BACKGROUND: The number of elderly patients undergoing surgery is steadily growing. Therefore, this study was designed to determine the prevalence and predictors of postoperative complications in patients older than 80 years. METHODS: The medical records of 532 patients above 80 years in age who underwent elective or emergent noncardiac surgery between June 2011 and May 2013 were reviewed retrospectively. Preoperative concomitant disease, operation site, anesthetic technique, and postoperative complications were analyzed. RESULTS: A total of 81.4% of the patients had pre-existing concomitant diseases, while 22.9% had severe systemic diseases. The incidence of severe complications within the first month after operation was 4.1%, and the in-hospital mortality rate was 1.3%. Among the severe postoperative complications, respiratory and cardiovascular complications were commonly observed. In multivariate logistic regression analysis, the predictors of postoperative severe complications included American Society of Anesthesiologists physical status classification of 3 or greater (odds ratio [OR], 5.271; 95% confidence interval [CI], 2.019-13.758; p=0.001), neurosurgery (OR, 23.132; 95% CI, 2.528-211.707; p=0.005) and duration of operation (OR, 1.006; 95% CI, 1.001-1.012; p=0.027). CONCLUSION: Proper preoperative evaluation and appropriate treatment for age-related concomitant diseases are suggested for patients older than 80 years in order to reduce postoperative complications. After operation, the respiratory and cardiovascular systems should be carefully monitored.
Aged ; Anesthesia ; Cardiovascular System ; Classification ; Hospital Mortality ; Humans ; Incidence ; Intraoperative Complications ; Logistic Models ; Medical Records ; Neurosurgery ; Postoperative Complications* ; Prevalence* ; Retrospective Studies

BACKGROUND: 5-Hydroxytryptamine3 (5-HT3) receptor antagonists have been reported to attenuate spinal anesthesia-induced hemodynamic changes. This study was conducted to determine whether the second generation 5-HT3, antagonist palonosetron attenuates hypotension and bradycardia during spinal anesthesia. METHODS: Sixty adult patients scheduled for lower limb surgery were enrolled in this study. Patients were randomly assigned to receive either normal saline (Control group, N = 30) or palonosetron (0.075 mg, i.v.) (Palonosetron group, N = 30) prior to spinal anesthesia. Hemodynamic variables were recorded during anesthesia. RESULTS: The mean blood pressure (MBP) were 89.2 ± 11.4 mmHg in the control group and 87.6 ± 12.1 mmHg in the palonosetron group at 10 min after intrathecal injection (P = 0.609). The median blocked levels of the control group and the palonosetron group were T10 (interquartile range, 9-10) and T10 (8-10) at 20 min after intrathecal injection (P = 0.939). Requirements for ephedrine, phenylephrine, and atropine were similar (P = 0.652, 0.533 and 0.417, respectively). The incidences of hypotension (40% vs. 41%) and bradycardia (7% vs. 17%) were comparable (P = 0.562, P = 0.198, respectively) between the control and the palonosetron group. There were no significances in the changes of systolic blood pressure, diastolic blood pressure, MBP and heart rate by the group (P = 0.632, 0.287, 0.556, 0.733, respectively). CONCLUSIONS: Intravenous palonosetron (0.075 mg) prior to spinal anesthesia might not attenuate spinal anesthesia-induced hypotension during low level of neuroaxial block for lower limb surgery.
Adult ; Anesthesia ; Anesthesia, Spinal ; Atropine ; Blood Pressure ; Bradycardia ; Ephedrine ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Incidence ; Injections, Spinal ; Lower Extremity ; Orthopedics* ; Phenylephrine

BACKGROUND: Elevated blood pressures during emergence from general anesthesia in patients with hypertension often result in undesirable complications such as myocardial ischemia, intracranial hemorrhages. The aim of this study was to assess the effect of intracuff 4% lidocaine on the dosage of nitroglycerine required to maintain the stable blood pressure during peri-extubation period in patients with hypertension. METHODS: Forty-nine patients scheduled for elective surgery were randomly allocated to group 1 and 2. We filled endotracheal tube's cuff with normal saline for group 1 and with 4% lidocaine for group 2. Blood pressures and heart rates were recorded before operation, during emergence, and after extubation. Nitroglycerine infusion was adjusted to maintain systolic blood pressure below 150 mmHg. Total infused dosages of nitroglycerine were recorded during operation and after stop of inhalational anesthetics for comparison of both groups' hemodynamic stability. RESULTS: Mean infused volume (microg/kg/min) of nitroglycerine during peri-extubation period was less in the group 2 than group 1. CONCLUSIONS: Intra-cuff 4% lidocaine in patients with hypertension during emergence from general anesthesia reduces the nitroglycerine dosage required to maintain hemodynamic stability.
Anesthesia, General ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Intracranial Hemorrhages ; Lidocaine* ; Myocardial Ischemia ; Nitroglycerin*

