Pheochromocytoma is functioning tumor which originates in the adrenal medulla or in chromaffin tissue along the paravertebral sympathetic chain. This tumor releases epinephrine and norepinephrine causing increase of peripheral resistance and resulting in increased blood pressure and reducing plasma volume. The anesthetic management of patients with pheochromocytoma presents many difficult problems such as hypertension, cardiac arrhythmias, and hypotension. A 40 year-old female underwent resection of pheochromocytoma under general anesthesia. Thiopental was used for induction followed N2O-O2-enflurane supplemented with fractional doses of fentanyl and vecuronium for muscle relaxation. Hypertensive crisis during induction of anesthesia and surgical manipulation of the tumor were managed with phentolamine and sodium nitroprusside, and premature ventricular beats were controlled with lidocaine. We experienced marked fluctuation of blood pressure during anesthetic course.
Adrenal Medulla ; Adult ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Epinephrine ; Female ; Fentanyl ; Humans ; Hypertension ; Hypotension ; Lidocaine ; Muscle Relaxation ; Nitroprusside ; Norepinephrine ; Phentolamine ; Pheochromocytoma* ; Plasma Volume ; Thiopental ; Vascular Resistance ; Vecuronium Bromide ; Ventricular Premature Complexes

No abstract available.
Blood Pressure Monitors* ; Blood Pressure* ; Fingers*

No abstract available.
Anesthesia* ; Emergencies*

No abstract available.
Humans ; Intensive Care Units* ; Critical Care* ; Korea*

A sensitive and simple liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous quantification of ticagrelor and its active metabolite, AR-C124910XX from 50 µL human plasma using tolbutamide as an internal standard as per regulatory guidelines. Analytes in plasma were extracted by simple protein precipitation using acetonitrile, followed by chromatographic separation with an Acclaim™ RSLC 120 C₁₈ column (2.2 µm, 2.1 × 100 mm) and a gradient acetonitrile-water mobile phase containing 0.1% formic acid within 8 min. Mass spectrometric detection and quantitation were conducted by selected reaction-monitoring on a negative electrospray ionization mode with the following transitions: m/z 521.11 → 361.10, 477.03 → 361.10, and 269.00 → 169.60 for ticagrelor, AR-C124910XX, and tolbutamide, respectively. The lower limit of quantifications was 0.2 ng/mL with linear ranges of 0.2–2,500 ng/mL (r² ≥ 0.9949) for both analytes. All validation data, including selectivity, cross-talk, precision, accuracy, matrix effect, recovery, dilution integrity, stability, and incurred sample reanalysis, were well within acceptable limits. This assay method was validated using K₂-EDTA as the specific anticoagulant. Also, the anticoagulant effect was tested by lithium heparin, sodium heparin, and K₃-EDTA. No relevant anticoagulant effect was observed. This validated method was effectively used in the determination of ticagrelor and its active metabolite, AR-C124910XX, in plasma samples from patients with myocardial infarction.
Heparin ; Humans ; Lithium ; Mass Spectrometry ; Methods ; Myocardial Infarction ; Pharmacokinetics ; Plasma ; Tolbutamide

Appendiceal intussusception is a rare disease with variable clinical findings, ranging from acute appendicitis to chronic recurrent abdominal pain or rectal bleeding. Occasionally, it is incidentally discovered with no symptoms. Because a preoperative diagnosis is difficult, it can be diagnosed either after surgery, in the case of acute appendicitis, or after a polypectomy, based on being mistaken for a polyp. During a colonoscopy, an appendiceal intussusception should be suspected if the appendiceal orifice is not observed at the cecum and there is a polypoid lesion at the location where the appendiceal orifice is expected. Treatments are usually determined according to preceding diseases. It is important that the colonoscopist avoid careless endoscopic removal by mistaking the intussusception for a polyp.
Abdominal Pain ; Appendicitis ; Cecum ; Colonoscopy ; Hemorrhage ; Intussusception ; Polyps ; Rare Diseases

