Background: Postoperative sore throat is a complaint after general anesthesia of multifactorial etiology. The laryngeal mask airway (LMA) reduces sore throat and discomfort during maintenance of the airway and make patients more comfortable. The purpose of this study was to compare effect of patient's position during operation on postoperative sore throat after the use of LMA. Methods: The fifty three patients were randomly divided into two groups. Group 1 (n=30) was underwent general anesthesia with supine position and group 2 (n=23) with prone position. After the LMA was positioned in the hypopharynx and the cuff inflated, fiberoptic laryngoscope was immediately passed down through the LMA. Number of attempts, degree of postoperative sore throat and other complications were also noted. Results: The incidence of postoperative sore throat after the use of LMA was 10% in supine position and 4% in prone position. But the difference between the groups was not statistically significant. All of the reported sore throats were rated as mild. Conclusions: Postoperative sore throat after the use of LMA is mild and the incidence is not affected by the prone position during the operation.
Anesthesia, General ; Humans ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Laryngoscopes ; Pharyngitis* ; Prone Position* ; Supine Position

BACKGROUND/AIMS: Hepatic fibrosis in rat induced by thioacet amide shares similar morphological and biochemical characteristics with human liver cirrhosis. Thioacetamide (T AA) initially induces accumulation of collagen in Disse space and eventually leads to macro- and micronodular cirrhos is. Ito cell was believed to play a main role in hepatic fibrosis. And it s activity was known to be regulated by the expression of various genes. But little has been discovered about the upstream signal trans duction pathway of these genes in hepatic fibrosis. The expression of genesrelated to Ito cell activity was regulated by many transcription factors , the activity of which was regulated by protein kinase C( PKC) is oforms. So it is s upposed that PKC could be as s ociated with fibrosis in liver. METHODS: We investigated the correlation of PKC is oforms and It ocell activity in the course of hepatic fibrosis using TAA induced rat liver cirrhosis model. We used six week- old male rats , and administered 0.03% TAA in drinking water. The animals were sacrificed at 9, 20, and 30 weeks after TAA administration. The degree of hepatic fibrosis was evaluated by measuring the total amount of collagen.-SMA immunohist ochemical st aining of liver tissue was done to determine the Ito cell activity. The expression pattern of PKC isoforms was investigated by West ern blotting. RESULTS: In TAA- treated group, collagen cont ent and Ito cell activity did not increase until 30 weeks and 20 weeks of treatment , respectively, while in control group collagen cont ent and Ito cell activity were not detected. Collagen content showed linear correlation with Ito cell activity. This implied that the proliferation of activated Ito cells was prior to the increase of collagen content. In view of expression pattern of PKC is oforms, PKC alpha showed no difference in TAA- treated group and control group. In TAA-treated group, PKCbeta1 exhibited increased level of expression in both particulate and cytosolic forms at 9 weeks, while PKCdelta and PKC epsilon showed striking shift to particulated form. After 20 weeks, all of the PKC beta1, delta, and epsilon degenerated and showed remarkably decreased level of expression. This suggested PKC alpha had no relation to hepatic fibrosis,while PKC beta1, delta, and epsilon, showing activity at 9 weeks, were related to fibrosis og liver. In response to fibrogenic factors, molecules engaged in intracellular signal transduction pathway like PKC beta1, delta, and epsilon, began to change prior to the increase of Ito cell activity, morphologic changes and alterations of collagen content. CONCLUSION: Our results strongly suggest that the activity of PKC isoforms play an important role in early step of hepatic fibrosis, while accompanying Ito cell activity do in later step.
Animals ; Collagen ; Cytosol ; Drinking Water ; Fibrosis ; Hepatic Stellate Cells ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Protein Isoforms ; Protein Kinase C-epsilon ; Protein Kinases ; Rats ; Signal Transduction ; Strikes, Employee ; Thioacetamide ; Transcription Factors

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.
Adult ; Analgesia ; Analgesics ; Bupivacaine* ; Central Nervous System Sensitization ; Herniorrhaphy* ; Humans ; Pain, Postoperative* ; Postoperative Period ; Skin ; Traction ; Wounds and Injuries

