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: 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

No abstract available.
Cholangiopancreatography, Endoscopic Retrograde ; Dexmedetomidine

Hemostasis and a clear field are obtained by the local infiltration of a local anesthetic mixed with epinephrine. However, epinephrine may in itself, due to its cardiovascular effect, cause arryhthmia, heart failure, pulmonary edema, and even cardiac arrest. We describe a 10-year-old patient who developed ventricular premature contraction and acute pulmonary edema due to epinephrine infiltration during tonsillectomy. The patient recovered without any sequelae after intensive treatment involving fluid restriction, diuretics, dobutamine infusion, and oxygen by mask at 5 L/min.
Child ; Diuretics ; Dobutamine ; Epinephrine* ; Heart Arrest ; Heart Failure ; Hemostasis ; Humans ; Masks ; Oxygen ; Pulmonary Edema* ; Tonsillectomy*

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: 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: Reversal of heparin anticoagulation by protamine often produces hemodynamic changes such as hypotension, bradycardia, decreased cardiac output and various complications as anaphylactic reaction. Some studies have reported that intraaortic administration of protamine prevent profound hypotension and provide stable hemodynamics. The purpose of this study is to compare the hemodynamic changes following intraaortic and intravenous administration of protamine after cardiopulmonary bypass. METHODS: In a prospective double-blind trial, 30 patients undergoing cardiac valve replacement surgery were randomly assigned to receive intravenous protamine (n = 15) or intraaortic protamine (n = 15). Arterial pressure (AP), pulmonary arterial pressure (PAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were measured. RESULTS: The changes of HR, AP, PAP, CI, SVRI, PVRI were not significantly different between both groups. Both groups maintained hemodynamic stability afer protamine administration. CONCLUSIONS: There were no significant difference in the hemodynamic changes following intraaortic and intravenous administration of protamine after cardiopulmonary bypass. And there were no hemodynamic benefits of intraaortic versus intravenous administration of protamine.
Administration, Intravenous* ; Anaphylaxis ; Arterial Pressure ; Bradycardia ; Cardiac Output ; Cardiopulmonary Bypass* ; Heart Rate ; Heart Valves ; Hemodynamics* ; Heparin ; Humans ; Hypotension ; Prospective Studies ; Vascular Resistance

BACKGROUND: Minimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery. METHODS: Forty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery. RESULTS: Demographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O2 concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups. CONCLUSIONS: In prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.
Alanine Transaminase ; Anesthesia ; Aspartate Aminotransferases ; Blood Gas Analysis ; Blood Urea Nitrogen ; Carboxyhemoglobin ; Natural Resources ; Creatinine ; Hemodynamics ; Humans ; Isoflurane ; Laparoscopy ; Male

BACKGROUND: The change of expression of the alpha2-adrenergic receptor (alpha(2)-AR) subtypes in the thalamus and hypothalamus were investigated in a neuropathic pain rat model. METHODS: The left sciatic nerve was clamped for creating a neuropathic pain model in five rats. A sham operation was done in three rats as control group. Behavioral tests for pain were conducted by using mechanical stimuli applied to the hind paws. After 7 days, the expression of alpha(2)-AR subtype mRNA in the rat thalamus and hypothalamus was measured using real time polymerase chain reaction. RESULTS: Mechanical allodynia were developed on postoperative 1, 3, and 7 days in the neuropathic pain model. The expression of alpha(2A)-AR, alpha(2B)-AR, and alpha(2C)-AR was significantly higher in the thalamus and hypothalamus in the neuropathic pain model (P > 0.05). CONCLUSIONS: These results would suggest that the subtypes of alpha(2)-AR in thalamus and hypothalamus may contribute to produce neuropathic pain.
Animals ; Central Nervous System* ; Hyperalgesia ; Hypothalamus ; Models, Animal ; Neuralgia ; Peripheral Nerve Injuries ; Peripheral Nerves* ; Rats* ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Sciatic Nerve ; Thalamus

< 0.05) but there was no significant differences between the two groups. CONCLUSIONS: These results suggest that PCEA has no added influences on the cytokine responses after a gastrectomy.
Analgesia, Patient-Controlled ; Gastrectomy* ; Humans ; Pain, Postoperative*