Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia.
Anesthesia, Spinal* ; Blood Patch, Epidural ; Epidural Space ; Headache ; Humans ; Incidence ; Post-Dural Puncture Headache ; Punctures* ; Supine Position

Intrathecal clonidine injection induces analgesia without significant respiratory depression, but decreases blood pressure and causes sedation. Injection of spinal cholinesterase inhibitor alone increases blood pressure in animals, and enhances clonidine induced analgesia. To evaluate the effect of pretreated pyridostigmine on the change of blood pressure and heart rate, clonidine was injected intrathecally in cats. We divided fifteen cats into three groups and administered saline(0.5 cc) to group 1, pyridostigmine(0.5 cc, 2.5 mg) to group 2, pyridostigmine(0.5 cc, 2.5 mg) and glycopyrrolate(0.5 cc, 0.1 mg) to group 3 before 20 minute of clonidine injection and measured mean arterial pressure, heart rate, P CO2 and central venous pressure. The results were as follows: 1)After clonidine injection, all mean arterial pressure values were significantly reduced in group 1, but in group 3, 20, 30 and 40 minutes values were significantly reduced, and 10, 40 minutes values after clonidine injection were not reduced significantly in group 2 compared to group 1. 2)After clonidine injection, heart rates were significantly reduced in all groups, but there was no significant difference between group 1, group 2 and group 3. 3)There was no significant difference of central venous pressure in any groups. 4)There was no significant difference for reversal of pyridostigmines effect by glycopyrrolate. Based on these results, these data suggest that pyridostigmine pretreatment counteracts clonidine induced hypotension, but further study of spinal az adrenergic-cholinergic combination for pain therapy is needed before clinical application.
Analgesia ; Animals ; Arterial Pressure ; Blood Pressure* ; Cats* ; Central Venous Pressure ; Cholinesterases ; Clonidine* ; Glycopyrrolate ; Heart Rate* ; Heart* ; Hypotension ; Pyridostigmine Bromide* ; Respiratory Insufficiency

BACKGROUND: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. METHODS: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patient's religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patient's response to the music was measured on the postoperative 5-6th day. RESULTS: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2+/-3.4 vs 4.4+/-2.9, 11.0+/-3.2 vs 5.7+/-3.1). At post-music, anxiety score in Group I showed significant reduced compaired with Group II (p<0.05). Patients showed relatively good satisfaction with music in both groups. CONCLUSION: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.
Anesthesia ; Anesthetics ; Anxiety* ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Music ; Operating Rooms* ; Pain, Postoperative ; Preanesthetic Medication ; Premedication

Myasthenia gravis (MG) is a disease of neuromuscular junction and mainly autoimmune in aetiology. The state of thymus is a critical determinant for the prognosis. In this retrospective review study, we aimed at clarifying the relationship between the mode of clinical presentation of MG and the radiopathological classification of the thymus. We identified patients with MG from the database of our medical center from 1988 – 2017. The patients were classified into two groups according to their clinical presentation: those with a typical presentation with diurnal variation, and those with an atypical presentation of persistent weakness or respiratory failure from the beginning. The underlying thymic state was categorized into six groups: normal, abnormal by imaging (if no operation was performed), hyperplasia, benign thymoma, cortical type thymoma, and malignant thymoma. In total, 227 patients (133 females and 94 males) were included in the analysis, of whom 68% were classified into the typical presentation group. The atypical presentation correlated significantly with thymic categories (p = 0.014) and sex (p = 0.026) but not age at onset (p = 0.232). The atypical presentation was more common in the male patients and in those with thymic carcinoma.

