The leading cause of death after anesthesia and operations is cardiac complications, defined as myocardial infarction, unstable angina, congestive heart failure. We experienced a case of transient chest pain mimicking to myocardial ischemia after total intravenous anesthesia using propofol. The patient was 56 year-old female who underwent metatarsal osteotomy and distal soft tissue procedure. There was no specific abnormality on preoperative laboratory tests. Anesthesia induction and intraoperative course were completely uneventful. Immediately after transfered to the recovery room, the patient revealed transient cyanosis and complained anterior chest pain with tightness after fully awakening. In the study of electrocardiogram, there were ST abnormality in II, III, AVF and then T inversion in II, III, AVL, AVF, V2-6 leads. In the simultaneous study of echocardiogram, there was hypokinetic wall movement in the distal septum area. After treatment of nitroglycerine, the pain was subsided and the patient was discharged without any sequelae.
Anesthesia ; Anesthesia, Intravenous ; Angina, Unstable* ; Cause of Death ; Chest Pain ; Cyanosis ; Electrocardiography ; Female ; Heart Failure ; Humans ; Metatarsal Bones ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Orthopedics ; Osteotomy ; Propofol ; Recovery Room*

BACKGROUND: Major spine surgery can be associated with dramatic blood loss, thereby requiring a high-volume transfusion. Tranexamic acid inhibits fibrinolysis and it has been used in general surgery. The effect of tranexamic acid on blood loss and transfusion requirements during spine surgery was prospectively studied. METHODS: Twenty-two patients scheduled for orthopaedic surgery for spinal stenosis under general anesthesia were randomly selected to receive, either tranexamic acid administered as a bolus of 15 mg/kg, or the equivalent volume of saline, during the operation and postoperatively. The anesthetic and perioperative management were standardized. The total blood loss of each patient and transfusion requirements were noted. Hematocrit, PT, PTT, and platelet count measure were performed before and after surgery. RESULTS: The tranexamic acid group demonstrated a significantly less amount of blood loss (859.5 +/- 280.0 ml) compared to the placebo group (1366.0 +/- 333.7 ml). In addition the fluid and homologous transfusion requirements in the placebo group were greater than in the tranexamic acid group. CONCLSIONS: Tranexamic acid during major spine surgery significantly reduces both blood loss and consequent blood transfusion requirements.
Anesthesia, General ; Blood Transfusion ; Fibrinolysis ; Hematocrit ; Humans ; Platelet Count ; Prospective Studies ; Spinal Stenosis ; Spine* ; Tranexamic Acid*

BACKGROUND: Hypotension can occur after high level of epidural anesthesia. Like ephedrine, epidural phenylephrine is known to reduce the incidence of hypotension induced by the epidural administration of lidocaine. The purpose of this study was to determine whether combining epidural phenylephrine can reduce the incidence of hypotension in epidural anesthesia. METHODS: Ninety-two patients undergoing a cesarean section were divided into three groups. Patients assigned to three groups received 20-25 ml of lidocaine containing fentanyl 50 microgram with one of three doses of phenylephrine; 0 microgram (Group 1), 100 microgram (Group 2), or 200 microgram (Group 3), injected via the lumber epidural catheter. The mean blood pressure and heart rate were recorded every 10 min for 1 h after injection and were compared among the groups. Pinprick testing was performed to determine the highest level of sensory block and the time to two-segment regression. Also, the incidence of hypotension and ephedrine required were investigated. RESULTS: The incidence of hypotension was 37%, 28%, and 40% in Group 1-3, respectively. The time to two-segment regression was 94.7 +/- 21.6 in group 1, 100.8 +/- 20.1 min in Group 2, compared to 118.2 +/- 26.3 min in Group 3. CONCLSIONS: We found that epidural phenylephrine significantly prolonged the duration of epidural anesthesia, but it was ineffective for preventing hypotension induced by lidocaine epidural anesthesia.
Anesthesia, Epidural* ; Blood Pressure ; Catheters ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Heart Rate ; Humans ; Hypotension* ; Incidence ; Lidocaine ; Phenylephrine* ; Pregnancy

