No abstract available.
Humans ; Intubation

No abstract available.
Humans ; Intubation* ; Klippel-Feil Syndrome* ; Laryngoscopes*

The antiphospholipid syndrome (APS) is characterized by vascular thrombosis despite of prolongation of coagulation profile in laboratory findings and pregnancy morbidity in the presence of antiphospholipid antibody. It occurs primarily or secondarily to autoimmune disease. This case report concerns a pelviscopic left ovarian cystectomy in a 32-year-old female with APS and systemic lupus erythematosis. To manage the hypercoagulability, oral warfarin and low molecular weight haparin were given pre- and postoperatively. In perioperative period, we monitored activated clotting time to prevent intraoperative thrombosis and tried to avoid dehydration, hypothermia and infection.
Adult ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Autoimmune Diseases ; Cystectomy ; Dehydration ; Female ; Humans ; Hypothermia ; Critical Care ; Molecular Weight ; Perioperative Period ; Pregnancy ; Thrombophilia ; Thrombosis ; Warfarin

BACKGROUND: Obstetrics departments are unique and medical accidents in obstetric anesthesia may show differences from non-obstetric anesthesia accidents.So we compared both groups in several aspects for the understanding their characters and decreasing their incidence. METHODS: Obstetric anesthesia accidents (n = 30) and non-obstetric anesthesia accidents (n = 106) were compared in 6 categories (patient age, anesthesia method, damaging event, anesthetic care, severity of injury, payment). RESULTS: The most common complications in obstetric anesthesia accidents were maternal death (40%), maternal brain damage (13%), and maternal nerve injury (13%).In contrast, the most common complications in non-obstetric anesthesia accidents were patient death (62%), and patient brain damage (27%). The severity of injury score of obstetric anesthesia adverse outcomes was analogous to that of non-obstetric anesthesia adverse outcomes, but the payment for obstetric accidents was significantly greater than that for non-obstetric accidents. CONCLUSIONS: Obstetric anesthesia accidents revealed distinct medical risk profiles, such as patient age, damaging event, severity of injury, and payment.Special care should be used when anesthetizing younger women and caring for a newborn in obstetric anesthesia.More studies and analyses are necessary to prevent obstetric anesthesia accidents.
Anesthesia ; Anesthesia, Obstetrical ; Brain ; Female ; Humans ; Infant, Newborn ; Maternal Death ; Obstetrics and Gynecology Department, Hospital

A 26 year old, healthy, 41 week primiparous woman received a patient-controlled epidural analgesia (PCEA) and experienced paraplegia 11 hours later after a vaginal delivery. This was thought to be the result of complications from PCEA but there was no specific abnormality on magnetic resonance imaging (MRI) of the lumbosacral spine. On an electromyography (EMG) study performed 15 days following delivery, signs of tibial neuropathy were present and peripheral nerve injury during vaginal delivery was suspected. Motor weakness and hypoesthesia of both lower extremities improved rapidly, but a decrease in the desire to urinate or defecate, followed by urinary incontinence and constipation persisted, We suspected the sacral plexus had been severely damaged during vaginal delivery. Seven months later, the patient's conditions improved but had not fully recovered.
Analgesia ; Analgesia, Epidural ; Constipation ; Delivery, Obstetric ; Electromyography ; Female ; Humans ; Hypesthesia ; Lower Extremity ; Lumbosacral Plexus ; Magnetic Resonance Imaging ; Paraplegia ; Peripheral Nerve Injuries ; Spine ; Tibial Neuropathy ; Urinary Incontinence

