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

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

No abstract available.
Arthroplasty* ; Knee*

No abstract available.
Arthroplasty* ; Knee*

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

BACKGROUND: Endovascular stent graft placement is a useful treatment option in lesions of the thoracic aorta. The aim of this study was to assess the possibility of sedation with dexmedetomidine compared with general anesthesia in patients undergoing thoracic endovascular aortic repair (TEVAR) in a multi-center clinical trial. METHODS: Data from 38 patients with thoracic aorta lesions treated by TEVAR between April 2010 and November 2013 were retrospectively collected at two hospitals. General anesthesia or sedation with dexmedetomidine was determined according to the hospital. Demographics, anesthetic recordings, and complications were reviewed. RESULTS: Stent graft placement was technically successful in all patients. There were no events during the anesthetic period. A total of 38 patients underwent TEVAR; 29 patients received general anesthesia, and 9 received sedation. Dexmedetomidine sedation (loading dose: 0.5-1.0 microg/kg for 10 min, maintenance: 0.2-0.8 microg/kg/h) was successfully performed without anesthesia-related complications or mortality. During the procedure, mean arterial pressure, heart rate, and saturation of peripheral oxygen were not statistically different between general anesthesia and dexmedetomidine sedation. CONCLUSIONS: In our study, TEVAR under sedation with dexmedetomidine was shown to be a feasible procedure that was well tolerated without specific complications.
Anesthesia, General* ; Aorta, Thoracic ; Arterial Pressure ; Blood Vessel Prosthesis ; Demography ; Dexmedetomidine* ; Heart Rate ; Humans ; Mortality ; Oxygen ; Retrospective Studies*

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*

Small bowel transplantation is becoming the treatment of choice for short-gut syndrome. Improvements in surgical techniques, immunosuppressants, and anesthetic management of patients have allowed this procedure to become the standard of treatment for patients who are unable to continue total parenteral nutrition (TPN) therapy due to TPN-associated complications. We experienced small bowel transplantation in a 10-month-old male infant who had small bowel resection for small bowel volvulus and has suffered from complications such as recurrent sepsis, disseminated intravascular coagulation (DIC) due to long-term TPN. We report our experience with a brief review of the relevant literature.
Disseminated Intravascular Coagulation ; Humans ; Immunosuppressive Agents ; Infant* ; Intestinal Volvulus ; Male ; Parenteral Nutrition, Total ; Sepsis

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

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.
Adolescent ; Atenolol ; Blood Pressure ; Catecholamines ; Cerebral Hemorrhage ; Dexmedetomidine ; Hemodynamics ; Humans ; Hypotension ; Losartan ; Nicardipine ; Nitroprusside ; Pheochromocytoma ; Piperidines ; Piracetam ; Prazosin ; Propanolamines ; Seizures ; Trachea