Ganglion impar block is a known useful method of controlling perineal cancer pain. Moreover, this method may be suitable for hyperhidrosis because the visceral cancer pain signal and sweating are transmitted by the same sympathetic chain. We experienced a patients who had suffered from systemic hyperhidrosis especially in the sacral and buttock area. She also had long-standing diabetes mellitus and chronic renal failure. Her excessive sweating occurred during hemodialysis. We treated this patients using a ganglion impar block and achieved a good result.
Buttocks ; Diabetes Mellitus ; Ganglion Cysts* ; Humans ; Hyperhidrosis* ; Kidney Failure, Chronic ; Renal Dialysis* ; Sweat ; Sweating

General anesthesia is the most common method used for operations and volatile anesthetics are commonly used for general anesthesia. Moreover, it is known that the newly developed volatile anesthetics are safe in liver and kidney. However, inorganic fluoride levels increase with anesthetic time and increase the possibility of renal toxicity and repeat a anesthesia in short term period increase the possibility of hepatic failure. We experienced 2 cases who received general anesthesia with volatile anesthetics more than 50 times without any organ failure. Here, we review the anesthetic records and preoperative laboratory findings of each operation.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Fluorides ; Kidney ; Liver ; Liver Failure

Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

Partial airway obstruction is common in anesthesia and has several causes, but total airway obstruction is rare and may result in severe complications if not corrected early. We experienced total airway obstruction of a dependent bronchus by cancer materials during pneumonectomy and removal of these materials with Fogarty and Foley catheters took considerable time. PaCO2 increased to more than 170 mmHg and pH decreased to less than 7 at 1 hour after obstruction. But, no metabolic derangement or neurologic sequelae were observed after the operation.
Airway Obstruction ; Anesthesia ; Bronchi* ; Catheters ; Hydrogen-Ion Concentration ; Pneumonectomy*

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

BACKGROUND: The microRNA (miRNA) pathway has emerged as one of the biologic pathways implicated in stem cell regulation. miRNA is a noncoding, single-stranded RNA consisting of 20-25 nucleotides that inhibits the protein production at the step of translation. The molecular effects of lidocaine and procaine on adipose stem cells were investigated by examining RNA expression array. METHODS: Adipose stem cells were isolated from a prior abdominal liposuction procedure. The human adipose stem cells were cultured and then added to a mixture of 1 ml of culture medium plus 1 ml of 2% lidocaine or 2% procaine for the duration of 30 minutes. The expression levels of miRNAs were estimated by using peptide nucleic acid (PNA)-miRNA array analysis throughout the denaturation and hybridization processes after the isolation of miRNA. The miRNAs detected by microarray that either decreased by half fold or increased by 1.5 fold from the control level were interpreted as significant. RESULTS: According to microarray analysis there were 61 miRNAs in total, and no miRNA had decreased expression levels. The stem cells treatment with lidocaine showed 4 alteration of expression with miR-9a* (1.53 fold), miR-29a (1.64 fold), miR-296-5p (1.64 fold) and miR-373 (1.94 fold). The stem cells treated with procaine showed 32 miRNAs that were significantly up-regulated with a range of 1.5 to 2.06 fold. They were stem cell differentiation-related miRNAs, apoptosis and cell cycle-associated miRNAs, immunity-associated miRNAs and hormonal response-related miRNAs. CONCLUSIONS: Lidocaine and procaine affect the miRNA expression on adipose stem cells and the effect of procaine is more marked than that of lidocaine.
Adult ; Adult Stem Cells ; Apoptosis ; Chimera ; Humans ; Lidocaine ; Lipectomy ; Microarray Analysis ; MicroRNAs ; Nucleotides ; Procaine ; RNA ; Stem Cells

BACKGROUND: The microRNA (miRNA) pathway has emerged as one of the biologic pathways implicated in stem cell regulation. miRNA is a noncoding, single-stranded RNA consisting of 20-25 nucleotides that inhibits the protein production at the step of translation. The molecular effects of lidocaine and procaine on adipose stem cells were investigated by examining RNA expression array. METHODS: Adipose stem cells were isolated from a prior abdominal liposuction procedure. The human adipose stem cells were cultured and then added to a mixture of 1 ml of culture medium plus 1 ml of 2% lidocaine or 2% procaine for the duration of 30 minutes. The expression levels of miRNAs were estimated by using peptide nucleic acid (PNA)-miRNA array analysis throughout the denaturation and hybridization processes after the isolation of miRNA. The miRNAs detected by microarray that either decreased by half fold or increased by 1.5 fold from the control level were interpreted as significant. RESULTS: According to microarray analysis there were 61 miRNAs in total, and no miRNA had decreased expression levels. The stem cells treatment with lidocaine showed 4 alteration of expression with miR-9a* (1.53 fold), miR-29a (1.64 fold), miR-296-5p (1.64 fold) and miR-373 (1.94 fold). The stem cells treated with procaine showed 32 miRNAs that were significantly up-regulated with a range of 1.5 to 2.06 fold. They were stem cell differentiation-related miRNAs, apoptosis and cell cycle-associated miRNAs, immunity-associated miRNAs and hormonal response-related miRNAs. CONCLUSIONS: Lidocaine and procaine affect the miRNA expression on adipose stem cells and the effect of procaine is more marked than that of lidocaine.
Adult ; Adult Stem Cells ; Apoptosis ; Chimera ; Humans ; Lidocaine ; Lipectomy ; Microarray Analysis ; MicroRNAs ; Nucleotides ; Procaine ; RNA ; Stem Cells