No abstract available.
Embolism, Air ; Volatilization

A 43-year-old male was admitted for reconstruction surgery to repair posterolateral rotatory instability of the knee. At the request of the surgeon, ranitidine was slowly administered intravenously immediately before the patient was transferred to the operating room to reduce the incidence of acid reflux. A few minutes later, during the transfer of the patient, anaphylaxis developed with hypotension, nausea, dyspnea, change in consciousness and urticaria. The patient had no previous history of any allergic tendency. After appropriate management, he recovered without complication. Following surgery, an allergic skin prick test was performed to determine if the patient was allergic to any of the drugs used during the surgery. According to the results, only ranitidine showed a positive reaction.
Adult ; Anaphylaxis ; Consciousness ; Dyspnea ; Humans ; Hypotension ; Incidence ; Knee ; Male ; Nausea ; Operating Rooms ; Patient Transfer ; Ranitidine ; Skin ; Urticaria

BACKGROUND: The postoperative bowel function can affect the number of hospital days and morbidity. This study examined the effect of intravenous lidocaine on the postoperative bowel function. METHODS: Forty patients scheduled to undergo a laparoscopic hysterectomy were randomly allocated to receive intravenous lidocaine or an equal volume of saline. The lidocaine group received a continuous lidocaine infusion of 2 mg/kg/hr intraoperatively and for one hour after surgery. The saline group received an equal volume of saline. The time to the first flatus, defecation and hospital discharge were recorded. The incidence of postoperative nausea and vomiting (PONV) were assessed. The consumption of intravenous patient controlled analgesia (IV-PCA) over a twenty-four hour period and the dose of the rescue drug were measured. The visual analogue scale of pain was assessed at the recovery room and 24 hour after surgery. The side effects of intravenous lidocaine were recorded. RESULTS: The patients' demographics were similar in both groups. The median time to the first flatus was 30 hours in the lidocaine group and 42 hours in the saline group (P < 0.05). The median time to defecation was 65.5 hours in the lidocaine group and 96 hours in the saline group (P < 0.05). The number of hospital days was similar. Intravenous lidocaine significantly decreased the level of IV-PCA consumption (P < 0.05). In the lidocaine group, the incidence of PONV was significantly lower (P < 0.05), and no side effects were observed. CONCLUSIONS: Intravenous lidocaine facilitates the recovery of the bowel function after a laparoscopic hysterectomy by reducing the flatus time and defecation time. In addition, the level of IV-PCA consumption after surgery and the incidence of PONV were also reduced by intravenous lidocaine.
Analgesia, Patient-Controlled ; Defecation ; Demography ; Flatulence ; Humans ; Hysterectomy ; Incidence ; Lidocaine ; Postoperative Nausea and Vomiting ; Recovery Room

BACKGOUND: Patients with tracheostomy tubes have altered glottic closure in deglutition that may result in aspiration and may cause dangerous pulmonary complication including bronchopneumonia and atelectasis. The incidence of pulmonary aspiration in patients with tracheosomy may be high but difficult to determine because investigators often apply different criteria. The present study was prepared to document the incidence of aspiration in patients with tracheostomy using a simple dye-marker test. METHODS: Thirty six surgical and medical patients (14 male and 22 female) in ICU with tracheostomy tube (high volume, low pressure cuffed tube) were included in this study. Mental status (presence of response to verbal command), the presence of nasogastric tube and the presence of ventilatory support were recorded in each patients to evaluate the effect of these factors on the incidence of aspiration. 1% solution of methylene blue dye was applied on the both side of posterior tongue and then any evidence of the blue dye-marker obtained microscopically on secretion through the tracheostomy tube at every 2 hours during 72 hours was considered the positive evidence of aspiration. RESULTS: Aspiration was detected by a positive methylene blue dye test in 11 of the 36 patients (30.5%) and average length of time before blue dye was obtained on tracheal secretion was 8.2 7.3 hours.The presence of response to verbal command, nasogastric tube and ventilatory support had no apparent effect on the incidence of aspiration. CONCLUSIONS: This observation suggests that a simple test using dye-maker is helpful to detect aspiration in patients with tracheostomy. Tracheostomy should be done under discreet decision because the high incidence of aspiration in trcheostomized patients.
Bronchopneumonia ; Deglutition ; Humans ; Incidence* ; Critical Care ; Male ; Methylene Blue ; Pulmonary Atelectasis ; Research Personnel ; Tongue ; Tracheostomy*