BACKGROUND: Smooth and rapid emergence from anesthesia without bucking, agitation or pain is ideal in terms of neck stabilization and early neurological assessment on potential complications immediately after cervical spine surgery. This study was designed to compare the severity of bucking, the level of awakening, and pain during the emergence from anesthesia with sevoflurane, remifentanil supplemented with sevoflurane or remifentanil supplemented with propofol in patients undergoing cervical spine surgery. METHODS: Sixty American Society of Anesthesiologists physical status class I to II patients undergoing cervical spine surgery were randomized into one of three groups: maintenance solely with sevoflurane (group S, n = 20); maintenance with remifentanil and supplementation with less than 1% sevoflurane (group RS, n = 20); and maintenance of anesthesia with remifentanil and propofol target controlled infusion (TCI) (group RP, n = 20). The severity of bucking, the level of awakening, and the perception of pain during the emergence phase were assessed using predetermined scoring scales by a nurse blinded to the method of anesthesia. RESULTS: The bucking, level of awakening, pain score were significantly better in both group RP and group RS than in the group S. However there was no significant difference between group RP and group RS. CONCLUSIONS: The quality of emergence from anesthesia in patients with cervical spine surgery could be improved with remifentanil-based anesthesia, but no significant differences were found between the propofol TCI and less than 1% sevoflurane as a concomitant hypnotic adjunct.
Anesthesia ; Dihydroergotamine ; Humans ; Methyl Ethers ; Neck ; Piperidines ; Propofol ; Spine ; Weights and Measures

No abstract available.

No abstract available.
Postoperative Nausea and Vomiting*

Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.
Bed Rest ; Blood Patch, Epidural ; Body Mass Index ; Caffeine ; Deception ; Diagnosis ; Female ; Headache ; Humans ; Needles ; Post-Dural Puncture Headache* ; Pregnancy ; Punctures ; Risk Factors

The clinical and pathological features of a paraganglioma arising in the cauda equina is described and compared with previous reports. The right microscopic fetures were similar to those of paragangliomas from other sites, with a 'Zellballen' pattern of cells containing arzyrophil granules. Immunohistocytochemical stains for neurone specific enolase, S-100 protein, cytokeratin were positive, but stains for glial fibrillary acidic protein were negative. Electron microscopy showed densely staining membrane-bound granules, cilia like structures and fibros bodies in the cytoplasm. The last two features only occur in paragangliomas from this site. The pathological findings suggest that paragangliomas in this site arise from pre-existing paraganglia, possibly of the visceral autonomic group.

No abstract available.
Analgesia

Labor pain is one of the most challenging experiences encountered by females during their lives. Neuraxial analgesia is the mainstay analgesic for intrapartum pain relief. However, despite the increasing use and undeniable advantages of neuraxial analgesia for labor, there have been concerns regarding undesirable effects on the progression of labor and outcomes. Recent evidence indicates that neuraxial analgesia does not increase the rate of Cesarean sections, although it may be associated with a prolonged second stage of labor and an increased rate of instrumental vaginal delivery. Even when neuraxial analgesia is administered early in the course of labor, it is not associated with an increased rate of Cesarean section or instrumental vaginal delivery, nor does it prolong the labor duration. These data may help physicians correct misconceptions regarding the adverse effects of neuraxial analgesia on labor outcome, as well as encourage the administration of neuraxial analgesia in response to requests for pain relief.
Analgesia* ; Cesarean Section ; Female ; Humans ; Labor Pain ; Labor, Obstetric ; Pregnancy

Percutaneous nephrolithotomy (PCNL) is currently the procedure of choice for the removal of large and complex renal calculi. With recent developments in percutaneous access technique and in equipment for the disintegration of calculi, simultaneous bilateral PCNL has become safe. However the complications include hemorrhage, extravasation and absorption of large volumes of irrigation fluid, fever, infection, colonic perforation and pneumothorax. A 46-year-old, 59 kg, female patient in our care developed acute pulmonary edema after simultaneous bilateral PCNL under general anesthesia. The preoperative chest X-ray was normal. The patient recovered following 36 hours of intensive treatment involving fluid restriction, diuretics, sedation and continuous airway pressure ventilation.
Absorption ; Anesthesia, General ; Calculi ; Colon ; Diuretics ; Female ; Fever ; Hemorrhage ; Humans ; Kidney Calculi ; Middle Aged ; Nephrostomy, Percutaneous* ; Pneumothorax ; Pulmonary Edema* ; Thorax ; Ventilation

In general, elderly patients are less able to respond to perioperative stress and are more likely to suffer from postoperative complications and even death because of the decline in their functional organ reserve. Although no definitive evidence indicates that regional anesthesia is superior to general anesthesia in terms of the long-term prognosis in the elderly, regional anesthesia appears to be beneficial in many ways because it reduces bleeding during surgery, the stress response, and the incidence of thromboembolic complications, as well as facilitating excellent postoperative pain control. However, some issues specific to the elderly should also be considered. Age-related anatomical changes in elderly patients may make it difficult to perform epidural and spinal anesthesia, and physiologic and pharmacodynamic responses to local anesthetics may change with age. Elderly patients also show a greater extent of sensory and motor block, and are at a greater risk of hypotension after epidural and spinal block. In order to provide optimal anesthetic care and to facilitate a rapid recovery and improved outcomes in elderly patients, clinicians must have a better understanding of age-related changes when regional anesthesia is administered. Additionally, tailored anesthetic techniques should be used, as well as good perioperative care, in accordance with the type of surgery and the individual physical status of elderly patients.
Aged* ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal ; Anesthetics, Local ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Pain, Postoperative ; Perioperative Care ; Postoperative Complications ; Prognosis