Intractable hiccups are defined as hiccup persisting for more than 48hours, and these appear in various diseases. A 28-year-old woman admitted due to intractable hiccups without gastroenteral system abnormalities and peripheral nervous systemic involvement. High signal intensity lesion of the medulla oblangata in the tegmental region was detected on T2-weighted MR imaging, which might be a causative etiology. We encountered a rare case developing intractable hic-cups as presenting symptom of 'clinically definte' multiple sclerosis.
Adult ; Female ; Hiccup* ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Peripheral Nervous System

BACKGROUND: The number of elderly patients undergoing orthopedic surgery is steadily growing. Aging modifies the physiology, pharmacokinetics and pharmacodynamics, and co-morbidity is common in the elderly. Therefore, it is important and necessary to evaluate the anesthetic management for orthopedic surgery in elderly patients. METHODS: Four hundred and twenty two patients, older than 80 yr, who underwent orthopedic surgery, between September 1996 and March 2004, were retrospectively reviewed according to age, sex, operation site, preexisting concomitant disease, anesthetic techniques, postoperative complications and mortality. RESULTS: Three hundred and fifty seven patients had a pre-existing concomitant disease. There were no meaningful differences in the postoperative morbidity and mortality according to the anesthetic technique employed, although there was a clearly reduced incidence of deep vein thrombosis with regional anesthesia. There were significantly higher postoperative morbidity and mortality among patients with a pre-existing concomitant disease. CONCLUSIONS: Appropriate anesthetic management is suggested for patients older than 80 yr undergoing orthopedic surgery, which will require proper preoperative evaluation, sufficient vigilance of their hemodynamics and an awareness of impaired circulatory function, as well as other age related concerns.
Aged ; Aging ; Anesthesia* ; Anesthesia, Conduction ; Hemodynamics ; Humans ; Incidence ; Mortality ; Orthopedics* ; Pharmacokinetics ; Physiology ; Postoperative Complications ; Retrospective Studies ; Venous Thrombosis

BACKGROUND: Three isoforms of the neuronal acetylcholine receptors (AChRs) have been described in muscle epsilonAChRs, gammaAChRs and alpha7AChRs. The adult neuromuscular junctions are composed of epsilonAChRs. During immobilization, new AChRs with subunit compositions of gammaAChRs and alpha7AChRs appear in the perijunctional and extrajunctional area. This study evaluated the contribution of these isoforms to neurotransmission during immobilization, by using waglerin-1 which selectively blocks the epsilonAChRs. METHODS: Male mice (n = 20) were used and each group was divided into sham operated or immobilized. A leg was immobilized in mice for 14 days by pinning, after which nerve-evoked twitch tension was examined under anesthesia in tibialis muscle of both legs, with the contralateral leg serving as control. Neuromuscular transmission was monitored by using a peripheral nerve stimulator with the tibialis muscle and sciatic nerve. Electrical stimuli of 0.2 msec duration were applied to sciatic nerve 2 Hz for 2 sec every 30 sec. After administration of waglerin-1, the evoked twitch was recorded. The percent depression of T1 relative to baseline was transformed to probit scale to determine the effective dose of waglerin-1 for 5%, 50%, and 95% twitch depression. RESULTS: The twitch tension in the control group was higher than immobilized group, confirming the efficacy of immobilization. Waglerin-1 produced 99% twitch suppression on the control group. But on the immobilized group, waglerin-1 produced only 70% twitch suppression even at 37 pg. CONCLUSIONS: The functional role of epsilonAChRs in neurotransmission decreases during immobilization while that of gammaAChRs and alpha7AChRs increases.
Adult ; Anesthesia ; Animals ; Depression ; Hindlimb ; Humans ; Immobilization ; Leg ; Male ; Mice ; Muscles ; Neuromuscular Junction ; Neurons ; Peripheral Nerves ; Protein Isoforms ; Receptors, Cholinergic ; Salicylamides ; Sciatic Nerve ; Synaptic Transmission

