BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

Tracheoesophageal fistula (TEF) occurs in approximately 1 in 3,000 to 5,000 live births. TEF arises from failure of normal division of proximal foregut into separate respiratory and digestive tracts at 4 weeks' gestation. TEF and esophageal atresia are interrelated anomalies, and TEF usually occurs with esophageal atresia. These are usually diagnosed shortly after birth. However, the diagnosis is often delayed in TEF without esophageal atresia, because babies with this anomaly are usually normal in size and seldom have other anomalies. Therefore, sometimes TEF without esophageal atresia is found during operation for an unrelated condition when positive pressure ventilation causes massive inflation of the gastrointestinal tract. We report a case of TEF in adult patient found during general anesthesia for emergency exploratory laparotomy.
Adult ; Anesthesia, General* ; Diagnosis ; Emergencies* ; Esophageal Atresia ; Gastrointestinal Tract ; Humans ; Inflation, Economic ; Laparotomy* ; Live Birth ; Parturition ; Positive-Pressure Respiration ; Pregnancy ; Tracheoesophageal Fistula*

BACKGROUND: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. METHODS: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. RESULTS: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. CONCLUSIONS: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.
Arthroscopy* ; Dislocations ; Elbow ; Humans ; Joint Instability ; Recurrence* ; Reoperation ; Risk Factors* ; Shoulder* ; Surgeons ; Suture Anchors* ; Sutures*

In the published article by Choi et al., a part of expression of the Abstract and the Conclusion section in the main body text have been corrected. Underlined text should be read carefully.

We had a case of respiratory difficulty following tracheal extubation due to bilateral vocal cord paralysis. The patient was a 66-year-old woman undergoing craniotomy for cerebellopontine angle meningioma. Anesthesia was uneventful. Spontaneous respiration resumed after reversal of neuromuscular blockade. Following extubation she showed inspiratory stridor, tachypnea, and chest retraction. Reintubation was done and then tracheostomy was performed. Every factor contributing vocal cord paralysis such as pressure on the nerve by an overexpanded endotracheal tube cuff, unique posture of the neck during the operation, and female gender, long operating time(about 11 hours) were seemed to be possible causes and we considered the interaction of these combinations responsible for the bilateral vocal cord paralysis. Eight weeks later, the patient's vocal cord function had returned to normal.
Aged ; Airway Extubation* ; Anesthesia ; Cerebellopontine Angle ; Craniotomy ; Female ; Humans ; Meningioma ; Neck ; Neuromuscular Blockade ; Posture ; Respiration ; Respiratory Sounds ; Tachypnea ; Thorax ; Tracheostomy ; Vocal Cord Paralysis* ; Vocal Cords*

BACKGROUND: Opioids are increasingly being administered intrathecally as adjuncts to local anesthetics. They enhance spinal anesthesia without prolonging motor recovery. We evaluated the effect of 10 microgram of fentanyl to bupivacaine on sensory, motor block and side effects. METHODS: Thirty six patients undergoing urologic surgery were randomized into two groups. Control group received bupivacaine 10 mg combined with normal saline 0.2 ml, and Fentanyl group received bupivacaine 10 mg with fentanyl 10 microgram (0.2 ml). RESULTS: There were no significant differences between two groups in the peak level of sensory block, onset of peak level, duration of motor block, and side effects. However, the time of regression from peak level to T10 in Fentanyl group was longer significantly than that of Control group. CONCLUSIONS: Intrathecal small dose fentanyl (10 microgram) on bupivacaine spinal blockade prolonged duration of sensory block and did not augment side effects and provide reliable anesthesia for urologic surgery.
Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine* ; Fentanyl* ; Humans

The purpose of this study was to investigate the effects of smoking on adult periodontitis after non-surgical periodontal therapy. The study population consisted of 40 patients with moderate to advanced periodontitis. Smokers(n=20) were defined as individuals smoking at least twenty cigarettes per day at the time of the initial examination. The non-smoking group(n=20) consisted of individuals who were not smoking at the initial examination. The average age was 42.4 years for the smoking and non-smoking group. Examination regarding plaque index, gingival index, pocket depth and contrast phase microscope were performed. Evaluation were made at the first, the second and the fourth weeks after periodontal non-surgical therapy. The results were as follows: 1. Clinical indices including plaque index, gingival index, and pocket depth were decreased in both smoking and non-smoking group at the first, the second, and the fourth weeks. Especially, clinical indices of non-smokers were more significantly decreased than those of smokers. 2. Non-motile rods were increased and motile rods were reduced at the fourth week. spirochetes were reduced significantly in the non-smoking group at the fourth week. These results suggest that smoking play a minor role in adult periodontitis after non-surgical periodontal therapy.
Adult* ; Chronic Periodontitis* ; Humans ; Periodontal Index ; Periodontitis ; Smoke* ; Smoking* ; Spirochaetales ; Tobacco Products

The purpose of this study was to investigate the effects of smoking on adult periodontitis after non-surgical periodontal therapy. The study population consisted of 40 patients with moderate to advanced periodontitis. Smokers(n=20) were defined as individuals smoking at least twenty cigarettes per day at the time of the initial examination. The non-smoking group(n=20) second and the fourth weeks after periodontal non-surgical therapy. The results were as follows; 1. Clinical indices including plaque index, gingival index, and pocket depth were decreased in both smoking and non-smoking group at the first, the second, and the fourth weeks. Especially, clinical indices of non-smokers were more significantly decreased than those of smokers. 2. Non-motile rods were increaseed and motile rods were reduced at the fourth week. spirochetes were reduced significantly in the non-smoking group at the fourth week. These results suggest that smoking play a minor role in adult periodontitis after non-surgical periodontal therapy.
Adult* ; Chronic Periodontitis* ; Humans ; Periodontal Index ; Periodontitis ; Smoke* ; Smoking* ; Spirochaetales ; Tobacco Products

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires