No abstract available.
Hemodynamics

BACKGROUND: Recently developed taper-shaped cuffs (TG cuffs) of endotracheal tubes (ETTs) are known to have a more potent sealing effect than cylindrical high-volume low-pressure cuffs (HL cuffs) of conventional ETTs. The aim of this study was to compare TG cuffs with HL cuffs of ETTs in a bench-top model with regard to air leakage under various positive end-expiratory pressures (PEEP). METHODS: HL cuffs and TG cuffs made from PVC were included (HL group vs. TG group). A model trachea with an internal diameter (ID) of 22 mm was attached to a test lung. The test lung was ventilated using an anesthesia respirator with volume controlled mode and PEEPs of 0, 5, 10, or 15 cm H2O. Using spirometry, percentages of expired to inspired tidal volumes (TVe/i) were calculated as a measure of air leakage. RESULTS: With regard to PEEPs, the HL group showed significantly higher air leakage compared to the TG group (p < 0.0001), and a higher PEEP resulted in greater air leakage (p < 0.0001). Air leakage with higher PEEP was greater in the HL group than in the TG group at ID 7.0 mm and 7.5 mm (p = 0.0467, p = 0.0045). CONCLUSIONS: This study shows the superior sealing ability of the TG cuff during ventilation at various PEEPs.
Anesthesia ; Equipment Design ; Intubation, Intratracheal ; Lung ; Positive-Pressure Respiration* ; Spirometry ; Tidal Volume ; Trachea ; Ventilation ; Ventilators, Mechanical

PURPOSE: To report a case of immunoglobulin G4 (IgG4)-related ophthalmic disease associated with adult xanthogranulomatous disease. CASE SUMMARY: A 38-year-old male with a history of cholecystectomy visited our clinic for bilateral periorbital swelling. Histopathology of the orbital biopsy showed diffuse infiltration of foamy histiocytes with Touton giant cells and lymphoid follicles, with a diagnosis of adult-onset xanthogranuloma. After excisional biopsy, he was treated with azathioprine and prednisolone. Four years after treatment, he again visited the clinic due to bilateral, yellowish eyelid masses. Serological examinations were all nonspecific findings, except for elevation of IgG and IgG4 levels. Magnetic resonance imaging showed bilateral symmetric soft tissue enlargement with slightly heterogeneous T1/T2 isosignal intensity, with contrast enhancement at the superolateral aspect of extraconal spaces. Excisional biopsy and blepharoplasty were performed. Immunohistochemical sections showed that the IgG4+/IgG plasma cell ratio was 10–20% and the IgG4 plasma cell count was 22/high power field (HPF). His past sections of 2013 from the pathology department were again stained and showed that the IgG4+/IgG plasma cell ratio was 40–50% and the IgG4 plasma cell count was 59/HPF. Thus, he was definitely diagnosed with IgG4-related ophthalmic disease. CONCLUSIONS: If there is recurrent eyelid swelling, IgG4-related ophthalmic disease should be considered as a differential diagnosis. And the patient with adult xanthogranulomatous disease can be diagnosed with IgG4-related ophthalmic disease.
Adult ; Azathioprine ; Biopsy ; Blepharoplasty ; Cholecystectomy ; Diagnosis ; Diagnosis, Differential ; Eyelids ; Giant Cells ; Histiocytes ; Humans ; Immunoglobulin G ; Immunoglobulins ; Magnetic Resonance Imaging ; Male ; Orbit ; Pathology ; Plasma Cells ; Prednisolone

BACKGROUND: The regional cerebral oxygen saturation (rSO2) decreases significantly during ordinary anesthetic recovery in pediatric patients anesthetized with sevoflurane or desflurane. The present study examined the relationship between rSO2 and the clinical parameters associated with the degree of anesthetic recovery. METHODS: Twelve pediatric patients with American Society of Anesthesiologists physical status 1 were assigned randomly to receive anesthesia with sevoflurane or desflurane. All children underwent general anesthesia for minor surgery. After surgery, the rSO2, the age-adjusted MAC fraction of anesthetic concentration (F(E)), and the bispectral index (BIS) were recorded over a 10-minute period. The correlations between rSO2 and candidate predictors, such as F(E), BIS, anesthetic, and duration of anesthesia, were analyzed. RESULTS: All children recovered uneventfully. The lowest observed rSO2 reached 63% and the maximum decrease in rSO2 was 24%. The mean blood pressure and heart rate were maintained within clinical ranges. The decrease in rSO2 correlated positively with the F(E) (r = 0.25, P = 0.00) and the duration of anesthesia (r = 0.24, P = 0.01), and inversely with the use of sevoflurane (r = -0.30, P = 0.00). CONCLUSIONS: Despite normal parameters, cerebral desaturation occurred during the emergence of ordinary general anesthesia even without hemodynamic compromise or arterial desaturation. Cerebral desaturation might be associated with the degree of anesthetic recovery and the use of sevoflurane.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Child ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane ; Methyl Ethers ; Oxygen ; Pediatrics ; Surgical Procedures, Minor

Arteriovenous fistula (AVF) involving the inferior mesenteric artery and vein is very rare with only 33 cases described in the literature and may be of congenital or acquired (iatrogenic or traumatic) or idiopathic etiology. The pathophysiology of AVF that acts as a left-to-right shunt has accounted for clinical signs and symptoms associated with ischemic colitis, portal hypertension, and heart failure. A low incidence and nonspecific clinical signs and symptoms such as abdominal pain, thrill and mass, lower and upper gastrointestinal bleeding make it difficult to establish a diagnosis of inferior mesenteric AVF. Diagnosis of inferior mesenteric AVF is usually established by radiological or intraoperative examination. We report a case of idiopathic inferior mesenteric AVF causing ischemic colitis in a 56-year-old man that was diagnosed preoperatively by multidetector computed tomography and angiography and successfully treated by surgical resection.
Abdominal Pain ; Angiography ; Arteriovenous Fistula* ; Colitis, Ischemic ; Diagnosis ; Heart Failure ; Hemorrhage ; Humans ; Hypertension, Portal ; Incidence ; Mesenteric Artery, Inferior ; Middle Aged ; Multidetector Computed Tomography ; Veins