Background: Remifentanil can be used as adjuvants during remimazolam induction without neuromuscular blockade. We evaluated the 95% effective concentration (EC) of remifentanil effect-site concentration (Ce) for the successful insertion of an i-gel using the biased-coin up-and-down method in adult patients during remimazolam induction. Methods: Forty 19–65 year-old patients scheduled to undergo surgery using i-gel were enrolled. Anesthesia was induced using remimazolam infusion (12 mg/kg/h). Simultaneously, remifentanil was infused at a predetermined Ce. After 5 min of anesthesia induction, the i-gel was inserted. The 95% EC (EC95) of remifentanil in each patient was determined using a biased-coin up-and-down method based on a successful insertion in a preceding patient. The step size of remifentanil Ce was 0.4 ng/ml. If the insertion failed, remifentanil Ce was increased in the next patient. Following successful insertions, the corresponding concentration decreased in subsequent patients with a probability of 1/19 or was maintained with a probability of 18/19. The time from remimazolam infusion initiation to a bispectral index (BIS) < 60 (time to BIS60) and hemodynamic variables were measured and recorded. Results: The EC95 (95% CI) of Ce was 2.07 (1.94, 2.87) ng/ml. The overall time to BIS60 was 154.0 ± 39.9 s. No patient experienced significant hypotension or bradycardia during remimazolam induction. Conclusions The EC95 of remifentanil Ce was 2.07 (1.94, 2.87) ng/ml for successful i-gel insertion during remimazolam induction at 12 mg/kg/h without hemodynamic instability in adult patients. Future studies should measure remifentanil Ce in elderly patients or using remimazolam at various infusion doses.

BACKGROUND: In ambulatory surgery, which is of short duration, anesthesiologists often do not use a muscle relaxant, or any other induction technique which could facilitate muscle relaxation for endotracheal intubation.Incomplete muscle relaxation, however, results in vocal cord movement and the possibility of damage to the vocal cords and adjacent structure.The aim of this study was to evaluate the macroscopic sequelae of intubation on vocal cord and laryngeal structure and assess postoperative sore throat or hoarseness. METHODS: 100 patients with class I or II ASA physical status were enrolled in this study.It was divided into two groups, Group C (conventional intubation dose of rocuronium; 0.6 mg/kg) and group L (low intubation dose 0.45 mg/kg).Anesthesia was induced with 10microgram/kg of alfentanil and 2.0 mg/kg of propofol i.v.Intubation was performed 90 second after rocuronium injection and the intubation condition was checked.Macroscopic sequelae ofthe laryngeal structure were evaluated using a flexible fiberoptic bronchoscope. After completion of surgery, the patient was asked to report sore throat or hoarseness. RESULTS: Macroscopic sequelae, such as erythema or hemorrhage, were statistically different between the two groups.There were no cases of minimal hemorrhage of either vocal cords or of the arryepiglottic folds in group C whereas there were two cases in group L.There was no statistical difference in incidence and severityof sore throat or hoarseness between the two groups. CONCLUSIONS: Although there were more macroscopic effects in the vocal cords and aryepiglottic folds, a low intubation dose of rocuronium can be used during surgery of short duration without fear of any significant sore throat or hoarseness after surgery.
Alfentanil ; Ambulatory Surgical Procedures ; Androstanols ; Bronchoscopes ; Erythema ; Hemorrhage ; Hoarseness ; Humans ; Incidence ; Intubation ; Muscle Relaxation ; Muscles ; Pharyngitis ; Propofol ; Vocal Cords

BACKGROUND: Insufficient sample volume can cause unnecessary blood loss and inaccurate arterial blood gas and electrolytes testing. The aim of this study was to determine the adequate sample volume, that is required for accurate arterial blood gas and electrolyte testing from arterial catheters. METHODS: Patients had four different arterial blood samples (0.2 ml, 0.4 ml, 0.6 ml and 1 ml [control], respectively) taken sequentially in random order. Samples were analyzed for pH, PaCO2, PaO2, hematocrit, Na+, K+, Ca2+ and Mg2+ using NOVA blood gas analyzer. RESULTS: A total of 27 patients were recruited for the study. All sample volumes tested provided the results of pH, PaCO2, PaO2 and hematocrit that were statistically similar to control values. However, the results of electrolytes (K+, Ca2+ and Mg2+) in all sample volumes tested were significantly lower than the control values and an increasing sample volume equated to blood results trending closer to those obtained with the control sample. CONCLUSIONS: This study showed that there is not one sample volume that will provide accurate results for all blood components. The study tested a variety of sample volumes and found that although even small sample volume of 0.2 ml provided accurate results for pH, PaCO2, PaO2 and hematocrit. No sample volume that was tested provided accurate results for K+, Ca2+ and Mg2+.
Electrolytes ; Hematocrit ; Humans ; Hydrogen-Ion Concentration

