BACKGROUND: Dexmedetomidine has been widely used during spinal anesthesia to provide sedation. However, dexmedetomidine frequently causes significant bradycardia. This study was designed to evaluate whether fluid loading could reduce the incidence of bradycardia after intravenous dexmedetomidine infusion in patients under spinal anesthesia. METHODS: A total of 99 patients, 18 to 65 years of age, with American Society of Anesthesiologists physical status 1 or 2, who were scheduled for elective total knee replacement or internal fixation of lower leg fracture under spinal anesthesia were enrolled. The patients were randomly assigned into one of the three groups, and fluid was loaded as follows: group LOW - 4 ml/kg, group MID - 8 ml/kg, and group HI - 12 ml/kg. After fluid loading and spinal anesthesia, dexmedetomidine was infused as follows: 1 μg/kg of loading dose for 10 minutes, thereafter continuous infusion at 0.4 μg/kg/h. RESULTS: The heart rate of group HI was significantly higher than that of group LOW (P = 0.049). The dosage of atropine administration was significantly lower in group HI than in group LOW (P = 0.003). The change in thoracic fluid contents was significantly higher in group HI than in group LOW (P = 0.018). CONCLUSIONS: Fluid loading during spinal anesthesia can reduce the incidence and extent of bradycardia after intravenous dexmedetomidine infusion.
Anesthesia, Spinal* ; Arthroplasty, Replacement, Knee ; Atropine ; Bradycardia* ; Dexmedetomidine* ; Fluid Therapy ; Heart Rate ; Humans ; Incidence ; Leg

BACKGROUND: The main disadvantage of rocuronium is the pain associated with vascular injection. We evaluated the efficacy of palonosetron for reducing pain after rocuronium injection. METHODS: Eighty patients scheduled for elective surgery were randomly divided into two groups: Group C (normal saline 1.5 ml, n = 40) and Group P (palonosetron 0.075 mg, n = 40). Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds. Thirty seconds after the injection of the test drug, rocuronium 0.6 mg/kg was injected over 30 seconds and the response was recorded. Injection pain was graded using a 4-point scale. The grade was 0 points for no movement, 1 point for wrist movement, 2 points for elbow or shoulder movement, and 3 points for whole body movement. Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection. RESULTS: There was no significant difference in the grade 1 response between the two groups; however, the grade 2 and 3 responses in Group P were 5 (12.5%) and 4 (10%), respectively, which were significantly lower than in Group C, with 13 (32.5%) responses for each grade. There were no significant differences in hemodynamic changes within each group. However, the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P. CONCLUSIONS: Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration.
Anesthesia ; Arterial Pressure ; Elbow ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Operating Rooms ; Shoulder ; Thiopental ; Wrist

Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Brain Death ; Humans ; Orbital Fractures ; Pneumothorax ; Pulmonary Edema ; Respiration ; Surgical Instruments ; Tidal Volume ; Tracheostomy ; Ventilation ; Young Adult

Functioning adrenocortical oncocytomas are extremely rare and most reported patients are 40-60 yr of age. To our knowledge, only 2 cases of functioning adrenocortical oncocytomas have been reported in childhood. We report a case of functioning adrenocortical oncocytoma in a 14-yr-old female child presenting with virilization. She presented with deepening of the voice and excessive hair growth, and elevation of plasma testosterone and dehydroepiandrosterone sulfate. She had an adrenalectomy. The completely resected tumor composed predominantly of oncocytes without atypical mitosis and necrosis. A discussion of this case and a review of the literature on this entity are presented.
Adenoma, Oxyphilic/*complications/metabolism/pathology/surgery ; Adolescent ; Adrenal Cortex Neoplasms/*complications/metabolism/pathology/surgery ; Adrenalectomy ; Adult ; Female ; Humans ; Male ; Middle Aged ; Virilism/*etiology/pathology/surgery

PURPOSE: In this study we compared the surface wettability of ocular prosthesis and depositions depending on different types of artificial tear eye drops. METHODS: The artificial tear eye drops contain sodium hyaluronate (HA) 0.1%, 0.18%, 0.3%, carboxylmethylcellulose sodium (CMC), hydroxymethylcelluose + dextran (HMC), propylene glycol + polyethylene glycol (PG), polysorbate 80 (PS) povidone (Pov) were evaluated. Flat rectangular parallelepiped blocks consisting of polymethylmethacrylate (PMMA) or silicone materials were made. One artificial tear eye drop was applied on the surface of two different blocks of artificial eyes using a 23-gauge needle. Then, the static method contact angle was measured by using a contact angle goniometer. To measure the deposits, a petri dish was covered with 3 mL of artificial tear eye drops and dried for 48 hours at room temperature. Then, the light transmittance at the center of the petri dish was measured to investigate the amount of the residue. RESULTS: The contact angles of HA 0.1%, 0.18%, 0.3%, CMC, HMC, PG, PS and Pov on PMMA were 78.69degrees, 84.29degrees, 75.46degrees, 80.93degrees, 66.29degrees, 71.26degrees, 58.40degrees and 70.24degrees, respectively. The contact angles on silicone were 53.68degrees, 60.87degrees, 64.46degrees, 62.78degrees, 38.89degrees, 63.58degrees, 30.68degrees and 51.41degrees, respectively. The largest decrease in transparency was observed in the artificial tear eye drops containing HMC. CONCLUSIONS: The wettability and deposits on the surface of ocular prosthesis can vary based on the components and concentration of artificial tear eye drops. The results from this study should be considered when choosing the right artificial tear eye drops for improving dry eye symptoms in patients wearing ocular prostheses.
Anophthalmos ; Dextrans ; Dry Eye Syndromes ; Eye, Artificial* ; Humans ; Hyaluronic Acid ; Needles ; Ophthalmic Solutions* ; Polyethylene Glycols ; Polymethyl Methacrylate ; Polysorbates ; Povidone ; Propylene Glycol ; Silicones ; Sodium ; Tears* ; Wettability*

