Subcutaneous emphysema can occur as the result of trauma, surgical procedure and anesthetic complication. As increasing numbers of laparoscopic procedures are performed, increasing numbers of complications directly related to laparoscopy will occur. A case is presented of subcutaneous emphysema without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy in difficultly intubated patient. The cause is suspected of inadvertent subcutaneous insufflation of carbon dioxide during the initial Verres needle puncture for the establishment of pneumoperitoneum. Etiology and evaluation of subcutaneous emphysema possibly associated with this case are reviewed.
Carbon Dioxide ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Emphysema ; Humans ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema*

BACKGROUND: From a clinical perspective, the regurgitation of the gastric contents above the upper esophageal sphincter has greater clinical relevance than gastroesophageal reflux. The authors investigated the incidence of regurgitation of gastric contents above the upper esophageal sphincter associated with the laryngeal mask airway(LMA) and the endotracheal tube(ETT) by methylene blue(50mg) gelatine capsule and pH probe in positive pressure ventilated patients during long surgical procedures . METHODS: Sixty patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n=34) or a ETT(n=26) for airway management. For the detection of regurgitation episodes during anesthesia, a pH monitoring probe was positioned in the hypopharynx 30 minutes before induction and a methylene blue capsule was swallowed just before induction. At the end of anesthesia, the episodes of regurgitation of gastric contents above upper esophageal sphincter were analyzed according to the pharyngeal blue staining or pH< or =4. RESULTS: There were no episodes of regurgitation of gastric contents(pH< or =4 or/and methylene blue staining) above the upper esophageal sphincter detected during the course of measurement. There was no clinical evidence of aspiration in either group. CONCLUSIONS: In comparison with ETT, the use of LMA does not appear to result in increased incidence of regurgitation of gastric contents above upper esophageal sphincter in positive pressure ventilated patients during long surgical procedures.
Airway Management ; Anesthesia ; Esophageal Sphincter, Upper* ; Gastroesophageal Reflux ; Gelatin ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Incidence* ; Laryngeal Masks* ; Methylene Blue ; Orthopedics

BACKGREOUND: The sympathetic investigations during thoracic sympathectomy are essential to an adequate sympathectomy that will lead to sufficient and lasting relief of palmar hyperhidrosis. The measurement of palmar skin temperature has been used as an indicator of success of transcutaneous chemical thoracic sympathectomy. We measured intraoperative palmar skin temperature to know whether it can be used as a same purpose in the endoscopic thoracic sympathectomy under general anesthsia. METHODS: Fifteen patients (18 to 25 years old) with palmar hyperhidrosis underwent endoscopic thoracic sympathectomy under general anesthesia. The palmar skin temperature was measured with a skin probe of a thermometer applied on the both index finger tips. The palmar skin temperature was monitored continuously from the beginning of anesthesia to the complete arousal. RESULTS: The palmar skin temperature increased significantly by about 3 degrees C just after induction. There was no significant difference in the palmar skin temperature between just before sympathectomy and soon after sympathectomy during the endoscopic thoracic sympathectomy. CONCLUSIONS: Intraoperative measurement of palmar skin temperature can not indicate a definite sympathectic denervation during the endoscopic thoracic sympathectomy under general anesthesia.
Anesthesia ; Anesthesia, General ; Arousal ; Denervation ; Fingers ; Humans ; Hyperhidrosis* ; Skin Temperature* ; Skin* ; Sympathectomy* ; Thermometers

We designed a study to determine if the tracheal tube cuff inflation in the oropharynx improves the success rate of blind nasotracheal intubation in normal, paralyzed patients because of lacking of controlled study about it. In prospective, randomized fashion, 100 ASA I or II patients undergoing elective oral surgery were studied. The trachea was intubated once keeping the tracheal tube cuff deflated throughout the maneuver and once using the technique of tracheal tube cuff inflation in the oropbarynx. A maximum of two attempts was allowed for each technique. If the first attempt was failed, the second attempt was tried with an addition of application of thyroid cartilage compression in each technique. Witb the tracheal tube cuff inflated, the success rate was significantly higher than the cuff-deflated technique(p<0.05). A application of thyroid cartilage compression increased the success rate of the blind nasotracheal intubation in each technique, but it was more useful in the cuff inflation technique(p<0.05). Time taken to intubate the trachea was longer in the cuff inflation technique. We suggest that, in normal paralyzed patients, the tracheal tube cuff inflation in the oropharynx increases the success rate of blind nasotracheal intubation.
Humans ; Inflation, Economic* ; Intubation* ; Oropharynx* ; Prospective Studies ; Surgery, Oral ; Thyroid Cartilage ; Trachea

