BACKGROUND: The size and depth of the double-lumen tube (DLT) are important for one-lung ventilation (OLV). In patients of a short stature, it is difficult to perform OLV successfully. We designed this study to evaluate the dimensions and margin of safety of the left main bronchi in patients of a short stature for appropriate OLV. METHODS: Chest computed tomography (CT) scans of 241 patients (22 male, 219 female) of a short stature (height below 155 cm) were analyzed retrospectively. The diameters of the trachea (DT), the right and left main bronchi (DR and DL), and the lengths of the right and left main bronchi (LR and LL) were measured at the coronal section of the chest CT scans using a picture archiving communication system program. RESULTS: There were no significant correlations between the heights and lengths of the right and left main bronchi. In addition, the ages and weights of the patients showed no significant correlations with the airway dimensions. The lengths of the bronchial lumen of the left-sided Mallinckrodt DLT show variations of 3 to 5.5 mm with tubes of identical sizes. The margin of safety is 13.8 +/- 4.1 mm assuming that appropriately sized DLTs are inserted. CONCLUSIONS: For successful and safe OLV in patients of a short stature, anesthesiologists should consider the length of the main bronchus and the actual length of the bronchial lumen of the DLT.
Body Height ; Bronchi ; Humans ; Male ; One-Lung Ventilation ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Trachea ; Weights and Measures

Intraoperative formation and management of a thrombus in right atrium has been reported occasionally. Nevertheless, it is rare that a right atrial thrombus with unstable hemodynamic changes detected by transesophageal echocardiography is resolved spontaneously. We report upon the 44-year-old woman, who had a right atrial thrombus detected by transesophageal echocardiography during laparoscopic assisted vaginal hysterectomy and resolved during thromboembolectomy.
Adult ; Echocardiography, Transesophageal ; Female ; Heart Atria ; Hemodynamics ; Humans ; Hysterectomy, Vaginal ; Laparoscopy ; Thrombosis

BACKGROUND: This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. METHODS: A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 microg/kg (Group D, n = 30), remifentanil 1 microg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 microg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 microg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. RESULTS: The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). CONCLUSIONS: In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.
Androstanols ; Anesthesia ; Blood Pressure ; Dexmedetomidine ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Methyl Ethers ; Nitrous Oxide ; Oxygen ; Piperidines ; Propofol

Achondroplasia is the most common non-lethal skeletal dysplasia. Underdevelopment and premature ossification of bones result in characteristic craniofacial and spinal abnormalities. Achondroplastic dwarfs have low fertility rates and require delivery by cesarean section due to their cephalo-pelvic disproportion. Controversy exists regarding the ideal anesthesia for an achondroplastic parturient dwarf for urgent cesarean section. Anesthesia, whether general or regional, presents many potential problems during cesarean section. We report the experience of the epidural anesthesia in an achondroplastic dwarf undergoing elective cesarean section.
Achondroplasia ; Anesthesia ; Anesthesia, Epidural ; Birth Rate ; Cesarean Section ; Female ; Pregnancy

BACKGROUND: Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia. METHODS: One hundred twenty patients aged 20 to 65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the group N received normal saline 1 hour before induction and after the resection of gall bladder. The patients in the group S1 received dexamethasone 8 mg 1 hour before induction and normal saline after the resection of gall bladder. The patients in the group S2 received normal saline 1 hour before induction and dexamethasone 8 mg after the resection of gall bladder. RESULTS: VAS scores of group S1 and S2 were lower than that of group N during 48 hours after laparoscopic cholecystectomy. There were no significant differences of VAS scores between the group S1 and the group S2. The analgesic consumption of group S1 and S2 were significantly lower than that of group N. CONCLUSIONS: A single dose of dexamethasone (8 mg) intravenously given 1 hour before induction or during operation was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. The analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during surgery was not significantly different.
Aged ; Analgesia ; Cholecystectomy, Laparoscopic ; Dexamethasone ; Humans ; Laparoscopy ; Pain, Postoperative ; Urinary Bladder

Breakage of epidural catheter during insertion and removal is a rare but dilemmatic complication. Although it is favorable to remove a broken catheter entrapped in tissue, there is a controversy about whether retained fragments should be managed even in asymptomatic patients. We experienced two cases of breakage of epidural catheter in patients with thoracic epidural analgesia. One case happened during removing of the entire catheter and needle together and the other, during the removal of the catheter alone. Because neurologic or infective complications were not detected until 14 days after the events, surgical interventions were withheld. In both cases, there were no sequelae on long-term follow up.
Analgesia ; Analgesia, Epidural ; Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Needles

