Myasthenia Gravis is a neuromuscular disorder manifested by increasing weakness and fatigability of voluntary muscles with exercise, and partial or complete restoration of function following rest or the administration of anticholinesterase drugs. The anesthesiologists may be called upon to assist in the diagnosis of myasthenis, in treating the patient by artificial ventilation during acute exacerbations, to anesthetise the patient for thymectomy or other surgery. Therefore, the anesthesiologists must be familiar with the diagnosis and treatment of myasthnia gravis to carry on the appropriate therapy. Two cases of anesthesia for thymectomy in myasthenia gravis without using muscle relaxants was experienced, and no respiratory problems were encountered postoperatively.
Anesthesia* ; Cholinesterase Inhibitors ; Diagnosis ; Humans ; Muscle, Skeletal ; Myasthenia Gravis* ; Thymectomy* ; Ventilation

We experienced a case of deep vein thrombosis after spine surgery in the prone position with a central venous catheter (CVC). Posterior lumbar interbody fusion was performed on a 73-year-old female patient who was diagnosed with spinal stenosis. Accordingly, in the operation room under general anesthesia, two-lumen CVC were inserted into the left subclavian vein. The surgery was performed in the prone position with a Wilson frame. On the next day, there was a sudden occurrence of severe edema in the patient's left arm. By ultrasonography and computed tomography scanning, extensive deep vein thrombosis was observed in the left subclavian vein. The existence of a factor affecting blood flow such as the prone position may increase the risk of thrombus formation. Therefore, careful perioperative evaluation should be implemented.
Aged ; Anesthesia, General ; Arm ; Catheterization* ; Catheters* ; Central Venous Catheters ; Edema ; Female ; Humans ; Prone Position* ; Spinal Stenosis ; Spine* ; Subclavian Vein ; Thrombosis ; Ultrasonography ; Upper Extremity Deep Vein Thrombosis ; Venous Thrombosis*

No abstract available.
Animals ; Cesium Radioisotopes/analysis/chemistry ; *Environmental Exposure ; Half-Life ; Humans ; Perciformes/metabolism ; Seafood/*analysis ; Water Pollutants, Radioactive/*analysis/chemistry

Two cases of cavernous hemangioma of the cauda equina are presented. Cavernous hemangioma of the cauda equina is rare vascular malformation. This is the fifth and sixth case of cavernous hemangioma of the cauda equina in the literature. These cases are female patients. MRI is more sensitive method than spinal myelography and CT in diagnosis of cavernous hemangioma of the cauda equina. Total removal was possible without immediate post-operative complication.
Cauda Equina* ; Diagnosis ; Female ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Myelography ; Vascular Malformations

Several studies have indicated that the addition of sodium bicarbonate and opioid to soiutions of locl anesthetics shortens the onset time,increases the intensity and prolongs the duration of neural blockade. This study was performed to compare onset times and duration of neural blockade in each groups. Eighty-two parturients scheduled for cesarean section at term under epidural anesthesia were assigned to three groups. Group 1 (n=19) received 1.5% lidocaine hydrochloride (pH 6.32+/-0.01), group 2 (n=26) received 1.5% lidocaine hydrochloride plus fentanyl 50 mcg (pH 6.27+/-0.02) and group 3 (n=37) received l.5% lidocaine hydrochloride plus fentanyl 50 mcg plus 8.4% sodium bicarbonate (sodium bicarbonate l mEq/lidocaine 10 ml)(pH 7.32+/-0.03). All groups were given 22-28 ml of local anesthetic solutions according to their height. Onsei times and duration of sensory blockade were evaluated using pin prick test at two minutes interval after epidural injection at L2, 76, T4 dermatomes. Onset timcs (time between the completion of anesthetic injection and loss of pin prick sensation at each dermatome) of sensory blockade at L2 dermatome were 3.1+/-0.2 minutes in Group 3, which were shorter than 5.0+/-0.3 minutes in Group l and 4.7+/-0.4 minutes in Group 2 (p<0.05). At T6 dermatome, onset times of sensory blockade were 6.9+/-0.6 minutes in Group 3, which were shorter than 15.4+/-1.2 minutes in Group l and 12.9+/-1.0 in Group 2 (p<0.05). At T4 dermatome, onset times of sensory blockade were 10.l+/-0.2 minutes in Group 3, which were shorter than 22.3+/-1.2 minutes in Group 1 and 18.8+/-1.1 in Group 2 (p<0.05). The duration (time between loss of pin prick sensation and complete recovery of pain at each dermatome) of sensory blockade at T4 dermatome in Group 3 were 74.0+/-3.8 min, which were longer than 52.9+/-2.4 minutes in Group 1 and 52.7+/-1.4 minutes in Group 2 (p<0.05). The duration of sensory blockade at L2 dermatome in Group 3 were 119.6+/-4.4 minutes,which were longer than 78.6+/-4.8 minutes in Group 1 and 81.6+/-2.5 minutes in Group 2 (p<0.05). The above results suggested that alkalinization of lidocaine solution is an effective way to shorten the latency and to prolong the duration of epidural block for cesarean section.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local* ; Cesarean Section* ; Female ; Fentanyl ; Injections, Epidural ; Lidocaine ; Pregnancy ; Sensation ; Sodium Bicarbonate