BACKGROUND: Compared to inhalation and local anesthetics, little is known about the mechanisms of vascular effects of intravenous anesthetics. So we studied the effects of thiopental sodium, midazolam, propofol and ketamine on the endothelial nitric oxide-cGMP pathway and also on the membrane cyclooxygenase pathway. METHODS: After isolating ring strips of rat thoracic aorta, we measured the relaxation ED50 values of the four intravenous anesthetics from the maximally contracted using phenylephrine 10(-5)M. Then using L-NAME and methylene blue, we studied the effects of the drugs upon the NO-cGMP system. In addition, another pathway of vasodilation through membrane prostaglandin metabolism was examined using the membrane cyclooxygenase inhibitor, indomethacine. RESULTS: The following results were obtained. 1. Thiopental sodium (10(-5)M) did not have any effect on the PE induced contractions of aortic rings but midazolam (10(-6)M), propofol (10(-4)M) and ketamine (10(-3)M) significantly (P < 0.05) inhibited the PE induced contractions of aortic rings. 2. Midazolam 10(-6)M and propofol 10(-4)M induced relaxation of aortic rings were recovered with L-NAME pretreatment but ketamine induced relaxation was not recovered with L-NAME. 3. Midazolam 10(-6)M induced relaxation was not recovered with methylene blue pretreatment, but propofol 10(-4)M induced relaxation was recovered with methylene blue. 4. Indomethacine pretreatment induced further relaxation of midazolam or propofol induced relaxation of aortic rings. CONCLUSIONS: Midazolam, propofol and ketamine, but not thiopental sodium, relax rat thoracic aortic rings, and these relaxation effects of midazolam and propofol are endothelium dependent. Cyclooxygenase inhibition is related at least in part to midazolam or propofol induced relaxation, and guanylate cyclase to propofol induced relaxation.
Anesthetics, Intravenous ; Anesthetics, Local ; Animals ; Aorta, Thoracic ; Endothelium ; Guanylate Cyclase ; Indomethacin ; Inhalation ; Ketamine* ; Membranes ; Metabolism ; Methylene Blue ; Midazolam* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Phenylephrine ; Propofol* ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Relaxation ; Thiopental* ; Vasodilation

BACKGROUND: Every practitioner, however skilled, will encounter patients who are unexpectedly difficult to intubation. The incidence of difficult laryngoscopy appears to be approximately 0.5% to 2%. So many methods are used to intubate the trachea, but endotraheal intubation by them is not always possible. The purpose of the this study is to evaluate the effectiveness of magnet on the endotracheal intubation. METHODS: Twenty patients(aged 30 to 59yr, ASA physical status 1) required general anesthesia with an endotracheal tube. Anesthesia was induced with thiopental sodium and succinylcholine, ventilation was controlled with 100% O2. The tip of the epiglottis was exposed wtih a No.3 MacIntosh laryngoscope. A catheter with ferrous stylet was placed behind epiglottis close to tracheal lumen and a magnet was placed over the cricoid cartilage allowing the stylet to be pulled. Endotraheal tube was guided into the trachea over the stylet. The time to intubation, the blood pressure and heart rate of pre- and postintubation, and the difficulty of intubation were recorded and the complications of the endotracheal intubation such as bronchial spasm, oral and tracheal mucosal trauma, and sore throat, were observed. RESULTS: The mean time to intubation was 31.2+/- 8(18 to 50)sec. There were statistically signigicant increase in blood pressure and heart rates following intubation. The incidence of excellent and good intubating condition were 14 and 6 respectively. Seventeen and three intubations were successful on the 1st and 2nd attempts respectively. There were no differences in incidence of complications of endotracheal intubation compared to other reports. CONCLUSIONS: Though magnet guided technique has some limitations to use in case of difficult laryngoscopy, it can be used with merits such as simplicity and cheapness when other methods are not available.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Bronchial Spasm ; Catheters ; Cricoid Cartilage ; Epiglottis ; Heart Rate ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Laryngoscopy ; Pharyngitis ; Succinylcholine ; Thiopental ; Trachea ; Ventilation