BACKGROUND: The patients with traumatic brain injury showed ischemia due to increased intracranial pressure. This study evaluated the relationship of pre-anesthetic serum lactate level with in-hospital mortality. METHODS: The archived medical records of 121 patients were retrospectively reviewed. Demographics and preoperative serum lactate level were analyzed. RESULTS: Of the 121 patients, 32 patients expired in the hospital after decompressive craniectomy. Preoperative serum lactate levels were 3.2 +/- 2.2 mmol/L in the survivors and 5.4 +/- 3.0 mmol/L in the dead (P = 0.001), and the receiver operating characteristic curve revealed that a cut off value of 3.60 mmol/L was reasonable for predicting mortality. CONCLUSIONS: Preoperative serum lactate level is highly correlated with in-hospital mortality after decompressive craniectomy in traumatic brain injury.
Brain Injuries* ; Decompressive Craniectomy* ; Demography ; Hospital Mortality* ; Humans ; Intracranial Pressure ; Ischemia ; Lactic Acid* ; Medical Records ; Mortality ; Retrospective Studies ; ROC Curve ; Survivors

BACKGROUND: General anesthesia for cesarean section is usually maintained at a low dose after induction with using other agents. Many anesthesiologists have experience difficulty in maintaining stable blood pressure at intubation, as compared with nonobstetric anesthesia. We wanted to determine the efficacy of nicardipine for treating rising blood pressure that is related to intubation. METHODS: Twenty one parturient women, who were scheduled for elective cesarean section, were randomly allocated to two groups. Group 1 (n = 10) received no nicardipine and group 2 (n = 11) received nicardipine (7microg/kg) 60 seconds before intubation. The systolic blood pressures, diastolic blood pressures and heart rates were measured at preoperation, after induction of anesthesia, before intubation, immediately after intubation and at 1, 5, 10, 15 and 30 minutes after intubation. RESULTS: The systolic and diastolic blood pressures were lower in group 2 than group 1 at immediate after intubation. Yet the heart rate was higher in group 2 than in group 1 at the same time. CONCLUSIONS: Intravenous nicardipine given 60 seconds before intubation has some benefit from the viewpoint of blood pressure stability at intubation during cesarean section.
Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Cesarean Section* ; Female ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal* ; Nicardipine* ; Pregnancy

BACKGROUND: Epidural pressure is reported to change in accordance with intracranial pressure (ICP). As ICP changes during general anesthesia, it is also possible that epidural pressure may change during general anesthesia. The aim of this study was to obtain trends of epidural pressure change during general anesthesia. METHODS: Eighteen patients scheduled for gastrectomy were allocated for this study after obtaining informed consent. Epidural catheter was inserted at T7-8, T8-9 interspace before induction. Catheter was connected to a pressure transducer after calibration. General anesthesia was induced with thiopental sodium (5 mg/kg), succinylcholine (1 mg/kg), followed by 3% enflurane. Anesthesia was maintained with 50% N2O in oxygen and 1-2% enflurane with vecuronium (0.1 mg/kg). Each patients was mechanically ventilated with tidal volume of 10 ml/kg at a rate of 10 bpm. Epidural pressure was measured before induction, at the time of injection of thiopental sodium, succinylcholine, laryngoscopy, intubation, surgical incision, and 30 minutes after surgical incision. Stastical analysis was done using repeated measures of ANOVA with Helmert option (p<0.05). RESULTS: Epidural pressure significantly changed dynamically during general anesthesia. Epidural pressures increased at intubation and at 30 minutes after surgical incision when compared with those at the time of laryngoscopy and incision, respectively (p<0.05). CONCLUSION: Our study indicates that epidural pressures changes dynamically during induction period of general anesthesia and also showed possibility that epidural pressure monitoring could be used instead of more invasive direct ICP monitoring.
Anesthesia* ; Anesthesia, General ; Calibration ; Catheters ; Enflurane ; Gastrectomy ; Humans ; Informed Consent ; Intracranial Pressure ; Intubation ; Laryngoscopy ; Oxygen ; Succinylcholine ; Thiopental ; Tidal Volume ; Transducers, Pressure ; Vecuronium Bromide

A 70-year-old woman with an infectious thrombus in her left internal jugular vein (IJV) underwent carotid endarterectomy for stenosis and a highly movable plaque in her right carotid artery. She had been treated with antibiotics for four weeks before surgery due to Lemierre syndrome, a rare septic thrombophlebitis in the IJV secondary to an oropharyngeal infection. The right IJV was in a two-fold dilated state due to compensation for a thrombotic left IJV. Accordingly, superficial cervical plexus block was performed under ultrasound guidance to ensure safety and accuracy. During surgery, the alertness was maintained and the patient did not complain of pain in the absence of additional analgesics. No block-related complications were encountered. The authors report for the first time their regional anesthetic experiences in a patient with Lemierre syndrome.
Aged ; Analgesics ; Anti-Bacterial Agents ; Carotid Arteries ; Cervical Plexus Block* ; Cervical Plexus* ; Compensation and Redress ; Constriction, Pathologic ; Endarterectomy, Carotid* ; Female ; Humans ; Jugular Veins ; Lemierre Syndrome* ; Thrombophlebitis ; Thrombosis ; Ultrasonography