We experienced a case of postoperative mental change with seizure after propofol-N2O anesthesia for thoracoscopic sympathectomy. A 23-year-old male patient was anesthetized with N2O-O2-propofol, and postoperative pain control was achieved with intravenous morphine. Bilateral electrocauterization of the upper dorsal sympathetic chain at the T2 and T3 level was performed with thoracoscopy. Thoracoscopy was done with carbon dioxide insufflation. In the postoperative recovery room, the patient experienced seizure, fever and a mental change. He was transferred to the intensive care unit and treated with acyclovir, mannitol, diphenylhydantoin and dexamethasone. Fourteen days after the operation, the patient was discharged with a clear mentality.
Acyclovir ; Anesthesia* ; Carbon Dioxide ; Dexamethasone ; Fever ; Humans ; Insufflation ; Intensive Care Units ; Male ; Mannitol ; Morphine ; Pain, Postoperative ; Phenytoin ; Propofol ; Recovery Room ; Seizures* ; Seizures, Febrile ; Sympathectomy* ; Thoracoscopy ; Young Adult

Neonates undergoing surgery are at higher risk than older children for anesthesia-related adverse events. During the perioperative period, the maintenance of optimal hemodynamics in these patients is challenging and requires a thorough understanding of neonatal physiology and pharmacology. Data from animals and human cohort studies have shown relation of the currently used anesthetics may associate with neurotoxic brain injury that lead to later neurodevelopmental impairment in the developing brain. In this review, the unique neonatal physiologic and pharmacologic features and anesthesia-related neurotoxicity will be discussed.
Anesthesia* ; Anesthetics ; Animals ; Brain ; Brain Injuries ; Child ; Cohort Studies ; Hemodynamics ; Humans ; Infant, Newborn ; Neurotoxicity Syndromes ; Parental Consent ; Perioperative Period ; Pharmacology ; Physiology

No abstract available.
Arthroplasty* ; Knee*

No abstract available.
Arthroplasty* ; Knee*

Surgical excision was performed on a 30-years old woman with a painful mass on her left thigh. The pathologic findings on the mass indicated fibromatosis. After the operation, she complained of allodynia and spontaneous pain at the operation site and ipsilateral lower leg. We treated her based on postoperative femoral neuropathy, but symptom was aggravated. We found a large liposarcoma in her left iliopsoas muscle which compressed the lumbar plexus. In conclusion, the cause of pain was lumbar plexopathy related to a mass in the left iliopsoas muscle. Prompt diagnosis of acute neuropathic pain after an operation is important and management must be based on exact causes.
Female ; Femoral Neuropathy ; Fibroma ; Humans ; Hyperalgesia ; Leg ; Liposarcoma ; Lumbosacral Plexus ; Muscles ; Neuralgia ; Thigh

Sudden hearing loss is a rare complication after general anesthesia.The variety of etiologies and the difficulty in treatment must be a challenge to anesthesiologists.In this patient who was otherwise normal in her right ear, sudden sensorineural hearing loss occurred immediately after general anesthesia.The possible causes of her sensorinerual hearing loss we supposed are the inner ear dysfunction by drilling noise or the pressure change of middle ear cavity or the microvascular circulatory deficiency related to head-rotated position.After steroid, prostaglandin injection and stellate ganglion block therapy, remarkable improvement of hearing was observed.
Anesthesia, General ; Ear ; Ear, Inner ; Ear, Middle ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Mandrillus ; Noise ; Stellate Ganglion

BACKGROUND: Endoscopic thyroidectomy was recently introduced and has been rapidly accepted by surgeons and patients. The present study was conducted to estimate and compare the incidences of postoperative nausea and vomiting (PONV) after endoscopic thyroidectomy using two different anesthetic methods: sevoflurane based balanced anesthesia; total intravenous anesthesia (TIVA). METHODS: Ninety nine female patients that were scheduled to undergo elective endoscopic thyroidectomy under general anesthesia were enrolled. These patients were randomly allocated to receive sevoflurane based balanced anesthesia (BA group) or propofol-remifentanil anesthesia (TIVA group). PONV was evaluated using a 4-point Likert scale, and pain using a visual analogue scale (VAS; range 0 to 100) for 0-2, 2-6, and 6-24 hours postoperatively. At 24 hours postoperatively, overall patient satisfaction regarding PONV and pain were recorded. RESULTS: The incidence of PONV was 14.6% in the TIVA group and 51.3% in the BA group. The incidence of nausea at 0-2 and 2-6 hours postoperatively was lower in the TIVA group than in the BA group (4.2% vs. 35.9%, 6.3% vs. 23.1%, respectively), but no between-group difference was observed at 6-24 hours postoperatively (8.3% vs. 5.1%). Antiemetic usage at 0-2 and 2-6 hours was lower in the TIVA than the BA group (4.2% vs. 38.5%, 6.3% vs. 23.1%), but no between-group difference was observed for 6-24 hours (6.3% vs. 7.7%). There were no differences in pain or in patient satisfaction. CONCLUSIONS: After endoscopic thyroidectomy, total intravenous anesthesia with propofol-remifentanil is associated with less PONV during the early postoperative period (0-6 hours) than sevoflurane based balanced anesthesia.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Balanced Anesthesia ; Female ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Postoperative Period ; Thyroidectomy

