BACKGROUND: Dental trauma is a rare event but a considerable worry to the anesthesiologist as teeth are especially vulnerable to damage during general anesthesia with an endotracheal intubation. METHODS: In this prospective study, 1,500 patients scheduled for elective surgery that required general anesthesia during the period of May 2006-August 2007 were included. The modified Mallampati test (MMT), and upper lip bite test (ULBT) for predicting difficult intubation by anesthesiologists and a dental check performed by a dental surgeon were assessed preoperatively. Anesthetic services were performed by six residents at each level of training (from resident first grade to resident third grade) and an examination to identify dental damage was performed by a dental surgeon postoperatively. RESULTS: In predictive values for screening tests to predict the occurrence of dental injury, CBT (a test that combined the two screening tests) was higher than ULBT and MMT for specificity, positive predictive value, and accuracy.The incidence of dental trauma among the levels of resident training was not significantly different. CONCLUSIONS: CBT, among the screening tests for predicting difficult intubation, will be helpful in the prediction of dental injury.The various levels of training of residents did not affect the incidence of dental injury during general anesthesia.
Anesthesia ; Anesthesia, General ; Bites and Stings ; Humans ; Incidence ; Intubation ; Lip ; Mass Screening ; Organometallic Compounds ; Prospective Studies ; Sensitivity and Specificity ; Tooth

Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents potentially life-threatening consequences, and it is important that anesthesiologists recognize this syndrome because the sudden development of tachyarrhythmias may result in deleterious hemodynamic changes. We report an episode of severe hemodynamic changes induced by the insertion of a guide wire during central venous cannulation and operation in a 62-yr-old female patient with WPW syndrome. Initially, unstable paroxysmal supraventricular tachycardia was developed during central venous cannulation, which was disappeared immediately upon removing the guide wire. Subsequently, paroxysmal supraventricular tachycardia with severe hemodynamic changes developed 2 hours after operation, and this was successfully treated with an intravenous injection of adenosine, deep anesthesia with sevoflurane and fentanyl, and dopamine infusion. The patient recovered uneventfully after the operation.
Adenosine ; Anesthesia ; Catheterization* ; Dopamine ; Female ; Fentanyl ; Hemodynamics ; Humans ; Injections, Intravenous ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome*

Lafora' disease is an autosomal recessive, fatal, generalized polyglucosan storage disorder that occurs in childhood or adolescence with stimulus sensitive epilepsy (resting and action myoclonias, grand mal, and absence), dementia, ataxia and rapid neurological deterioration. We present a 19-year-old, 32 kg woman with lafora's disease was scheduled for tonsillectomy under general anesthesia. Her preanesthetic examination revealed extreme muscle atrophy and dementia. Grand mal, myoclonic seizures, and upper airway obstruction were frequent. General anesthesia and tracheal intubation with sevoflurane and nitrous oxide provided safe anesthesia. The intraoperative course was uneventful and the emergence of anesthesia was smooth.
Adolescent ; Airway Obstruction ; Anesthesia ; Anesthesia, General ; Ataxia ; Dementia ; Epilepsy ; Female ; Glucans ; Humans ; Intubation ; Methyl Ethers ; Muscular Atrophy ; Nitrous Oxide ; Seizures ; Tonsillectomy ; Young Adult

Charcot-Marie-Tooth disease, which is also known as hereditary motor and sensory neuropathy, is a heterogenous group of inherited diseases of the peripheral nerve. The spectrum of severity varies from asymptomatic individuals to those with severe limb abnormalities requiring corrective surgery. We report two brothers who had previously been diagnosed with Charcot-Marie- Tooth disease 3 years earlier and were scheduled to undergo a correction osteotomy of both feet under general anesthesia. General anesthesia was induced with propofol 2 mg/kg, rocuronium 0.8 mg/kg and was maintained with O2-N2O-Sevoflurane. The younger brother showed no delay in recovery of the neuromuscular blockade but the elder brother showed a delay.
Anesthesia, General ; Charcot-Marie-Tooth Disease* ; Extremities ; Foot ; Hereditary Sensory and Motor Neuropathy ; Humans ; Neuromuscular Blockade* ; Osteotomy ; Peripheral Nerves ; Propofol ; Siblings ; Tooth Diseases

BACKGROUND: Opioid tolerance may involve activation of the N-methyl-D-aspartate (NMDA) system. The possible involvement of the NMDA system suggests that one of the NMDA receptor antagonists, magnesium may be a useful adjunct to opioids for the treatment of postoperative pain following remifentanil infusion. METHODS: For this study, 70 patients scheduled for major abdominal surgery under remifentanil-based anesthesia were randomly allocated into groups that received either magnesium sulfate (group M) or saline (group C) intravenously. The patients in the group M received 25% magnesium sulfate at a dose of 50 mg/kg in 100 ml of saline, and those in the group C received an equal volume of saline prior to the induction of anesthesia. In addition, patients in both groups received 10 mg/kg/h infusion of either magnesium sulfate (group M) or an equal volume of saline (group C) until the end of surgery. Pain was assessed using a visual analog scale at 30 min, and 6, 12, 24, and 36 hours after operation. The time to the first use of postoperative analgesic and cumulative analgesic consumption in both groups were also evaluated. RESULTS: The visual analog scale scores for pain and cumulative analgesic consumption were significantly lower in the group M than in the group C. The time to the first use of postoperative analgesic was significantly shorter in group C than in the group M. CONCLUSIONS: Use of the NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic reduced postoperative pain in patients undergoing major abdominal surgery under remifentanil-based anesthesia.
Analgesics, Opioid ; Anesthesia ; Humans ; Magnesium ; Magnesium Sulfate ; N-Methylaspartate ; Pain, Postoperative ; Piperidines

BACKGROUND: Early oral intake (EOI) associated with early recovery of normal bowel function has been shown to be an important determinant for improving patients' satisfaction. We investigated the tolerability of EOI and its effects on the recovery of bowel function after epidural anesthesia. METHODS: A prospective randomized trial of patients undergoing lower extremities surgery under epidural anesthesia was performed. A liquid drink was given to 150 patients in the EOI group 1 hours after surgery, and to 150 patients in the delayed oral intake (DOI) group 8 hours after surgery. We recorded presence of bowel sounds immediately after operation, symptoms of ileus, time to the first flatus, time to the first defecation, degree of appetite before the first meal, and patients' satisfaction. RESULTS: There was no significant difference in the presence of immediate postoperative bowel sounds, the degree of appetite before the first meal, mild ileus, and severe ileus between groups. Time to the first flatus and time to the first defecation in the EOI group were shorter than those of the DOI group. The patients' satisfaction in the EOI group was higher than that of the DOI group. CONCLUSIONS: For uncomplicated patients undergoing lower extremities under epidural anesthesia, beginning oral hydration as early as 1 hour after the operation is safe and well tolerated and resulting in faster recovery of bowel function and higher patients' satisfaction.
Anesthesia, Epidural ; Appetite ; Defecation ; Flatulence ; Humans ; Ileus ; Lower Extremity ; Meals ; Prospective Studies