BACKGROUND: Urinary retention is the most common complication after perianal surgery. The authors tried to evaluate the influence of the types and duration of the operation and the types of anesthesia on the incidence of urinary retention. METHODS: The medical and anesthetic records of 106 patients were reviewed retrospectively. They got perianal surgerys after recieving one of the regional blocks; 0.5% hyperbaric bupivacaine 5~8 mg intrathecally, 0.5% hyperbaric tetracaine 5~8 mg intrathecally, or 2% lidocaine 300 mg with epinephrine 5 g/ml caudally. The incidences of urinary retention were compared with each other by Chi-square test and Student t-test, according to the above mentioned points. RESULTS: Fifty percent of these patients underwent urinary catheterization. The incidence of urinary retention after hemorrhoidectomy (56.6%) was higher than that of other anorectal procedures (p<0.05, Chi-square test). The longer operating time was associated with urinary retention (p<0.05, Student t-test). The influence of local anesthetics (bupivacaine, tetracaine, and lidocaine) was absent (p>0.05, Chi-square test), but the difference between spinal and caudal anesthesia was slightly significant (p<0.05, Chi-square test), i.e. the incidence of urinary retention after caudal anesthesia was low. CONCLUSIONS: Short duration of operation, less traumatized perianal surgery, and caudal anesthesia are thought to lead to the lower incidence of urinary retention.
Anesthesia ; Anesthesia, Caudal ; Anesthesia, Conduction ; Anesthetics, Local ; Bupivacaine ; Epinephrine ; Hemorrhoidectomy ; Humans ; Incidence ; Lidocaine ; Retrospective Studies ; Tetracaine ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention*

Arthroscopic repair of an isolated teres minor tendon tear without associated shoulder joint pathology has not been reported in the literature. We report on a case of isolated teres minor tendon tear after trauma. The patient complained of severe shoulder pain and progressive limited range of motion 4 months after the injury. Magnetic resonance imaging showed a full-thickness tear of the teres minor tendon at its musculotendinous junction and arthroscopic repair was performed. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. Here, the authors report this case and provide a review of literature.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pathology ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Tears* ; Tendons*

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

The aim of this study was to compare the hemodynamic responses with various administration routes of lidocatine, which was used to blunt the sympathetic stimulation associated with intubation. The study population was from 24 patients scheduled for elective open heart surgery at Yeungnam University Hospital. Patients were randomly assigned to receive lidocaine by intravenous administration, laryngotracheal spray, and oropharyngeal gargling, and endotracheal intubation was performed. Heart rate, mean arterial pressure, central venous pressure, and arterial oxygen saturation were measured at 30 seconds, 1 minute, 3 minutes and 5 minutes after intubation and compared with the control group. The results were as follows: 1) In the control group which was not administered lidocaine, heart rate and mean arterial 1pressure were significantly increased (p<0.05, p<0.01). 2) In the group of intravenous lidocaine administration, heart rate was significantly increased (p < 0.05), but mean arterial pressure was not significantly changed after endotracheal intubation. Compared with control group, the changes of heart rate and mean artrerial pressure were statistically significant (p<0.05). 3) In the group of laryngotracheal lidocaine spray, heart rate and mean arterial pressure were increased after endotracheal intubation. 4) In the group of oropharyngeal lidocaine gargling, heart rate and mean arterial pressure showed significantly increased (p<0.05, p<0.01), and heart rare mintained an increased state but mean arterial pressure was reduced to the baseline value 5 minutes following intubation. 5) Laryngotracheal spray and oropharyngeal gargling group showed more significant increase in heart rate and mean arterial pressure than intravenous administration group. 6) No significant changes were observed in central venous pressure and arterial ocygen saturation in all three groups. It is concluded that intravenous administration of lidocaine before endotracheal intubation is more effective than laryngotracheal spray or oropharyngeal gargling.
Administration, Intravenous ; Arterial Pressure ; Central Venous Pressure ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Intubation, Intratracheal ; Lidocaine* ; Oxygen ; Thoracic Surgery