PURPOSE: In this study we compared the surface wettability of ocular prosthesis and depositions depending on different types of artificial tear eye drops. METHODS: The artificial tear eye drops contain sodium hyaluronate (HA) 0.1%, 0.18%, 0.3%, carboxylmethylcellulose sodium (CMC), hydroxymethylcelluose + dextran (HMC), propylene glycol + polyethylene glycol (PG), polysorbate 80 (PS) povidone (Pov) were evaluated. Flat rectangular parallelepiped blocks consisting of polymethylmethacrylate (PMMA) or silicone materials were made. One artificial tear eye drop was applied on the surface of two different blocks of artificial eyes using a 23-gauge needle. Then, the static method contact angle was measured by using a contact angle goniometer. To measure the deposits, a petri dish was covered with 3 mL of artificial tear eye drops and dried for 48 hours at room temperature. Then, the light transmittance at the center of the petri dish was measured to investigate the amount of the residue. RESULTS: The contact angles of HA 0.1%, 0.18%, 0.3%, CMC, HMC, PG, PS and Pov on PMMA were 78.69degrees, 84.29degrees, 75.46degrees, 80.93degrees, 66.29degrees, 71.26degrees, 58.40degrees and 70.24degrees, respectively. The contact angles on silicone were 53.68degrees, 60.87degrees, 64.46degrees, 62.78degrees, 38.89degrees, 63.58degrees, 30.68degrees and 51.41degrees, respectively. The largest decrease in transparency was observed in the artificial tear eye drops containing HMC. CONCLUSIONS: The wettability and deposits on the surface of ocular prosthesis can vary based on the components and concentration of artificial tear eye drops. The results from this study should be considered when choosing the right artificial tear eye drops for improving dry eye symptoms in patients wearing ocular prostheses.
Anophthalmos ; Dextrans ; Dry Eye Syndromes ; Eye, Artificial* ; Humans ; Hyaluronic Acid ; Needles ; Ophthalmic Solutions* ; Polyethylene Glycols ; Polymethyl Methacrylate ; Polysorbates ; Povidone ; Propylene Glycol ; Silicones ; Sodium ; Tears* ; Wettability*

PURPOSE: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant. METHODS: Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA. RESULTS: Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161). CONCLUSIONS: The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.
Anesthesia, General ; Anesthesia, Intravenous* ; Humans ; Recurrence ; Supine Position

PURPOSE: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant. METHODS: Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA. RESULTS: Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161). CONCLUSIONS: The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.
Anesthesia, General ; Anesthesia, Intravenous* ; Humans ; Recurrence ; Supine Position

Localized amnesia is characterized by a failure to recall events that occurred during a circumscribed period of time. Localized amnesia is the most common type of dissociative amnesia. It is assumed that this is a disorder of memory retrieval. Recent neuroimaing studies reported that posterior cingulate cortex may play a important role in memory(autobiographical) retrieval. The authors reported a case of localized amnesia with mass on left posterior cingulate cortex.
Amnesia* ; Gyrus Cinguli* ; Humans ; Memory

The serotonin 6(5-HT6) receptor gene is a candidate gene for influencing the clinical response to treatment with antidepressants. The purpose of this study was to determine the relationship between the C267T polymorphism in the 5-HT6 receptor gene and the treatment response to citalopram in a Korean population with major depressive disorder(MDD). METHODS: Citalopram was administered for 8 weeks to the 90 patients who completed study. 21-item Hamilton depression rating scale(HAMD-21) was used as a outcome measure. RESULTS: We found that the genotype, allele, and allele-carrier distributions did not differ significantly between MDD patients and normal controls. A main effect of an interaction of genotype with time on the decrease in the HAMD-21 score during the 8 weeks study period was not found. ANOVA revealed no significant effects of the C825T polymorphism on the decrease in the HAMD-21 score at each time period. CONCLUSIONS: These results suggest that the C267T polymorphism in the 5-HT6 receptor gene is not associated with the treatment response to citalopram.
Alleles ; Antidepressive Agents ; Citalopram* ; Depression ; Depressive Disorder, Major* ; Genotype ; Humans ; Outcome Assessment (Health Care) ; Serotonin