Spinal muscular atrophy (SMA) in children leads to progressive muscle weakness, dysphagia, aspiration, and death. The most common and severe form of SMA is designated as type I, also known as Werdnig-Hoffman Disease or Floppy Baby syndrome. We anesthetized an 8 month-old female infant with SMA type I undergoing feeding gastrostomy. We planned to use inhalational anesthesia without muscle relaxants. Anesthesia and surgery were uneventful. We herein report a case of successful peri-operative anesthetic management for SMA type I infant with aspiration pneumonia.
Anesthesia ; Anesthesia, General ; Child ; Deglutition Disorders ; Female ; Gastrostomy ; Humans ; Infant ; Muscle Weakness ; Muscles ; Muscular Atrophy, Spinal ; Neuromuscular Diseases ; Pneumonia, Aspiration ; Spinal Muscular Atrophies of Childhood

BACKGROUND: Volatile-based anesthesia resulted in a significantly reduced cilia beat frequency. This study was to evaluate the effect of bronchodilator on bronchial mucus transport (BMT) distance measured with a bronchoscope during Inhalational anesthesia. METHODS: Twenty-four adult patients undergoing elective orthopedic surgery under inhalation anesthesia using sevoflurane and nitrous oxide were included. Twenty minutes after tracheal intubation, they were manually inspired without nebulization of salbutamol (control group: n = 12) or with nebulization of salbutamol(salbutamol group: n = 12). And then a single drop of 0.02 ml methylene blue was applied to the posterior mucosal surface of the right main bronchus 5 cm away from the carina under the bronchoscope. The distance of dye movement was measured 5 min after its application. RESULTS: BMT distance and velocity of methylene blue during 5min were 6.2 +/- 3.1 mm and 1.2 +/- 0.6 mm/min in control group, and 23.3 +/- 16.6 mm and 4.7 +/- 3.3 mm/min in salbutamol group, respectively. BMT distance and velocity of methylene blue in salbutamol group were longer and faster than those in control group(P < 0.05). CONCLUSIONS: Salbutamol facilitates the transport of bronchial secretion under sevoflurane-based inhalational anesthesia in term of BMT velocity.
Adult ; Albuterol ; Anesthesia ; Anesthesia, Inhalation ; Bronchi ; Bronchoscopes ; Cilia ; Humans ; Intubation ; Methyl Ethers ; Methylene Blue ; Mucus ; Nitrous Oxide ; Orthopedics

BACKGROUND: Similar to lipid emulsion propofol, microemulsion propofol also causes a high incidence of pain during intravenous injection. Various methods have been used to minimize the incidence and severity of pain on injection of lipid emulsion propofol. In this study, we investigated the effect of a lidocaine mixture on pain induced by microemulsion propofol injection, and sought to determine the optimal dose of lidocaine that could reduce pain on injecting a propofol-lidocaine mixture. METHODS: One hundred sixty (n = 160) patients of American Society of Anesthesiologists physical status class I or II were randomly allocated to four groups: Group A, control; Group B, 20 mg lidocaine; Group C, 30 mg lidocaine; Group D, 40 mg lidocaine. In each patient, pain on microemulsion propofol solution injection was graded as none, mild, moderate, or severe. RESULTS: The incidence of pain in groups A, B, C, and D was 97.5%, 80%, 65%, and 50%, respectively. Increasing the lidocaine dose significantly reduced pain (P < 0.05). One patient in Group D (2.5%) had moderate to severe pain, which was significantly lower than groups B (42.5%) and C (32.5%) (P < 0.05). CONCLUSIONS: The lidocaine and propofol mixture is effective in alleviating pain associated with microemulsion propofol injection. Within this dose range and in this patients population, increasing lidocaine dosage significantly reduced pain during injection of microemulsion propofol.
Humans ; Incidence ; Injections, Intravenous ; Lidocaine ; Propofol

Thoracic outlet syndrome has neurologic symptoms caused by compression of brachial plexus, blood vessel symptoms are caused by compression of the artery or vein. The authors report a case of sudden decrease in blood pressure of the left arm after turning the patient from supine position to prone position. They confirmed that the patient had thoracic outlet syndrome after performing computed tomography.
Arm ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Vessels ; Brachial Plexus ; Glycosaminoglycans ; Humans ; Neurologic Manifestations ; Prone Position ; Supine Position ; Thoracic Outlet Syndrome ; Veins