To define the effect of alkalinization of bupivacaine 0.5% in supraclavicular approch of brachial plexus bock, the onset of sensory and motorblock were determined. Fourty physical status ASA 1 were randomly allocated to two groups.: Group 1 (n=20); bupivacaine 0.5% 20 ml (pH 6.0-6.2). Group 2 (n=20); alkalinized buivacaine 0.5% 20 ml (pH 6.9-7.2). Onest of sensory blockade were determined by pinprick in the C4 - T2 skin dermatome, and extend of sensory block was assessed by the number of dermatomes blocked while motor blockade was assessed by scoring on a scale: Grade 1; inability to flex the elbow against resistance. Grade 2; inability to flex the elbow against gravity. Grade 3; inability to flex the wrist against gavity. The results were as follows. 1) The average time for sensory blockade of five dermatonies was significantly more rapid in group 2 (within 15 min) than those in group 1 (over 25 min). 2) The average time of motor blockade was significantly more rapid in group 2 (Grade 1: 2 min 43 sec, Grade 2: 11 min 36 sec) than those in group 1 (Grade 1: 5 min 4 sec, Grade 2: 18 min 36 sec). 3) There was no pneumothorax, phrenic nerve paralvsis and general seizure or other side effects but Horners syndrome in 10 cases and hematoma in 2 cases were observed. The results indicate that alkainized bupivacaine for supraclavicular approch of rachial plexus block has more rapid onset than plain bupivacaine.
Brachial Plexus* ; Bupivacaine* ; Elbow ; Gravitation ; Hematoma ; Horner Syndrome ; Phrenic Nerve ; Pneumothorax ; Seizures ; Skin ; Wrist

Complications from use of the light wand have been reported rarely. We present a case of arytenoid cartilage dislocation incurred by using this technique for intubation of a patient. A 35-year-old healthy woman was admitted for microsurgical cervical diskectomy. Anesthesia was induced and a 7.0 mm cuffed endotracheal tube with a light wand was inserted during blind orotracheal intubation. The trachea was extubated without any difficulty in the operating room after the surgery. In the third postoperative day, the patient complained sore throat and mild hoarseness. In the eighth postoperative day, the patient was discharged for follow-up of Department of neurosurgery. In the second day after the discharge, she was consulted to otolaryngology service in our hospital because she suffered from persistent hoarseness. Flexible nasopharyngolaryngoscopy revealed anterior and inferior dislocation of left arytenoid cartilage. The patient was taken to the operating room for reduction of the dislocated cartilage by the otolaryngologists. Despite the delayed reduction, which was performed tenth day after her initial injury, the patient,s hoarseness had resolved completely without further treatment.
Adult ; Anesthesia ; Arytenoid Cartilage* ; Cartilage ; Diskectomy ; Dislocations* ; Female ; Follow-Up Studies ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal* ; Neurosurgery ; Operating Rooms ; Otolaryngology ; Pharyngitis ; Trachea

It is clinically important to know the size of normal trachea for airway management and respiratory care. The knowledge is useful for avoiding many possible complications due to tracheal intubation by appropriate choice of endotracheal tube size. Therefore, we investigated antero-posterior(A-P) diameter, transverse diameter and cross- sectional area(CSA) of trachea at various level with MRI(magnetic resonance imaging) in 70 males and 79 females who were divided into three age groups(group 1: 16-39 year of age, group 2: 40-59 year of age, group 3: 60-83 year of age), and they had no abnormalities in cardiopulmonary system. The results were as follows; 1. A-P 2. Transverse 3. Narrowing portion 4. CSA 1. A-P diameter of trachea was 17.1+/-1.4 mm in male and 13.9+/-1.3 mm in female. Transverse diameter of trachea was 15.1+/-1.6 mm in male and 13.3+/-1.5 mm in female(Table 1). A-P and Transverse diameters were greater in male than in female (P<0.05). 2. C-7 was the narrowest portion of A-P diameter in both sex (P<0,05). C-5 was the narro- west portion of transverse diameter in both sex (P<0.05). 3. A-P diameters of trachea among male patients were 17.1+/-1.2 mm, 17.41.6 mm, and 16.6+/- 1.3 mm in group 1, 2 and 3 (Table 3, Fig. 4). A-P diameters of trachea in female age group 1, group 2 and group 3 were 13.7+/-1.2 mm, 14.3+/-1.3 mm, and 13.6+/-1.5 mm(Table 3, Fig. 4). Transverse diameters of trachea in male age group 1, group 2 and group 3 were 14.8+/-1.4 mm, 15.1+/-1.7 mm, and 15.4+/-1.6 mm(Table 3, Fig. 4). Transverse diameters of trachea in female age group 1, group 2 and group 3 were 13.0+/- 1.2 mm, 13.6+/-1.9 mm and 13.5+/-1.4 mm(Table 3, Fig. 4). 4. CSA(cross sectional area) of trachea were 201.1+/-31.3 mm(2) in male and 145.4+/-27.7(2) mm in female(Table 4). 5. CSA at C5, C6, C7 and Tl in male were 175.9+/-61.1 mm(2), 201.1+/-43.8 mm(2), 196.2+/-36.2 mm(2) and 230.9+/-463 mm(2) (Table 4, Fig. 5). CSA at C5, C6, C7 and Tl in female were 127.0+/- 33.4 mm(2), 138.434.6 mm(2), 140.734.7 mm(2) and 171.7+/-42.0 mm(2) (Table 4, Fig. 5). 6. CSA of trachea among male patients were 198.1+/-28,5 mm(2), 206.2+/-33.0 mm(2) and 198.3+/-33.1 mm(2) in group 1, 2 and 3 (Table 5, Fig. 6). CSA of trachea in female age group 1, group 2 and group. 3 were 140.2+/-25.0 mm(2), 152.8+/-32.4 mm(2) and 145.6+/-25.1 mm(2) (Table 5, Fig. 6). But there was no significant difference between groups according to the sex. 7. CSA of trachea in age groups were stastically insignificant for both sex.
Adult* ; Airway Management ; Female ; Humans ; Intubation ; Magnetic Resonance Imaging* ; Male ; Trachea*