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

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.

No abstract available.
Postoperative Nausea and Vomiting*

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

BACKGROUND: There is a high incidence of pain associated with an intravenous injection of propofol, and different methods have been used in an attempt to minimize the incidence and severity of this pain. This study compared the effect of a ketamine pretreatment with that of a remifentanil pretreatment on the pain associated with a propofol injection. METHODS: 225 ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into this randomized double blind study. The patients received 2 ml of saline (n = 45), 2 ml of ketamine 20 mg (n = 45), 2 ml of remifentanil 0.01 mg (n = 45), or 2 ml of remifentanil 0.02 mg (n = 45) or 2 ml of remifentanil 0.03 mg (n = 45) 30 seconds prior to administering 2 mg/kg of 1% propofol. An anesthesiologist who was blinded to the study asked the patients to evaluate the pain using a four-point scale (none, mild, moderate, severe). RESULTS: The remifentanil 0.02 mg, remifentanil 0.03 mg and ketamine groups showed significantly less frequent and intense pain than the saline group (P < 0.05). The remifentanil 0.02 mg and 0.03 mg provided as much pain relief as ketamine (P > 0.05), but the remifentanil 0.01 mg did not (P < 0.05). There was a similar incidence of injection pain in the remifentanil 0.02 mg and remifentanil 0.03 mg groups. CONCLUSIONS: An intravenous remifentanil 0.02 mg or remifentanil 0.03 mg pretreatment is as effective in alleviating the pain associated with a propofol injection as a intravenous ketamine pretreatment. The remifentanil 0.03 mg pretreatment had a similar analgesic effect relative to the remifentanil 0.02 mg pretreatment.
Adult ; Double-Blind Method ; Humans ; Incidence ; Injections, Intravenous ; Ketamine* ; Propofol*

BACKGROUND: There is a high incidence of pain associated with an intravenous injection of propofol, and different methods have been used in an attempt to minimize the incidence and severity of this pain. This study compared the effect of a ketamine pretreatment with that of a remifentanil pretreatment on the pain associated with a propofol injection. METHODS: 225 ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into this randomized double blind study. The patients received 2 ml of saline (n = 45), 2 ml of ketamine 20 mg (n = 45), 2 ml of remifentanil 0.01 mg (n = 45), or 2 ml of remifentanil 0.02 mg (n = 45) or 2 ml of remifentanil 0.03 mg (n = 45) 30 seconds prior to administering 2 mg/kg of 1% propofol. An anesthesiologist who was blinded to the study asked the patients to evaluate the pain using a four-point scale (none, mild, moderate, severe). RESULTS: The remifentanil 0.02 mg, remifentanil 0.03 mg and ketamine groups showed significantly less frequent and intense pain than the saline group (P < 0.05). The remifentanil 0.02 mg and 0.03 mg provided as much pain relief as ketamine (P > 0.05), but the remifentanil 0.01 mg did not (P < 0.05). There was a similar incidence of injection pain in the remifentanil 0.02 mg and remifentanil 0.03 mg groups. CONCLUSIONS: An intravenous remifentanil 0.02 mg or remifentanil 0.03 mg pretreatment is as effective in alleviating the pain associated with a propofol injection as a intravenous ketamine pretreatment. The remifentanil 0.03 mg pretreatment had a similar analgesic effect relative to the remifentanil 0.02 mg pretreatment.
Adult ; Double-Blind Method ; Humans ; Incidence ; Injections, Intravenous ; Ketamine* ; Propofol*