A 50-year-old man with bladder cancer had spinal anesthesia for transurethral resection of bladder. After he had spinal block at the T8 level, he developed a persistent penile erection, making it impossible to introduce the 24 French cystoscope. To treat a persistent penile erection, intravenous glycopyrrolate was incrementally given for a total of 0.4 mg. A persistent penile erection was markedly subsided 5 minutes after last 0.2 mg glycopyrrolate was given. Then corpus cavernosum blood was aspirated. The cystoscope was easily introduced, and transurethral resection of bladder proceeded without further complication.
Anesthesia, Spinal* ; Cystoscopes ; Glycopyrrolate ; Humans ; Male ; Middle Aged ; Penile Erection* ; Urinary Bladder ; Urinary Bladder Neoplasms

BACKGROUND: It is stated frequently that patients with spinal block may be drowsy, although they may not have received any sedative drugs. Intrathecal clonidine increase the duration of sensory and motor blockades, and also has a sedative effect. Thus we conducted this study to investigate the effects of spinal anesthesia and intrathecal clonidine on propofol hypnotic requirements. METHODS: Forty-five adult patients scheduled to undergo local or spinal anesthesia were enrolled in this study. Group 1 included patients on local anesthesia, group 2 were patients on spinal anesthesia with 0.5% hyperbaric bupivacaine, and group 3 were patients on spinal anesthesia with 0.5% hyperbaric bupivacaine and 75microgram clonidine. The target controlled infusion (TCI) of propofol was started at a target concentration of 1microgram/ml. We checked the lowest BIS during 5 min observation after the effect site concentration (Ce) had been reached (1microgram/ml). The TCI of propofol was then restarted at a target concentration of 1.5microgram/ml and we checked the lowest BIS during 5 min observation after the Ce had been reached (1.5microgram/ml). We also checked the Ce when the BIS reached 80 and 70. RESULTS: The minimum BIS's at 1 microgram/ml Ceiiwere 86.9 +/- 11.3 (Group 1), 80.5 +/- 8.5 (Group 2) and 66.9 +/- 15.5 (Group 3), and the minimum BIS's at 1.5microgram/ml Ce were 76.0 +/- 13.4, 62.9 +/- 12.4, 48.5 +/- 13.7, respectively. The Ce's of propofol at BIS 80 were checked initially at 1.4 +/- 0.5microgram/ml (Group 1), 1.1 +/- 0.3microgram/ml (Group 2) and 0.8 +/- 0.3microgram/ml (Group 3). The Ce's of propofol at BIS 70 were 1.8 +/- 0.6microgram/ml, 1.4 +/- 0.3microgram/ml and 1.0 +/- 0.3microgram/ml, respectively. The Ce's of Group 2 and Group 3 at BIS 80 and BIS 70 were statistically lower than those of Group 1 (P < 0.05), and the Ce's of Group 3 at BIS 80 and BIS 70 were statistically lower than those of Group 2 (P < 0.05). CONCLUSIONS: Spinal anesthesia and intrathecal clonidine reduce the requirement of propofol for conscious sedation. The Ce of propofol for conscious sedation is 1.4-1.8microgram/ml for local anesthesia, 1.1-1.4microgram/ml for spinal anesthesia with 0.5% hyperbaric bupivacaine, and 0.6-1.0microgram/ml for spinal anesthesia with 0.5% hyperbaric bupivacaine and 75microgram clonidine.
Adult ; Anesthesia, Local ; Anesthesia, Spinal* ; Bupivacaine ; Clonidine* ; Conscious Sedation* ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Propofol*

The laryngeal mask airway (LMA) has several advantages over endotracheal intubation for the airway management in tracheal stenosis patients. Endotracheal tubes are narrower than the natural trachea and can induce reflex airway constriction resulting in more resistance to ventilation. Furthermore, an endotracheal tube can injure the trachea, and cause airway edema, and further tracheal constriction. In contrast, the increase in airway resistance that occurs when using the laryngeal mask is relatively low, because the diameter of the laryngeal mask airway is larger than that of the endotracheal tube and the laryngeal mask airway is not intubated. However, patients with a mechanically obstructed trachea, those with tracheomalacia or an external compression of the trachea, cannot be managed with a laryngeal mask airway, because it cannot prevent tracheal collapse. Thus it is important that the causes of tracheal obstruction are differentiated. This report suggests that the laryngeal mask airway can be used as a route for mechanical ventilation and as a conduit for tracheal evaluation and endotracheal intubation using fiberoptic bronchoscope during tracheal reconstruction surgery in patients with tracheal stenosis.
Airway Management ; Airway Resistance ; Bronchoscopes ; Constriction ; Edema ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Reflex ; Respiration, Artificial ; Trachea ; Tracheal Stenosis ; Tracheomalacia ; Ventilation