Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication.
Aged ; Anesthesia ; Female ; Fistula ; Humans ; Intubation ; Lacerations ; Mediastinal Emphysema ; Mouth ; Pneumothorax ; Postoperative Period ; Rupture* ; Subcutaneous Emphysema ; Trachea ; Ventilation

BACKGROUND: Though the proper administration of midazolam in the geriatric patients under the spinal anethesia reduce the stress, the anxiety and the agitation during surgery, it can cause the hypoxemia owing to decreasing their ventilatory function, and the aim of this study was to evaluate the dose response of midazolam to determine the degree of hypoxemia, the change of cardiovascular functions after the intravenous administration of midazolam in geriatric patients during the period of TURP under the spinal anesthesia. METHODS: On thirty two geriatric male patients(> or =65 yrs), the changes of O2 saturation in pulse oximetry, systolic and diastolic pressure in NIBP, heart rate in EKG before and after the administration of midazolam were studied during perioperative period of TURP under the spinal anesthesia in randomized method, and they were allocated randomly to four groups to receive only normal saline (group 1), midazolam 0.01 mg/kg(group 2), midazolam 0.02 mg/kg(group 3), midazolam 0.03 mg/kg (group 4) in normal saline 3ml, respectively. RESULTS: The results were that the desaturation between 85% and 90% in SpO2 occurred in three patients(one patient in group 3, two patients in group 4), that the desaturation below 85% in SpO2 occurred in three patients (group 4), immediately 100% oxygen was administered to the patients by mask, that the occurrances of the desaturation below 90% in SpO2 appeared about 4-7minutes after the administration of midazolam and there was no statistically significant changes in cardiovascular function in all groups. CONCLUSIONS: It is concluded that the intravenous administration of midazolam more than 0.02 mg/kg can cause hypoxemia in geriatric patients under the spinal anesthesia and the close observation and monitoring must be needed during sedative period.
Administration, Intravenous ; Age Factors ; Anesthesia, Spinal* ; Anoxia ; Anxiety ; Blood Pressure ; Dihydroergotamine ; Electrocardiography ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Male ; Masks ; Midazolam* ; Oximetry ; Oxygen ; Oxyhemoglobins* ; Perioperative Period ; Transurethral Resection of Prostate

BACKGROUND: Nitric oxide (NO) may act as an oxygen radical scavenger or as an antioxidant, and inhibit neutrophil superoxide anion production. In contrast, NO combines with superoxide to form peroxynitrite, a very damaging material whose decomposition RESULTS in the generation of a hydroxyl radical. This study was designed to determine the role of NO in the development of acute lung injury and lipid peroxidation induced by lipopolysaccharide (LPS) in rats. METHODS: Male Sprague-Dawley rats (200 - 250 g) were given one of the following treatments; intraperitoneal normal saline 0.5 ml, intraperitoneal E. coli LPS (5 mg/kg) in 0.5 ml normal saline, 4 mg/kg L-N(6)-(1-iminoethyl)lysine (L-NIL) + LPS, or L-arginine (80 mg/kg) + LPS. Four hours after treatment, the rats were killed by an intraperitoneal pentobarbital injection (100 mg/kg) and plasma nitrate/nitrite concentration (Griess reagents) and lipid peroxide (LPO) concentration of the lung (Yagi's method) were measured (n = 8). In the other sets of experiments, myeloperoxidase activity of the lung (n = 5) and protein concentration of the bronchoalveolar lavage (BAL) fluid (BCA protein assay reagents, n = 4) were assayed. RESULTS: LPS treatment increased plasma nitrate/nitrite concentrations approximately 6 times (20.9 1.8nM, P < 0.01) compared with the control group (3.6 +/- 0.7nM), and L-NIL treatment prevented this increase. L-NIL plus LPS treatment resulted in greater increase of LPO concentrations of the lung compared with the control (P < 0.05). Myeloperoxidase activity and protein concentrations of BAL fluids were higher in LPS and L-NIL plus LPS treatment groups than the control group. CONCLUSIONS: These results suggest that inhibition of the increase of NO by selective inducible NO synthase inhibitor L-NIL may increase lipid peroxidation in septic rats.
Acute Lung Injury* ; Animals ; Arginine ; Bronchoalveolar Lavage ; Humans ; Hydroxyl Radical ; Indicators and Reagents ; Lipid Peroxidation* ; Lung ; Male ; Neutrophils ; Nitric Oxide Synthase ; Nitric Oxide* ; Oxygen ; Pentobarbital ; Peroxidase ; Peroxynitrous Acid ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Superoxides

BACKGROUND: Although post-anesthetic shivering may be a temporary phenomenon, it leads to detrimental effects such as increased oxygen consumption, hypoxemia, and difficulty in monitoring. Doxapram is a relatively new treatment for post-anesthetic shivering, but there have been few reports about its minimum effective dose. The purpose of this study was to find the minimum dose of doxapram which would show an antishivering effect. METHODS: Sixty patients who had developed post-anesthetic shivering were divided into six groups of ten patients each. The groups were divided into a control group, which received normal saline, and the doxapram groups, which received five different doses of doxapram (0.15, 0.2, 0.5, 1.0, 1.5 mg/kg). The antishivering effect (2, 5, 10, 15 minutes after treatment), blood pressure, heart rate and temperature were compared among the groups. RESULTS: There was a significant difference in antishivering effect between the group which received normal saline and the groups which received doxapram; however, there was no significant difference within the groups which received doxapram. CONCLUSIONS: We conclude that the dose of doxapram required to achieve an antishivering effect is much less than that currently in use.
Anoxia ; Blood Pressure ; Doxapram* ; Heart Rate ; Humans ; Oxygen Consumption ; Shivering*

