OBJECTIVE: This study aimed to examine the usefulness of each subscale score of the Clinical Dementia Rating (CDR) for predicting Alzheimer's disease (AD) dementia progression in amnestic mild cognitive impairment (MCI) elderly subjects. METHODS: Fifty-nine elderly MCI individuals were recruited from a university dementia and memory disorder clinic. Standardized clinical and neuropsychological tests were performed both at baseline and at the time of 2 years follow-up. Logistic regression analyses were conducted to examine the ability of various clinical measures or their combinations to predict progression to AD dementia in MCI individuals. RESULTS: MCIp individuals showed significantly higher CDR Orientation subscale and CDR sum-of-boxes (SOB) score than MCInp ones, while there were no significant differences in other CDR subscale scores between the two. MCIp individuals also showed marginally higher MMSE scores than MCInp ones. A series of logistic regression analyses demonstrated that the model including CDR Orientation subscale had better AD dementia prediction accuracy than either the model with either MMSE or CDR-SOB. CONCLUSION: Our findings suggest that CDR Orientation subscale score, a simple and easily available clinical measure, could provide very useful information to predict AD dementia progression in amnestic MCI individuals in real clinical settings.
Aged ; Alzheimer Disease* ; Dementia* ; Follow-Up Studies ; Humans ; Logistic Models ; Memory Disorders ; Mild Cognitive Impairment* ; Neuropsychological Tests

There are many cause of cholinesterase deficiency, including drugs, liver disease, chronic anemia, malignant states, cardiac failure, severe acute infection, surgical shock, severe burn, collagen disease and vasculitis syndromes. Vasculitis syndromes are relatively rare, and among them, Churg-Strauss syndrome (CSS) is even rarer. We report here on a case of a patient with CSS who underwent endoscopic sinus surgery under general anesthesia.
Anemia ; Anesthesia, General ; Burns ; Cholinesterases ; Churg-Strauss Syndrome ; Collagen Diseases ; Heart Failure ; Humans ; Liver Diseases ; Shock, Surgical ; Vasculitis

There are many causes of prolonged postoperative muscle weakness, including drugs, residual anesthetics, cerebrovascular events, electrolyte imbalance, hypothermia, and neuromuscular disease. Neuromuscular diseases are relatively rare, with the most common being myasthenia gravis and Lambert-Eaton myasthenic syndrome (LEMS). We report an unusual case in which a patient who was given a muscle relaxant during mediastinoscopy developed postoperative muscle weakness that was ultimately diagnosed as secondary to LEMS.
Anesthetics ; Humans ; Hypothermia ; Lambert-Eaton Myasthenic Syndrome ; Mediastinoscopy ; Muscle Weakness ; Muscles ; Myasthenia Gravis ; Neuromuscular Diseases

BACKGROUND: The administration of a single dose of propofol is reported to be effective in decreasing the incidence and severity of emergence agitation (EA) in children following sevoflurane anesthesia. The aim of this study was to investigate the clinical usefulness of a single dose of propofol 1 mg/kg at the end of adenotonsillectomy for reducing the incidence of EA after sevoflurane anesthesia. METHODS: Ninety children, aged 3-8 years, undergoing adenotonsillectomy were randomized into two groups: the propofol group (n = 45) and the saline group (n = 45), of which 88 children completed the study. Anesthesia was maintained with sevoflurane 2-2.5 vol% and nitrous oxide/oxygen (50%/50%). At the completion of adenotonsillectomy, the propofol group patients were given 1 mg/kg of propofol and the saline group patients were given saline 0.1 ml/kg in the same volume. The incidence of EA was assessed with Aono's four point scale and the severity of EA was assessed with pediatric anesthesia emergence delirium (PAED) scale at 5 min (T5), 15 min (T15) and 30 min (T30) after emergence. RESULTS: Of the 88 patients, the incidence of EA at T5, T15 and T30 was 61.4%, 27.3%, and 4.5% in the propofol group while in the saline group was 68.2%, 29.5%, and 9.1%, respectively. The incidence and severity of EA were not found to be significantly different between the two groups, but the scales in each group decreased significantly over time. CONCLUSIONS: The administration of propofol 1 mg/kg at the end of surgery did not have any significant effect in reducing the incidence and severity of EA in children undergoing adenotonsillectomy under sevoflurane anesthesia.
Aged ; Anesthesia ; Child ; Delirium ; Dihydroergotamine ; Humans ; Incidence ; Methyl Ethers ; Propofol ; Weights and Measures

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

BACKGROUND: This study was done to evaluate the effect on pain relief when acetaminophen was added to lidocaine for intravenous regional anesthesia (IVRA). METHODS: Sixty patients undergoing hand or forearm surgery received IVRA were assigned to three groups: Group C received 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml (n = 20), Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml (n = 20) and Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketorolac 10 mg made up to a total volume of 40 ml (n = 20). Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed. RESULTS: Sensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C (P < 0.001). CONCLUSIONS: The addition of acetaminophen to lidocaine for IVRA shortens the onset time of sensory block and delays tourniquet pain onset time, but not with ketorolac. Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.
Acetaminophen ; Anesthesia, Conduction ; Fentanyl ; Forearm ; Hand ; Humans ; Ketorolac ; Lidocaine ; Pain, Postoperative ; Tourniquets

