BACKGROUND: Pediatric outpatient anesthesia is beneficial because it is more comfortable to children and more convenient for families, but delayed discharge causes distress for parents and children and increases health care personnel workload. Therefore, we examined past medical records to evaluate factors affecting discharge time in pediatric outpatient anesthesia. METHODS: We reviewed the anesthetic and post-anesthetic care records of 119 children who required ventilation tube insertion for ambulatory surgery, and who were anesthetized and monitored by an anesthesiologist between June 2001 and February 2004. Data were classified according to the anesthetic technique and agents used, duration of operation and anesthesia, and complications in the recovery room. We then examined the relationships between these factors and discharge time. RESULTS: Compared to intravenous anesthesia, endotracheal anesthesia increased anesthesia time (P <0.05), but not discharge time. Ketamine dosage was found to be closely correlated with discharge time (P <0.01), and complications in the recovery room delayed discharge time (P <0.05). CONCLUSION: We conclude that excessive ketamine use and postoperative complications delay discharge in pediatric outpatient anesthesia. More attention should be paid to minimize ketamine use and reduce postoperative complications so as not to delay discharge in pediatric outpatient anesthesia.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthesia, Intravenous ; Child* ; Delivery of Health Care ; Ear, Middle* ; Humans ; Ketamine ; Medical Records ; Middle Ear Ventilation* ; Outpatients* ; Parents ; Postoperative Complications ; Recovery Room ; Ventilation

A 48 years old female patient was scheduled for emergency surgery due to bleeding after intracerebral aneurysmal clipping under general anesthesia. Previously checked chest X-ray taken just a few hours before surgery showed no abnormal finding and she didn't show any sign of pneumothorax or hemothorax including dyspnea, tachypnea or cyanosis. Surgery was uneventful. After the completion of surgery, patient was transferred to the neurosurgical intensive care unit with intubation. During transfer, patient showed bucking and signs of subcutaneous emphysema around chest, shoulder and face. Oxygen saturation was low when she admitted to the neurosurgical intensive care unit, so the ventilator care was started. The patient's oxygenation were getting worse progressively, so we checked chest AP several times and one of the chest X-ray taken at that time revealed no vascular and lung marking on the left lung field suggesting pneumothorax. Emergency chest tube drainage was performed. She recovered dramatically and three days later, ches X-ray showed the complete resorption of the pneumothorax.
Anesthesia, General ; Aneurysm ; Chest Tubes ; Cyanosis ; Drainage ; Dyspnea ; Emergencies ; Female ; Hemorrhage ; Hemothorax ; Humans ; Intensive Care Units* ; Critical Care* ; Intubation ; Lung ; Middle Aged ; Oxygen ; Patient Transfer* ; Pneumothorax* ; Shoulder ; Subcutaneous Emphysema* ; Tachypnea ; Thorax ; Ventilators, Mechanical

Laparoscopy is a surgical procedure used both for diagnosis and for various treatments. A rare but sometimes fatal complication of laparoscopy is pulmonary embolism with CO2 resulting in pulmonary edema. During laparoscopic gynecological surgery in a 29-year-old woman who had previously undergone lower abdominal surgery, the end-tidal CO2 suddenly increased from 40mmHg to 85mmHg and then decreased to 13mmHg with hemodynamic deterioration. These events are characteristic of a CO2 embolism. When this occurred, CO2 insufflation was immediately stopped and the patient was resuscitated. The patient's condition gradually improved with aggressive treatment, but the clinical course was complicated by bilateral pulmonary edema. This case of pulmonary edema was soon resolved with supportive management. The formation of a CO2 embolism during laparoscopy must be suspected whenever there is a sudden change in the end-tidal CO2. In addition, the possibility of pulmonary edema should be considered when a CO2 embolism occurs.
Adult ; Carbon Dioxide/*metabolism ; *Cystectomy ; Female ; Humans ; *Laparoscopy ; Ovarian Cysts/*surgery ; Pulmonary Edema/*complications/metabolism/radiography ; Pulmonary Embolism/*complications/metabolism/radiography

Atrial fibrillation is one of the most common arrhythmias in everyday life, and it is responsible for substantial mortality and morbidity in the general population.When atrial fibrillation is first noticed and it persists for a long time, it will be more difficulty to control and it will recur more often.A 58-year old female patient was scheduled for surgery due to the increased size of an intracranial arteriovenous malformation.During the preparation of anesthesia, we noticed the presence of atrial fibrillation.After about 2 hours of sedation and consultation, we decide to proceed with the surgery. With the induction of anesthesia by using thiopental sodium, we observed the rapid conversion of atrial fibrillation to sinus tachycardia.During the maintenance of anesthesia, the patient showed normal sinus rhythm and the surgery was completed without complications.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Female ; Humans ; Thiopental

Muscle relaxants are the most common cause of anaphylaxis during anesthesia. An intradermal skin test is commonly used to investigate the cause of anaphylaxis. A 46-year-old man was scheduled for percutaneous nephrolithotripsy. He had a history of a positive intradermal skin test to muscle relaxants for general anesthesia. After injection of thiopental sodium, anesthesia was induced, which gradually deepened with increments of sevoflurane in 100% oxygen. Tracheal intubation was performed smoothly, without adjunct muscle relaxant. After stabilization, a small dose of vecuronium was administered, but the blood pressure transiently decreased, and the oxygen saturation was decreased from 98 to 92% for 30 minutes. No muscle relaxant was used thereafter, and the anesthesia was maintained with sevoflurane, nitrous oxide and oxygen with intermittent propofol administration. Surgery was completed uneventfully, and the patient recovered without any adverse reaction. To prevent anaphylaxis, the use of a suspicious causative agent should be avoided.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Humans ; Intubation ; Middle Aged ; Nitrous Oxide ; Oxygen ; Propofol ; Skin Tests* ; Skin* ; Thiopental ; Vecuronium Bromide

