A number of drug administered during anesthesia can provoke pathologic response by immunologic or nonimmunologic mechanisms. Known drugs involved in hypersensitivity reactions are muscle relaxants, local anesthetics, narcotics, barbiturates, contrast media, protamine and antibiotics. Clinical manifestations of anaphylaxis are diverse, but during anesthesia, cardiovascular collapse is predominate. We experienced a case of anaphylactoid reaction with erythema on upper thoracic region, severe hypotension, tachycardia and ventricular fibrillation. After defibrillation, the patient was recovered. During follow-up, we knew that this patient was exposed aprotinin repeatedly, and suspect the possibility of anaphylactoid reaction due to aprotinin.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Anti-Bacterial Agents ; Aprotinin ; Barbiturates ; Contrast Media ; Erythema ; Follow-Up Studies ; Heart Arrest* ; Humans ; Hypersensitivity ; Hypotension ; Narcotics ; Tachycardia ; Ventricular Fibrillation

No abstract available.
Sturge-Weber Syndrome*

No abstract available.
Thanatophoric Dysplasia*

Reexpansion pulmonary edema(RPE) is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis, and generally believed to occur ipsilaterally when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid. Clinical manifestations of RPE are dyspnea, tachypnea, cyanosis, frothy blood-tinged sputum, wet rale, and expiratory wheezing. Hypotension and decrease in organ perfusion can occur. We experienced intraoperative tension pneumothorax probably due to positive pressure ventilation or pleural injury during central venous catheterization through internal jugular vein. And bilateral RPE combined with acute renal failure occurs after spontaneous decompression of tension pneumothorax with chest tube insertion, even with brief duration of lung collapse.
Acute Kidney Injury ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Cyanosis ; Decompression* ; Dyspnea ; Edema ; Hypotension ; Jugular Veins ; Lung ; Perfusion ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiratory Sounds ; Sputum ; Tachypnea

BACKGROUND: Since the initial report on anesthesia for the renal transplantation from Peter Bent Brighan Hospital in 1962, the anesthesia for kidney transplantation has been reviewed and discussed by many authors. We have performed 200 renal transplantations from August 1990 to October 1996. No cadaveric donor was used and all except two cases was the first graft. METHODS: Anesthetic procedures in the recipients were as follows; 1) The recipient was dialysed within 24 hrs prior to operation. 2) Premedication was done as glycopyrrolate and fentanyl, or glycopyrrolate and diazepam. 3) Thiopental and vecuronium, or thiopental and succinylcholine were used for anesthetic induction. 4) N2O-O2-relaxant (vecuronium) with halothane or isoflurane were used for maintenance. 5) Neostigmine or pyridostigmine were also used to antagonize against the relaxant. 6) CVP was maintained around 10~17 cmH2O. RESULTS: The results were as follows; 1) The mean ages of donors and recipients were 35.3 and 37.4, respectively. The ratio of male to female of donors and recipients was 1.6 : 1 and 1.6 : 1, respectively. 2) One hundred and ten cases (55.0%) were living unrelated donors and 90 cases (45.0%) were living related donors. 3) Overall graft and patient survival rate was 96.9 and 98.0 at 1 year, 94.1 and 95.1 at 3 years. CONCLUSIONS: Most patients with renal failure have several common problems that are of significance to anesthesiologists, including anemia, bleeding tendency, electrolyte imbalance, acidosis, hypertension, hyper- or hypovolemia, and previous therapy with steroids and immunosuppressants, etc. Therefore anesthesiologists should keep in mind the risk factors above mentioned for the anesthetic management of patients with renal failure.
Acidosis ; Anemia ; Anesthesia ; Cadaver ; Diazepam ; Female ; Fentanyl ; Glycopyrrolate ; Halothane ; Hemorrhage ; Humans ; Hypertension ; Hypovolemia ; Immunosuppressive Agents ; Isoflurane ; Kidney Transplantation* ; Male ; Neostigmine ; Premedication ; Pyridostigmine Bromide ; Renal Insufficiency ; Risk Factors ; Steroids ; Succinylcholine ; Survival Rate ; Thiopental ; Tissue Donors ; Transplants ; Unrelated Donors ; Vecuronium Bromide

Authors experienced an unusual case of malunited trans-epiphyseal fracture of the proximal femur in a 2 year-old girl. She was treated at a private clinic by closed reduction and cast immobilization, which subsequently resulted in malunion and capital subluxation. Because of subsequent failure of remodelling of the subluxated malunited fracture for two years, corrective femoral varisation and internal rotation osteotomy was done to reduce the subluxated femoral head. Postoperatively congrous reduction was obtained and gradual remodelling of the malunited fracture took place during 5 and a half years follow-up period.
Child ; Female ; Femur ; Follow-Up Studies ; Fractures, Malunited ; Head ; Hip ; Humans ; Immobilization ; Osteotomy

Computerized tomography has been used in the evaluation of the intracranial lesions. Recently the usage of computerized tomography has progressively widened in many fields of clinical practice. In orthopedics computerized tomography has been tried in the diagnosis and the determination of treatment of tumors, spinal disorders, hip disorders and knee problem. Four problem cases in which concentric reduction could not be obtained after closed reduction of hip dislocations were evaluated by computerized tomography from Apr, 1, 1983 to Mar. 31, 1984 in the Capital Armed Forces General Hospital and following conclusiions were obtained: 1. Open reduction revealed that muscles(adductor and pyriformis muscles), joint capsule and osteocartilaginous loose bodies (femoral and acetabular) were interposed to hinder concentric reduction. Large posterior acetabular fragment induced instability and redislocation of the hip. 2. When there were 2-3 mm lack of symmetry of the two femoral heads or any abnormal findings(breakage of Shenton's line etc.) in plain roentgenography, computerized tomography was recommanded, and muscles, osteocartilaginous loose bodies and instability were found. 3. Computerized tomography is an easy simple method and has a great diagnostic value in the evaluation of asymmetry and instability after closed reduction of traumatic hip dislocations.
Acetabulum ; Arm ; Diagnosis ; Head ; Hip Dislocation ; Hip ; Hospitals, General ; Joint Capsule ; Knee ; Methods ; Muscles ; Orthopedics ; Radiography

Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.
Blood Pressure ; Carbon Dioxide ; Cardiotonic Agents ; Catheters ; Embolism, Air* ; Female ; Fractures, Compression ; Heart Arrest ; Heart Rate ; Humans ; Middle Aged ; Noise ; Resuscitation ; Spinal Fusion*

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.
Analgesics* ; Anesthesia, Spinal* ; Anoxia* ; Fentanyl ; Humans ; Hypnotics and Sedatives* ; Incidence* ; Injections, Intravenous ; Midazolam ; Oximetry ; Oxygen ; Recovery Room

Myasthenia Gravis is a neuromuscular disorder manifested by increasing weakness and fatigability of voluntary muscles with exercise, and partial or complete restoration of function following rest or the administration of anticholinesterase drugs. The anesthesiologists may be called upon to assist in the diagnosis of myasthenis, in treating the patient by artificial ventilation during acute exacerbations, to anesthetise the patient for thymectomy or other surgery. Therefore, the anesthesiologists must be familiar with the diagnosis and treatment of myasthnia gravis to carry on the appropriate therapy. Two cases of anesthesia for thymectomy in myasthenia gravis without using muscle relaxants was experienced, and no respiratory problems were encountered postoperatively.
Anesthesia* ; Cholinesterase Inhibitors ; Diagnosis ; Humans ; Muscle, Skeletal ; Myasthenia Gravis* ; Thymectomy* ; Ventilation