Cardiac papillary fibroelastoma (CPF) is the second or third most common primary cardiac tumor. Although histologically benign, it can cause serious symptoms depending on its location of occurrence, size, and motility. Herein, we report CPF in the left ventricular trabeculation as a potential cause of cerebral infarction.

Cardiac papillary fibroelastoma (CPF) is the second or third most common primary cardiac tumor. Although histologically benign, it can cause serious symptoms depending on its location of occurrence, size, and motility. Herein, we report CPF in the left ventricular trabeculation as a potential cause of cerebral infarction.

Background: Methods of determining proper endotracheal tube (ETT) cuff pressure to prevent air leakage include the minimal occlusive volume (MOV) technique, which uses auscultation, and the spirometer technique, which directly measures inspiratory and expiratory breathing volumes. Spirometers may measure even small air leakage, therefore, the spirometer technique requires a higher cuff pressure than the MOV technique to completely seal the airway. This study aimed to evaluate the difference in cuff pressure between the two techniques used to seal the airway. Methods: Thirty-five female patients were intubated using an ETT with a cuff, and cuff inflation was performed with both techniques at a 10-min interval in random order—the MOV technique and then the spirometer technique or vice versa. The cuff pressure was measured at each period. Results: The cuff pressures were 16.7 ± 1.2 cm H2O and 18.7 ± 1.3 cm H2O for the MOV and spirometer techniques, respectively. The cuff pressure for the spirometer technique was 2 cm H2O higher than that for the MOV technique and this difference was statistically significant (95% confidence interval, 0.7–3.3; P = 0.003). Considering the upper end (3.3 cm H2O) of the 95% confidence interval and the size of one scale unit (2 cm H2O) of a manometer, the difference in cuff pressure was up to 4 cm H2O in practice. Conclusions Even though the air leakage sound disappears on auscultation, unlike the previous recommendation, the airway sealing would be completed only by increasing the cuff pressure by approximately 4 cm H2O.

BACKGROUND: Tracheal complications caused by excessive mucosal pressure from an inflated endotracheal tube are major concerns during anesthesia; hence, an intracuff pressure of 20–30 cmH₂O is recommended as a clinically acceptable intracuff pressure. Diffusion of nitrous oxide (N₂O) into the endotracheal tube cuff increases the intracuff pressure, which may also be influenced by the cuff shape. Therefore, we investigated whether the intracuff pressure of a tapered cuff was different from that of a cylindrical cuff in patients undergoing general anesthesia using 60% N₂O. METHODS: Twenty-six patients who underwent general anesthesia using 60% N₂O in supine position were randomly allocated to the cylindrical cuff group (Group C) or tapered cuff group (Group T). The baseline intracuff pressure was set at 20 cmH₂O, and measured every 10 minutes for 60 minutes. RESULTS: The primary outcome was the intracuff pressure at 60 minutes after N₂O exposure, which was 40 cmH₂O in Group C (95% CI 36–44) and 40 cmH₂O (95% CI 35–45) in Group T (P = 0.895). The lower confidence limit of the intracuff pressures in both groups exceeded 30 cmH₂O at 60 minutes of N₂O exposure, which is the upper limit for clinically acceptable intracuff pressure (20–30 cmH₂O). CONCLUSIONS: There was no significant difference in the intracuff pressures between cylindrical and tapered cuffs. Continuous or frequent monitoring is recommended regardless of the duration of the 60% N₂O exposure because the intracuff pressure can exceed 30 cmH₂O within an hour.
Airway Management ; Anesthesia ; Anesthesia, General ; Clinical Study* ; Diffusion ; Humans ; Intubation, Intratracheal ; Nitrous Oxide* ; Supine Position

The purpose of this study was to compare the effect of sodium fluoride(NaF) varnish and potassium iodide(KI) on remineralization efficacy of silver diamine fluoride(SDF) by measuring microhardness and evaluating surface morphology by scanning electron microscope(SEM).
Artificial caries lesions were induced on extracted primary molars and vickers microhardness was measured. Specimens were randomly separated into 4 groups for treatment. The specimens in group I were treated with SDF, group II with NaF varnish after SDF, group III with KI after SDF and group IV with distilled water. After 8 days of pH cycling, vickers microhardness was measured and difference before and after treatment was calculated. For SEM, 2 samples were evaluated respectively after enamel polishing, lesion formation and after pH cycling.
Group III showed highest increase in microhardness. Group I showed higher increase in microhardness than Group II but without statistical difference. Group IV showed lowest increase in microhardness value among 4 groups.
On SEM image, group I, II and III showed smoother and less irregular surface compared to group IV. Amorphous crystal pellicles were observed in group III.
In conclusion, SDF, SDF and NaF, SDF and KI groups showed smoother surface and increase in microhardness suggesting the possibility that remineralization effect might take place in oral conditions. In addition, in limited conditions of this study, applying NaF varnish after SDF did not increase the remineralization efficacy of SDF while KI significantly increased the remineralization efficacy of SDF. However, additional study considering various conditions that might affect demineralization and remineralization in clinical situations need to be conducted.