BACKGROUND: The "gold standard" for proper epidural catheter positioning is a clinical response, as assessed by a pinprick test. Yet it may take time or it may be difficult to perform this test after epidural catheter placement in sedated or uncooperative patients or during general anesthesia. We assessed the usefulness of aspirating injected air via an epidural catheter as an indicator of correct epidural catheter placement. METHODS: We surveyed 200 patients who underwent surgery under general or epidural anesthesia. A Tuohy needle was inserted into the epidural space with using the hanging drop technique. After placement of the epidural catheter, 3 ml of air was injected via the catheter, and then the volume of aspirated air was measured. RESULTS: The mean volume of aspirated air was 2.3 +/- 0.7 ml (75% of the injected air volume) and this ranged from 0 to 3 ml. CONCLUSIONS: Aspiration of injected air is a simple alternative method for identifying the appropriate placement of epidural catheters in the epidural space.
Anesthesia, Epidural ; Anesthesia, General ; Catheters ; Epidural Space ; Humans ; Needles

BACKGROUND: QT dispersion (QT(d)) is an indirect measure of the heterogeneity of ventricular repolarization and can be used as a risk factor for complex ventricular arrhythmias. We measured the effect of remifentanil on QT(d) and heart-rate corrected QT dispersion (QT(cd)). METHODS: Sixty ASA class I and II patients, who were between 20 and 60 years old, and who were scheduled for general anesthesia, were studied. After the patient entered the operating room, a 12 lead EKG recording was taken and intravenous infusion of remifentanil was started. The infusion rate was 0.1 microg/kg/min in group 1 and 0.2 microgram/kg/min in group 2. Another EKG recording was taken 10 minutes after infusion had started. RESULTS: In both groups, QT(d) following remifentanil infusion was not significantly different than control values (76.6 +/- 23.3 ms vs 81.8 +/- 34.9 ms, P = 0.459 in group 1; 70.7 ms +/- 29.7 ms vs 73.7 ms +/- 37.1 ms, P = 0.734 in group 2). Neither was QT(cd): (83.2 ms +/- 25.2 ms vs 89.6 ms +/- 36.2 ms, P = 0.371 in group 1; 81.0 ms +/- 35.2 ms vs 83.4 ms +/- 40.9 ms, P = 0.829 in group 2). CONCLUSIONS: Remifentanil infusion at a rate less than 0.2 microg/kg/min does not change QT(d) or QT(cd).
Anesthesia, General ; Arrhythmias, Cardiac ; Electrocardiography ; Heart Conduction System ; Humans ; Infusions, Intravenous ; Operating Rooms ; Piperidines ; Population Characteristics ; Risk Factors

A 39 year old man arrived at the hospital with semi-comatose state as a result of spontaneous intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH). For emergency craniectomy and hematoma removal, general anesthesia with desflurane and vecuronium was planned. Before the induction of anesthesia, the body temperature and end-tidal carbon dioxide (ETCO2) levels were 38.3degrees C and 38 mmHg, respectively. The body temperature and ETCO2 increased during surgery. After 2 hours of anesthesia, the temperature had increased to 41degrees C, despite bladder irrigation and body cooling. After 3 hours of anesthesia, the temperature reached 43.5degrees C and cardiac arrest developed. Cardiopulmonary resuscitation was attempted, but the patient expired.
Anesthesia ; Anesthesia, General ; Body Temperature ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Cerebral Hemorrhage ; Emergencies ; Fever ; Heart Arrest ; Hematoma ; Hemorrhage ; Humans ; Isoflurane ; Subarachnoid Hemorrhage ; Urinary Bladder ; Vecuronium Bromide

BACKGROUND: Postoperative nausea and vomiting (PONV) is extremely distressing and uncomfortable, and is noted frequently in patients who have undergone gynecologic laparoscopic surgery. In this study, we compared the efficacy of a combination of ramosetron plus dexamethasone and ramosetron alone in reducing of PONV after gynecologic laparoscopic surgery. METHODS: Sixty patients who received gynecologic laparoscopic surgery were randomly divided into two groups: the R group (ramosetron 0.3 mg) and RD group (ramosetron 0.3 mg plus dexamethasone 5 mg). Dexamethasone, 5 mg, or saline, 1 ml, was administered randomly before the induction of anesthesia in each group. The two groups received intravenous ramosetron, 0.3 mg, at the end of surgery. General anesthesia was induced using thiopental and rocuronium, and maintained with sevoflurane in nitrous oxide. The incidence and severity of nausea, frequency of vomiting and rescue medication, VAS score, and adverse events were evaluated for 48 hours after the operation. RESULTS: In the first 12 hours after operation, the incidence of PONV in the RD group (33%) was significantly lower than the R group (67%; P < 0.05). However, there were no significant differences between two groups in PONV incidence 12-48 h postoperatively. Adverse events and VAS scores were similar in the two groups. CONCLUSIONS: The combination of ramosetron plus dexamethasone is superior to ramosetron alone for prevention of PONV during the first 12 hours after gynecologic laparoscopic surgery.
Androstanols ; Anesthesia ; Anesthesia, General ; Benzimidazoles ; Dexamethasone ; Humans ; Incidence ; Laparoscopy ; Methyl Ethers ; Nausea ; Nitrous Oxide ; Postoperative Nausea and Vomiting ; Thiopental ; Vomiting