No abstract available.

A reduced retroversion angle of humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft tissue procedures. Rotation osteotomy of proximal humerus is one of many surgical modalities proposed for recurrent anterior shoulder dislocation. To support such an operation, fundamental knowledge of shoulder anatomy is essential. The semi-axial view by Soderlund have been regarded as simple and reliable method for measuring humeral head retroversion angle. The purpose of this study was to evaluate validity of the semi-axial view and to assess reference values for humeral head retroversion angle in Korean. Humeral head retroversion angle was determined from 80 healthy subjects, 48 men and 32 women. Radiographs which shown less than 10degrees between humeral shaft axis and epicondylar axis were defined as acceptable radiographs by Soderlund. Acceptable radiographs were selected and two orthopedic surgeons measured retroversion angle, separately. Acceptable radiographs were obtained in only 70 shoulders (43.8%). The mean angle was 35.2+/-8.24degrees for dominant hand and 32+/-6.27degrees for nondominant in Korean. The mean angle was 35.3+/- 7.78degrees for right side and 31.9+/-6.8degrees for left. The interobserver difference was 2.9degrees. The semi-axial view by Soderlund was not reproducible solely. But if correct arm position is considered, the method presented is easy to use daily.
Arm ; Axis, Cervical Vertebra ; Female ; Hand ; Humans ; Humeral Head* ; Humerus ; Male ; Orthopedics ; Osteotomy ; Reference Values ; Shoulder ; Shoulder Dislocation

Airway perforation is a rare but potentially fatal complication following laser surgery. A 66 years old man was admitted for surgery of tracheal stenosis. He had undergone 2 prior anesthesia for similar surgery and had diabetes mellitus due to chronic steroid therapy. 2 hours after surgery, tracheal perforation lead to pneumomediastinum, tension pneumothorax and perforation of innominate artery with potential risk to injury, which lies in the close proximity to perforation site of trachea. Arterial wall was so weak and fragile that it was difficult to repair the ruptured site. During the procedure, hemorrhage persisted and cardiac arrest developed. Immediate CPR(cardiopulmonary resuscitation) with internal cardiac massage was done but the patient did not recover. We believe that in patient with history of multiple operations, chronic steroid therapy and diabetes mellitus, the vascular structure of thin and fragile should be approached with greater caution when using CO2 laser during surgery.
Aged ; Anesthesia ; Brachiocephalic Trunk ; Diabetes Mellitus ; Granulation Tissue* ; Heart Arrest ; Heart Massage ; Hemorrhage ; Humans ; Laser Therapy ; Lasers, Gas* ; Mediastinal Emphysema ; Metabolism ; Pneumothorax ; Trachea ; Tracheal Stenosis

BACKGORUND: infusion of propofol by a target-controlled infusion (TCi) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. However, there is no report of conscious sedation for mandibular fracture patients using propofol TCi. The objective of this study was to evaluate the appropriation of a conscious sedation using propofol for mandibular fracture patients. METHODS: Twenty patients with a mandibular fracture undergoing an open reduction and miniplate insertion operation were analyzed. We anesthetized patients using a propofol infusion by a TCi system (Diprifusor :Master TCi:Pilot Anesthesia is, France) with local anesthesia using lidocaine. The BiS score was evaluated continually during surgery using a microcomputer (A-2000 BiS monitor , Aspect Medical System, USA). We set the infusion machine at a target concentration 2mug/ml, and adjusted the propofol concentration for a BiS score range of 80-85. infusion rate, total dosage, duration of induction, recall of operative procedure and cooperation scores were checked. BiS, heart rate, noninvasive arterial blood pressure, and SpO2 were recorded during the operation. RESULTS: The mean BiS score was 82.95, the mean target concentration of propofol was 2.645mug/ml, the mean infusion rate was 136.3mug/kg/min, and the mean cooperation score was 2.5, the patients were cooperative. The score of amnesia was 0.2, almost patients did not recall the intraoperative event. The mean duration of stay in the recovery room was 22.2 minutes, and the most frequent side effect was pain on injecion of propofol. CONCLUSiONS: Conscious sedation with propofol TCi is an effective anesthesia method substitute for general anesthesia with quick emergence, few side effects, and safety for mandibular fracture patients.
Amnesia ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Arterial Pressure ; Conscious Sedation* ; Heart Rate ; Humans ; Lidocaine ; Mandibular Fractures* ; Microcomputers ; Propofol* ; Recovery Room ; Surgical Procedures, Operative

