BACKGROUND: Acute normovolemic hemodilution (ANH) is accepted to be the easiest and most economical method of autotransfusion. This study was performed to investigate the clinical usefulness of ANH in patients undergoing off-pump CABG. METHODS: Thirty patients were randomly divided into two groups. In the ANH group, 753.3 +/- 51.6 ml of fresh autologous whole blood were sequestrated from a pulmonary artery catheter following induction of anesthesia with simultaneous infusion of colloids and crystalloid solution from a separate line. Perioperative changes of hemoglobin, hematocrit level, platelet counts, prothrombin time, cardiac output, transfusion requirement and the amount of postoperative drainage were compared between the two groups. RESULTS: Perioperative changes of platelet counts and PT showed no significant differences between the two groups. Less allogenic blood was used in the ANH group (0.27 +/- 0.46 unit) than in the control group (1.27 +/- 0.80 unit) in the operation room. CONCLUSIONS: ANH can decrease the transfusion requirement in off-pump CABG.
Anesthesia ; Blood Transfusion, Autologous ; Cardiac Output ; Catheters ; Colloids ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Platelet Count ; Prothrombin Time ; Pulmonary Artery

BACKGROUND: The i-gel(TM) (i-gel) is a new single-use supraglottic airway device with a non-inflatable cuff. This study investigated the safety and efficacy of the i-gel during general anesthesia in children. METHODS: Ninety-eight children at ASA physical status I-II who underwent general anesthesia were included in this prospective observatory study. The size of the i-gel was selected based on patient's body weight. We evaluated success rates, insertion time, airway leak pressure, fiberoptic examination, airway manipulation, airway quality, and postoperative complications. RESULTS: The first-attempt success rate was 96.9% with overall success rate of 98.0%. The insertion time was 15.6 +/- 4.7 seconds. The airway leak pressure was 28.2 +/- 5.9 cmH2O. The maximal peak inspiratory pressure was 15.4 +/- 3.0 cmH2O. On fiberoptic examination, vocal cords were visible in 86.5% of patients. During maintenance of anesthesia, manipulations of i-gel were required for 32 (33.3%) children to maintain airway. Controlled ventilation was possible in all cases, although excess leak transiently occurred in three children. Postoperative complications including blood-staining on device, cough, and sore throat were infrequent. CONCLUSIONS: The i-gel size at 1.5-2.5 provided a satisfactory airway and ventilation during anesthesia in children. However, i-gel required a number of manipulations to maintain patency of airway during general anesthesia.
Anesthesia ; Anesthesia, General* ; Body Weight ; Child* ; Cough ; Humans ; Pharyngitis ; Postoperative Complications ; Prospective Studies ; Ventilation ; Vocal Cords

BACKGROUND: Emergence delirium is a common problem after general anesthesia in children. Postoperative pain control reduces the incidence of emergence delirium. Opioids and NSAIDs have been successfully used to inhibit intraoperative and postoperative pain. Instead of them, acetaminophen is used to reduce side effects of opioids and NSAIDs. This study evaluated the effect of acetaminophen on emergence delirium after general anesthesia in children undergoing a epiblepharon correction. METHODS: Sixty children, aged 1-10 years (ASA physical status I, II) undergoing epiblepharon correction, were enrolled in this study. Acetaminophen (group A) received 15 mg/kg of acetaminophen, control group (group C) received 1.5 ml/kg of normal saline. Anesthesia was induced with 2.0 mg/kg of ketamine and maintained by 2.0-3.0 vol% sevoflurane with N2O 1.5 L/min-O2 1.5 L/min. The delirium score was recorded at 10 minutes after arrival at recovery room by an independent observer using the four point scale of Aono. RESULTS: There were no significant differences between the two groups regarding the time to extubation and discharge from the recovery room. The incidence of emergence delirium was 23% in group A and 32% in group C, but this did not have statistical significance. The incidence of vomiting was similar in both group. CONCLUSIONS: Preoperative intravenous acetaminophen of 15 mg/kg application does not reduce the incidence of postoperative delirium in children undergoing epiblepharon correction.
Acetaminophen ; Aged ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Anti-Inflammatory Agents, Non-Steroidal ; Child ; Delirium ; Humans ; Incidence ; Ketamine ; Methyl Ethers ; Pain, Postoperative ; Recovery Room ; Vomiting