BACKGROUND: In the present study, we examined the effect of morphine on NO- and peroxynitrite-induced cell death using a human neuroblastoma SH-SY5Y cell line which abundantly expresses micro, delta and K-opioid receptors. METHODS: The cultured cells were pretreated with morphine (100 micrometer) and exposed to 3-morpholinosydnonimine (SIN-1, 1mM). Agarose gel electrophoresis of DNA was done with the extracts from SH-SY5Y cells. The cells were treated with selective ligands for opioid receptor subtypes and with PI3-kinase inhibitors. Cell damage was assessed by using an MTT assay. Spectrophotometric absorption spectra were measured from the mixture of morphine (100 micrometer) plus peroxynitrite (1 mM) at room temperature. RESULTS: SIN-1 treated cells showed the occurrence of a specific form of chromosomal DNA fragmentation which pretreatment with morphine inhibited. The selective ligands for opioid receptor subtypes, [D-Ala2, N-Me-Phe4, Gly-ol5]enkephalin (DAMGO, micro-opioid receptor agonist), [D-Pen2,5] enkephalin (DPDPE, delta-opioid receptor agonist) and U-69593 (K-opioid receptor agonist) at a concentration of 10 micrometer did not prevent the cell death induced by SIN-1. Naloxone (20 micrometer) hardly antagonized the effect of morphine in SIN-1-induced cell death. The PI3-kinase inhibitors Wortmannin and LY294002 did not inhibit the action of morphine on apoptotic cell death. In the measurements of spectrophotometric absorption spectra, the peak of the absorbance of the mixture of morphine plus peroxynitrite at 295 300 nm disappeared three minutes after mixing. CONCLUSIONS: The present study showed that morphine protected the human neuroblastoma cell line,SH-SY5Y, from peroxynitrite-induced apoptotic cell death. However, it is suggested that the protective action of morphine is not via the activation of opioid receptors and/or the PI3-kinase pathway but possibly via direct chemical reaction.
Absorption ; Cell Death ; Cell Line ; Cells, Cultured ; DNA ; DNA Fragmentation ; Electrophoresis, Agar Gel ; Enkephalins ; Humans* ; Ligands ; Morphine* ; Naloxone ; Neuroblastoma* ; Peroxynitrous Acid ; Phosphatidylinositol 3-Kinases ; Receptors, Opioid

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. However, our previous study, Verapamil and esmolol did not attenuate heart rate and blood pressure. The aim of the present study was to evaluate the efficacy of combined administration of these drugs for controlling hemodynamic responses to tracheal intubation. METHODS: Forty-eight patients, ASA physical status I or II, were randomly assigned to one of four groups (n = 12 each):normal saline (control), verapamil 0.1 mg/kg, esmolol 1 mg/kg, and verapamil 0.05 mg/kg mixed with esmolol 0.5 mg/kg. Anesthesia was induced with thiopental 5 mg/kg intravenously, and then saline, verapamil, esmolol or the mixed drugs were administered as an intravenous bolus, and immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was performed 90 s after intravenous injection of experimental drugs. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic blood pressure after tracheal intubation in the verapamil and mixed groups compared to the control and esmolol groups. Heart rates were significantly lower in the esmolol and mixed groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Combined administration of Verapamil 0.05 mg/kg with esmolol 0.5 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Succinylcholine ; Thiopental ; Verapamil*

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different from one another. The authors of this study measured the intraesophageal pH at 5cm above lower esophageal sphincter(LES) to compare the incidence of gastroesophageal reflux associated with the LMA and the endotracheal tube(ETT) in positive pressure ventilated patients during long surgical procedures. METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n=49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and a probe with a pH electrode was passed nasally into the esophagus and positioned at 5 cm above LES one day before the operation. After that, recordings of pH for the diagnosis of gastroesophageal reflux disorder and for the detection of reflux episodes during and immediate after anesthesia were performed. RESULTS: There was no significant difference in the incidence of reflux(pH< or =4) between groups; only two patients in LMA and three patients in ETT had reflux episodes in the removal or arousal phase. All of them had experiences such as a coughing or straining during those phases. There was no clinical evidence of aspiration of gastric contents in either group. CONCLUSION: In comparison with ETT, use of LMA does not appear to result in increased incidence of reflux in positive pressure ventilated patients during long surgical procedures.
Airway Management ; Anesthesia ; Arousal ; Cough ; Diagnosis ; Electrodes ; Esophageal Motility Disorders ; Esophagus ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Laryngeal Masks* ; Manometry ; Orthopedics

No abstract available.
Vulva*

PURPOSE: It is known that deficiency of metallothionein (MT) and manganese-containing superoxide dismutase (Mn-SOD), scavengers of reactive oxygen species, results in aging and carcinogenesis by inducing DNA damage. Paraquat can produce reactive oxygen species and induce antioxidants in human. In this study, an attempt was made to verify the relation between gastric carcinogensis and the induction rates of these antioxidants. METHODS: Peripheral blood of 24 randomly selected patients with gastric cancer, who were treated at Chosun University Hospital between Febuuary 1999 and December 1999, was examined. 3 male and 3 female patients in each decade from 40 to 70 years were selected. Twenty-four (24) volunteers with no laboratory, chemical, radiologic and endoscopic abnormalities during the same period were used for the normal control group. White blood cells were isolated from peripheral blood and incubated in culture media, including paraquat, for 18 hours at 37oC. MT and Mn-SOD mRNA expressions were examined using the reverse transcription-polymerase chain reaction (RT-PCR) method. RESULTS: The induction rates of MT and Mn-SOD mRNA in the cancer group due to paraquat were lower than those in the control group. Also, the rates decreased in both groups with age. CONCLUSION: The inducibilities of MT and Mn-SOD mRNA by paraquat may play a role in the carcinogenesis of gastric cancer and in the aging process. Based on this result, patients with a high risk of gastric cancer should be screened actively for early detection.
Aging ; Antioxidants ; Carcinogenesis ; Culture Media ; DNA Damage ; Female ; Humans ; Leukocytes* ; Male ; Metallothionein* ; Paraquat* ; Reactive Oxygen Species ; RNA, Messenger ; Stomach Neoplasms* ; Superoxide Dismutase* ; Superoxides* ; Volunteers

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*