BACKGROUND: The speed of injection of local anesthetic solutions into the subarachnoid space may influence the spread of these agents in the cerebrospinal fluid by the amount of turbulence generated, especially with large volume. To determine the proper injection speed of anesthetics in hypobaric spinal anesthesia on jack-knife position, the anesthetic level and duration were measured with the fast or slow injection speed. METHODS: Twenty patients for perianal surgery in jack-knife position under hypobaric spinal anesthesia were randomly assigned to one of two groups. Tetracaine (0.1%) in distilled water 5 ml was administered to all the patients. Group I patients received the drug with the speed of injection as 5 ml/20 sec (15 ml/min) and the others (Group II) as 5 ml/4 min (1.25 ml/min). The mean arterial pressures and heart rates at the preanesthetic period, and 5, 10, 15 and 20 min after the end of injection were measured. The anesthetic levels at 5, 10, 15 and 20 min after the injection and anesthesia duration were measured. RESULTS: There was no significant difference in mean arterial pressures, heart rates and anesthetic duration between two groups. The anesthetic level 20 min after the injection was higher in Group I than Group II, and not different at the other time sequences. CONCLUSION: At the injection speed within 1.25-15 ml/min in hypobaric spinal anesthesia on jack-knife position at 15o head-down, we acquired appropriate anesthetic level and duration for perianal surgery without any undesirable effects.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Arterial Pressure ; Cerebrospinal Fluid ; Head-Down Tilt* ; Heart Rate ; Humans ; Subarachnoid Space ; Tetracaine* ; Water

BACKGROUND: Lidocaine's sedative effect has not been known well. The purpose of this study was to evaluate its sedative and cardiovascular effects during induction of anesthesia. METHODS: Twenty patients were randomly allocated to group I or II, with or without lidocaine 1.5 mg/kg intravenously (IV) before induction, respectively. The BIS, blood pressure and heart rate were measured at before and 2 minutes after lidocaine IV injection, preintubation, and 1, 2, 3 and 5 minutes after tracheal intubation. The enflurane concentrations were continuously maintained at 2 volume%. RESULTS: The BIS of group I was more decreased at 1 and 2 minutes after intubation than those of group II. The systolic blood pressures of group I were less increased at 1 and 2 minutes after intubation than those of group II. The diastolic blood pressures and heart rates of group I were not different from those of group II at each stage of the procedure. CONCLUSIONS: Lidocaine reduced BIS and blunted the intubation-induced systolic hypertensive response. In addition it is thought that it has a sedative effect and is effective to maintain cardiovascular stability after tracheal intubation.
Anesthesia ; Blood Pressure ; Enflurane ; Heart Rate ; Humans ; Hypnotics and Sedatives* ; Intubation ; Intubation, Intratracheal* ; Lidocaine*

Mishaps related to valve malfunction in a self-inflating bag-valve unit can lead to fatal complications. We report a case of severe hypotension that resulted from the locking of the Laerdal valve in the inspiratory position during transport in the operating room. A 36 year old man had undergone an off-pump coronary artery bypass graft. Immediately before leaving the operating room, severe hypotension developed abruptly. But an EKG showed only a reduction of heart rate. We started closed cardiac massage with an intravenous bolus injection of epinephrine 0.5 microgram and reconnected the anesthesia breathing circuit. The patient was manually ventilated using the anesthesia reservoir bag. Vital signs immediately recovered. At that time, the patient's abdomen was distended and we suspected an expiratory abnormality. The self-inflating bag-valve unit was tested with an anesthesia reservoir bag as a test lung. Expiration did not occur. Another self-inflating bag-valve unit was substituted and normal ventilation was restored. It is essential that before use, a self-inflating bag-valve unit should be tested for proper function during both expiration and inspiration using a test lung such as, an anesthesia reservoir bag.
Abdomen ; Adult ; Anesthesia ; Coronary Artery Bypass, Off-Pump ; Electrocardiography ; Epinephrine ; Heart Massage ; Heart Rate ; Humans ; Hypotension* ; Lung ; Operating Rooms ; Respiration ; Resuscitation ; Transplants ; Ventilation ; Vital Signs

A 56-year old female who had an atrial septal defect with tricuspid regurgitation received a patch repair and tricuspid annuloplasty. During weaning from cardiopulmonary bypass (CPB), bright red blood filled the endotracheal tube and breathing circuit. We suctioned the blood through the endotracheal tube. The bleeding was massive (about 400 ml) but the airway could be cleared with endotracheal suction. We irrigated endotracheal tube with normal saline with phenylephrine. The weaning of CPB was done and protamine was administered. The bleeding ceased when protamine was administered. Weaning from CPB was accomplished uneventfully. We found a little bleeding in the right main stem bronchus by flexible bronchoscopy but did not do any more procedures. In the intensive care unit, the patient had stable vital signs and good respiratory function. The patient was extubated without any problems at postoperative 1 day and transferred to ward without any complications.
Bronchi ; Bronchoscopy ; Cardiopulmonary Bypass* ; Female ; Heart Septal Defects, Atrial ; Hemoptysis* ; Hemorrhage ; Humans ; Intensive Care Units ; Middle Aged ; Phenylephrine ; Respiration ; Suction ; Tricuspid Valve Insufficiency ; Vital Signs ; Weaning

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a larger cuff and a drainage tube. This study was designed to assess the usefulness and the safety of the PLMA in a laparoscopic cholecystectomy. METHODS: Forty patients undergoing a laparoscopic cholecystectomy were randomly allocated to two groups; an endotracheal tube (ETT) group or a PLMA group. Anesthesia was induced with intravenous fentanyl and propofol and maintained with TCI-propofol. Blood pressure, heart rate, peak inspiratory pressure, peripheral O2 saturation (SpO2), end-tidal CO2 tension (PETCO2) and PaCO2 was measured during the operation. The incidence of gastric content regurgitation and gross pulmonary aspiration were evaluated. Postoperatively, SpO2, the visual analogue scale (VAS) of pain, nausea and vomiting (PONV), and sore throat were evaluated at 30 minutes intervals in post-anesthetic care unit (PACU) and at night. RESULTS: There were no significant differences in intraoperative PIP, SpO2, PETCO2, postoperative SpO2, VAS scores, PONV, and sore throat between the two groups. Gross pulmonary aspiration was not found in either group, but minimal gastric regurgitation occurred in 2 cases of the ETT group and 1 case of the PLMA group. CONCLUSIONS: We concluded that there were no differences in patient safety and adequate ventilation for a laparoscopic cholecystectomy between the ETT group and PLMA group. Moreover, there were no increases in blood pressure and heart rate in PLMA group during insertion/intubation.
Anesthesia ; Blood Pressure ; Cholecystectomy, Laparoscopic* ; Drainage ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Laryngeal Masks* ; Laryngopharyngeal Reflux ; Nausea ; Patient Safety ; Pharyngitis ; Postoperative Nausea and Vomiting ; Propofol ; Ventilation ; Vomiting

BACKGROUND: Remifentanil has been shown to be effective at treating potentially adverse hemodynamic responses to tracheal intubation even at low doses (< 1 microg/kg/min), which needs to be evaluated in patients with diverse cardiovascular conditions. METHODS: A low-dose regimen of remifentanil (continuous infusion of 0.1 microg/kg/min, preceded by 0.5 microg/kg bolus) was given before induction with bolus propofol and rocuronium, and heart rate as well as systolic, diastolic, and mean arterial pressures were measured at 1 min intervals from before induction to 5 min after tracheal intubation in normotensive patients, untreated hypertensive patients, and patients with known hypertension. RESULTS: The low-dose regimen of remifentanil resulted in parallel hemodynamic responses in all three groups, and was effective at limiting hemodynamic responses to tracheal intubation without excessive cardiovascular depression. Hemodynamic responses in our study showed a similar pattern to that reported in previous investigations, except for elevations in heart rate and arterial pressures over the baseline values immediately after intubation. CONCLUSIONS: We suggest that the low-dose regimen of remifentanil in our study could be routinely used to modify hemodynamic responses to tracheal intubation in patients with diverse hemodynamic characteristics. However, the development of supplementary regimens is still needed to control the brief, but exaggerated responses to tracheal intubation, especially in untreated hypertensive patients.
Androstanols ; Arterial Pressure ; Depression ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Piperidines ; Propofol