BACKGROUND: Supraglottic airway devices can be used to maintain stable hemodynamics during intubation, to secure a difficult airway and to administer muscle relaxants at reduced levels for brief operation. We investigated the insertion success rates, hemodynamic stabilities after insertion, intraoperative ventilatory parameters, and postoperative laryngopharyngeal discomforts of three supraglottic airway devices: the ProSealTM laryngeal mask airway (PLMA), the laryngeal tube (LT), and the PAxpressTM (PAX). METHODS: After induction with thiopental 5 mg/kg with fentanyl 1microgram/kg and rocuronuim 0.6 mg/kg as muscle relaxants, manual control ventilation was done with N2O : O2 (1 : 1) and sevoflurane 5-6 vol% for 2 minutes. The supraglottic airway devices were inserted into 94 adult ASA physical status I and II patients. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The success rates of first-attempts were similar (PLMA: 96.9%, LT: 93.1%, PAX: 96.8%). The time to achieve effective ventilation was shorten for PLMA. Peak inspiratory pressure (PIP) was significant higher for PAX than PLMA. Cuff pressure significantly increased in LT at 60 and 90 minutes after insertion. LT provided the tightest seal for positive ventilation. The incidence of blood-tinged and sore throat was highest for PAX. CONCLUSIONS: These three supraglottic airway devices can be used successfully and effectively without gastric insufflation. We suspected that the incidences of airway complications were proportional to PIP and cuff pressure and that they are dependent upon insertion skill.
Adult ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Insufflation ; Intubation ; Laryngeal Masks* ; Pharyngitis ; Thiopental ; Ventilation

BACKGROUND: The 5-hydroxytryptamine 3 receptor (5-HT3R) is a member of a superfamily of ligand-gated ion channels which has structural similarities and common evolutionary origin to those of the nicotinic acetylcholine receptor (nAChR). 5-hydroxytryptamine (5-HT) and muscle relaxants may have cross reaction. Rocuronium is a non-depolarizing neuromuscular blocking agent which has a rapid onset. The aim of this study was to examined the effects of 5-HT on rocuronium-induced neuromuscular blockade in a rat phrenic nerve-hemidiaphragm preparation. METHODS: Institutional approval was obtained for the experimental procedure. Fifty male Sprague-Dawley rats (150-200 g) were divided into 5 groups; the control, and 0.1, 1, 10, and 20microgram/ml of 5-HT. The animals were injected with phentobarbital at 40 mg/kg into the peritoneal cavity. The hemidiaphragm with the phrenic nerve was dissected and then mounted in a bath containing 100 ml Krebs solution at room temperature. The phrenic nerve was stimulated at the supramaximal intensity using a Grass(R) S88 stimulator via an SIU5 isolation unit. The twitch height was measured and recorded using a precalibrated Grass(R) FT88 force displacement transducer and recorded with a Grass(R) 79 polygraph, respectively. In the cumulative dose-response study, the rocuronium 100microgram/dl and each dose of 5-HT were administered simultaneously administered, with additional 50microgram/dl incremental doses of rocuronium were added to obtain grteater than 95% neuromuscular twitch inhibition. The ED5, ED50, ED90, and ED95 of rocuronium in each group were calculated using a probit model. RESULTS: The ED50, ED90, and ED95 of rocuronium were significantly reduced in 5-HT 20microgram/ml group (P < 0.05), but no differences were observed with the other 5-HT groups compared to the control groups. CONCLUSIONS: 5-HT at 20microgram/ml enhanced the neuromuscular blockade of rocuronium.
Animals ; Baths ; Cross Reactions ; Humans ; Ligand-Gated Ion Channels ; Male ; Neuromuscular Blockade* ; Peritoneal Cavity ; Phrenic Nerve ; Rats* ; Rats, Sprague-Dawley ; Receptors, Nicotinic ; Serotonin* ; Transducers