BACKGROUND: The aim of the present study was to examine whether gabapentin, a new anti-epileptic agent with relatively low toxicities and side effects, could reduce postoperative pain. METHODS: Thirty-two patients scheduled for an elective total hysterectomy were investigated in this randomized, double blind, placebo-controlled study. The patients were randomized to receive either oral gabapentin 400 mg (gabapentin group, n = 16) or a matching placebo capsule (control group, n = 16) the night before and again 30 min before surgery as an adjunct to morphine patient-controlled analgesia (PCA). The visual analogue scale (VAS) for pain at rest and on movement, morphine consumption, overall satisfactions and postoperative side effects including sedation were recorded for 24 h after surgery. RESULTS: Total morphine consumption for 24 h after surgery was not significantly different between the two groups, but mean hourly morphine consumption during the period of 2 6 h after surgery was significantly greater in the control group. Movement VAS of gabapentin group measured at 6 h and 12 h after surgery was significantly lower than those of control group. There were no significant differences between the two groups with respect to the sedation score, patient's satisfaction and the frequencies of side effects. CONCLUSIONS: We observed that preoperatively administered oral gabapentin 800 mg reduced postoperative morphine consumption and incidental pain without increasing side effects. The addition of gabapentin to a morphine regimen may lower morphine consumption and provide better pain relief without increasing side effects.
Analgesia, Patient-Controlled ; Humans ; Hysterectomy ; Morphine ; Pain, Postoperative

Although a bronchospastic attack is common during the induction and emergence of general anesthesia, it is quite rare during maintenance of it. We experienced a severe case of a bronchospasm in a male patient during the maintenance of general anesthesia. His past medical history indicated no risk factors for the bronchospasm except for heavy smoking. He suffered from poor ventilation, hypercarbia and a pneumothorax that occurred abruptly, 2 hours after inducing general anesthesia. Ten hours later, he recovered his normal respiratory function without any respiratory complication. This case highlights the possibility of a bronchospasm during the maintenance of general anesthesia.
Anesthesia, General* ; Bronchial Spasm* ; Humans ; Male ; Pneumothorax ; Risk Factors ; Smoke ; Smoking ; Ventilation

Although perioperative pulmonary thromboembolisms (PTEs) are not rare, most anesthetists are unfamilar with the condition. We experience a case, which showed a sudden capnographic score drop, increased pumonary arterial pressure, and a D-shaped right ventricle by echocardiography in a femur surgery patient under general anesthesia. The case described provides an example of PTE and should remind anesthetists of the clinical course and treatment of this condition.
Anesthesia, General* ; Arterial Pressure ; Echocardiography ; Femur* ; Heart Ventricles ; Humans ; Orthopedics ; Pulmonary Embolism* ; Thromboembolism

Despite the high incidence of subdural block (SDB) during epidural anesthesia, the condition is unfamiliar to anesthesiologist. We experienced a case of SDB: severe hypotension, transient hemiplegia, wide extent of block and late onset and recovery from block. The case described is an examples of SDB and should remind anesthesiologist of the clinical course and treatment.
Anesthesia, Epidural* ; Hemiplegia ; Hypotension ; Incidence

Although the incidence of epidural abscess is rare, once it occurs, its high morbidity rate and high mortality rate create a great deal of serious sequalae for these patient, if this condition is not diagnosed in time. We experienced a case of epidural abscess after performing percutaneous vertebroplasty in a patient who had a lumbar spinal compression fracture. This case will remind the pain clinician of the possibility of epidural abscess after such a procedure.
Epidural Abscess* ; Fractures, Compression ; Humans ; Incidence ; Mortality ; Vertebroplasty*

BACKGROUND: Laparoscopic surgery in the Trendelenburg position affects the cardiopulmonary system and may also influence intraocular pressure (IOP). The purpose of this study was to compare the effects of propofol and sevoflurane anesthesias on IOP change during laparoscopic hysterectomy. METHODS: Thirty-one women were randomly allocated to either a propofol (P-group, n = 15) intravenous anesthesia group or a sevoflurane (S-group, n = 16) inhaled anesthesia group with fentanyl-N2O/O2-vecuronium. Heart rate, mean arterial pressure, plateau airway pressure, ETCO2, and IOP were measured before induction (T1), 10 min after induction (T2), 10 min after pneumoperitoneum in the Trendelenburg position (T3), and 5 min after pneumoperitoneum deflation in the horizontal position (T4). RESULTS: IOP was significantly decreased in both groups after induction. IOP was increased in both groups after pneumoperitoneum in the Trendelenburg position, but IOP in the sevoflurane group was significantly higher than that in the propofol group. CONCLUSIONS: Propofol intravenenous anesthesia may be a better choice for IOP control during laparoscopic surgery.
Anesthesia* ; Anesthesia, Intravenous ; Arterial Pressure ; Female ; Head-Down Tilt ; Heart Rate ; Humans ; Hysterectomy* ; Intraocular Pressure* ; Laparoscopy ; Pneumoperitoneum ; Propofol*