Arnold-Chiari malformation type I (ACM I) is anatomically defined as the displacement of the cerebellar tonsils below the level of the foramen magnum. Syringomyelia is a condition in which a cavity called a syrinx develops in the spinal cord and is filled with cerebrospinal fluid. Here we report the anesthetic management of a case of ACM I with associated syringomyelia scheduled for suboccipital craniectomy, cervical laminectomy and duraplasty.
Arnold-Chiari Malformation ; Displacement (Psychology) ; Foramen Magnum ; Humans ; Laminectomy ; Palatine Tonsil ; Spinal Cord ; Syringomyelia

Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups that are caused by gastric distention, spicy foods and neural dysfunction can resolve themselves without any treatment. Some hiccups are associated with certain diseases or they occur postsurgically, and life-restricting intractable hiccups should be treated. The cause of hiccups should be quickly determined so as to administer the proper treatment. Hiccups often remit spontaneously within a short period of time, but they may also occur without remission for a prolonged period in some cases. We report here on a 36-year-old man who suffered with intractable hiccups for 5 years. We administered a single oral dose of baclofen, and then the hiccups disappeared. We conclude that a single dose of baclofen is a good treatment for intractable hiccups.
Adult ; Baclofen ; Diaphragm ; Glottis ; Hiccup ; Humans ; Spasm

BACKGROUND: Preoperative dexamethasone improves the surgical outcome after laparoscopic cholecystectomy (LC). The purpose of this study was to determine the effect of preoperative dexamethasone on the postoperative pain according to age and gender in patients who undergo LC. METHODS: In this double blind prospective study, 400 patients, males or females < or = 45 yr and males or females > or = 65 yr (n = 50 in each of eight groups) who undergoing LC were randomized to receive dexamethasone 8 mg (5 ml) or saline 5 ml intravenously 100 minutes before their operation. Postoperative pain was assessed on a visual analog scale (VAS) at 1, 6, 12, and 24 hour, and the time to administering the first postoperative analgesics was recorded. RESULTS: Dexamethasone was administered without consideration for age and gender, and it reduced the postoperative pain VAS score at 1, 6, and 12 hours, and the opioid analgesic requirement, but there was no significant difference between administering saline or dexamethasone in the same gender and age groups. Females < or = 45 yr who were administered saline had the most pain sensitivity and males > or = 65 yr who were administered dexamethasone had the least pain sensitivity. CONCLUSIONS: Preoperative dexamethasone reduces the pain intensity and opioid consumption, but does not reduce the pain intensity, according to age and gender in the patients undergoing LC. As a result, preoperative dexamethasone should be considered for routine use for patients who are undergoing laparoscopic cholecystectomy.
Analgesics ; Cholecystectomy, Laparoscopic ; Dexamethasone ; Female ; Humans ; Male ; Pain, Postoperative ; Prospective Studies

BACKGROUND: Postanesthetic shivering affects up to 65% of patients after general anesthesia, and it can be very distressing. Various drugs have been used to treat or prevent postanesthetic shivering, but the ideal drug has not yet been found. The aim of this study was to find the minimum dose of ketamine that would show an antishivering effect. METHODS: Ninety patients scheduled for total or subtotal thyroidectomy under general anesthesia were randomly allocated to three groups: Patients received saline 3 cc (Group 1; n = 30), ketamine 0.5 mg/kg (Group 2; n = 30) or ketamine 1.0 mg/kg (Group 3; n = 30) at the end of surgery. The postanesthetic shivering was evaluated by an blind investigator who was "blinded" to the dose of ketamine. The grade of shivering was assessed using a five-point scale at 0, 10, 20 and 30 minutes after the arrival to the recovery room. RESULTS: The number of patients shivering on arrival to the recovery room, and at 10 minutes after the arrival of recovery room was significantly less in Groups 2 and 3 than in Group 1 (P < 0.05). However, at 20 and 30 minutes, the number of patients was not different among the groups. There was no difference within the groups that received ketamine. CONCLUSIONS: The prophylactic use of 0.5 mg/kg intravenous ketamine was effective in preventing shivering after general anesthesia.
Anesthesia, General ; Humans ; Ketamine ; Recovery Room ; Research Personnel ; Shivering ; Thyroidectomy