BACKGROUND: Ropivacaine is a new local anesthetic approved for epidural analgesia. The addition of fentanyl improves analgesia from epidural ropivacaine. We studied the effects of two solutions of ropivacaine/fentanyl for postoperative pain after a total abdominal hysterectomy. METHODS: Twenty five female patients scheduled for an elective total abdominal hysterectomy were prospectively randomized to receive one of two solutions. Group 1 (n = 13) received 0.2% ropivacaine and 5 microgram/ml of fentanyl at a rate of 2 ml/hour (bolus: 10 ml). Group 2 (n = 12) received 0.08% ropivacaine and 2 microgram/ml fentanyl at a rate of 5 ml/h (bolus: 25 ml) postoperative for two days. After an epidural bolus injection, we assessed the blood pressure, pulse rate, respiratory rate, visual analog scale (VAS), level of sensory block, motor block and sedation score among the two groups. Additional analgesic requirements and side effects such as nausea, itching and urinary retention were assessed for 48 hours post operation. RESULTS: There were no significant differences in the blood pressure, pulse rate and respiratory rate between the two groups. The sum of VAS for 48 hours, the level of sensory block after an epidural bolus injection, additional analgesics, and the number of patients showing motor blockade were similar. Although statistically insignificant, the incidence of nausea, and urinary retention in group 2 was higher than group 1. CONCLSIONS: Both the continuous epidural infusion of 0.2% ropivacaine with fentanyl (2 ml/hour) and 0.08% ropivacaine with fentanyl (5 ml/h) showed similar quality of analgesia on postoperative pain. To reduce the side effect of fentanyl, the volume of ropivacaine/fentanyl solution is important.
Analgesia ; Analgesia, Epidural* ; Analgesics ; Blood Pressure ; Female ; Fentanyl ; Heart Rate ; Humans ; Hysterectomy ; Incidence ; Nausea ; Pain, Postoperative ; Prospective Studies ; Pruritus ; Respiratory Rate ; Urinary Retention ; Visual Analog Scale

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

Dextran 40, a polysaccharide with molecular weight of 40,000, has been used clinically for expansion of plasma volume, improvement of microcirculation in low flow states and thromboprophylaxis especially in major operation such as vascular and hip surgery. However severe anaphylactoid reaction to dextran 40 can occur rarely. We experienced a case of cardisc arrest due to a severe reaction of dextran 40 in a patient who underwent aortofemoral bypass surgery. The patient was resuscitated immediately and followed up carefully.
Dextrans* ; Heart Arrest ; Hip ; Humans ; Microcirculation ; Molecular Weight ; Plasma Volume

BACKGROUND: Several survey reported that use of dietary supplements including herbal medicine was common in the preoperative period. The use of such remedies has implications for the anesthesiologists because of the potential for drug interactions and side effects. Little information is available on the frequency of use in the surgical population in Korea. This study was purposed to find out the frequency and predictors of the use of dietary supplements in presurgical patients. METHODS: A questionnaire was distributed to all patients at the preoperative visit from May 2006 to August 2006. The questionnaire inquired as to basic demographics, use of dietary supplements, the name and number of dietary supplements used, reasons to take the dietary supplements, and whether the patient had informed anesthesiologist of the use. RESULTS: A total 1,072 completed surveys showed that overall 37% of presurgical patients reported the use of dietary supplements. Less than half of the patients told their anesthesiologists that they were using dietary supplements. The most commonly used dietary supplements were ginseng, soy, glucosamine, garlic, prunus mume, mushroom, siberian ginseng, fish oils, aloe, ginger, and gingko in order of incidence. Young age was predictor associated with lower use of dietary supplements. CONCLUSIONS: Use of dietary supplements is common in the preoperative period in Korea. Documentation of the use of these products in the perioperative period is important to consider the potential interaction of dietary supplements with medical medicine or anesthetics.
Agaricales ; Aloe ; Anesthetics ; Demography ; Dietary Supplements* ; Drug Interactions ; Eleutherococcus ; Fish Oils ; Garlic ; Ginger ; Ginkgo biloba ; Glucosamine ; Herbal Medicine ; Humans ; Incidence ; Korea ; Panax ; Perioperative Period ; Preoperative Period ; Prunus

BACKGROUND: Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanisms. We evaluated the additive effects of ketamine (30 mg) on 0.5%, and 0.75% ropivacaine (total 30 ml) for an interscalene brachial plexus blockade (IBPB). METHODS: Thirty five adult patients scheduled for major forearm or hand surgery were prospectively randomized to receive one of the following solutions. Group 1 received 0.75% ropivacaine 28 ml with normal saline 2 ml, group 2 received 0.75% ropivacaine 28 ml with 5% ketamine 0.6 ml and normal saline 1.4 ml, group 3 received 0.75% ropivacaine 20 ml with normal saline 10 ml, and group 4 received 0.75% ropivacaine 20 ml with 5% ketamine 0.6 ml and normal saline 9.4 ml. At 1 minute intervals after IBPB, patients were assessed to determine loss of shoulder abduction, elbow flexion, wrist flexion and loss of pinprick in the deltoid, radial, median, and ulnar dermatomes. At 5 minute intervals after IBPB, pulse rate, blood pressure, sedation score and level of discomfort were assessed. Before discharge, patients were asked to document when incisional discomfort began and when full sensation and motor control returned to the arm. RESULTS: The onset time of loss of pinprick and motor blockade were similar. Duration of sensory and motor blockade were similar in all groups. Hemodynamic changes and sedation scores were not significantly different in all groups. CONCLUSIONS: We demonstrated that 30 mg of ketamine didn't enhance the onset and duration of sensory or motor blockade of ropivacaine during the 0.75% or 0.5% ropivacaine IBPB.
Adult ; Arm ; Blood Pressure ; Brachial Plexus* ; Bupivacaine ; Elbow ; Forearm ; Hand ; Heart Rate ; Hemodynamics ; Humans ; Ketamine* ; Prospective Studies ; Sensation ; Shoulder ; Wrist