BACKGROUND: Emergence agitation (EA) frequently occurs after general anesthesia in children. This multicenter study was investigated to determine incidence and risk factors of EA after general anesthesia in children. METHODS: This prospective study evaluated 816 pediatric patients receiving elective surgery under general anesthesia at 10 university hospitals. Emotional and behavioral status of the patients upon emergence from anesthesia was assessed by Aono's four point scale. Those with an Aono's four point scale of 3 or 4 were considered to be affected by EA. Patient physical, anesthetic, and surgical variables were analyzed to find the risk factors of EA. RESULTS: One-hundred-fifty-two children (18.6%) developed EA. No relationships between the incidence of EA and age, sex, ASA physical status, premedicants, anesthetic induction agents, anesthetic maintenance methods, or postoperative analgesia were found. A multivariate analysis identified preanesthetic emotional status (OR = 1.774, P < 0.001), perioperative airway complication (OR = 1.867, P < 0.007) and rhinolaryngologic surgery (OR = 1.597, P < 0.017) as risk factors of EA. CONCLUSIONS: Preanesthetic emotional status, perioperative airway complication and rhinolaryngologic surgery were risk factors of EA after general anesthesia in children.
Analgesia ; Anesthesia ; Anesthesia, General ; Anesthetics ; Child ; Dihydroergotamine ; Hospitals, University ; Humans ; Incidence ; Multivariate Analysis ; Prospective Studies ; Risk Factors

BACKGROUND: Bispectral index (BIS) is a useful tool to assess depth of anesthesia. Recently, spectral entropy has been promoted as a monitor of anesthetic depth in adult, but its characteristics in children remains poorly defined. This study was to compare BIS and entropy indices during sevoflurane anesthesia in children. METHODS: Forty children (aged 1-12 yr) scheduled for ENT surgery, were included. Anesthesia was induced with 5.0% sevoflurane in O2 6 L/min. Tracheal intubation was performed with rocuronium 0.6 mg/kg. Heart rate, blood pressure, end-tidal sevoflurane concentration (Etsev), BIS, response entropy (RE) and state entropy (SE) were measured every 5 minutes. The correlation between BIS and entropy index and Etsev was calculated, RESULTS: The BIS, SE and RE values decreased with induction and increased with recovery. The BIS, RE, and SE values were inversely proportionally related to the Etsev. The RE and SE values were closely correlated with the BIS values (respectively r = 0.948 and r = 0.946, P< 0.001). CONCLUSIONS: We demonstrated a close correlation of SE and RE with Etsev and with BIS during sevoflurane anesthesia in children. State entropy and RE seem to be useful electroencephalographic measures of sevoflurane drug effect in children.
Adult ; Androstanols ; Anesthesia ; Blood Pressure ; Child ; Entropy ; Heart Rate ; Humans ; Intubation ; Methyl Ethers ; Organothiophosphorus Compounds

BACKGROUND: Acute normovolemic hemodilution (ANH) is recognized as the easiest, the most economical and valuable autologous blood saved method among the types of autotransfusion. We studied whether this method could reduce the transfusion requirement of allogenic blood in total knee arthroplasty to investigate the efficacy of ANH. METHODS: The thirty patients were randomized and divided into two groups. In the ANH group (n = 15), 2 units of autologous blood were procured from a CVP catheter immediately before or after anesthetic induction, while Ringer's lactate and colloid solution were infused to maintain normovolemia via a different venous catheter. Perioperative changes of hemoglobin, hematocrit, platelets, prothrombin time (PT), transfusion requirements and the amount of postoperative drainage were compared. RESULTS: There were no significant difference between the two groups in terms of perioperative changes of hemoglobin, hematocrit or platelets. And, there was significantly reduced demand for packed RBC transfusion in the ANH group (362.7+/-236.4 ml) compared with the control group (668.0+/-259.3 ml) (P <0.05). However, no significant difference was observed between the two groups in terms of postoperative drainage amount. CONCLUSIONS: ANH can reduce transfusion requirements in total knee arthroplasty surgery if this is accompanied by appropriate patient selection and monitoring.
Arthroplasty* ; Blood Transfusion, Autologous ; Catheters ; Colloids ; Drainage ; Hematocrit ; Hemodilution* ; Humans ; Knee* ; Lactic Acid ; Patient Selection ; Prothrombin Time