A 64-year-old woman presented with severe chest pain and indigestion for ten days. She had been repeatedly admitted for the same symptoms, and had been treated with oral medication with no improvement. Coronary angiography revealed total occlusion of the left anterior descending and circumflex arteries. The patient was referred to our department because the other medical treatments had been unsuccessful and neither angioplasty nor coronary artery bypass surgery was safe. An epidural catheter was placed at the T2-3 level and a 5 mL bolus of 0.25% bupivacaine completely relieved the patient's angina. The arterial blood pressure and heart rate remained unchanged and the IV nitrates were discontinued. An infusion of 100 mL 0.0625% bupivacaine with 10 mg morphine was started at 4 mL/h. During the following 13 days, the patient remained pain free with 5 mL of 0.25% bupivacaine. Her symptoms continued to diminish and she remained free of pain even after discontinuing the high thoracic epidural anesthesia (HTEA), but she still took an occasional oral dose of nitrates.
Analgesia, Epidural* ; Anesthesia, Epidural ; Angina Pectoris* ; Angioplasty ; Arterial Pressure ; Arteries ; Bupivacaine ; Catheters ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass ; Dyspepsia ; Female ; Heart Rate ; Humans ; Middle Aged ; Morphine ; Nitrates

BACKGROUND: Midazolam relaxes airway smooth muscle. The aim of this study is to evaluate the influence of flumazenil or verapamil on the relaxation effects of midazolam in tracheal smooth muscle of guinea pig. METHODS: After isolating guinea-pig tracheal preparations, the maximal tracheal tones were induced by 2 10(-7) M carbachol. When tracheal tones stabilized, midazolam was added cumulatively (10(-6), 3 10(-6), 10(-5), 3 10(-5), 10(-4) M, n=14) with or without flumazenil (10(-6) M, n=15) and verapamil (10(-5) M, n=13) to obtain the concentration-relaxation curves, and then the ED50 and ED95 calculated. RESULTS: Midazolam decreased maximal tracheal smooth muscle tones in concentration-dependent manners. Pretreatment with flumazenil had no effect on the midazolam-induced relaxation. Verapamil enhanced the relaxation effect of midazolam. CONCLUSIONS: Midazolam relaxes airway smooth muscle and has synergistic effect with calcium channel blocker, verapamil.
Animals ; Calcium Channels ; Carbachol ; Flumazenil* ; Guinea Pigs ; Midazolam* ; Muscle, Smooth* ; Relaxation* ; Verapamil*

BACKGROUND: The operating room should provide an optimum environment that is safe for the patient and the working personnel. In this point of view, we investigated 8 items of temperature, humidity, air flow, noise, brightness, dust, CO2 and NO2. METHODS: Operating rooms, corridors and recovery rooms were tied as region I, II and III depending on their characteristics. 29 points were measured using appropriate instruments. After that, averaged values were calculated. RESULTS: Indoor climate (temperature, humidity and air flow) in region I were averaged 24.7, 65, 0.18/II were 25.5, 68, 0.18/III were 22.3 (degrees C), 56 (%), 0.22 (m/sec). Physcial condition (noise, brightness and dust) in region I were averaged 63, 295, 63/II were 67, 138, 87/III were 63 (db), 139 (lux), 26 (microgram/m3). Harmful gas (CO2 and NO2) concentration in region I were averaged 1152, 0.008/II were 913, 0.009/III were 1367 (ppm), 0.013 (ppm). CONCLUSIONS: Temperatures were appropriate but humidities were high except partial points. Air flow showed low values in average. Values of noise, dust and CO2 were relatively high. NO2 was low but brightness was variable. These mean that adequate improvement for quiet condition and air ventilation should be considered.
Climate ; Dust ; Humans ; Humidity ; Noise ; Operating Rooms* ; Recovery Room ; Ventilation