BACKGROUND: The increased pain at the latent phase can be associated with dysfunctional labor as well as increases in cesarean delivery frequency. We aimed to research the effect of the degree of pain at the time of epidural analgesia on the entire labor process including the mode of delivery. METHODS: We performed epidural analgesia to 102 nulliparous women on patients' request. We divided the group into three based on NRS (numeric rating scale) at the moment of epidural analgesia; mild pain, NRS 1-4; moderate pain, NRS 5-7; severe pain, NRS 8-10. The primary outcome was the mode of delivery (normal labor or cesarean delivery). RESULTS: There were significant differences in the mode of delivery among groups. Patients with severe labor pain had a significantly higher cesarean delivery compared to patients with moderate labor pain (P = 0.006). The duration of the first and second stage of labor, fetal heart rate, use of oxytocin and premature rupture of membranes had no differences in the three groups. CONCLUSIONS: Our research showed that the degree of pain at the time of epidural analgesia request might influence the rate of cesarean delivery. Further research would be necessary for clarifying the mechanism that the augmentation of pain affects the mode of delivery.
Analgesia, Epidural* ; Delivery, Obstetric ; Female ; Heart Rate, Fetal ; Humans ; Labor Pain* ; Membranes ; Oxytocin ; Pregnancy ; Rupture

Several factors can affect the perioperative immune function. We evaluated the effect of propofol and desflurane anesthesia on the surgery-induced immune perturbation in patients undergoing breast cancer surgery. The patients were randomly assigned to receive propofol (n = 20) or desflurane (n = 20) anesthesia. The total and differential white blood cell counts were determined with lymphocyte subpopulations before and 1 hr after anesthesia induction and at 24 hr postoperatively. Plasma concentrations of interleukin (IL)-2 and IL-4 were also measured. Both propofol and desflurane anesthesia preserved the IL-2/IL-4 and CD4+/CD8+ T cell ratio. Leukocytes were lower in the propofol group than in the desflurane group at 1 hr after induction (median [quartiles], 4.98 [3.87-6.31] vs. 5.84 [5.18-7.94] 10(3)/microL) and 24 hr postoperatively (6.92 [5.54-6.86] vs. 7.62 [6.22-9.21] 10(3)/microL). NK cells significantly decreased 1 hr after induction in the propofol group (0.41 [0.34-0.53] to 0.25 [0.21-0.33] 10(3)/microL), but not in the desflurane group (0.33 [0.29-0.48] to 0.38 [0.30-0.56] 10(3)/microL). Our findings indicate that both propofol and desflurane anesthesia for breast cancer surgery induce a favorable immune response in terms of preservation of IL-2/IL-4 and CD4+/CD8+ T cell ratio in the perioperative period. With respect to leukocytes and NK cells, desflurane anesthesia is associated with less adverse immune responses than propofol anesthesia during surgery for breast cancer. (Clinical trial registration at https://cris.nih.go.kr/cris number: KCT0000939)
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anesthesia/adverse effects ; Anesthetics, Inhalation/*therapeutic use ; Anesthetics, Intravenous/*therapeutic use ; Breast Neoplasms/immunology/*surgery ; *CD4-CD8 Ratio ; Female ; Humans ; Interleukin-2/blood ; Interleukin-4/blood ; Isoflurane/*analogs & derivatives/therapeutic use ; Middle Aged ; Postoperative Period ; Propofol/*therapeutic use ; Young Adult