A variety of anesthetic equipment has been introduced for one-lung ventilation (OLV) during video-assisted thoracoscopic surgeries. A double-lumen endobronchial tube or bronchial blockers are the most common techniques used for achieving OLV. We herein describe a case of general anesthesia requiring both the OLV and two-lung ventilation with a Coopdech bronchial blocker and a single-lumen endotracheal tube. A 43-year-old woman is being scheduled to undertake mediastinal mass removal and tonsillectomy. After performing tonsillectomy by using an endotracheal tube, a Coopdech bronchial blocker is being inserted into her right bronchus for video-assisted thoracoscopic surgery. After her surgery, we have encountered resistance while carefully trying to remove the bronchial blocker. When using fiberoptic bronchoscopy, we have observed that the cuff was being avulsed, which could be removed without difficulty. We thus describe a case in which the balloon cuff was detached and retained in the right bronchus.
Adult ; Anesthesia, General ; Bronchi ; Bronchoscopy ; Female ; Humans ; One-Lung Ventilation* ; Thoracic Surgery, Video-Assisted ; Tonsillectomy ; Ventilation

No abstract available.
Anesthesia, Spinal ; Humans ; Hypertension ; Pheochromocytoma

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is a recently described clinical entity which is associated with a chest pain occurring during a stress, an abnormal ECG and/or an increase in the troponin blood level and a transient left ventricular dysfunction. Transient left ventricular dysfunction generally involves the midsection and the apex of the heart with an akinesis. We reported a case of a 55-year-old female patient who developed a stress-induced cardiomyopathy after local epinephrine use during ophthalmologic surgery.
Cardiomyopathies ; Chest Pain ; Electrocardiography ; Epinephrine ; Female ; Heart ; Humans ; Middle Aged ; Takotsubo Cardiomyopathy ; Troponin ; Ventricular Dysfunction, Left

BACKGROUND: The Cobra Perilaryngeal Airway (CobraPLA) and the Laryngeal Mask Airway (LMA) Classic are supraglottic airway devices. We compared the performance of the CobraPLA and the LMA Classic devices during volume-controlled ventilation in children. METHODS: Eighty children, ASA physical status I-II, aged 1-10 years were randomly assigned with either the CobraPLA or the LMA Classic for airway management. Anesthesia was induced with 1 mg/kg ketamine and 2.0 mg/kg propofol, and muscle relaxation was obtained with the use of 0.5 mg/kg rocuronium. All patients were mechanically ventilated with a tidal volume of 10 m/kg in 1-3% sevoflurane, oxygen and air. The number of insertions, oropharyngeal leak pressure, and fiberoptic airway position were measured. Measurements of blood pressure, heart rate, oxygen saturation, end-tidal carbon dioxide, and peak inspiratory pressure were recorded every 5 minutes. Postoperative adverse events were assessed. RESULTS: There was no significant difference between the use of the two devices with respect to the number of insertions, time of insertion, and fiberoptic score. The oropharyngeal leak pressure was significantly higher for the CobraPLA than the LMA Classic (25.4 +/- 4.9 cmH2O versus 20.3 +/- 5.4 cmH2O; P < 0.001). Hemodynamic and respiratory variables were similar with the use of both devices. The incidence of adverse events was not different with the use of both devices. CONCLUSIONS: Both airway devices provided an adequate airway and effective ventilation during volume-controlled ventilation in children. The CobraPLA had a higher sealing pressure than the LMA Classic.
Aged ; Airway Management ; Androstanols ; Anesthesia ; Blood Pressure ; Carbon Dioxide ; Child ; Elapidae ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Ketamine ; Laryngeal Masks ; Methyl Ethers ; Muscle Relaxation ; Oxygen ; Propofol ; Tidal Volume ; Ventilation