BACKGROUND: Postoperative nausea and vomiting (PONV) along with postoperative pain is one of the most frequently encountered complaints after the surgery. The goal of this study is to elucidate the probable high risks factors of PONV by making 24 hr-observations on 4008 patients undergone general anesthesia. METHODS: PONV scores (0: no PONV; 1, nausea; 2, retching; 3, vomiting) and characteristics of patient, surgery, anesthesia were recorded by patient interview and chart review at post anesthesia care unit and at ward 24 hours after operation. Risk factors of PONV were investigated by Odds ratio and P value. Multiple regression analysis was performed to produce the provability of PONV. RESULTS: Incidence of PONV was 26.1% at PACU and 22.9% at ward. Total incidence of PONV during 24 hrs was 39.3. High risk factors of PONV were as follows in decreasing order: 1) female, 2) history of PONV or motion sickness, 3) nonsmoker, 4) operative time of longer than 60 minutes and 5) patient controlled analgesia. P (probability of PONV) = 1/1 + e-Z Z = -1.928 + 0.899 (Gender) + 0.664 (Hx) + 0.558 (OP-duration) + 0.261 (Smoking Status) + 0.184 (Postop-opioid). CONCLUSIONS: We could identify 5 risk factors and developed a Korean PONV risk model enabling to predict the probability of PONV by this study of 4008 patients.
Analgesia, Patient-Controlled ; Anesthesia ; Anesthesia, General ; Female ; Humans ; Incidence ; Motion Sickness ; Nausea ; Odds Ratio ; Operative Time ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Risk Factors*

BACKGROUND: The creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy. METHODS: Sixty patients undergoing laparoscopic colectomy were randomly allocated to one of the two groups: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5). RESULTS: In both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05). CONCLUSIONS: Respiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia.
Anesthesia* ; Colectomy* ; Humans ; Laparoscopy ; Lung Compliance ; Pneumoperitoneum ; Propofol ; Respiratory Mechanics*

BACKGROUND: Coughing is a side effect of opioids that is rarely studied. Here, we evaluated the incidence of remifentanil induced coughing during anesthesia induction in an attempt to identify its risk factors and to examine the preventive effects of lidocaine and salbutamol. METHODS: A total of 237 patients scheduled to undergo general anesthesia were allocated randomly into three groups. Group C received no medication, while Group L received 2% lidocaine at 0.5 mg/kg intravenously 1 minute prior to remifentanil infusion and Group S inhaled one metered aerosol puff of salbutamol 15 minutes prior to entering the operating room. Remifentanil was infused at 5 ng/ml by target controlled infusion and coughing was measured for five minutes and graded as none, mild, moderate, or severe based on the number of coughs. RESULTS: The incidences of coughing were 30.4%, 25.3%, and 35.4% in Groups C, L, and S, respectively. The incidences, onset times, and severity of coughing did not differ significantly among groups. In addition, multivariate analysis showed that non-smoking and a lower body weight were risk factors of remifentanil-induced coughing (odds ratio, 8.13; P = 0.024, 1.11, and 0.004, respectively). CONCLUSIONS: The incidence of remifentanil-induced coughing was 30%. A total of 0.5 mg/kg lidocaine and 1 metered aerosol puff of salbutamol did not prevent coughing. Non-smoking and low body weight were found to be risk factors of remifentanil-induced coughing.
Albuterol ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Body Weight ; Cough ; Humans ; Incidence ; Lidocaine ; Multivariate Analysis ; Operating Rooms ; Piperidines ; Risk Factors