BACKGROUND: Recently obesity population is epidemically rapidly increasing. But, in the anesthetic field the study for obesity patients is not good enough. So, we designed the study to see the effect of obesity on awareness in general anesthesia with propofol. METHODS: The 52 subjects were between 20 to 60 years old and ASA physical status 1, 2 undergoing general anesthesia for elective surgery. According to asia pacific obesity criteria, we divided the patients into the obesity group (BMI > or = 25) and the non-obesity group (BMI < 25). Propofol was infused using TCI for induction and maintenance. BIS was used for monitoring the depth of anesthesia. During operation, we tried to keep BIS between 40-49 by manipulate the target concentration of TCI. After the operation, without stimulating patients, we measured the time (T-BIS(5070)) from the BIS passes 50 then goes to 70. We compare the T-BIS(5070) between the obesity and the non-obesity group. RESULTS: The obesity and the non-obesity group do not show significant difference in age, sex, height, body temperature, anesthesia time, and total used propofol amounts. BMI in obesity group was 27.3 +/- 1.9 kg/m(2) and in non-obesity group was 22.2 +/- 1.8 kg/m(2). T-BIS(5070), the awareness time was significantly different between the obesity group (170.3 +/- 54.8 sec) and the non-obesity group (212.7 +/- 81.8 sec). CONCLUSIONS: Our data suggest that in general anesthesia with propofol the obesity group's awareness time is shorter compared with the non-obesity group and the effects may come from the uniqueness of the propofol's pharmacokinetics and the obesity patient's physical characteristics.
Anesthesia ; Anesthesia, General* ; Asia ; Body Height ; Humans ; Middle Aged ; Obesity* ; Pharmacokinetics ; Propofol*

Actinomycosis is a very rare infectious disease caused by Actinomyces, which are gram-positive, predominantly anaerobic, non acid-fast bacillus. Actinomyces are normal flora in the upper and lower aerodigestive tracks but can become pathogenic after mucosal injuries such as tooth extraction and trauma to the mouth or jaw. Actinomycosis of the maxillary sinus is very difficult to diagnose due to its low incidence and lack of characteristic clinical findings. We recently experienced a case of maxillary actinomycosis in a 78-year-old immunocompetent male who underwent endoscopic sinus surgery 10 months previously and a molar tooth extraction 3 months previously. CT scans showed soft tissue density with a focal calcification and flexible fiberscopy indicated a brown-colored mass at the maxillary sinus floor. The maxillary sinus lesion was removed by sinus irrigation through the ostium and histopathology confirmed sulfur granules compatible with actinomycosis. The patient was treated with a 6-month course of oral augmentin-clavulanate. A diagnosis of actinomycosis should always be considered in a patient with unilateral intractable maxillary sinusitis, focal calcification in CT scans, and a history of molar tooth extraction.
Actinomyces ; Actinomycosis ; Aged ; Bacillus ; Communicable Diseases ; Floors and Floorcoverings ; Humans ; Incidence ; Jaw ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Molar ; Mouth ; Sinusitis ; Sulfur ; Tooth Extraction ; Track and Field

To study the effect of one part of hemodynamic changes following spinal aneethesia on the time-dependent change of aterial oxygen saturation (SaO2) from the upper extremities and lower extremities, we analyzed the ASA class I, 30 patients (Group I, Tetracaine only (n =15), 40+/-6 years, 58+/-7kg, 162+/-6cm, Group II, Tetracaine+/-Epinephrine (n=15), 41+/-6 years, 59+/-6kg, 161+/-7cm) scheduled for urologic surgery under lower spinal anesthesia. The results were as follows: 1) There was no significant difference of preanesthetic SaO2 between upper and lower extremities in two groups (p>0.05). 2) There was no significant diference of time-dependent changes of postanesthetic SaO, in the upper extremities as compared with preanesthetic value (p=0.05). 3) There was significant ifference of time-dependent changes of postanesthetic SaO2, at 5 min, 10 min and 15 min in the lower extremities of Group I, on the other hand, at 10 min and 15 min in Group II as compared with control value (p<0.05). 4) There was significant difference of postanesthetic SaO at 10 min and 15 min in the lower extremities between two groups (p<0.05). 5) It took more longer to reach the maximum level of SaO2, after inal anesthesia in Group II as compared with Group I (p<0.05).
Anesthesia ; Anesthesia, Spinal ; Hand ; Hemodynamics ; Humans ; Lower Extremity* ; Oxygen* ; Tetracaine ; Upper Extremity*

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, induding traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group l (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group ll (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group l with group ll, there were similar effect to prevention of the oculocardiac reflex (p> 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus muscles were 30.0% and 26.3% in group l, and 28.2% and 28.2% in group ll respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.
Administration, Intravenous ; Anesthesiology ; Arrhythmias, Cardiac ; Atropine ; Cardiac Complexes, Premature ; Child* ; Heart Arrest ; Heart Rate ; Humans ; Muscles ; Reflex ; Reflex, Oculocardiac* ; Strabismus* ; Traction

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, induding traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group l (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group ll (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group l with group ll, there were similar effect to prevention of the oculocardiac reflex (p> 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus muscles were 30.0% and 26.3% in group l, and 28.2% and 28.2% in group ll respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.
Administration, Intravenous ; Anesthesiology ; Arrhythmias, Cardiac ; Atropine ; Cardiac Complexes, Premature ; Child* ; Heart Arrest ; Heart Rate ; Humans ; Muscles ; Reflex ; Reflex, Oculocardiac* ; Strabismus* ; Traction