BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

The occurrence of CRPS after a snake bite was very rare, only two cases were reported worldwide. Here we report a case that the 44-year-old female patient bitten by snakes CRPS type 1 was treated consecutive intravenous regional block, lumbar sympathectomy and antiepileptic drug therapy, also discuss the possible pathophysiology.
Adult ; Drug Therapy ; Female ; Humans ; Snake Bites* ; Snakes* ; Sympathectomy

BACKGROUND: One of the difficulties we have in the management of anesthesia for the optimal liver transplantation is involved in coagulopathy. The purpose of this paper is to observe and investigate the variation of the heparin effects occurred before and after the fulfillment of reperfusion done in terms of native thromboelastogram (nTEG) or heparinase-guided Thromboelastogram (hgTEG). METHODS: In 134 patients who had a living related liver transplantation, by grouping them into four according to the presence or the absence of heparin effects, we are to observethe effects on the quantity of transfusion which each group shows and clinical variables like CTP score, UNOS classification, PT, and preoperative platelet count. RESULTS: It is found that 54 out of 134 patients (40.3%) had heparin effects before the reperfusion, while 101 (75.4%) had the effects after the reperfusion to the grafted liver. It is showed that there was no significant difference in a comparison between groups involved with packed red blood cell transfused, fresh frozen plasma, platelet concentrates, fluid by RIS. In the comparison between groups involved in clinical factors, it is disclosed that although there was no significant difference in four factors, that is, CTP score, UNOS classification, PT, and preoperative platelet count. CONCLUSIONS: We can confirm that the occurrence of heparin effect after reperfusion is remarkably increasing compared to that of heparin effect before reperfusion. Also, it can be reported that heparin effects can occur frequently during liver transplantation, but they have no direct relation to transfusion.
Anesthesia ; Blood Platelets ; Classification ; Cytidine Triphosphate ; Erythrocytes ; Heparin* ; Humans ; Liver Transplantation* ; Liver* ; Plasma ; Platelet Count ; Reperfusion* ; Transplants

BACKGROUND: Herpes Zoster is a disease that occurs after the virus is reactivated due to infection of the varicella virus in childhood. Risk factors are advanced age, malignant neoplasm, organ transplantation, immunosuppressive agents taking are known. The purpose of this study was to investigate the relationship between the seasonal effect and other risk factors on the incidence of herpes zoster. METHODS: The medical records of 1,105 patients admitted to the outpatient diagnosed with herpes zoster were retrospectively examined. The patients' sex, age, dermatome, onset, underlying disease, residential areas were collected. RESULTS: The incidence of women outnumbered men and increased for those above the age of 50. The number of occurrences of herpes zoster patients was higher in the spring and summer than in winter. Unlike men, women had the most frequent outbreaks in March. The most common occurrence of dermatome is in the thoracic region. The number of occurrence was similar on the left as the right. CONCLUSIONS: In this study, herpes zoster occurs more often in women than in men and more frequently occurs in women in the spring and summer.
Chickenpox ; Chungcheongnam-do ; Disease Outbreaks ; Epidemiologic Studies* ; Epidemiology ; Female ; Herpes Zoster* ; Humans ; Immunosuppressive Agents ; Incidence* ; Male ; Medical Records ; Organ Transplantation ; Outpatients ; Retrospective Studies ; Risk Factors ; Seasons ; Transplants

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver ; Veins

Benign metastatic leiomyomatosis (BML) is a rare disease characterized by smooth muscle cell proliferation in extrauterine sites including the lung, abdomen, pelvis, and retroperitoneum. Depending on location, BML is classified as intravenous leiomyomatosis and diffuse peritoneal leiomyomatosis. Pathogenesis of BML can be iatrogenic after previous myomectomy or hysterectomy, hormonal, or coelomic metaplasia. Treatment options are observation, hormonal suppression, and/or surgical debulking via laparotomy or laparoscopy. Laparoscopic surgery is gaining in popularity in the gynecologic field compared to laparotomic surgery and single-port laparoscopy has the benefits of cosmesis and early tissue extraction by transumbilical morcellation. We report a 39-year-old woman with BML who underwent single-port laparoscopy debulking surgery.
Abdomen ; Adult ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Laparotomy ; Leiomyomatosis* ; Lung ; Metaplasia ; Myocytes, Smooth Muscle ; Pelvis ; Rare Diseases

BACKGROUND: Many pieces of previous research on measuring blood pressure (BP) using different methods focused on the disparity in the results. However, none of them dealt with the disparity caused by the difference in age and inhalation anesthetics. We attempted to find the variance in accordance with age, body part, and measuring methods (invasive vs noninvasive) and also studied how sevoflurane influences BP as the operation progresses. METHODS: In sixty patients, we measured the arterial BP in the upper and lower limbs by noninvasive methods before inducing anesthesia. After induction, we used sevoflurane to maintain anesthesia, and injected catheters into the radial artery and dorsalis pedis artery to measure arterial pressure at every ten minute by both invasive and noninvasive methods. RESULTS: The patients who were 40 or older showed significantly higher values in the systolic BP than the patients younger than 40. The values of systolic and diastolic BP measured by a noninvasive oscillometric method were meaningfully higher than those measured by an invasive method. As the operations progressed, the lower limbs showed higher systolic pressure than the upper limbs regardless of measuring methods, whereas the opposite is true for diastolic pressure. CONCLUSIONS: The values in the arterial BP were measured high by noninvasive method. Systolic BP were estimated significantly high in the older patients and in the lower leg. Due to the effect of sevoflurane, the diastolic BP in the lower limbs becomes lower than that of upper limbs regardless of measuring methods, as the operation progresses.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Arterial Pressure ; Arteries ; Blood Pressure ; Catheters ; Humans ; Leg ; Lower Extremity ; Methyl Ethers ; Radial Artery ; Upper Extremity