BACKGROUND: We investigated effect-site concentrations of propofol, changes in blood pressure and heart rate, time to loss of consciousness, time to loss of eyelid reflex and awakening time during anesthesia using effect-site target-controlled infusion, to compare the differences between Schnider and modified Marsh model. METHODS: Forty American Society of Anesthesiologists (ASA) physical status I or II patients between the ages of 18 and 55 years old and who were scheduled for elective surgery under general anesthesia were enrolled in this study. The patients were randomized into two groups: one group using modified Marsh model (Group 1) and the other group using Schnider model (Group 2). Effect-site concentrations of propofol, blood pressure, heart rate and BIS at each anesthetic stage were recorded. Time to loss of consciousness, time to loss of eyelid reflex and awakening time were measured. RESULTS: Group 1 showed shorter time to loss of consciousness and eyelid reflex at the lower effect-site concentration of propofol than Group 2 (P < 0.05). The effect-site concentrations of Group 1 were higher than those of Group 2 at eye opening and extubation (P < 0.05). CONCLUSIONS: Induction of anesthesia is achieved at lower effect-site concentration of propofol and more rapidly in the modified Marsh model than in the Schnider model. However the effect-site concentrations of propofol for awakening are higher in the modified Marsh model than in the Schnider model.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Eye ; Eyelids ; Heart Rate ; Humans ; Propofol ; Reflex ; Unconsciousness ; Wetlands

BACKGROUND: Transversus abdominis plane (TAP) block is a new regional anesthetic technique for postoperative pain control after lower abdominal surgery. We evaluated the analgesic efficacy of ultrasound-guided (US-) TAP block in patients undergoing lower abdominal surgery. METHODS: Thirty American Society of Anesthesiologists physical status I or II patients between 20-80 years of age undergoing lower abdominal surgery were randomized to receive standard care (n = 15) including intravenous patient-controlled analgesia (IV-PCA), or to undergo bilateral US-TAP block adjunctively (n = 15). A standard general anesthetic technique was used. After induction of anesthesia, bilateral US-TAP block was performed using total 30 ml of 2% lidocaine. Each patient was assessed postoperatively at 20, 30, and 60 min in postanesthesia care unit (PACU) and at 6, 12, and 24 h in ward for pain scores using verbal numerical rating scale (VNRS), analgesic requirements, quality of sleep, and complications. RESULTS: US-TAP block significantly reduced VNRS pain scores at 20, 30, and 60 min postoperatively (P < 0.001). The US-TAP block group required significantly fewer remifentanil intraoperatively (P < 0.05). Additional analgesic requirements were significantly lower in both PACU and ward (P < 0.05) in the US-TAP block group. There were no statistically significant between-group differences in total infused volume of IV-PCA, time to first requirement of analgesics in ward, and quality of sleep. CONCLUSIONS: US-TAP block with 2% lidocaine provided superior analgesia after lower abdominal surgery especially in the first 60 postoperative min when used as a component of a multimodal analgesic regimen.
Abdominal Wall ; Analgesia ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia ; Humans ; Lidocaine ; Nerve Block ; Pain, Postoperative ; Piperidines ; Postoperative Period

Dislodgement of tumor fragment with airway obstruction in a dependent bronchus can be a cause of severe hypoxemia, which is a rare but very serious complication of lung surgery. We describe a case of airway obstruction following deflation of a balloon of a bronchial blocker of a Univent tube during right bilobectomy. Following reintubation with a single lumen tube, the patient was simultaneously extubated with the biopsy forceps holding the mass. This report underlines that anesthesiologist should be alert to a possibility of airway obstruction following deflation a balloon of a bronchial blocker.
Airway Obstruction ; Anoxia ; Biopsy ; Bronchi ; Humans ; Lung ; Surgical Instruments

BACKGROUND: Femoral vein (FV) catheterization is required for critically ill patients, patients with difficult peripheral intravenous access, and patients undergoing major surgery. The purpose of this study was to evaluate the effects of hip abduction with external rotation (frog-leg position), and the frog-leg position during the reverse Trendelenburg position on diameter, cross-sectional area (CSA), exposed width and ratio of the FV using ultrasound investigation. METHODS: Ultrasonographic FV images of 50 adult subjects were obtained: 1) in the neutral position (N position); 2) in the frog-leg position (F position); 3) in the F position during the reverse Trendelenburg position (FRT position). Diameter, CSA, and exposed width of the FV were measured. Exposed ratio of the FV was calculated. RESULTS: The F and FRT positions increased diameter, CSA and exposed width of the FV significantly compared with the N position. However, the F and FRT positions had no significant effect on exposed ratio of the FV compared with the N position. The FRT position was more effective than the F position in increasing FV size. CONCLUSIONS: The F and FRT positions can be used to increase FV size during catheterization. These positions may increase success rate and reduce complication rate and, therefore, can be useful for patients with difficult central venous access or at high-risk of catheter-related complication.
Adult ; Catheterization ; Catheters ; Critical Illness ; Femoral Vein ; Head-Down Tilt ; Hip ; Humans

