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

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

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

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

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: 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: Inhalation anesthetics are an important factor for postoperative hepatic and renal dysfunction. In this regard, TIVA can reduce the risk of hepatic and renal dysfunction inherited to inhalation anesthetics. The present study was conducted to determine whether hepatic and renal functions differ after anesthesia with sevoflurane and propofol. METHODS: Two hundred patients, ASA physical status class I, II, scheduled for an elective thyroidectomy were randomly divided into two groups. Anesthesia was maintained with sevoflurane 1-2% and remifentanil in the sevoflurane group (Group S) and propofol 2-5 ug/ml and remifentanil 2-5 ng/ml at the effect site, using a target controlled infusion (TCI) pump in the TIVA group (Group T) to maintain BIS of 40-60. To evaluate the hepatic and renal function, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were tested at preoperation (baseline), postoperative 1 day and 3 days. RESULTS: AST was increased at postoperative 1 day and 3 days, compared with that of the preoperation in Group S, and postoperative 1 day in Group T, but the values were within its normal limit. ALT was not changed after anesthesia in both groups. BUN was increased at postoperative 1 day, compared with that of the preoperation in Group S, but the value was within its normal limit. Creatinine was not changed after anesthesia in both groups. CONCLUSIONS: The changes of hepatic and renal function after inhalation anesthesia with sevoflurane and TIVA with propofol and remifentanil for thyroidectomy were clinically insignificant, and there was no difference between the two methods.
Alanine Transaminase ; Anesthesia ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Creatinine ; Humans ; Inhalation ; Methyl Ethers ; Piperidines ; Propofol ; Thyroidectomy

Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler's position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV).
Arm ; Brain ; Catheters ; Cavernous Sinus ; Central Venous Catheters ; Cerebral Infarction ; Consciousness ; Diffusion ; Embolism, Air ; Facial Paralysis ; Humans ; Hyperbaric Oxygenation ; Intensive Care Units ; Intracranial Embolism ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Neurologic Examination ; Paralysis ; Pneumonia ; Seizures ; Valsalva Maneuver ; Ventilation

BACKGROUND: Postoperative nausea and vomiting (PONV) after thyroidectomy in women is especially frequent. Ramosetron and dexamethasone prevent cancer chemotherapy-related nausea and vomiting- and PONV. METHODS: Ninety three women undergoing thyroidectomy under general anesthesia with sevoflurane and remifentanil were allocated to one of three groups: Control (n = 30), ramosetron (Group R, n = 30), ramosetron with dexamethasone (Group RD, n = 33). Doses of ramosetron (0.1 mg) oral tablet by oral route and intravenous dexamethasone (5 mg) were used. The incidence and severity of PONV, and postoperative blood glucose level in each group were studied. RESULTS: The incidence of PONV in the control and R and RD groups were 43%, 20%, and 18% respectively. The incidence and severity of PONV were similar in the R and the RD groups. Blood glucose levels postoperatively were higher in RD group compared with control and R groups. CONCLUSIONS: Oral ramosetron reduced the incidence of postoperative nausea. The combination of ramosetron and dexamethasone increased postoperative blood glucose levels significantly without additional effect on PONV.
Anesthesia, General ; Antiemetics ; Benzimidazoles ; Blood Glucose ; Dexamethasone ; Female ; Glucose ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Piperidines ; Postoperative Nausea and Vomiting ; Thyroidectomy