BACKGROUND: Desflurane and sevoflurane have been shown to induce pharmacologic preconditioning in experimental studies. The present study was aimed at comparing the myocardial protective effects of these two halogenated anesthetics in terms preconditioning induction. METHODS: Three groups of Sprague-Dawley rat hearts (n = 10 each) were perfused with oxygenated modified Kreb's solution using a Langendorff perfusion device. All groups underwent 30 minutes of global ischemia and 60 minutes of reperfusion after a stabilization period of 30 minutes. Before ischemia, hearts underwent a preconditioning period consisting of either no inhalation for 20 minutes (control group), or 15 minutes of either MAC desflurane or sevoflurane followed by 5 minutes of washout. Left ventricular end systolic pressure (LVESP), left ventricular end diastolic pressure (LVEDP), heart rate (HR) and maximal rate of change of ventricular pressure (dP/dt) were measured at after inhalation, before ischemia, and 5 minutes, 30 minutes and 60 minutes after reperfusion. Coronary sinus effluent also was measured. Infarct size was measured by triphenyl tetrazolium staining. RESULTS: LVESP and dP/dt were decreased in the control group, but remained unchanged in the desflurane and sevoflurane groups during the reperfusion period. LVEDP was increased in all groups, but the magnitude of the increase was smaller in the desflurane and sevoflurane groups than in the control group during the reperfusion period. HR was increased in the control group, but remained unchanged in the desflurane and sevoflurane groups during the reperfusion period. Coronary blood flow was decreased in all groups. Infarct size for the two anesthetics were smaller than in the control group. Differences in hemodynamics was observed between the desflurane and sevoflurane group at any time. CONCLUSIONS: Desflurane and sevoflurane had similar myocardial preconditioning effects in isolated rat heart.
Anesthetics ; Animals ; Blood Pressure ; Coronary Sinus ; Heart Rate ; Heart* ; Hemodynamics ; Inhalation ; Ischemia* ; Ischemic Preconditioning, Myocardial ; Oxygen ; Perfusion ; Rats* ; Rats, Sprague-Dawley ; Reperfusion Injury* ; Reperfusion* ; Ventricular Pressure

BACKGROUND: Urinary retention after anorectal surgery is thought to be a mild complication but has a high incidence. Since anal pain and distention can contribute to the urethral spasm reflex which may cause urinary retention, we investigated the effect of absorbable gelatin sponge (Gelfoam(R)) used for anal packing postoperatively on urinary retention after hemorrhoidectomy under spinal anesthesia. METHODS: One hundred and nineteen ASA Physical Status I patients scheduled for hemorrhoidectomy were selected. Patients were randomly divided into Group A, postoperative anal packing free group and Group B, postoperative anal packing group and studied prospectively. Spinal anesthesia was performed with the bevel of 25 gauge Quincke needle parallel to dura fibers at lumber 3 4 intervertebral space and the injection of hyperbaric 0.5% tetracaine 6 mg (1.2 ml) to patients in sitting position. After hemorrhoidectomy, all patients were permitted to ambulate as soon as possible and urinate spontaneously. If urinary retention occurred, urinary catheterization was done temporarily. The number of patients who received urinary catheterization were recorded. Surgical technique and the total amount of intravenous fluid during the operation were controlled. RESULTS: The incidence of urinary retention in Group A (11/57, 19.3%) was similar to that in Group B (10/62, 16.1%) (P = 0.651, chi 2 = 0.205, degree of freedom = 1). CONCLUSIONS: Our study did not indicate the clue that the absence of anal packing helped to reduce the incidence of urinary retention after hemorrhoidectomy under spinal anesthesia.
Anesthesia, Spinal* ; Freedom ; Gelatin Sponge, Absorbable ; Hemorrhoidectomy* ; Humans ; Incidence ; Needles ; Prospective Studies ; Reflex ; Spasm ; Tetracaine ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention*