Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

Perioperative stroke can lead to mortality or serious disability and usually occurs in patients undergoing cardiac, vascular, or neurologic surgery; it is rare in gynecological surgery. We report the case of a patient who suffered life-threatening cerebral infarction after elective laparoscopic hysterectomy. During the surgery, the patient was placed in the Trendelenburg position. On postoperative day one, the patient was diagnosed with right hemisphere cerebral infarction; brain computed tomographic angiography showed proximal right internal carotid artery occlusion. Decompressive craniectomy was performed to resolve brain swelling, but the patient died 10 days later.
Angiography ; Brain ; Brain Edema ; Carotid Artery, Internal ; Cerebral Infarction* ; Decompressive Craniectomy ; Female ; Gynecologic Surgical Procedures ; Head-Down Tilt* ; Humans ; Hysterectomy* ; Mortality ; Stroke

Submental intubation has been the recommended airway management procedure for maxillofacial surgery since proposed by Altemir in 1986. We adopted various submental intubation modifications based on modified intubation protocols and report on the effectiveness and problems of each modified method. Case: Among a total of 13 submental intubation cases during the last five years, five representative methods are described. The proximal end of the endotracheal tube was protected by a nelaton catheter in case 1, by a suction connector in case 2, and by a dental needle cap in case 3. In case 4, a nasal speculum was used to expand a single route, and in case 5, a laparoscopic trocar was used to secure a single route. Conclusions: Use of a laparoscopic trocar might be the most effective way to obtain a single submental route. However, considering cost, use of a nasal speculum is also an effective suboptimal solution.

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced ; Hysterectomy ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Pregnant Women ; Resuscitation

PURPOSE: Peroxynitrite plays a critical role in vascular pathophysiology by increasing arginase activity and decreasing endothelial nitric oxide synthase (eNOS) activity. Therefore, the aims of this study were to investigate whether arginase inhibition and L-arginine supplement could restore peroxynitrite-induced endothelial dysfunction and determine the involved mechanism. MATERIALS AND METHODS: Human umbilical vein endothelial cells (HUVECs) were treated with SIN-1, a peroxynitrite generator, and arginase activity, nitrite/nitrate production, and expression levels of proteins were measured. eNOS activation was evaluated via Western blot and dimer blot analysis. We also tested nitric oxide (NO) and reactive oxygen species (ROS) production and performed a vascular tension assay. RESULTS: SIN-1 treatment increased arginase activity in a time- and dose-dependent manner and reciprocally decreased nitrite/nitrate production that was prevented by peroxynitrite scavenger in HUVECs. Furthermore, SIN-1 induced an increase in the expression level of arginase I and II, though not in eNOS protein. The decreased eNOS phosphorylation at Ser1177 and the increased at Thr495 by SIN-1 were restored with arginase inhibitor and L-arginine. The changed eNOS phosphorylation was consistent in the stability of eNOS dimers. SIN-1 decreased NO production and increased ROS generation in the aortic endothelium, all of which was reversed by arginase inhibitor or L-arginine. N(G)-Nitro-L-arginine methyl ester (L-NAME) prevented SIN-1-induced ROS generation. In the vascular tension assay, SIN-1 enhanced vasoconstrictor responses to U46619 and attenuated vasorelaxant responses to acetylcholine that were reversed by arginase inhibition. CONCLUSION: These findings may explain the beneficial effect of arginase inhibition and L-arginine supplement on endothelial dysfunction under redox imbalance-dependent pathophysiological conditions.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Acetylcholine ; Arginase* ; Arginine ; Blotting, Western ; Endothelium ; Human Umbilical Vein Endothelial Cells ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase Type III* ; Oxidation-Reduction ; Peroxynitrous Acid ; Phosphorylation* ; Reactive Oxygen Species

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.
Blood Pressure ; Deglutition Disorders ; Heart Rate ; Hemodynamics* ; Hemorrhage ; Hoarseness ; Humans ; Intubation* ; Laryngoscopes* ; Pharyngitis ; Propofol

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.
Blood Pressure ; Deglutition Disorders ; Heart Rate ; Hemodynamics* ; Hemorrhage ; Hoarseness ; Humans ; Intubation* ; Laryngoscopes* ; Pharyngitis ; Propofol

BACKGROUND: The Korean Computerized Neurobehavioral Test (KCNT) is a psychological assessment tool used as part of Workers’ Special Health Examinations in Korea. Due to the spread of mobile technology, this study aimed to compare results of the KCNT administered on a tablet PC versus a desktop computer, and, therefore, assess the clinical applicability of mobile devices. METHODS: A total of 72 participants enrolled in this study. Their age, sex, and years of formal education were collected during an interview, as well as their typing speed. The test battery comprised five subtests: Simple Reaction Time test, Choice Reaction Time test, Digit Addition test, Symbol-Digit Substitution test, and Finger Tapping Speed test. Participants repeated the KCNT test battery in a randomly assigned order using four different testing systems: a desktop computer equipped with a conventional 106-key keyboard (System 1), a desktop computer equipped with a simplified keyboard (System 2), a tablet PC with a simplified 17-key on-screen keyboard (System 3), and a tablet PC equipped with a simplified keyboard (System 4). RESULTS: Results of the Digit Addition test did not differ significantly for different testing systems. In contrast, results of the Simple Reaction Time test, Choice Reaction Time test, Symbol-Digit Substitution test, and Finger Tapping test were lower for the tablet PC (Systems 3 and 4) compared to the desktop computer (Systems 1 and 2). Systems 1 and 2 did not show significantly different results. Performance on System 3 was inferior to that on System 4, only for the Choice Reaction Time test and Finger Tapping Speed test. There were also significant differences in performance by computer familiarity when adjusted for age and education; however, the performance of each group on the test systems showed similar patterns. CONCLUSIONS: It is not recommended to use a tablet PC to administer the KCNT to evaluate neurobehavioral performance for the Simple Reaction Time test and Choice Reaction Time test; however, tablet PCs with an on-screen keyboard may be used to perform the Digit Addition test, and the Symbol-Digit Substitution test and Finger Tapping Speed test to a limited degree.
Education ; Fingers ; Korea ; Reaction Time ; Recognition (Psychology)