BACKGROUND: Postoperative pain after a spinal laminectomy has very harmful effects on human physiology, and many people are trying to control it more easily and safely. There are controversies in methods used for controlling postoperative pain after a spinal laminectomy. The purpose of this study was to examine an effective way to control postoperative pain after a spinal laminectomy. METHODS: Ninety patients (ASA I-II, aged 40 to 70) scheduled for a spinal laminectomy were divided into three groups. In group A, we administered fentanyl 1,000 microgram and morphine 5 mg (mixed in 0.9% normal saline) using the continuous epidural infuser; in group B, we administered fentanyl 500 microgram and morphine 5 mg and 0.25% bupivacaine (mixed in 0.9% normal saline) using the continuous epidural infuser; in group C, we administered fentanyl 1,500 microgram and morphine 10 mg (mixed in 0.9% normal saline) using the continuous IV infuser. We compared effects between the continuous epidural infusion and the continuous intravenous infusion by using the visual analogue scale and side effects. RESULTS: There was no significant difference between continuous epidural infusion groups. When the continuous epidural infusion groups and the continuous IV infusion group were compared, there were significant differences in 3 hr, 6 hr, and 12 hr VAS scores (P < 0.01). The incidence of side effects was very low, and there was no significant difference in side effects between the continuous epidural infusion and the continuous IV infusion groups. CONCLUSIONS: It was found that continuous epidural infusion methods were more effective than the continuous IV infusion method, but none of them showed satisfactory postoperative pain control in the early periods.
Bupivacaine ; Fentanyl ; Humans ; Incidence ; Infusions, Intravenous ; Laminectomy* ; Morphine ; Pain, Postoperative ; Physiology

PURPOSE: Recent studies show that chorioamnionitis has an important role in the pathogenesis of bronchopulmonary dysplasia(BPD) and it induces thymic involution. The purpose of this study is to test the usefulness of thymic size at birth as a predictor of BPD. METHODS: This study was conducted on 91 very low birth weight infants of <1, 500 g with mean gestational age of 29.3 weeks and mean birth weight of 1, 161 g who were admitted at NICU of Dong Kang General Hospital for past 4 years of whom 21 infants had BPD. Thymic size was measured on routine chest radiographs taken in the first 3 hours after birth and measured as the ratio between the width of the cardiothymic shadow at the level of the carina and that of the thorax at the costophrenic angles (CT/ T). RESULTS: Correlation of thymic size with gestational age was statistically significant (P=0.003). CT/T of BPD group was smaller than that of non-BPD group (0.27+/-0.06, 0.33+/-0.07, respectively, P<0.01). A significant positive correlation between small thymus at birth and BPD was detected (P=0.003, odds ratio, 21.7), but not in other disease groups. CONCLUSIONS: We concluded that a small thymus at birth on the chest radiograph could be used as an early predictive parameter of the BPD.
Birth Weight ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Female ; Gestational Age ; Hospitals, General ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Odds Ratio ; Parturition* ; Pregnancy ; Radiography, Thoracic ; Thorax ; Thymus Gland

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anoxia ; Catheters ; Heart Arrest* ; Humans ; Hypotension ; Intestinal Obstruction ; Intubation, Intratracheal ; Oxygen ; Pain, Postoperative* ; Punctures ; Respiration ; Respiratory Insufficiency ; Unconsciousness

A 62-year-old female patient was scheduled for emergent explo-laparotomy under general anesthesia because of traffic accident. Preoperative checked chest x-ray showed multiple fractures of the ribs but didn't show the sign of pneumothorax or hemothorax. she had no dyspnea. Compared with previous value(PaO2; 210.5 mmHg), Arterial PO2 value(PaO2; 143.0 mmHg) was reduced significantly two hours after starting general anesthesia. Chest x-ray was taken in the operating room, which showed pneumothorax in the right side lung. The patient was treated with immediate closed thoracostomy. She recovered uneventfully three days later with complete resorption of the pneumothorax.
Accidents, Traffic ; Anesthesia, General* ; Dyspnea ; Female ; Hemothorax ; Humans ; Lung ; Middle Aged ; Operating Rooms ; Pneumothorax* ; Ribs ; Thoracic Injuries* ; Thoracostomy ; Thorax*