BACKGROUND: At present, epidural steroid injection is one of the most frequently used methods in the treatment for low back pain.. But this method is nonspecific and results in a widespread of injected agent around the target point. Therefore we thought direct injection to the nerve root is more specific and effective. METHODS: The authors evaluated the effects of lumbar paravertebral steroid injection in 39 patients with low back pain and radicular pain, retrospectively. We used triamcinolone 40mg(1ml) and 0.25% bupivacaine 3ml as injection agents and used pain relief scale(PRS) score for assessment of the effect. RESULTS: One week after injection, the patients of PRS score less than 5 were 65% in spinal stenosis and 85% in herniated intervertebral disc(HIVD). The patients of effective response more than 4 weeks after injection were 48% in spinal stenosis and 68% in HIVD, more than 12 weeks were 22% and 38%, respectively. The patients of PRS score less than 5 were 45% at the time of follow-up study. CONCLUSIONS: We think paravertebral steroid injection is effective in patients with low back pain and radicular pain. Therefore, this technique could be alternative method to epidural steroid injection.
Bupivacaine ; Follow-Up Studies ; Humans ; Low Back Pain* ; Retrospective Studies ; Spinal Nerve Roots* ; Spinal Nerves* ; Spinal Stenosis* ; Triamcinolone

BACKGROUND: Preemptive analgesia may prevent nociceptive input generated during surgery from sensitizing central neurons and, therefore, may reduce postoperative pain. The purpose of this study is to examine the effect of epidural fentanyl between preincisional (preemptive) and postincisional groups on postoperative morphine requirements. METHODS: Sixty patients (ASA physical status 1 or 2) scheduled for elective total abdominal hysterectomy under general anesthesia were allocated randomly to one of two groups and prospectively studied in a double-blind manner. Group 1 received epidural fentanyl(2 g/kg in 15 ml normal saline) before surgical incision followed by epidural normal saline (15 ml) 15 minutes after skin incision. Group 2 received epidural normal saline(15 ml) before surgical incision followed by epidural fentanyl(2 g/kg in 15 ml normal saline) 15 minutes after skin incision. No additional analgesics were used before or during the operation. Postoperative visual analogue pain scores, PCA morphine requirements and side effects were assessed. RESULTS: Postoperative PCA morphine requirements in preincisional group were significantly less (p<0.05) than those in postincisional group between 6 and 24 hours postoperatively. VAPS was also significantly less (p<0.05) in preemptive group than in postincisional group 12 hours after surgery. CONCLUSIONS: Preemptive analgesia with epidural fentanyl is more effective in reducing the postoperative morphine requirements and VAPS than analgesia with postincisional epidural fentanyl in patients with total abdominal hysterectomy.
Analgesia ; Analgesics ; Anesthesia, General ; Fentanyl* ; Humans ; Hysterectomy ; Morphine ; Neurons ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Prospective Studies ; Skin

Cerebral autoregulation is the mainternance of a constant cerebral blood flow over a wide range of cerebral perfusion pressure. But irreversible hypoxic brain damage may occur as a consequence of such diverse conditions as lung and heart disease, shock, seizure or an episode of severe hypotension, and is potential hazard to any patient undergoing general anesthesia. The ultimate degree of neurological recovery may range from brain death and vegetative state to minor psychiatric disturbance and even normality, and is determined by the severity of the initial stress and wheather or not adequate resuscitation was commenced before irreversible brain damage. We performed an experiment to determine the protective effect of the calcium channel blocker nimodipine on the neuronal injury following cerebral ischemia in a rat model. The result were as follows: 1) Mean arterial pressure decreased more significantly in the nimodipine-treated group than the saline-treated group (p<0.01). 2) With respect to the degree of neuronal damage following cerebral ischemia, it decreased more significantly in the nimodipine-treated group than the saline-treated group (p<0.01).
Anesthesia, General ; Arterial Pressure ; Brain ; Brain Death ; Brain Ischemia* ; Calcium Channels ; Heart Diseases ; Homeostasis ; Humans ; Hypotension ; Hypoxia, Brain ; Lung ; Models, Animal ; Neurons* ; Nimodipine* ; Perfusion ; Persistent Vegetative State ; Resuscitation ; Seizures ; Shock