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*

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: There are several advantages of low flow anesthesia including safety, economics, and eco-friendliness. However, oxygen concentration of fresh gas flow and inspired gas are large different in low flow anesthesia. This is a hurdle to access to low flow anesthesia. In this study, we aimed to investigate the change in inhaled oxygen concentration in low flow anesthesia using oxygen and medical air. Methods: A total of 60 patients scheduled for elective surgery with an American Society of Anesthesiologist physical status I or II were enrolled and randomly allocated into two groups. Group H: Fresh gas flow rate (FGF) 4 L/min (FiO₂ 0.5). Group L: FGF 1 L/min (FiO₂ 0.5). FGF was applied 4 L/min in initial phase (10 min) after intubation. After initial phase FGF was adjusted according to groups. FGF continued at the end of surgery. Oxygen and inhalation anesthetic gas concentration were recorded for 180 min at 15 min interval. Results: The inspired oxygen concentration decreased by 5.5% during the first 15 min in the group L. Inspired oxygen decreased by 1.5% during next 15 min. Inspired oxygen decreased by 1.4% for 30 to 60 min. The inspired oxygen of group L is 35.4 ± 4.0% in 180 min. The group H had little difference in inspired oxygen concentration over time and decreased by 1.8% for 180 min. Conclusions The inspired oxygen concentration is maintained at 30% or more for 180 min in patients under 90 kg. Despite some technical difficulties, low flow anesthesia may be considered.

BACKGROUND: It is well known that opioids induce coughing. Many drugs such as lidocaine and ketamine are used to effectively prevent the coughing induced by opioids and this has been revealed to be effective. In this study, we evaluated the preventive effect of a graded escalation of the remifentanil concentration using a target controlled infusion pump and we compared this with the effect of lidocaine. METHODS: One hundred fifty ASA I and II patients who were scheduled for elective surgery were randomly divided into 3 groups. The patients were pretreated with 2% lidocaine 1 mg/kg (Group L) or saline (Group S) and remifentanil infusion (an effect site concentration of 4.0 ng/ml) was followed 1 minute later by using a target controlled infusion pump. Group R was pretreated with saline and this was followed by remifentanil infusion (effect site concentration of 2.0 ng/ml at first and then it was reset to 4.0 ng/ml). We evaluated the incidence, severity and onset time of cough after remifentanil infusion. RESULTS: The incidence of coughing was significantly decreased in Group R (6 cases, 12%) and Group L (7 cases, 14%), as compared to that of Group S (17 cases, 34%) (P < 0.05), but there was no significant difference between Group R and Group L. The groups showed no significant difference in the severity and the onset time of coughing. CONCLUSIONS: This study demonstrated that administering graded escalation of the remifentanil concentration suppresses remifentanil-induced coughing as effectively as lidocaine 1 mg/kg pretreatment.
Analgesics, Opioid ; Cough ; Humans ; Incidence ; Infusion Pumps ; Ketamine ; Lidocaine ; Piperidines

BACKGROUND: Many disinfectants have been used clinically in both single and combination applications, but there have been few studies on disinfective power according to sterilization sequence when using a combination of disinfectants. The purpose of this study was to evaluate the disinfective power of a combination of 70% isopropyl alcohol and 10% povidone-iodine (PVP-I) according to sterilization sequence. METHODS: Two hundred healthy volunteers were recruited. Subjects were disinfected with a combination of 70% isopropyl alcohol and 10% PVP-I on both forearms, in varying sequence. The AP group included disinfections on the left forearm with isopropyl alcohol first followed by 10% PVP-I, while the PA group included disinfections on the right forearm with same disinfectants in reverse order. Skin cultures were obtained using cotton swabs 3 min after application of each disinfectant, and then were inoculated on blood agar plates for bacterial culture. Cultures were incubated at 37degrees C under aerobic conditions for 48 hours. RESULTS: There was no significant difference in the number of positive cultures after the 1st disinfection (AP, 45; PA, 36, P = 0.262) or the 2nd disinfection (AP, 6; PA, 13, P = 0.157), suggesting that there is no relationship between disinfective power and the sequence of the disinfectants used. The number of positive cultures significantly decreased after the 2nd disinfection (P < 0.01), however. CONCLUSIONS: There was no significant difference in disinfective power according to sterilization sequence with 70% isopropyl alcohol and 10% PVP-I in healthy volunteers. The combination of 70% isopropyl alcohol and 10% PVP-I was more effective than disinfection with a single agent regardless of sterilization sequence.
2-Propanol* ; Agar ; Disinfectants ; Disinfection ; Forearm ; Healthy Volunteers ; Povidone-Iodine* ; Skin ; Sterilization

At the confluence of the superior, anterior, and middle mediastinum are the middle portion of the superior vena cava, the tracheal bifurcation, the main pulmonary artery, the aortic arch, and parts of the cephalad surface of the heart.Tumors in this region can cause compression and obstruction of tracheobronchial tree in the region of tracheal carina even though there is no sign and symptom related to respiratory failure in preinduction period.We experienced airway (tracheal) obstruction due to mechanical compression by mediastinal mass during anesthetic induction.She is 24-year old who had no symptom of respiratory distress in preinduction period.
Airway Obstruction ; Anesthesia ; Aorta, Thoracic ; Mediastinum ; Pulmonary Artery ; Respiratory Insufficiency ; Vena Cava, Superior ; Ventilation

At the confluence of the superior, anterior, and middle mediastinum are the middle portion of the superior vena cava, the tracheal bifurcation, the main pulmonary artery, the aortic arch, and parts of the cephalad surface of the heart.Tumors in this region can cause compression and obstruction of tracheobronchial tree in the region of tracheal carina even though there is no sign and symptom related to respiratory failure in preinduction period.We experienced airway (tracheal) obstruction due to mechanical compression by mediastinal mass during anesthetic induction.She is 24-year old who had no symptom of respiratory distress in preinduction period.
Airway Obstruction ; Anesthesia ; Aorta, Thoracic ; Mediastinum ; Pulmonary Artery ; Respiratory Insufficiency ; Vena Cava, Superior ; Ventilation

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