Arytenoid subluxation or recurrent laryngeal nerve paralysis may result from injury to the larynx following endotracheal intubation or blunt laryngeal trauma. Early diagnosis is important for appropriate treatment and better prognosis. A 62-years-old man was admitted for cholecystectomy. He was intubated without any difficulty and nasogastric tube was inserted with the help of laryngoscope and Magill forcep before surgery. He had a weak voice and hoarseness after atraumatic extubation and those symptoms did not improve even 2 days after. Indirect laryngoscopy, videolaryngotelescopy, electromyography(EMG) and computed tomographic findings revealed anterior, inferior subluxation of left cricoarytenoid cartilage associated with left thyroarytenoid muscle denervation and resultant unilateral vocal cord palsy. Conservative treatment for 40 days after the operation and follow-up examination was done. The voice quality was improved and indirect laryngoscopy examination showed that right vocal cord crossed midline in a attempt to meet its paralyzed counterpart on phonation.
Anesthesia, General* ; Cartilage ; Cholecystectomy ; Denervation ; Early Diagnosis ; Follow-Up Studies ; Hoarseness ; Intubation, Intratracheal ; Laryngeal Muscles ; Laryngoscopes ; Laryngoscopy ; Larynx ; Paralysis* ; Phonation ; Prognosis ; Recurrent Laryngeal Nerve* ; Surgical Instruments ; Vocal Cord Paralysis ; Vocal Cords ; Voice ; Voice Quality

BACKGROUND: Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. METHODS: Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg (n=15), ketamine 1 mg/kg (n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group (n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. RESULTS: Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups (p<0.05). After intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups (p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. CONCLUSIONS: Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.
Anesthesia ; Anesthesia, Intravenous ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine* ; Mothers ; Pregnancy ; Propofol*

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: l. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64+/-5.43 cm H2O and 10.05+/-5.55cm H2O (Mean+/-SD) respectively in first 10 patients. Pressure difference was 0.59+/-0.39cm H2O (p<0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77+/-3.37 cm H 0 and 7.05+/-3.49cm H2O (Mean+/-SD) respectively in second 10 patients. Pressure difference was 0.73+/-0.59cm H2O (p<0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP (r=0. 99, p<0.005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p<0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.
Anesthesia ; Catheters ; Central Venous Pressure* ; Humans ; Subclavian Vein ; Venous Pressure

Oxygen-derived free radicals have been implicated in many important functions in the biological system. Electrical field stimulation (EFS) causes arterial relaxation in animal models. We found that EFS applied to neither muscle nor nerve but to Krebs solution caused a relaxation of rat aorta that had been contracted with phenylephrine. In the present study, therefore, we investigated the characteristics of this EIRF (electrolysis-induced relaxing factor) using rat isolated aorta. Results indicated that EIRF acts irrespective of the presence of endothelium. EIRF shows positive Griess reaction and is diffusible and quite stable. EIRF-induced relaxation was stronger on PE-contracted aorta than on KCl-contracted one, and inhibited by the pretreatment with methylene blue. Zaprinast, a cGMP-specific phosphodiesterase inhibitor, potentiated the EIRF-induced relaxation. NG-nitro-L-arginine, NO synthase inhibitor, did not inhibit the EIRF-induced relaxation. Deferroxamine, but not ascorbic acid, DMSO potentiated the EIRF-induced relaxation. These results indicate that electrolysis of Krebs solution produces a factor that relaxes vascular smooth muscle via cGMP-mediated mechanism.
Animals ; Aorta ; Ascorbic Acid ; Dimethyl Sulfoxide ; Electrolysis* ; Endothelium ; Free Radicals ; Methylene Blue ; Models, Animal ; Muscle, Smooth, Vascular* ; Nitric Oxide Synthase ; Nitroarginine ; Phenylephrine ; Rats ; Reactive Oxygen Species ; Relaxation

BACKGROUND: Propofol is a short-acting intravenous sedative-hynotic agent that can be used for induction and maintenance of general anesthesia. This study was perfomed to evaluate adequate dose requirements of propofol by injection during anesthesia induction, and to evaluate the induction technique by assessing induction dose, induction time, success rate of induction and hemodynamic effects. METHODS: Ninety healthy adult patients(ASA class I or II), scheduled for elective surgery under general anesthesia, were randomly assigned to receive propofol 1 mg/kg(group I), 2 mg/kg(group II), and 3 mg/kg(group III) respectively as an induction agent. Mean arterial pressure(MAP) and heart rate(HR) were measured before the administration of propofol and just after successful induction. We determined the speed of injection as lasting 40 seconds. RESULTS: Success rate of induction in group I(30%) was lower than group II(100%) and III(100%). The induction time in group I(81s) was longer than group II(51s) and III(47s). The MAP were statistically significant difference among three groups(p<0.05 compared with before induction). In group III, the MAP was more decreased than group I and II and HR was more increased than group I and II. CONCLUSIONS: We concluded that propofol in group II(2 mg/kg) is more desireable dose than group I(1 mg/kg) and group III(3 mg/kg) for induction of general anesthesia.
Adult ; Anesthesia* ; Anesthesia, General ; Anesthetics ; Arterial Pressure ; Heart ; Hemodynamics ; Humans ; Propofol*

