BACKGROUND: Sevoflurane is characterized by the lack of an unpleasant odor, airway irritation and its low blood/gas partition coefficient (0.68), which provides rapid and smooth induction. Inhaled induction with sevoflurane is commonly used in pediatric patients, but not in adult patients. This study was designed to investigate the time to completion of LMA insertion and end-tidal sevoflurane concentration during induction with sevoflurane 8% and N2O 50%, after midazolam administration, in adults. METHODS: Twenty eight patients, aged 20(-60) years, were administered intravenous midazolam 30 microgram/kg and after one minute, sevoflurane 8% and N2O 50% were inhaled with tidal-volume breathing. One minute after loss of consciousness, jaw thrust and mouth opening were checked and an LMA was inserted. The end-tidal concentration of sevoflurane, and the times to loss of consciousness and completion of insertion were recorded. The mean arterial pressure and heart rate were also recorded. RESULTS: From initiation of sevoflurane and N2O inhalation, it took 48 +/- 14 seconds until loss of consciousness, and 143 +/- 19 seconds until the completion of LMA insertion. The end-tidal sevoflurane concentration was 4.1 +/- 0.6% at loss of consciousness, 5.0 +/- 0.7% at one min after loss of consciousness, and 4.1 +/- 0.5% after LMA insertion. In all patients LMA insertion was successful and satisfactory. After LMA insertion, compared to baseline, the mean arterial pressure was reduced and the heart rate increased. CONCLUSIONS: After small-dose of midazolam, inhaled induction with sevoflurane 8% and N2O 50% allowed successful and satisfactory LMA insertion in adults.
Adult ; Arterial Pressure ; Heart Rate ; Humans ; Inhalation ; Jaw ; Laryngeal Masks ; Midazolam* ; Mouth ; Nitrous Oxide ; Odors ; Respiration ; Unconsciousness

Isolated left main coronary ostial stenosis is a very rare condition. In the majority of cases there are coexisting diseases in multiple coronary vessels. Here, a case of isolated left main coronary ostial stenosis due to an acute angle take-off, with clockwise rotation of the coronary sinus, confirmed by cardiac MRI is presented. A 44-year old female patient presented with an exertional and stabbing anterior chest pain. The patient had no premedical history. A coronary angiogram showed an isolated left main coronary ostial stenosis due to an acute take-off of the left main coronary artery. A cardiac MRI showed an acute angle take-off of the left main coronary artery, with clockwise rotation of the coronary sinus. The patient underwent surgical angioplasty of the coronary ostia, with a patch of autologous pericardium. This acute angle take-off may be due to rotation of the coronary sinus.
Adult ; Angioplasty ; Chest Pain ; Constriction, Pathologic* ; Coronary Sinus* ; Coronary Stenosis ; Coronary Vessels ; Female ; Humans ; Magnetic Resonance Imaging* ; Pericardium

PURPOSE: Paradoxical puborectalis contraction (PPC) or Anismus is known to have a pathogenesis of abnormal contraction of puborectalis at defecation and its managements are not satisfactory. Recently, therapy of PPC and its associated symptoms using Botulinum toxin-A (BTX-A) has been introduced. we evaluate the effect of BTX-A injection to the puborectalis for the patients with PPC. METHODS: Fourteen patients were diagnosed as paradoxical puborectalis contraction on defecography and/or anorectal manometry and electromyography (EMG) during September 1998 to January 2001 in Daegu Catholic Medical Centre, Catholic University of Daegu. All patients were underwent 30 (15 15) units of BTX-A injection on each side of puborectalis guided by EMG. Among them, five patients needed further injection of 20 (10 10) units because the expected results were not satisfied. Follow-up were conducted on one month and one year after BTX-A injection and the patients were assessed for the constipation score and anorectal manometry. RESULTS: After injection of BTX-A, constipation score was significantly decreased from 15.5 +/- 3.5 (mean SD) to 5.7 +/- 4.3. Maximal resting and squeezing pressure also decreased from 48.4 +/- 22 mmHg, 96.9 +/- 39.8 to 41.2 +/- 17, 68.3 +/- 38.2, respectively. Twelve patients who were followed up more than one year after injection, the constipation score (n=12) increased up to 7.7 +/- 2.9 (mean SD). Among them, three patients have had stool softeners or laxatives to evacuate and the remained nine patients did not have any kinds of drug or food for defecation. There was no complication for the injection BTX-A. CONCLUSIONS: BTX-A injection seems to be effective for the treatment of PPC and the long term therapeutic effect can be defined through double blind placebo-controlled trials.
Constipation ; Daegu ; Defecation ; Defecography ; Electromyography ; Follow-Up Studies ; Humans ; Laxatives ; Manometry