BACKGROUND: Sevoflurane anesthesia is associated with emergence agitation in children. This study examined the effect of a single intraoperative dose of ketamine and fentanyl on emergence agitation in children undergoing an adenotonsillectomy. METHODS: Ninety children, 3-10 years old, undergoing an adenotonsillectomy were enrolled in this study. The patients were randomly assigned to receive either normal saline (control group), ketamine 1 mg/kg (group K), or fentanyl 1microgram/kg (group F) after inducing anesthesia. Ketorolac 0.5 mg/kg was used for postoperative analgesia, and the anesthesia was maintained with sevoflurane. The recovery characteristics, including the time to extubation, the discharge time from the PACU, agitation, pain, and vomiting were assessed. RESULTS: There were no significant differences between the three groups regarding the time to extubation and discharge from the PACU. The incidence of emergence agitation in the control group, group K, and group F was 46.7%, 13.3%, and 33.3%, respectively. The incidence of emergence agitation and the pain score were significantly lower in group K than in the control group (P<0.05). The incidence of vomiting was similar in the three groups. CONCLUSIONS: Children undergoing tonsillectomy with sevoflurane and 1 mg/kg of ketamine given after induction had a reduced incidence of emergence agitation without a delay in recovery. However 1microgram/kg of fentanyl had no effect on the incidence of emergence agitation.
Analgesia ; Anesthesia* ; Child* ; Dihydroergotamine* ; Fentanyl* ; Humans ; Incidence* ; Ketamine* ; Ketorolac ; Tonsillectomy* ; Vomiting

Spontaneous intracranial hypotension (SIH) is believed to be a benign disease. However, numerous studies have reported serious complications related to SIH, including subdural hematoma. In this case report, a 54- year-old male patient visited the emergency room with orthostatic headache. A brain magnetic resonance imaging (MRI) study showed diffuse mild thickening and enhancement of pachymeninges, with a suspicious minimal amount of subdural fluid collected in the left posterior parietal area. His orthostatic headache showed no improvement with conservative treatment; but his pain was almost completely relieved after two trials of cervical epidural blood patch. On the 74th day after the onset of his pain, the patient showed a drowsy mental status and slurred speech when he visited the pain clinic. Brain computerized tomography indicated a left subdural hemorrhage, and he underwent emergency operation to drain the SDH. In conclusion, pain clinicians should pay attention to abrupt changes in mental status as well as continuous headache, for the early diagnosis of SDH in SIH patients.
Blood Patch, Epidural* ; Brain ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Headache ; Hematoma, Subdural* ; Humans ; Intracranial Hypotension ; Magnetic Resonance Imaging ; Male ; Pain Clinics ; Rabeprazole

BACKGROUND: The diagnosis of trigeminal neuralgia (TN) is based on only clinical criteria. The purpose of this study was to estimate the clinical manifestations of TN patients treated at our pain clinic. METHODS: A total of 341 patients with TN from Jan. 2004 to Dec. 2006 was evaluated the intensity, site, and onset of pain, facial sensation, duration of pain attack, pain free interval, triggering factors, and effects of the previous treatments with TN specific questionnaire and interview at the first visit of our pain clinic. RESULTS: About 80% of the patients were over 50 years of age and 256 (75%) patients were women. Average durations from first attack of their pain and from current pain attack were 7 years and 16 weeks, respectively. The two most frequently involved trigeminal nerve branches were maxillary (40%) and mandibular (39%) branches. Three quarters of the total patients experienced only paroxysmal pain that lasted less than one minute. About 90% of patients had pain free period at least one time. Most common triggering factors were chewing (88%), brushing teeth (82%), washing face (79%), and talking (70%). Only 16 patients (5%) had no previous treatment and the others had more than one treatment, such as medication (68%) and interventional procedures (35%). The most common reasons for early discontinuation of carbamazepine were dizziness, ataxia, and vomiting. CONCLUSIONS: TN has specific clinical features of pain, which should be considered at diagnosis.
Ataxia ; Carbamazepine ; Diagnosis ; Dizziness ; Facial Pain ; Female ; Humans ; Mastication ; Pain Clinics ; Surveys and Questionnaires ; Sensation ; Tooth ; Trigeminal Nerve ; Trigeminal Neuralgia* ; Vomiting

BACKGROUND: Balloon kyphoplasty is the new technique that helps to decrease the pain and improve mobility as well as restore the vertebral body height and kyphotic curve in fractured vertebrae. We evaluated the outcome of balloon kyphoplasty in the reduction of vertebral body height, kyphotic curve and clinical improvement in the patients with painful vertebral compression fractures. METHODS: From July 2002 to February 2005, 84 levels of vertebral compression fractures in 66 patients were treated with balloon kyphoplasty. The assessment criteria were the changes over time in visual analogue scale (VAS) and mobility score. We evaluated the vertebral body height and kyphotic curve at preoperative 1 day and postoperative 1 day. RESULTS: Procedures were performed in 66 patients with a total of 84 affected vertebral bodies. The anterior wall height was restored in 74 / 84 (88%) levels with a mean increment of 2.9 mm, and the mid-vertebral body height was restored in 79 / 84 (94%) levels with a mean increment of 4.2 mm. Kyphosis correction was achieved in 60 / 84 (71.4%) from 10.1 degrees to 7.5 degrees. Pain intensity reduced by 60% in one day after operation and by 75-85% in later time. Mobility scores of all patients were improved immediately after the procedure. Cement leakage occurred in 3 levels but there was no clinical problem. CONCLUSIONS: Kyphoplasty is an efficient and safe treatment of painful vertebral compression fracture in pain relief, mobility improvement, and reduction of deformity.
Body Height ; Congenital Abnormalities ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Kyphosis ; Spine