PURPOSE: To described the MR findings in the periodic changes of the size and signal intensity ofreconstructed anterior cruciate ligament (ACL) of the knee and the efficacy of oblique axial imaging in patientswho underwent arthroscopic ACL reconstruction using autogenous patellar tendon. MATERIALS AND METHODS: Twenty-onepatients who had undergone ACL reconstruction were evaluated by follow-up MRI at postoperative 1 week, 1, 2, 3 and6 months, and 1 year, Conventional Fast-Spin-Echo (FSE) sagittal and coronal images and oblique axial images(proton density and T2-WI; VEMP TR/TE, 2000/20/70) were obtained perpendicular to the ligament, and using an ROIcurve in the intra-articular area, periodic changes in the cross-sectional area were evaluated by proton densityimaging and signal intensity by T2WI imaging. Cross-sectional morphology was categorized as either smooth, andround or notch-shaped and periodic changes in configuration were observed. In three cases, we evaluated the retearof reconstructed ACL by comparing the oblique axizl image obtained by conventional sagittal and coronal imaging. RESULTS: The cross-sectional area and signal intensity of grafted ACL increased significantly (p<0.05) after 3months and at 1 year, respectively. Cross-sectional morphology was smooth and round in 86% of cases, and notchedin 14%, and during follow-up MR studies, no periodic changes were seen. Notch-shaped ACL and decreased perigraftsignal intensity, as seen on sagittal images, could lead to a misdiagnosis of partial tear ; on oblique axialimages, ACL and perigraft signal intensity were found to be normal. CONCLUSION: During the natural evolution ofgrafted ACL, cross-sectional area and signal intensity increased significantly after 3 months and at 1 year,respectively ; on follow-up MR studies, cross-sectional morphology did not change, however. Oblique axial imagingprovides important information for evaluating whether the reconstructed ACL is torn or not.
Anterior Cruciate Ligament* ; Cross-Sectional Studies ; Diagnostic Errors ; Follow-Up Studies* ; Knee* ; Ligaments ; Magnetic Resonance Imaging ; Patellar Ligament ; Prospective Studies* ; Protons ; Transplants*

BACKGROUND: Although sevoflurane is almost ideal for the ihalation induction of anesthesia, considerable hemodynamic and respiratory effects have been reported during inhalation induction. The goal of this study was to evaluate the effects of low-dose fentanyl on high concentration of sevoflurane induction in adult patients with midazolam premedication. METHODS: 104 healthy patients (16 55 yr) premedicated with midazolam were randomized to receive I.V. fentanyl 0.5mug/kg (F) or placebo (P) before induction. Three vital capacity breathing with 8 vol% sevoflurane/70% N2O was applied to patients after priming of circuit with the anesthetic mixture. A blinded observer recorded the sequence of breaths (1st, 2nd, 3rd) to loss of eyelash reflex, response to verbal command (RVC), side effects, and the intubation time. MAP, HR, respiratory rate (RR), sevoflurane ET%, BIS values, SpO2, and ETCO2 were recorded at 1 minute intervals. Hypotension, tachycardia, and tachypnea were defined as a 30% decrease in MAP, a HR over 100 bpm, and a RR of over 25/min, respectively. Data were analyzed using the Chi-Square Test, ANOVA, and Post Hoc test. Results were considered significant at a P < 0.05. RESULTS: No differences in sevoflurane ET% or overall changes in MAP were observed between the two groups. HR was significantly increased in P compared to F during induction. Loss of RVC was faster in F than in P. Tachycardia and tachypnea were more developed in P than in F. BIS values were increased after intubation to a greater extent in P (from 45.8+/-18.6 to 59.2+/-20.4) than in F (from 36.0+/-9.0 to 39.9+/-10.3). Time to Intubation showed no difference between groups. CONCLUSIONS: We conclude that low-dose fentanyl can reduce the incidence of marked changes in HR and RR, and even in BIS changes at intubation during inhalation induction with sevoflurane. Fentanyl may affect the quality of sevoflurane induction rather than induction speed.
Adult* ; Anesthesia ; Fentanyl* ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Inhalation ; Intubation ; Midazolam* ; Premedication* ; Reflex ; Respiration ; Respiratory Rate ; Tachycardia ; Tachypnea ; Vital Capacity

BACKGROUND: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. METHODS: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. RESULTS: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. CONCLUSIONS: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.
Adult ; Animals ; Blotting, Northern ; Gene Expression* ; Hepatocytes* ; Humans ; Liver ; Microscopy ; Rats ; RNA ; RNA, Messenger ; Spleen

The new onset of acanthosis nigricans in an adult-especially when the lesions appear on mucosal membranes such as the lips, periocular areas, and anus-may be indicative of an underlying tumor. Adenocarcinoma of the gastrointestinal tract is the most common malignancy-most often cancer of the stomach. A 72 years old female had disseminated, symmetrically distributed, brownish black pigmentation and papillary hypertrophy on the intertriginous and flexural areas for 12 months, and gastric adenocarcinoma was confirmed during the evaluation of internal malignancy. The cutaneous finding of acanthosis nigricans was a significant cutaneous marker of internal malignancy in this case.
Acanthosis Nigricans* ; Adenocarcinoma* ; Aged ; Female ; Gastrointestinal Tract ; Humans ; Hypertrophy ; Lip ; Membranes ; Pigmentation ; Stomach Neoplasms