Pulmonary alveolar proteinosis (PAP) is a noninflammatory diffuse lung disease, characterized by a dense accumulation of lipoproteinaceous material within the alveoli, causing hypoxemia, restrictive lung disease, and abnormalities on chest radiograph. The etiology of PAP is uncertain and various forms, including idiopathic and disease secondary to dust or fume exposure. Bronchopulmonary lavage (BPL) is a safe and effective treatment in PAP, and a unique procedure which requires general anesthesia and separation of the lung with a double lumen endobronchial tube. We experienced anesthetic management of BPL for the successful treatment of a 33 years old female patient with PAP.
Adult ; Anesthesia, General ; Anoxia ; Bronchoalveolar Lavage* ; Dust ; Female ; Humans ; Lung ; Lung Diseases ; Pulmonary Alveolar Proteinosis* ; Radiography, Thoracic

BACKGROUND: Portable glucometers are often utilized at the patient's bedside in the ICU or operating room for frequent measurements of the blood glucose concentration. Many of these devices are based on a glucose oxidase method that may be influenced by PO2. The aim of this study was to evaluate the influence of a high PO2 of arterial blood on measured glucose values compared with venous blood. METHODS: Forty adult patients who underwent surgery with general anesthesia were included in this study. Each patient had a cannula inserted into the radial artery and a central venous catheter through the right internal jugular vein. Two hours after the induction of anesthesia, we drew arterial and venous blood and measured the blood glucose concentration using both a bedside glucometer based on a glucose oxidase method and a laboratory glucometer based on a hexokinase method. We also measured blood gas, electrolyte, and hematocrit values. Statistical analyses were performed with repeated measure ANOVA, multiple linear regression, and Bland-Altman's analysis. Data is expressed as mean +/- SD. RESULTS: The arterial blood glucose concentration measured by the glucose oxidase method (119.5 +/- 25.0 mg/dl) was significantly lower than the venous blood (133.5 +/- 24.8 mg/dl) and hexokinase method (134.2 +/- 27.1 mg/dl). There was no significant difference between the venous blood glucose concentration by the glucose oxidase method and hexokinase method. When we used the correction formula: corrected glucose value = arterial glucose value by glucose oxidase method + 0.1053 X PaO2 - 5.414, the bias improved from - 14.6 mg/dl to 1.0 mg/dl. CONCLUSIONS: The blood glucose concentration measured by the glucose oxidase method is more accurate in venous blood than oxygenated arterial blood. When we measure the blood glucose level using the glucose oxidase method, we should consider the influence of high oxygen tension.
Adult ; Anesthesia ; Anesthesia, General ; Bias (Epidemiology) ; Blood Glucose* ; Catheters ; Central Venous Catheters ; Glucose Oxidase* ; Glucose* ; Hematocrit ; Hexokinase ; Humans ; Jugular Veins ; Linear Models ; Operating Rooms ; Oxygen* ; Radial Artery

BACKGOUND: Bacterial endotoxin or lipopolysaccharide (LPS) is believed to mediate the tissue damage and shock observed in Gram-negative sepsis (GNS) by initiating a cascade of events, including activation of the coagulation, fibrinolytic and complement systems, and release of proinflammatory cytokines. However, the clinical pictures that result from GNS and endotoxin are quite different. The physiologic changes induced with LPS were investigated in this study. METHODS: Fifty two male Sprague-Dawley rats were injected intraperitoneally with Escherichia coli LPS. Blood samples and bronchoalveolar lavage (BAL) fluid were obtained at baseline and at 2, 4, 8, 16, 24, and 48 hours after injection. Nitrate/nitrite levels were measured from plasma and BAL samples. Lipid peroxide (LPO) levels were measured from plasma. We measured also protein concentration and number of polymorphonuclear leukocytes (PMNL) and macrophages from BAL samples. RESULTS: Administration of LPS caused significant increase in nitrate/nitrite concentrations of plasma and BAL fluid (p<0.01). ED50 of LPS was 1.76 mg/kg in plasma nitrate/nitrite assay. Plasma LPO levels were increased slightly after administration of LPS, but no statistical significance. Protein concentration was increased significantly (p<0.01) 4 hours after the administration of LPS. LPS induced increase of the number of PMNLs and macrophages of BAL samples significantly (p<0.05). CONCLUSIONS: LPS increased NO production and alveolar permeability in rats. Also, LPS increased the number of inflammatory cells in the lung.
Animals ; Bronchoalveolar Lavage ; Complement System Proteins ; Cytokines ; Escherichia coli ; Humans ; Lung ; Macrophages ; Male ; Neutrophils ; Nitric Oxide ; Permeability ; Pharmacology ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Sepsis ; Shock