BACKGROUND: The aim of the present study was to determine the effect-site concentration of remifentanil needed to prevent haemodynamic instability during tracheal intubation with inhaled desflurane induction. METHODS: One hundred American Society of Anesthesiologists I and II female patients were randomized to receive an effect-site concentration of remifentanil of 0, 1, 2, 3, or 4 ng/ml. Induction of anaesthesia was started with intravenous injection of propofol 2 mg/kg. Ninety seconds after the completion of propofol injection, rocuronium (0.8 mg/kg) and remifentanil were administered simultaneously with 3% desflurane inhalation. Tracheal intubation was attempted 150 sec after the commencement of remifentanil administration. RESULTS: A probit model of remifentanil concentration was predictive of successful intubation without development of hypertension (P for goodness-of-fit = 0.419). The effect-site concentration of remifentanil needed to achieve successful intubation without development of hypertension in 95% of the patients was 3.3 ng/ml (95% confidence interval, 2.6-4.8 ng/ml). CONCLUSIONS: The effect-site concentration of remifentanil of 3.3 ng/ml is effective in blunting the haemodynamic response in 95% of the patients when 2.0 mg/kg of propofol induction was followed by 3% desflurane inhalation.
Androstanols ; Female ; Humans ; Hypertension ; Inhalation ; Injections, Intravenous ; Intubation ; Isoflurane ; Piperidines ; Propofol

BACKGROUND: Postoperative nausea and vomiting (PONV) remains a common complication of anesthesia. We tried to assess the amount patients were willing to pay for a hypothetical antiemetic that would completely prevent PONV. METHODS: Trained residents interviewed 86 patients, who were scheduled to undergo general anesthesia, and questionnaires were completed. RESULTS: Patients were willing to pay a median of 30,000 won for an antiemetic that would completely prevent PONV. The amounts patients were willing to pay correlated with age, previous history of PONV, and patient income. CONCLUSIONS: Patients assigned a value for avoidance of PONV. It is suggested that more efforts to prevent PONV would be helpful for the increase in patient satisfaction.
Anesthesia ; Anesthesia, General ; Humans ; Patient Satisfaction ; Postoperative Nausea and Vomiting

BACKGROUND: Journal editors have exercised their control over submitted papers having a high similarity index. Despite widespread suspicion of possible plagiarism on a high similarity index, our study focused on the real effect of the similarity index on the value of a scientific paper. METHODS: This research examined the percent values of the similarity index from 978 submitted (420 published) papers in the Korean Journal of Anesthesiology since 2012. Thus, this study aimed to identify the correlation between the similarity index and the value of a paper. The value of a paper was evaluated in two distinct phases (during a peer-review process vs. after publication), and the value of a published paper was evaluated in two aspects (academic citation vs. social media appearance). RESULTS: Yearly mean values of the similarity index ranged from 16% to 19%. There were 254 papers cited at least once and 179 papers appearing at least once in social media. The similarity index affected the acceptance/rejection of a paper in various ways; although the influence was not linear and the cutoff measures were distinctive among the types of papers, both extremes were related to a high rate of rejection. After publication, the similarity index had no effect on academic citation or social media appearance according to the paper. CONCLUSIONS: The finding suggested that the similarity index no longer had an influence on academic citation or social media appearance according to the paper after publication, while the similarity index affected the acceptance/rejection of a submitted paper. Proofreading and intervention for finalizing the draft by the editors might play a role in achieving uniform quality of the publication.
Anesthesiology ; Bibliometrics ; Literature Based Discovery ; Peer Review ; Plagiarism ; Publications ; Social Media

BACKGROUND: To determine if positive pressure pneumoperitoneum has adverse effects on autonomic nervous system function, we examined baroreflex sensitivity (BRS) during carbon dioxide pneumoperitoneum in patients undergoing laparoscopic surgery. METHODS: Twenty adult patients scheduled for laparoscopic gynecologic surgery were selected for the study. After general anesthesia was induced with sevoflurane, continuous electrocardiography and blood pressure were monitored. Spontaneous BRS was achieved using sequence method immediately before, and 5 minutes after, pneumoperitoneum. Heart rate variability (HRV) was also determined. RESULTS: After pneumoperitoneum, BRS decreased from 12.9 +/- 1.8 ms/mmHg to 8.1 +/- 1.1 ms/mmHg (P < 0.05), and the power of the high frequency band decreased from 237.8 ms2/Hz to 49.6 ms2/Hz (P < 0.05). CONCLUSIONS: Compared to recordings obtained before pneumoperitoneum, BRS was decreased during pneumoperitoneum. This may predispose patients undergoing laparoscopic surgery to hemodynamic instability in addition to pneumoperitoneum itself.
Adult ; Anesthesia, General ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Carbon ; Carbon Dioxide ; Electrocardiography ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy ; Methyl Ethers ; Pneumoperitoneum

While arthroscopic shoulder surgery is considered relatively safe, complications have been reported.Though rare, pneumothorax has been reported in patients undergoing arthroscopic shoulder surgery.Tension pneumothorax must be immediately recognized and treated due to its potentially life threatening consequences.The authors present a case of a patient who developed tension pneumothorax after arthroscopic shoulder surgery, and its anesthetic managements.
Humans ; Pneumothorax ; Shoulder