A 55 years old female was admitted for nausea, vomiting and right upper quadrant pain. On the admission physical examination revealed icteric sclera and right upper quadrant tenderness. She had no history of surgery and alcoholic intake. The levels of bilirubin and liver enzyme(ALT, AST) were elevated without evidence of viral hepatitis. After abdominal sonography, CT and ERCP, diagnosis was cholelithiasis. The laparoscopic cholecystectomy was done under enflurane anesthesia for 90 minutes without transfusion of blood and blood products. On the 9th postoperative day, she was discharged with symptomatic improvement and almost normal laboratory data. On the 20th postoperative day, she was admitted for follow up study and elevated liver enzyme were found. On the 30th postoperative day, she had suffered from acute hepatitis with symptoms of nausea, vomiting, chilling and jaundice and marked elevation of ALT, AST and eosinophilia. There were no evidence of viral hepatitis and remnant stone. The liver function was more aggravated and more advanced parenchymal damage of liver was shown by liver scan and sonography but liver function was improved gradually after 55th postoperative day. She recovered gradually and went home in good health on the 105th postoperative day. Postoperative hepatotoxicity might be developed as a result of many causes and we had suspected enflurane but the exact causes in this case were still unknown.
Alcoholics ; Anesthesia ; Anesthesia, General* ; Bilirubin ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Diagnosis ; Enflurane* ; Eosinophilia ; Female ; Follow-Up Studies ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Physical Examination ; Sclera ; Vomiting

BACKGROUND/AIMS: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS. METHODS: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed. RESULTS: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps. CONCLUSIONS: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features.
Abdominal Pain ; Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cohort Studies ; Constriction, Pathologic ; Follow-Up Studies ; Hand Strength ; Humans ; Pancreatitis, Chronic ; Plastics ; Stents

In the anesthesia for the Cesarean section, the anesthetists should select the agent and technique carefully which is safe for both the mother and baby. If a light plane of general anesthesia is chosen for fetal safety and rapid recovery, there may be increased incidence of maternal recall and intraoperative pain perception. We studied the effect of nalbuphine(N group) and fentanyl(F group) used as main analgesics in balanced anesthesia in 60 full term parturients, ASA physical status class I or II, scheduled for elective Cesarean section. The patients were questioned for recall, pain perception and unpleasant dreams during anesthesia. The results were as follows, 1) The 12 patients had positive reactions. Among them, 3 patients(10%) were in the N group and 9 patients(30%) in the F group. 2) The sedation was more in the N group(30%) than in the F group(6.6%). We concluded that the balanced anesthetic technique using nalbuphine caused less maternal recall and pain perception with more sedation than using fentanyL.
Analgesics ; Anesthesia ; Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Cesarean Section* ; Dreams ; Female ; Fentanyl* ; Humans ; Incidence ; Mothers ; Nalbuphine* ; Pain Perception ; Pregnancy

Epidural anesthesia is a technique of regional anesthesia in which the spinal nerves are blocked as they pass through the epidural space. The current study was conducted to determine the extent of contamination of epidural catheters and to attempt to idntify the factors contributing to contamination. The catheters removed from fifty patients were studied, two cultures were taken from each catheter and the following results were obtained. 1) Catheter tips(20%) in ten cultures and portions of the catheter located in the subcutaneous tissue in nine cultures(18%) were found to be contaminated. 2) Staphylococcus epidermidis was found in eight patients, and staphylococcus aureus and xanthomonas maltophilia were found in two patients each other. 3) In the contaminated populations, no significant difference between the growth rate of organisms and the factors in relation to the duration of catheter implantation, age of the patients and the site of catheter inserition was found.
Analgesia, Epidural* ; Anesthesia, Conduction ; Anesthesia, Epidural ; Catheters* ; Epidural Space ; Humans ; Spinal Nerves ; Staphylococcus aureus ; Staphylococcus epidermidis ; Stenotrophomonas maltophilia ; Subcutaneous Tissue