BACKGROUND: To investigate the clinical significance of flow diversion (FD) of the anterior cerebral artery (ACA) or posterior cerebral artery (PCA), a transcranial doppler (TCD) was used in patients with middle cerebral artery (MCA) occlusive disorders. METHODS: This is a retrospective study of 51 patients from 1999 to 2001. FD was determined using TCD. Leptomeningeal collateral channels (LMCs) were identified by conventional angiography. The author analyzed the sensitivity, specificity, positive and negative predictability of FD of ACA or PCA to predict the LMCs, and also evaluated the relationship between FD and leptomeningeal collateral circulation. RESULTS: LMC was noted in 41% of patients with M1 (MCA) occlusive disorders. It showed a tendency of increasing prevalence with an increasing degree of M1 MCA stenosis (rho=0.605, p<0.001). FD was noted in 47% of patients with MCA occlusive diseases. It also had a tendency of high prevalence with an increasing degree of M1 MCA stenosis (rho=0.382, p=0.006). To predict the presence of LMCs, FD of ACA or PCA had a sensitivity of 81%, specificity of 76%, positive predictive value of 71% and negative predictive value of 85%. FD of ACA or PCA had a good correlation with LMCs in patients with MCA occlusive disorders (rho=0.568, p<0.001). CONCLUSIONS: These results suggest that FD had good sensitivity and specificity to predict the LMCs, and demonstrated that FD was a reliable source of evidence of LMCs in patients with M1 MCA occlusive disorders. Patients with M1 MCA stenosis had heterogeneous hemodynamics in the development of collateral circulation.
Angiography ; Anterior Cerebral Artery ; Collateral Circulation* ; Constriction, Pathologic ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity

Charcot-Marie-Tooth disease, which is also known as hereditary motor and sensory neuropathy, is a heterogenous group of inherited diseases of the peripheral nerve. The spectrum of severity varies from asymptomatic individuals to those with severe limb abnormalities requiring corrective surgery. We report two brothers who had previously been diagnosed with Charcot-Marie- Tooth disease 3 years earlier and were scheduled to undergo a correction osteotomy of both feet under general anesthesia. General anesthesia was induced with propofol 2 mg/kg, rocuronium 0.8 mg/kg and was maintained with O2-N2O-Sevoflurane. The younger brother showed no delay in recovery of the neuromuscular blockade but the elder brother showed a delay.
Anesthesia, General ; Charcot-Marie-Tooth Disease* ; Extremities ; Foot ; Hereditary Sensory and Motor Neuropathy ; Humans ; Neuromuscular Blockade* ; Osteotomy ; Peripheral Nerves ; Propofol ; Siblings ; Tooth Diseases

Postherpetic neuralgia is one of the most troublesome diseases in pain clinics. The N-methyl-D-aspartate (NMDA) receptor antagonist, magnesium, reduces the level of neuropathic pain and hyperalgesia in patients with postherpetic neuralgia. Magnesium has been shown to exert a physiological block of the ion channel on the NMDA receptor, thereby preventing extracellular calcium ions from entering the cell and contributing to secondary neuronal changes. Accordingly, we attempted to administer a continuous intravenous infusion of magnesium, which resulted in a decrease in the VAS without side effects.
Calcium ; Humans ; Hyperalgesia ; Infusions, Intravenous* ; Ion Channels ; Ions ; Magnesium* ; N-Methylaspartate ; Neuralgia ; Neuralgia, Postherpetic* ; Neurons ; Pain Clinics

Transient global amnesia is characterized by a sudden inability to form new memories (anterograde amnesia) that usually last for minutes to several hours but never longer than 24 hours. and there are no other focal neurologic signs or symptoms. Retrograde amnesia from a few hours to many years may also be associated with this condition. We report a case of a 56-year-old female patient who experienced transient global amnesia in the recovery room after general anesthesia. She repeated the same queries several times to persons nearby and appeared perplexed. A detailed neurologic examination was otherwise entirely normal. Her symptoms resolved completely the next day.
Amnesia, Retrograde ; Amnesia, Transient Global* ; Anesthesia, General* ; Female ; Humans ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Recovery Room*

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.
Adult ; Amputation ; Extremities ; Humans ; Infusions, Intravenous* ; Ketamine* ; Leg ; Phantom Limb* ; Prevalence ; Sensation

BACKGROUND: Arthroscopic shoulder surgery can result in moderate to severe postoperative pain. This study compared the postoperative analgesic effects of an intra-articular patient-controlled analgesia (PCA) infusion of 0.25% ropivacaine used with or without fentanyl after arthroscopic shoulder surgery. METHODS: Sixty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. After surgery, normal saline 21 ml (group 1; n = 20), and 0.25% ropivacaine 21 ml (group 2 and group 3; n = 20 respectively), was infused into the articular space through a PCA catheter, which was followed by an infusion of normal saline 99 ml (group 1), 0.25% ropivacaine 99 ml (group 2), or 0.25% ropivacaine 99 ml, including fentanyl 400microgram (group 3) through the intra-articular PCA catheter at 2 ml/hr with a bolus dose of 0.5 ml with a lock out time of 15 minutes. The level of pain was assessed using a visual analogue scale (VAS) and a verbal pain score (VPS) 2, 4, 6, 8, 12, 24 and 36 hours after the intra-articular bolus injection. RESULTS: The pain scores were significantly lower after 2, 4, 6 hours in group 2 and 3 than in group 1. However, after 8 hours, the pain scores were significantly lower in group 3 than in the other two groups. CONCLUSIONS: An intra-articular continuous infusion of 0.25% ropivacaine after arthroscopic shoulder surgery is more effective when used in conjunction with 400 microgram fentanyl.
Analgesia, Patient-Controlled ; Anesthesia, General ; Catheters ; Fentanyl* ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Shoulder*