropivacaine and T6.4 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12/20 for bupivacaine. CONCLUSIONS: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine.
Analgesia ; Anesthesia ; Blood Pressure ; Bupivacaine* ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Lower Extremity*

BACKGROUND: We evaluated the appropriate dose of spinal isobaric 0.75% ropivacaine with fentanyl for cesarean section. METHODS: Forty-five healthy term parturients scheduled for an elective cesarean section randomly received 14, 16, 18 mg of 0.75% isobaric ropivacaine intrathecally, which was mixed with fentanyl 20microgram. Sensory blockade variables such as time to L1 block, max. block height, time to max block height, and time to recovery to L1 were assessed. Motor blockade variables such as time to Bromage scale 3, motor recovery time (Bromage scale 3 to 1) and muscle relaxation were assessed. We also checked side effects, and hemodynamic variables. RESULTS: Anesthesia was successful in 57%, 80%, and 93.3% of groups I (14 mg), II (16 mg), and III (18 mg) respectively and there was no significant difference between the three groups. The time to max. sensory and motor block and level of maximum sensory block were not significantly different between the three groups. All groups showed complete motor block, and muscle relaxation was equally excellent in the three groups. Sensory and motor recovery time were not significantly different. The incidence of hypotension was more frequent in group 3 compared with group 1. The incidence of nausea was more frequent in group 3 compared with group 1, and 2. CONCLUSIONS: An intrathecal injection of 16 mg of isobaric 0.75% ropivacaine with fentanyl 20microgram during spinal anesthesia is suitable for an elective cesarean section.
Anesthesia ; Anesthesia, Spinal* ; Cesarean Section* ; Female ; Fentanyl* ; Hemodynamics ; Hypotension ; Incidence ; Injections, Spinal ; Muscle Relaxation ; Nausea ; Pregnancy

BACKGROUND: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. METHODS: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and third lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. RESULTS: The duration of anhidrosis was 12.2 2.6 months (mean SD) in the single-needle group versus 13.6 3.6 months (mean SD) in the two-needle group. CONCLUSIONS: As these results were not significantly different from those obtained in patients having a two-needle sympathectomy, blockade of the single-needle technique under C-arm fluoroscopy is considered to be effective for a neurolytic lumbar sympathectomy.
Extremities ; Fluoroscopy ; Ganglia, Sympathetic ; Humans ; Hypohidrosis ; Needles ; Skin Temperature ; Sympathectomy

BACKGROUND: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. METHODS: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and third lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. RESULTS: The duration of anhidrosis was 12.2 2.6 months (mean SD) in the single-needle group versus 13.6 3.6 months (mean SD) in the two-needle group. CONCLUSIONS: As these results were not significantly different from those obtained in patients having a two-needle sympathectomy, blockade of the single-needle technique under C-arm fluoroscopy is considered to be effective for a neurolytic lumbar sympathectomy.
Extremities ; Fluoroscopy ; Ganglia, Sympathetic ; Humans ; Hypohidrosis ; Needles ; Skin Temperature ; Sympathectomy

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Baricity differences between spinal anesthetic solutions are thought to produce differences in distribution of anesthetics within the subarachnoid space. We evaluated the influence of baricity of bupivacaine on the quality of the block and the incidence of side effects obtained following intrathecal injection of bupivacaine 8 mg with fentanyl 20 microgram. METHODS: Thirty healthy term parturients scheduled for a cesarean section under combined spinalepidural procedures were randomly allocated into Group I, hyperbaric bupivacaine (n = 15); or Group II, isobaric bupivacaine (n = 15). The dose of both groups was bupivacaine 8 mg combined with fentanyl 20 microgram. The maximum level of sensory blockade, time to reach T4 level and maximum level, time to get complete motor recovery and perioperative complications were assessed. RESULTS: Time to sensory block T4, motor block Bromage scale 3, complete resolution of motor block and sensory regression time to T10 was significantly delayed in Group II compared to Group I. Maximal block height, and time to maximal block had no significant differences between the two groups. There were no significant clinical advantages of one preparation over the other. CONCLUSIONS: The data from this study suggests that intrathecal injection of either hyperic or isobaric bupivacaine produces satisfactory anesthesia with similar side effects.
Anesthesia ; Anesthetics ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl ; Incidence ; Injections, Spinal ; Pregnancy ; Subarachnoid Space