Buprenorphine is a semisynthetic, highly lipophilic opioid derived from thebaine and it is 30 to 40 times more potent than morphine. This study was performed to compare the clinical effects of epidural buprenorphine on postoperative pain control with those of epidural morphine in 150 cesarean deliveries. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered morphine 3 mg in group I, buprenorphine 0.15 mg in group II and buprenorphine 0.3 mg in group III as first dose mixed with 0.25% bupivacaine 10 ml respectively through indwelling epidural catheter at the time of ligation of umbilical cord. Second and third doses were administered with 8 hours intervals, morphine 3 mg with N/S 10 ml was injected in group I and buprenorphine 0.15 mg with N/S 10 ml was injected in group II and III respectively. Their analgesic effects were evaluated by VAS and severity of side effects was also evaluated. The Results were as follows; 1) VAS was significantly increased in group II compared to group I and III(p<0.05). There was no significant difference between group I and III. 2) Pruritus was lesser in group II and III than group I(p<0.05). 3) There was no significant difference in nausea and vomiting. 4) None of patients had respiratory depression. The authors' findings indicate that epidural administration of buprenorphine of suitable dose may be useful in the treatment of postoperative pain.
Analgesia ; Bupivacaine ; Buprenorphine* ; Catheters ; Classification ; Humans ; Ligation ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Thebaine ; Umbilical Cord ; Vomiting

A case changing blood pressure severely by manipulation of the huge tumor mass during the brain tumor surgery was observed. Decreased blood pressure (55/35 mmHg) might be caused by the stimulation of the brain increased to 150/75 mmHg after a neurosurgeon undermined and elevated the tomor mass, and blood pressure decreased again to 55/35 mmHg when he put it on the same position. Removing the mass completely, blood pressure was stabilized (about 130/70 mmHg). There are central vasomotor centers of autonomic nervous organization in the hypothalamus, midbrain, pons or medulla oblongata of the brain. By the stimulation of specific region in the above area, various features of responses were anatomically defined. The supratentorial contents may herniate through the tentorial incisura into the infratentorial spaces and posterior fossa, when intracranial pressure gradients become large enough to overcome the resistance of the brain tissue, and they can affect vital changes.
Blood Pressure* ; Brain Neoplasms* ; Brain* ; Hypothalamus ; Intracranial Pressure ; Medulla Oblongata ; Mesencephalon ; Pons

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) production in the respiratory epithelium and the demonstration of inducible nitric oxide synthase in ciliated epithelium of the upper airway have recently been reported. The aim of this study was to investigate the expression of inducible nitric oxide synthase in the nasal epithelium after capsaicin treatment, which stimulates the substance P innervation. MATERIALS AND METHODS: In vivo treatment -Capsaicin (112 nM) was applied to the nasal cavities of the rat and guinea pig, and 30 nl of normal saline was applied for the control groups. After 2 hours, animals were sacrificed with cardiac perfusion of 4% paraformaldehyde and septal mucosa were removed. The 8 nm serial frozen tissue sections were made, and the expression of inducible nitric oxide synthase was determined using nicotinamide adenine diphosphate-diaphorase histochemistry. In vitro treatment- The nasal septum of the rats and the trachea of the guinea pigs were incubated in DMEM culture media with or without 112 nM capsaicin for experimental or control groups. After 0, 30 or 120 minutes of incubation, the tissues were fixed and processed for nicotinamide adenine diphosphate-diaphorase histochemistry. RESULTS: Both in vivo and in vitro studies demonstrated that the strong positive histochemical reactivity were observed in the respiratory epithelium of the rats and guinea pigs after capsaicin treatment compared to control groups. CONCLUSION: These data imply that capsaicin induces the expression of inducible nitric oxide synthase and that the substance P innervation of the nasal mucosa may have a protective role in the airway defense mechanism through nitric oxide production.
Adenine ; Animals ; Capsaicin* ; Culture Media ; Epithelium* ; Guinea Pigs ; Guinea* ; Mucous Membrane ; Nasal Cavity ; Nasal Mucosa ; Nasal Septum ; Niacinamide ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Perfusion ; Rats* ; Respiratory Mucosa ; Substance P ; Trachea

Acidosis ; Administration, Intravenous ; Anesthesia ; Anesthetics ; Blood Pressure ; Dantrolene ; Diagnosis ; Early Diagnosis ; Emergency Treatment ; Fever ; Humans ; Incidence ; Male ; Malignant Hyperthermia ; Muscle Rigidity ; Orthognathic Surgery ; Succinylcholine ; Tachycardia ; Young Adult

To reverse the wrinkling & sagging of the skin on lower face and neck, there are various surgical methods such as suspension suture method, classical cervicofacial lift, SMAS-platysmal facelift, deep-plane facelift and composite facelift. Aging of lower face and neck present not only with sagging skin, but also is aggravated due to loss of elasticity of the SMAS and platysmal muscle. Successful surgical outcome is expected when tugging of the SMAS and platysma is performed with proper skin excision of lower face. Practically, deep-plane facelift methods present more satisfying outcome than the subcutaneous dissection, but takes longer recovery period and higher risk of postoperative complication. The authors would like to present a new method of lower face and neck lift, with periauricular minimally invasive suspension suture method, which does not required hospitalization, and gives higher patient satisfaction. In this study, 30 patients(26 females, 4 males) were operated from December of 2004 to February of 2007. Minimal periauricular subcutaneous dissection was performed. While measuring the sagging of the soft tissue on lower face and neck, suspension suture was performed anchoring platysma muscle from the submandibular slit incision site to the fascia of the mastoid process and stretched SMAS of the lower face was suspended to the fascia of the mastoid process with PDS 3-0 sutures. Most of the patients were satisfied without specific problems. The procedure carries advantages of simple operative method, easier access under intravenous sedation, much lesser risk of hematoma formation or facial nerve injury, shorter recovery period, improvement on the cervicomental angle and jaw line, and minimal postoperative scar.
Aging ; Cicatrix ; Elasticity ; Facial Nerve Injuries ; Fascia ; Female ; Hematoma ; Hospitalization ; Humans ; Jaw ; Mastoid ; Neck ; Patient Satisfaction ; Postoperative Complications ; Rhytidoplasty ; Skin ; Sutures*