Background: The purpose of this study was to identify factors inhibiting access of people with disability to health check-ups as well as identify pertinent solutions for improvement. Methods: Twenty-three people with disability older than the age of 19 who took respective health check-ups within the last 3 years were selected as participants. For the data collection, the 1:1 intensive interview was used. The data were analyzed by the grounded theory by Corbin and Strauss. Results: The results comprised nine categories, 23 subcategories, and 179 concepts. The central phenomenon was ‘failure to obtain check-ups.’ Causal conditions were observed as a ‘lack of communication method,’ ‘physical difficulties,’ and ‘staff unfamiliar with people with disability,’ Interventional conditions comprised ‘physical accessibility,’ ‘staffs’ competency,’ and ‘assistant manpower.’ The active strategy was included ‘to investigate the professional medical institution,’ ‘to find the medical institution of convenient traffic accessibility,’ ‘to overcome communication difficulties through equipment,’ and ‘to overcome linguistic barriers through sufficient communication.’ Whereas, ‘utilization of ancillary equipment,’ ‘the education of staffs on people with disability,’ ‘universal design manual,’ and ‘customized check-ups’ were included in the passive strategy. Such processes arose in the contextual conditions of ‘lack of expectations for daily lives’ and ‘lack of government support.’ As a consequence, the subjects participated experienced the ‘disadvantages,’ ‘discrimination,’ and ‘reduced reliability of the health check-ups.’ Conclusion The subjects who participated in this study emphasized ‘staffs familiar with people with disability’ and ‘systems customized for people with disability’ are mandatory to secure complete health check-ups for people with disability.

Although an epiglottic cyst is often asymptomatic and harmless to the patient, discovery of a large epiglottic cyst after induction of anesthesia is a potentially life-threatening problem for the patient and provides a challenge for the anesthesiologist in airway management. We experienced a case of unanticipated difficult mask ventilation and intubation as a result of an asymptomatic epiglottic cyst. A 37-year-old woman presented for elective removal of a brain tumor. She had normal mouth opening and neck extension; no masses or distortions of the tongue or neck were observed. She was premedicated with 0.2 mg glycopyrrolate intramuscularly. Anesthesia and paralysis were induced with 250 mg thiopental, fentanyl 100ng and pipecuronium 6 mg. It was noted that ventilation of the lungs via mask was difficult. Despite insertion of an oropharyngeal airway, ventilation proved to be more difficult. Intubation was attempted. Direct laryngoscopy revealed a 2 cm cyst arising from the epiglottis. The cyst completely obscured the view of the epiglottis and larynx, preventing intubation despite multiple attempts by three anesthesiologists. We consulted an otolaryngologist and awakened the patient. During further questioning in the post anesthesia care unit she admitted to a several-years of dysphagia. Next day, she was admitted to the operation room for removal of an epiglottic cyst. She was intubated using fiberoptic bronchoscope guided awake intubation, and the remainder of anesthetia and the operation proceeded uneventfully. The pathology report confirmed the finding of a 2.5 X 1.5 X 1.5 cm epidermal cyst.
Adult ; Airway Management ; Anesthesia ; Brain Neoplasms ; Bronchoscopes ; Deglutition Disorders ; Epidermal Cyst ; Epiglottis ; Female ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation* ; Laryngoscopy ; Larynx ; Lung ; Masks ; Mouth ; Neck ; Paralysis ; Pathology ; Pipecuronium ; Thiopental ; Tongue ; Ventilation

Multiple agents can cause anaphylaxis in a perioperative setting. Identifying the agent responsible is essential for avoiding future adverse reactions as well as to attenuate the progression of anaphylaxis. Being able to distinguish an anaphylactic reaction from an anaphylactoid reaction would help clarify the therapeutic and medicolegal issues. Anaphylaxis generally occurs after reexposure to a specific antigen and requires the release of proinflammatory mediators from mast cells and basophils. An increased concentration of mast cell tryptase is a highly sensitive indicator of anaphylactic reactions during anesthesia. Botropase(R) is a procoagulant hemocoagulase purified from venom of Bothrops jararaca, a Brazilian viper and in wide use in patients with high risk of bleeding. We report a case of suspected anaphylaxis to Botropase(R) in a 67 years old female patient undergoing segmental resection of the liver with elevated concentration of serum mast cell tryptase.
Aged ; Anaphylaxis* ; Anesthesia ; Basophils ; Batroxobin* ; Bothrops ; Female ; Hemorrhage ; Histamine ; Humans ; Liver ; Mast Cells* ; Tryptases* ; Venoms

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing a laparoscopic cholecystectomy. This study evaluated the effect of prophylactic metoclopramide (MCP) and induction with propofol on PONV. METHODS: 165 patients undergoing laparoscopic cholecystectomy were randomly divided into four groups. Groups 1 (control group) and 2 were inducted with thiopental sodium. Groups 3 (propofol group) and 4 were inducted with propofol. Prophylactic metoclopramide 10 mg i.v. was administered in Groups 2 (MCP group) and 4 (propofol + MCP group). The incidence of PONV, the need for rescue antiemetics, adverse events, and the nausea severity scores were assessed at 0 to 1 hour and at 1 to 24 hours postoperatively. RESULTS: During the first 24 hours after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 41.5%, 29.3%, 30.3% and 23.3%, respectively. There was no significant difference between the groups. During the period, 1 hour to 24 hours, after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 36.6%, 17.4%, 27.5% and 14.4%, respectively. The incidence of PONV in Group 4 was significantly lower than in Group 1 (P < 0.05). CONCLUSIONS: In patients with laparoscopic cholecystectomy, a combination of prophylactic metoclopramide administration and induction with propofol was found to reduce the incidence of PONV by about 22.6% during the period 1 hour to 24 hours after anesthesia.
Anesthesia ; Antiemetics ; Cholecystectomy, Laparoscopic ; Humans ; Incidence ; Metoclopramide* ; Nausea ; Postoperative Nausea and Vomiting* ; Propofol* ; Thiopental