BACKGROUND: Phenytoin and carbamazepine may augment a neuromuscular block from nondepolarizing muscle relaxants. The potency of rocuronium is increased after the administration of an acute high dose of phenytoin. We investigated the effects of phenytoin and carbamazepine on rocuronium-induced neuromuscular blockade. METHODS: Male Sprague Dawley rats (n = 80) were randomly allocated into a control group, phenytoin group, carbamazepine group, and phenytoin with carbamazepine group. The phrenic nerve was stimulated with supramaximal intensity and twitch responses were measured. After a stabilization period, 300microg rocuronium was added. After 10 minutes, in the pheytoin group of rats, phenytoin in Krebs solution was administered at a concentration of 1microg/ml (P1), 10microg/ml (P10) and 100microg/ml (P100). In the carbamazepine group of rats, carbamazepine in Krebs solution was administered at a concentration of 0.5microg/ml (C0.5), 5microg/ml (C5) and 50microg/ml (C50). In the phenytoin with carbamazepine group of rats, phenytoin simultaneously with carbamazepine was administered in Krebs solution at a phenytoin concentration of 10microg/ml (P10) and a carbamazepine concentration of 5microg/ml (C5). We measured twitch responses at 10 minutes after rocuronium administration and 10 minutes after the administration of the anticonvulsants. RESULTS: There were significant depressions in the twitch response of rocuronium in the 100microg/ml phenytoin group of rats, 5microg/ml and 50microg/ml carbamazepine group of rats, and the 10microg/ml phenytoin with 5microg/ml carbamazepine group of rats. CONCLUSIONS: The potency of rocuronium increased with phenytoin and carbamazepine administration. Phenytoin and carbamazepine can cause recurarization perioperatively.
Animals ; Anticonvulsants ; Carbamazepine* ; Depression ; Humans ; Male ; Neuromuscular Blockade* ; Phenytoin* ; Phrenic Nerve ; Rats ; Rats, Sprague-Dawley

BACKGROUND:Rocuronium is a non depolarizing muscle relaxant of rapid onset and of intermediate action duration. It is particularly suitable for short operation and rapid control airway. But, intravenous rocuronium cause pain and a withdrawal movement. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain and withdrawal movement in patients receiving rocuronium. METHODS: The study was approved by our institutional review board, and informed consent was obtained from all patients. One hundred and twenty patients, ASA physical status 1-2 undergoing general anesthesia for elective surgery were randomly enrolled. Allergy history to trial drug, chronic pain, pregnancy, patient on analgesics, difficult vein access and deeply sedated patients were excluded. Patients were not premedicated, and had a 20-18 G intravenous catheter inserted into a hand dorsum before operation. On arrival in the operation room, routine non-invasive monitors were placed and the free flow of intravenous fluid without edema, redness or hardness was confirmed. A subparalyzing dose of rocuronium 0.06 mg/kg (RS group) or vecuronium 0.01 mg/kg (VS group) was administered after 2 ml of 0.9% NaCl in one group, and a subparalyzing dose of rocuronium 0.06 mg/kg (RL group) or vecuronium 0.01 mg/kg (VL group) was administered after 2 ml of 2% lidocaine injection in a second group. All patients then received 5 mg/kg of 2.5% thiopental sodium and 0.6 mg/kg rocuronium (RS and RL group) or 0.1 mg/kg of vecuronium (VS and VL group). Muscle relaxant-induced pain and withdrawal movements were assessed using 4-grade scales (0-3). Vein redness was measured just after administration and vein hardness five minutes after intubation using 4-grade scales (0-3). RESULTS: Incidence of pain (8.2 times) and withdrawal movement (6.2 times) was more frequent in the rocuronium group than in the vecuronium group (P< 0.01). Lidocaine pretreatment decreased the incidence of pain significantly (5.7 times, P < 0.01). CONCLUSIONS: Rocuronium causes more pain and withdrawal movements than vecuronium. Lidocaine pretreatment significantly reduced the incidence and severity of pain, and withdrawal movements in both groups.
Analgesics ; Anesthesia, General ; Catheters ; Chronic Pain ; Edema ; Ethics Committees, Research ; Hand ; Hardness ; Humans ; Hypersensitivity ; Incidence ; Informed Consent ; Intubation ; Lidocaine* ; Pregnancy ; Thiopental ; Vecuronium Bromide ; Veins ; Weights and Measures

BACKGROUND: Supraglottic airway devices are currently available. We compared the efficacy of the Cobra perilaryngeal airway (CobraPLATM) and the ProSealTM laryngeal mask airway (PLMA) during anesthesia with controlled ventilation for the insertion success rate, hemodynamic stability after insertion, intraoperative ventilatory parameters, and postoperative laryngeal discomfort. METHODS: Forty-three patients received either a CobraPLATM or a PLMA after induction with thiopental 5 mg/kg, fentanyl 1microg/kg and rocuronium 0.6 mg/kg, and manual controlled ventilation with N2O: O2 (1:1) and sevoflurane 5-6 vol% for 2 minutes. Unblinded observers collected the intraoperative data, and blinded observers collected the postoperative data. RESULTS: The two devices were similar for hemodynamic stability after insertion, and for the intraoperative ventilatory parameters. The success rates of first-attempts were similar, but the insertion time was longer for the CobraPLATM. The cuff volume and pressure changes were significantly higher for the PLMA than the CobraPLATM. The cuff pressure was significantly higher for the CobraPLATM than the PLMA from insertion to 10 minutes after insertion, but at 30, 60 and 90 minutes after the insertion, there was no significant difference for the two devices. There were no differences with respect to the incidence of adverse events. CONCLUSIONS: During anesthesia with controlled ventilation, these two devices can be used successfully and effectively. We suggest that the CobraPLATM could be used an alternative device for airway management and further investigation is required.
Airway Management ; Anesthesia* ; Elapidae ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Laryngeal Masks* ; Masks ; Thiopental ; Ventilation*

BACKGROUND: Mivacurium is a nondepolarizing neuromuscular blocking agent hydrolyzed by pseudocholinesterase. Anticholinesterase used in the reversal of mivacurium-induced muscle relaxation may also inhibit plasma pseudocholinesterase, and delay hydrolysis of mivacurium. In this study, the effects of edrophonium and/or bovine pseudocholinesterase (BpChE) in the reversal of mivacurium were investigated with the rat phrenic nerve-diaphragm preparation. METHODS: Fifty Sprague-Dawley rats (150 - 200 g) were randomly allocated into 10 groups based on the dosage of edrophonium and BpChE. Each animal was anesthetized with thiopental sodium (40 mg/kg I.P.). The phrenic nerve-diaphragm was dissected and mounted in a bath containing an oxygenated Krebs' solution at 32degreesC. The phrenic nerve was stimulated at supramaximal intensity and the single twitch responses and train of four (TOF) ratio were measured. After stabilization of the twitch responses, mivacurium (1ng/ml) was administered incrementally to obtain more than 95% twitch inhibition. Reversal of the mivacurium-induced block by edrophonium (0.01, 0.1, 1, or 10ng/ml) and/or BpChE (0.1 u, or 1.0 u/ml) were tested. A single twitch height more than 75% of the baseline value was considered an adequate reversal. RESULTS: Mivacurium-induced paralysis was recovered more effectively by BpChE 1.0 u/ml than the other groups. Edrophonium improved a single twitch in a dose dependent manner. CONCLUSIONS: Mivacurium-induced paralysis can be more effectively reversed by BpChE than edrophonium. Inhibition of pseudocholinesterase was not observed by increasing the dose of edrophonium.
Animals ; Baths ; Edrophonium* ; Hydrolysis ; Muscle Relaxation ; Neuromuscular Blockade ; Oxygen ; Paralysis* ; Phrenic Nerve ; Plasma ; Pseudocholinesterase* ; Rats ; Rats, Sprague-Dawley ; Thiopental

Electroconvulsive therapy (ECT) is recommended for patients with psychotic disorders that do not respond to medication. Usually, many psychotropic medications have teratogenic effects on the fetus. ECT seems to be a relatively safe and effective treatment during pregnancy. We report here on a 33-year-old primigravida patient in her third trimester receiving ECT.
Adult ; Electroconvulsive Therapy ; Female ; Fetus ; Humans ; Pregnancy ; Pregnancy Trimester, Third ; Psychotic Disorders