BACKGROUND: The clinicians frequently use crystalloid solutions to manage inpatients and outpatients. Recently Normosol becomes available but there is little understanding of Normosol. So we surveyed residents to assess the level of knowledge about three crystalloid solutions. METHODS: The respondents were 46 residents of internal medicine, general surgery, pediatrics, and anesthesiology. The questionnaire asked for the following information: To list the constituents and their concentrations in each 1 litre of normal saline, Hartmann's solution, and Normosol; to match correct pH and osmolality to each solutions; to describe the metabolism and role of lactate in Hartmann's solution. RESULTS: All 46 (100%) knew that both sodium and chloride ions were present in normal saline. Twenty six (57%) of them knew correct concentration of sodium and chloride. The presence of sodium ion in Hartmann's solution was known by 44 (96%) and its concentration was recognized by 20 (43%). Chloride ion and potassium ion in Hartmann's solution were recognized by 43 (93%) and 42 (91%), respectively. Fifteen (33%) knew correct constituents of Hartmann's solution. Only three (7%) knew correct constituents and their concentration of Hartmann's solution. Thirty six (76%) knew that bicarbonate is formed by metabolism of lactate. No one accurately recorded the correct constituents of Normosol. CONCLUSIONS: The constituents and their concentrations of normal saline are well known to residents but those of Hartmann's solution and Normosol are not. Our survey reveals that there was little understanding of the reasons for including lactate in Hartmann's solution and even less of presence of acetate in Normosol.
Anesthesiology ; Surveys and Questionnaires ; Humans ; Hydrogen-Ion Concentration ; Inpatients ; Internal Medicine ; Ions ; Lactic Acid ; Metabolism ; Osmolar Concentration ; Outpatients ; Pediatrics ; Potassium ; Sodium

No abstract available.
Echocardiography* ; Heart Defects, Congenital* ; Prenatal Diagnosis*

PURPOSE: This study examined the effects of neck stabilization exercises with vibratory stimulation on the neck disability index and thickness of the deep neck flexor. METHODS: Thirty subjects (control group=15, experimental group=15) with mild neck pain were enrolled in the study. The control group underwent craniocervical flexion exercise (control group, CG) and the experimental group was given craniocervical flexion exercise with vibratory stimulus (experimental group, EG) (3 sets, 3 times per week for 6 weeks). To examine the effects of exercise, the subjects were evaluated using the neck disability index (NDI), the thickness of the deep neck flexor muscle, and muscle strength. An independent and paired t-test were used to compare the effects of the exercise between the groups. RESULTS: The NDI score of the two groups increased significantly after 6 weeks of treatment (p < 0.001) and there was a significant difference between the EG group at 3 weeks (p < 0.05) and 6 weeks (p < 0.01). The thickness of the deep neck flexor in the CG group increased significantly after 6 weeks of treatment in all pressure stages (p < 0.001). The EG group showed a significant increase after 3 and 6 weeks of treatment in all pressure stage (p < 0.001), and 22 mmHg, a significant difference between 3 and 6 weeks (p < 0.05) and among 24, 28, and 30 mmHg at 6 weeks (p < 0.05). The maximum muscle strength of the deep neck flexion muscles increased significantly in the two groups after 6 weeks of treatment (p < 0.001) and there was significant difference between the EG group at 6 weeks (p < 0.01). CONCLUSION: Craniocervical flexion exercise with vibratory stimulus decreases the NDI, and increases the thickness of the deep neck flexor and maximum muscle strength of the deep neck flexion muscles in patients with mild neck pain.
Exercise* ; Humans ; Muscle Strength ; Muscles ; Neck Pain* ; Neck* ; Vibration

It is difficult to determine respiratory criteria of fitness for surgery and anesthesia in patients with intractable chronic obstructive pulmonary disease (COPD), who have high mortality and morbidity in the perioperative period. Also, it is commonly assumed that general anesthesia carries a greater risk of perioperative pulmonary complications than regional anesthesia in patients with COPD. A 79-yr-old COPD female patient complaining of right hip pain due to fracture of right femur neck and dyspnea on rest was admitted for surgery. Even after aggressive medical management for COPD during the preoperative period, dyspnea on rest and expiratory wheezing were not improved. The results of the pulmonary function test and the immediate preoperative arterial blood gas analysis were as follows: FVC 0.97 L, FEV1 0.38 L, FEF25-75% 0.11 L/sec, PaO2 47.6 mmHg, and PaCO2 68 mmHg. We report the anesthetic considerations for the epidural block for the severe COPD patient associated with hypoxemia and hypercarbia.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anoxia ; Blood Gas Analysis ; Dyspnea ; Female ; Femur Neck ; Hip ; Humans ; Mortality ; Perioperative Period ; Preoperative Period ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Function Tests ; Respiratory Sounds

Hypoglycemic encephalopathy is a rare problem among diabetic patients who are receiving treatment with insulin or other glucose-lowering drugs. The MRIs of patients with hypoglycemic encephalopathy commonly show scattered lesions in the cerebral cortex, hippocampus and basal ganglia, but lesions in the cerebellum or brain stem are extremely rare. A 44-year-old alcoholic woman without diabetes was admitted with a semicomatose mentality and seizure with severe hypoglycemic encephalopathy with extensive brain lesions seen on MRI at the middle cerebellar peduncle and midbrain, as well as in the other brain areas.
Adult ; Alcoholics ; Alcoholism ; Basal Ganglia ; Brain ; Brain Stem ; Cerebellum ; Cerebral Cortex ; Female ; Hippocampus ; Humans ; Insulin ; Mesencephalon ; Seizures