To overcome venous congestion in fingertip replantation, we have used "salvage procedure" which consists of continuous external bleeding via a stab incision on paraungal area and dripping of heparinized saline solution at the incision site to maintain external bleeding. As this method requires continuous bleeding for a certain period of time, it may be a great burden for patients, therefore it is most important to minimize the duration of bleeding for patients. Many authors have studied on the new venous channel formation of the flap. However, to our knowledge a study on the new vascular connection in fingertip replantation has not yet been carried out. Between January of 1994 to August of 1999, we performed replantations for 60 fingers in 59 patients using our salvage procedure in the Korea University Guro Hospital. Among 60 cases, 49 cases were survived including partial necrosis. We reviewed medical records of these 49 cases retrospectively. We compared and analyzed the period of external bleeding according to sex, age, level, cause of amputation, and the type of injury. The average period of the salvage procedure was K4 days. 6.0 days was required for the patients under the age of 10, and 7.6 days for the teens, which were the shortest salvage period groups. Based on the types of injuries, it is shorter in guillotine injury group (6.9 days) than in crush (9.0 days) or avulsion (K7 days) groups. On the other hand, the sex and level of injury did not show much difference in the duration of the procedure.
Adolescent ; Amputation ; Fingers ; Hand ; Hemorrhage* ; Heparin ; Humans ; Hyperemia ; Korea ; Medical Records ; Necrosis ; Replantation* ; Retrospective Studies ; Sodium Chloride

Since the time of its inception within facial anatomy, wide variability in the terminology as well as the location and extent of retaining ligaments has resulted in confusion over nomenclature. Confusion over nomenclature also arises with regard to the subcutaneous ligamentous attachments, and in the anatomic location and extent described, particularly for zygomatic and masseteric ligaments. Certain historical terms—McGregor's patch, the platysma auricular ligament, parotid cutaneous ligament, platysma auricular fascia, temporoparotid fasica (Lore's fascia), anterior platysma-cutaneous ligament, and platysma cutaneous ligament—delineate retaining ligaments of related anatomic structures that have been conceptualized in various ways. Confusion around the masseteric cutaneous ligaments arises from inconsistencies in their reported locations in the literature because the size and location of the parotid gland varies so much, and this affects the relationship between the parotid gland and the fascia of the masseter muscle. For the zygomatic ligaments, there is disagreement over how far they extend, with descriptions varying over whether they extend medially beyond the zygomaticus minor muscle. Even the ‘main’ zygomatic ligament's denotation may vary depending on which subcutaneous plane is used as a reference for naming it. Recent popularity in procedures using threads or injectables has required not only an accurate understanding of the nomenclature of retaining ligaments, but also of their location and extent. The authors have here summarized each retaining ligament with a survey of the different nomenclature that has been introduced by different authors within the most commonly cited published papers.
Cheek* ; Fascia ; Ligaments* ; Masseter Muscle ; Parotid Gland ; Rejuvenation

Multiple agents can cause anaphylaxis in a perioperative setting. Identifying the agent responsible is essential for avoiding future adverse reactions as well as to attenuate the progression of anaphylaxis. Being able to distinguish an anaphylactic reaction from an anaphylactoid reaction would help clarify the therapeutic and medicolegal issues. Anaphylaxis generally occurs after reexposure to a specific antigen and requires the release of proinflammatory mediators from mast cells and basophils. An increased concentration of mast cell tryptase is a highly sensitive indicator of anaphylactic reactions during anesthesia. Botropase(R) is a procoagulant hemocoagulase purified from venom of Bothrops jararaca, a Brazilian viper and in wide use in patients with high risk of bleeding. We report a case of suspected anaphylaxis to Botropase(R) in a 67 years old female patient undergoing segmental resection of the liver with elevated concentration of serum mast cell tryptase.
Aged ; Anaphylaxis* ; Anesthesia ; Basophils ; Batroxobin* ; Bothrops ; Female ; Hemorrhage ; Histamine ; Humans ; Liver ; Mast Cells* ; Tryptases* ; Venoms

No definitive etiology or risk factors have been identified that predispose individuals to developing complex regional pain syndrome (CRPS). We experienced two cases of CRPS developed after arterial and venous puncture which were done in regular medical work. A 35-years old female patient was suffered from pain and allodynia with swelling at right hand and wrist after radial artery puncture for monitoring of blood pressure during general anesthesia. A 24-years old male patient had pain and swelling with allodynia at the right fingers and arm after median cubital vein puncture for blood sampling. They did not have proper pain management as CRPS patients in the past weeks and months after their pain occurred. They were diagnosed as CRPS and started undergoing various interventional procedures, which led to improve their pain condition. Our cases suggest that CRPS could develop without any proved tissue damage in routine medical practice. In conclusion, health care workers should be educated in knowledge about the uncommon medical condition and proper consultation to pain specialist when it happens.
Adult ; Anesthesia, General ; Arm ; Arteries* ; Blood Pressure ; Delivery of Health Care ; Female ; Fingers ; Hand ; Humans ; Hyperalgesia ; Male ; Pain Management ; Punctures* ; Radial Artery ; Risk Factors ; Specialization ; Veins* ; Wrist ; Young Adult