A 74-year-old woman underwent posterior lumbar decompressive fusion at L4-5 for treating spondylolisthesis, with the patient under general anesthesia and she was in the prone position. Following attempts to transfuse blood using a pressurized bag, the intravenous infusion site of the left hand along with the noninvasive blood pressure cuff was changed. Swelling and several bullae on the left forearm and hand were visible. Removal of intravenous catheter, hyaluronidase injection, wet dressing were subsequently performed. In postanesthesia recovery unit, the patient did not complain of pain, and the radial pulse and oxygen saturation of the left appeared normal. Three days after the incident, the edema on the patient's forearm and hand subsided, and the patient was discharged without any complications two weeks afterwards. Impending compartment syndrome should be given close attention, and particularly when performing pressurized infusion in patients who are unable to express pain because they are under general anesthesia.
Aged ; Anesthesia, General ; Bandages ; Blister ; Blood Pressure ; Catheters ; Compartment Syndromes ; Edema ; Female ; Forearm ; Hand ; Humans ; Hyaluronoglucosaminidase ; Infusions, Intravenous ; Oxygen ; Prone Position ; Spondylolisthesis

BACKGROUND: The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. METHODS: Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. RESULTS: The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P < 0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P < 0.05). CONCLUSIONS: The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol.
Androstanols ; Anesthesia ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam ; Piperidines ; Propofol ; Unconsciousness

Ritodrine hydrochloride is widely used for the treatment of premature uterine contraction because the drug has beta2-sympathomimetic effect on the uterus. Hypokalemia is one of the most common side effects of ritodrine. We experienced a case of hyperkalemia without ECG change that occurred during cesarean section in a healthy parturient, associated with low-dose ritodrine pretreatment for six and half hours to stop preterm labor. We treated the patient with potassium-free fluid and calcium chloride. Plasma potassium level returned to normal four hours after the ritodrine had been terminated.
Calcium Chloride ; Cesarean Section ; Electrocardiography ; Female ; Humans ; Hyperkalemia ; Hypokalemia ; Obstetric Labor, Premature ; Plasma ; Potassium ; Pregnancy ; Ritodrine ; Uterine Contraction ; Uterus

BACKGOUND: The elderly have increased sensitivity to opioids and anesthetics. The hemodynamic effects of propofol- remifentanil during induction are not known in the elderly. This study was designed to compare two different remifentanil administration methods during propofol-remifentanil induction and tracheal intubation in the elderly. METHODS: Forty patients, ages over 65 years were enrolled. Anesthesia was induced with propofol 1 mg/kg and remifentanil. In Group T (TCI : target controlled infusion), remifentanil 3.5 ng/ml were infused until laryngoscopy and tracheal intubation. In Group R (rapid infusion), infusion were stopped when effect-site concentration reaches 5.0 ng/ml. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (baseline), after remifentanil reaches its target effect-site concentration, after administration of propofol, 1 minute before intubation, 1 minute after intubation and 3 minute after intubation. RESULTS: In both groups, MAP decreased significantly after induction and then increases significantly after intubation (P < 0.05). In Group R, MAP decreased earlier and was significantly lower than that of Group T (P < 0.05) before intubation. HR shows no significant changes between groups. CONCLUSIONS: In these two methods, there are no severe hemodynamic compromise during induction and tracheal intubation in the elderly. However, lesser degree of hypotension occurs in Group T. So we conclude that TCI method can provide better hemodynamic stability than rapid infusion method.
Aged* ; Analgesics, Opioid ; Anesthesia ; Anesthetics ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Intubation ; Laryngoscopy ; Propofol