Bias affects the true intervention effect in randomized controlled trials (RCTs), making the results unreliable. We evaluated the risk of bias (ROB) of quasi-RCTs or RCTs reported in the Korean Journal of Anesthesiology (KJA) between 2010 and 2016. Six kinds of bias (selection, performance, detection, attrition, reporting, and other biases) were evaluated by determining low, unclear, or high ROB for eight domains (random sequence generation, allocation concealment, blinding of participants, blinding of personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias) according to publication year. We identified 296 quasi-RCTs or RCTs. Random sequence generation was performed better than allocation concealment (51.7% vs. 20.9% for the proportion of low ROB, P < 0.001 and P = 0.943 for trend, respectively). Blinding of outcome assessment was superior to blinding of participants and personnel (42.9% vs. 15.5% and 23.0% for the proportion of low ROB, P = 0.026 vs. P = 0.003 and 0.896 for trend, respectively). Handling of incomplete outcome data was performed best with the highest proportion of low ROB (84.8%). Selective reporting had the lowest proportion of low ROB (4.7%). However, the ROB improved year by year (P < 0.001 for trend). Authors and reviewers should consider allocation concealment after random sequence generation, blinding of participants and personnel, and full reporting of results to improve the quality of RCTs submitted hereafter for publication in the KJA.
Anesthesiology* ; Bias (Epidemiology)* ; Publications

Background: Chronic glucocorticoid exposure is associated with resistance to nondepolarizing neuromuscular blocking agents. Therefore, we hypothesized that sugammadex-induced recovery would occur more rapidly in subjects exposed to chronic dexamethasone compared to those who were not exposed. This study evaluated the sugammadex-induced recovery profile after neuromuscular blockade (NMB) in rats exposed to chronic dexamethasone. Methods: Sprague–Dawley rats were allocated to three groups (dexamethasone, control, and pair-fed group) for the in vivo study. The mice received daily intraperitoneal dexamethasone injections (500 μg/kg) or 0.9% saline for 15 days. To achieve complete NMB, 3.5 mg/kg rocuronium was administered on the sixteenth day. The recovery time to a train-of-four ratio ≥ 0.9 was measured to evaluate the complete recovery following the sugammadex injection. Results: Among the groups, no significant differences were observed in the recovery time to a train-of-four ratio ≥ 0.9 following sugammadex administration (P = 0.531). The time to the second twitch of the train-of-four recovery following rocuronium administration indicated that the duration of NMB was significantly shorter in Group D than that in Groups C and P (P = 0.001). Conclusions Chronic exposure to dexamethasone did not shorten the recovery time of sugammadex-induced NMB reversal. However, the findings of this study indicated that no adjustments to sugammadex dosage or route of administration is required, even in patients undergoing long-term steroid treatment.

BACKGROUND: Carbetocin is a long-acting synthetic analogue of oxytocin that is used to prevent postpartum hemorrhage. Cardiovascular effects of oxytocin include tachycardia and hypotension. We investigated hemodynamic changes induced by carbetocin during spinal anesthesia. METHODS: Carbetocin 100 microg was infused over 5 min in 40 women undergoing cesarean delivery. Hemodynamic parameters were measured noninvasively using the Finometer(R) device. The hemodynamic values were analyzed using multivariate analysis of variance followed by Bonferroni test for multiple comparisons. RESULTS: Statistically significant hemodynamic effects were seen with a maximal effect at about 75 seconds after infusion start compared with those of baseline: Mean arterial pressure (MAP) decreased 21.6 +/- 8.8 mmHg, systemic vascular resistance (SVR) decreased 28.6 +/- 11.1% and heart rate (HR) increased 15.3 +/- 7.9 beats/min. Following the maximal effect, MAP and SVR remained almost constant at this decreased level until the end of study period. However, HR was slowly recovered after the peak, approaching the baseline value. CONCLUSIONS: We observed that the maximal hemodynamic changes were occurred at about 75 seconds after administration of carbetocin. Therefore, careful observation is required during this early period.
Anesthesia, Spinal ; Arterial Pressure ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Multivariate Analysis ; Oxytocin ; Postpartum Hemorrhage ; Tachycardia ; Vascular Resistance

BACKGROUND: This study was undertaken to evaluate the effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation. METHODS: Eighty patients were enrolled and divided into four groups being assigned with different effect-site concentrations (Ce)of remifentanil of 0, 2, 3, or 4 ng/ml. Patients arrived at the operating room without premedication and their baseline vital signs were recorded. With preoxygenation of 100% O2, remifentanil was infused by target controlled infusion according to patient group. After achievement of a stable level of Ce, propofol 2 mg/kg and rocuronium 1.2 mg/kg were injected and the trachea was intubated one minute later. Hemodynamic changes were recorded at 1, 2, and 3 min after remifentanil infusion, immediately before and after endotracheal intubation, and 1 and 2 min after endotracheal intubation. RESULTS: The 50% effective Ce of remifentanil was 1.4 ng/ml (95% confidence interval, CI: 0.9-1.8) to blunt the increase of mean blood pressure and was 2.4 ng/ml (95% CI: 1.6-3.1) to blunt the increase of heart rate. The 50% Ce for the decrease of mean blood pressure was 2.8 ng/ml (95% CI: 2.2-3.4). CONCLUSIONS: During the rapid sequence intubation, the 50% effective effect site concentration of remifentanil to prevent hemodynamic changes is between 2.4 and 2.8 ng/ml.
Achievement ; Androstanols ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Operating Rooms ; Piperidines ; Premedication ; Propofol ; Trachea ; Vital Signs

While arthroscopic shoulder surgery is considered relatively safe, complications have been reported.Though rare, pneumothorax has been reported in patients undergoing arthroscopic shoulder surgery.Tension pneumothorax must be immediately recognized and treated due to its potentially life threatening consequences.The authors present a case of a patient who developed tension pneumothorax after arthroscopic shoulder surgery, and its anesthetic managements.
Humans ; Pneumothorax ; Shoulder