BACKGROUND: Intravenous palonosetron-HCl, a second-generation antagonist of selective serotonin type 3 (5-HT3) receptors, can prevent chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV). 5-HT3 receptors are abundant in the lower brainstem and the substantia gelatinosa of the spinal cord, which provides a theoretical rationale for neuraxial administration of 5-HT3 receptor antagonists for CINV, PONV, and opioid-induced nausea and vomiting. However, there are no reports of neuraxial administration of palonosetron-HCl. Before neuraxial administration of a drug is accepted for clinical use, its safety must be proven. This study was conducted to determine whether neuraxial administration of palonosetron-HCl produces neurologic injury. METHODS: Male Sprague-Dawley rats under general anesthesia were catheterized intrathecally and the catheter tip was advanced caudally to the L1 vertebra. After 7 days, 20 µl of normal saline (N group, n = 6) or 20 µl (1 µg) of palonosetron-HCl (P group, n = 6) were injected intrathecally once per day for 2 weeks. Neurotoxic changes were evaluated by light microscopy (LM) and electron microscopy (EM) of the spinal cord. Behavioral changes were also evaluated in both groups. RESULTS: One of the N group rats and three of the P group rats demonstrated abnormal behavior during intrathecal drug injection, but otherwise their behavior was normal. The spinal cords of the N group did not have any abnormal findings by LM or EM. The spinal cords of the P group had multiple vacuoles in the white matter by LM, especially in the dorsal funiculus, and EM revealed myelin, axonal, and mitochondrial swelling. CONCLUSIONS: Results suggest that chronic intrathecal administration of palonosetron-HCl produced microscopic morphologic changes in the spinal cords of rats.
Anesthesia, General ; Animals ; Axons ; Brain Stem ; Catheters ; Humans ; Injections, Spinal ; Male ; Microscopy ; Microscopy, Electron ; Mitochondrial Swelling ; Myelin Sheath ; Nausea ; Postoperative Nausea and Vomiting ; Rats* ; Rats, Sprague-Dawley ; Receptors, Serotonin, 5-HT3 ; Serotonin ; Spinal Cord* ; Spine ; Substantia Gelatinosa ; Vacuoles ; Vomiting ; White Matter

BACKGROUND: The Masimo Radical 7 (Masimo Corp., Irvine, CA, USA) pulse co-oximeter(R) noninvasively determines the hemoglobin concentration using the principle of transcutaneous spectrophotometry. We compared hemoglobin levels determined using this device (SpHb) with those determined using an invasive laboratory-based technique (tHb) during spinal anesthesia. METHODS: Thirty patients received spinal anesthesia with 0.5% hyperbaric bupivacaine. The pulse co-oximeter probe was mounted on the second toe, and arterial blood samples were obtained from a radial artery catheter. SpHb, tHb, and perfusion index (PI) values were recorded before and 20 and 40 min after intrathecal injection of bupivacaine. RESULTS: Before spinal anesthesia, the SpHb and tHb showed a significant difference of -2.86 +/- 1.56 g/dl (P < 0.005), but no significant differences were found between tHb and SpHb at 20 and 40 min after spinal anesthesia (-0.16 +/- 2.45 g/dl and 0.29 +/- 2.68 g/dl). Additionally, PI was significantly increased at 20 and 40 min after spinal anesthesia compared to the pre-anesthetic value (P < 0.001). CONCLUSIONS: The toe is not the monitoring site for pulse co-oximetry in adult patients, but the pulse co-oximetry on the toe appears to be appropriate as a noninvasive hemoglobin monitoring device after spinal anesthesia.
Adult ; Anesthesia, Spinal* ; Bupivacaine ; Catheters ; Humans ; Injections, Spinal ; Perfusion ; Radial Artery ; Spectrophotometry ; Toes

BACKGROUND: The popularity and the demand for Nuss procedure have increased dramatically. Many pediatric surgeons became familiarized with Nuss procedure and have applied it to a large number of patients. But the intraoperative and the postoperative complications have not been defined yet. METHODS: 630 patients, who underwent the Nuss procedure between August 1999 and December 2006, were studied retrospectively. Risk factors and complications were obtained from chart review and anesthesia records, and analyzed statistically. RESULTS: Complication rates were 127/630 (20.1%) in total patients. Frequent complications were arrhythmia 37 (5.8%), pneumothorax 29 (4.6%), pleural effusion 15 (2.4%), wound infection 14 (2.2%), bar displacement 13 (2%) and pericarditis 9 (1.3%) in order. Resk factors are severity of pectus excavatum and lack of surgeon's experience (P < 0.05). CONCLUSIONS: Nuss procedure has evolved into an effective method of pectus excavatum repair. To reduce the complications, there must be precise preoperative assessment of computed tomography index (CTI) and intensive postoperative management in the operative day.
Anesthesia ; Arrhythmias, Cardiac ; Displacement (Psychology) ; Funnel Chest ; Humans ; Pericarditis ; Pleural Effusion ; Pneumothorax ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Wound Infection