BACKGORUND: inhalation anesthetics have been known as bronchodilators, and there are reports that enflurane has some relaxing effects on tracheal smooth muscles. However, there are not so many reports on the ACh release in the postganglion nerve endings. We tried to evaluate the effect of enflurane on the contraction of the tracheal smooth muscle in the postganglion nerve ending in guinea pigs. METHODS:isolated tracheal preparations of guinea pigs were used and contractions were induced by electrical field stimulation (3 Hz & 30 Hz). in the pilocarpine- enflurane group, pilocarpine (10(-5) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the gallamine-enflurane group, gallamine (10(-6) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the enflurane 1 MAC group and 2 MAC group, contractions were induced by electrical field stimulation before and after administration of enflurane. The percentile contraction to the contraction induced by acetylcholine (10(-4) M) were evaluated. RESULTS: The potentiation of the contraction which was induced by electrical field stimulation was observed by enflurane administration and with prior administration of pilocarpine (10(-6) M), with prior administration of gallamine (10(-5) M). There was no potentiation of contractions, but potentiation of the contraction was observed with enflurazne (2 MAC, 30 Hz). CONCLUSiONS:Enflurane potentiates the contraction induced by electrical field stimulation in guinea pig tracheal smooth muscle. These findings seem to be related with prejunctional M2 receptor in the postganglionic nerve endings.
Acetylcholine ; Anesthetics, Inhalation ; Animals ; Bronchodilator Agents ; Enflurane* ; Gallamine Triethiodide ; Guinea Pigs* ; Guinea* ; Muscle, Smooth* ; Nerve Endings ; Pilocarpine ; Receptors, Muscarinic

A 43-year-old female was admitted for a laparoscopic surgical procedure. Her past history included two uneventful general anesthesias, but anaphylactic shock due to an unknown drug occurred during her third surgery. Induction was performed with thiopental sodium, but an immediate anaphylactic reaction developed with cardiovascular collapse. We resuscitated the patient and she recovered without any complication.
Adult ; Anaphylaxis* ; Anesthesia, General ; Female ; Humans ; Laparoscopy ; Thiopental*

Ergonovine have been used for the prevention and treatment of postpartum or postabortion hemorrhage. Although this modality has been considered relatively safe in the obstetric patients, there were a few cardiac events associated with this drug in the post-delivery or post-abortion patients, especially in patients with cardiovascular risk factors. We experienced cardiac arrest in a non-parturient with no discernible risk factors. Although resuscitated, she also suffered from pulmonary edema with unstable hemodynamics and low oxygenation. To manage the patient, extracorporeal membrane oxygenation was used and she recovered successfully without cardiopulmonary complications. Therefore, we recommend that when ergonovine is chosen as a modality, special caution should be paid to the pulmonary events, as well as cardiac, especially when administered by intravenously even in patients with no cardiovascular risk factors. If cardiac events occur, extracorporeal membrane oxygenation or other measures, such as intra-aortic balloon pump can be helpful when conventional cardiopulmonary resuscitation is not effective.
Aftercare ; Cardiopulmonary Resuscitation ; Ergonovine ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Hemodynamics ; Hemorrhage ; Humans ; Membranes ; Oxygen ; Postpartum Period ; Pulmonary Edema ; Risk Factors

Leiomyomas are common in the myometrial layer of the uterus, though they are rarely found in other reproductive organs. Leiomyomas are benign, hormone-sensitive smooth muscle tumors. They develop during the reproductive years and regress after menopause. Preoperative diagnosis is difficult to make. We present a case of a 54-year-old woman with a vaginal wall tumor. The management in this case included surgical excision. Histologic examination definitively confirmed the diagnosis of a vaginal leiomyoma. We report the details of this case along with a brief review of the literature.
Female ; Humans ; Leiomyoma ; Menopause ; Middle Aged ; Smooth Muscle Tumor ; Uterus ; Vagina

BACKGROUND: Various plasma substitutes are used for the correction of hypovolemia caused by blood loss. It is known that plasma substitutes themselves have some adverse effects on blood coagulation. We performed this study to show the actual effect of plasma substitutes on blood coagulation in clinical hypovolemic situation caused by blood loss. METHODS: 60 patients scheduled for radical hysterectomy were grouped by the plasma substitutes infused; group C, S, V and P correspondingly infused with Hartman's solution, Salinhes(R), Voluven(R) and Pentaspan(R). Thromboelastograms (TEG) at 15 minutes after induction of anesthesia (T(0)), after 15% blood loss of the estimated blood volume (T(1)) and just after infusion of the plasma substitutes (T(2)) were compared among the groups and changes with the time course within each group were investigated. RESULTS: Compared to group C, MA, A60, coagulation index, CL60 (parameters of TEG) were decreased and LY60 increased in group S and P while group V presented no significant changes. Hypercoagulability and reduced fibrinolysis were observed for T(1); for T(2), group C showed decrease in k-time, LY60 and increase in alpha angle, CL60. Group S presented decrease in MA, A60 compared to T0 and decrease in CL60 and increase in LY60. CONCLUSIONS: Surgery and blood loss accelerated coagulation and reduced fibrinolysis. These were aggravated after crystalloid infusion. In contrast, coagulability was reduced and fibrinolysis augmented after infusion of HES except HES 130/0.4/6.
Anesthesia ; Blood Coagulation ; Blood Volume ; Fibrinolysis ; Humans ; Hypovolemia ; Hysterectomy* ; Plasma Substitutes* ; Plasma* ; Thrombophilia