BACKGROUND: Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia. The purpose of this study is to determine the effect-site concentration of remifentanil for prevention of hemodynamic responses to tracheal intubation during fixed propofol infusion (4microgram/ml) and to find any sexual differences. METHODS: Thirty ASA physical status I-II patients undergoing general anesthesia were assigned to male (n = 15), and female (n = 15) group. All patients received a target controlled infusion (TCI) of propofol with a fixed effect-site concentration of 4microgram/ml. After target effect-site concentration of propofol and remifentanil was reached, tracheal intubation was performed. The hemodynamic changes (systolic/diastolic blood pressure, mean arterial pressure, and heart rate) were measured at 1 and 2 min before tracheal intubation (baseline), immediately after, 1, 2, 3, 4 and 5 min following tracheal intubation. In both groups, effect-site concentration of remifentanil was initiated with 3 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to tracheal intubation based on up and down sequential allocation. RESULTS: The mean EC50 of remifentanil for prevention of hemodynamic responses to tracheal intubation were 1.37 ng/ml (95% CI, 0.95-1.81 microgram/ml) in male group and 1.05 microgram/ml (95% CI, 0.68-1.40 ng/ml) in female group, respectively. In addition, there were no statistical significant differences between two groups. CONCLUSIONS: Relatively small dosages of remifentanil (0.68-1.81 microgram/ml) for attenuation of hemodynamic responses to tracheal intubation was needed in Korean population in propofol TCI and there were no sexual differences.
Anesthesia, General ; Anesthesia, Intravenous* ; Arterial Pressure ; Blood Pressure* ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Male ; Propofol ; Sex Characteristics

BACKGROUND: Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia. The purpose of this study is to determine the effect-site concentration of remifentanil for prevention of hemodynamic responses to tracheal intubation during fixed propofol infusion (4microgram/ml) and to find any sexual differences. METHODS: Thirty ASA physical status I-II patients undergoing general anesthesia were assigned to male (n = 15), and female (n = 15) group. All patients received a target controlled infusion (TCI) of propofol with a fixed effect-site concentration of 4microgram/ml. After target effect-site concentration of propofol and remifentanil was reached, tracheal intubation was performed. The hemodynamic changes (systolic/diastolic blood pressure, mean arterial pressure, and heart rate) were measured at 1 and 2 min before tracheal intubation (baseline), immediately after, 1, 2, 3, 4 and 5 min following tracheal intubation. In both groups, effect-site concentration of remifentanil was initiated with 3 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to tracheal intubation based on up and down sequential allocation. RESULTS: The mean EC50 of remifentanil for prevention of hemodynamic responses to tracheal intubation were 1.37 ng/ml (95% CI, 0.95-1.81 microgram/ml) in male group and 1.05 microgram/ml (95% CI, 0.68-1.40 ng/ml) in female group, respectively. In addition, there were no statistical significant differences between two groups. CONCLUSIONS: Relatively small dosages of remifentanil (0.68-1.81 microgram/ml) for attenuation of hemodynamic responses to tracheal intubation was needed in Korean population in propofol TCI and there were no sexual differences.
Anesthesia, General ; Anesthesia, Intravenous* ; Arterial Pressure ; Blood Pressure* ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Male ; Propofol ; Sex Characteristics

Stellate ganglion block, due to its wide range of indications, is the most widely practiced procedure in pain clinics. We experienced the case of a 44-year-old female patient who developed prolonged Horner's syndrome after the use of stellate ganglion block. The patient recovered spontaneously from the Horner's syndrome after 12 months. If Horner's syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.
Adult ; Female ; Horner Syndrome* ; Humans ; Pain Clinics ; Stellate Ganglion*

BACKGROUND: Laparoscopic cholecystectomy and gynecologic pelviscopy need to induce pneumoperitoneum to allow visualization of the operative field, but the former requires a head-up position whereas the latter needs a Lithotomy-Trendelenburg position. The authors observed hemodynamic changes using an esophageal doppler monitor in both cases. METHODS: Eight females planned for laparoscopic cholecystectomy were assigned to Group 1 and 10 females for gynecologic pelviscopy were assigned to Group 2. Thiopental (5 mg/kg) and vecuronium (0.1 mg/kg) were used to induce general anesthesia. 50% O2-N2O and 1.5 vol.% isoflurane were used to maintain anesthesia. Mechanical ventilation was used with a tidal volume of 10 ml/kg and a respiratory rate of 12 breaths per minute. Mean arterial pressure, heart rate, end-tidal CO2 and peak airway pressure were measured and cardiac output, corrected flow time, and peak velocity were monitored using an esophageal doppler monitor in each group after inducing anesthesia, CO2 inflation, position change, and CO2 deflation. RESULTS: Mean arterial pressure increased in each group while changing position. No significant changes in the heart rate were observed in each group. End-tidal CO2 increased in each group after changing position, and remained elevated even with position reversal and deflation. Peak airway pressure was elevated in each group after CO2 inflation and increased more so with changing posture in group 2 (post inflation: 18.5 +/- 1.4 cmH2O, after position change: 21.4 +/- 2.0 cmH2O). Cardiac output and cardiac index were reduced after the induction of pneumoperitoneum in each group, and reduced more on changing posture in group 2 (CO: 5.9 +/- 2.0 L/min vs. 4.4 +/- 1.5 L/min, CI: 3.7 +/- 1.4 L/min/m2 vs. 2.7 +/- 1.1 L/min/m2). Stroke volume also reduced after changing posture in each group. Corrected flow time was not changed, but peak velocity decreased after CO2 inflation in each group (group 1: 97.4 +/- 30.0 cm/s vs. 78.9 +/- 27.3 cm/s, group 2: 111.9 +/- 14.1 cm/s vs. 88.3 +/- 12.6 cm/s). CONCLUSIONS: The Lithotomy-Trendelenburg position can augment the hemodynamic changes resulting from pneumoperitoneum. Therefore, additional caution is required in patients with cardiovascular disease who are undergoing gynecologic pelviscopy.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Output ; Cardiovascular Diseases ; Cholecystectomy, Laparoscopic* ; Female ; Heart Rate ; Hemodynamics* ; Humans ; Inflation, Economic ; Isoflurane ; Pneumoperitoneum ; Posture ; Respiration, Artificial ; Respiratory Rate ; Stroke Volume ; Thiopental ; Tidal Volume ; Vecuronium Bromide

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.
Anesthesia, Spinal ; Aneurysm, False* ; Aorta, Thoracic ; Chest Pain* ; Diagnostic Tests, Routine ; Prostate* ; Thorax*

BACKGROUND: A hypertensive response is seen when a skull pin is inserted for a craniotomy. The risk of morbidity and mortality is high in patients with intracranial pathology. Many methods have been introduced to overcome the problem. We compared the hemodynamic effects and changes of intracranial pressure when we used lidocaine or fentanyl for blunting the hypertensive response. METHODS: Thirty-two patients scheduled for a craniectomy were divided into two groups: an IV (intravenous) bolus of fentanyl (2micro gram/kg) group or lidocaine (1.5 mg/kg) group. An anesthesia was induced with fentanyl (2micro gram/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg) and vecuronium (0.1 mg/kg), and was maintained with isoflurane 1 MAC (minimum alveolar anesthetic concentration) in nitrous oxide 50% and oxygen. After induction of anesthesia, a lumbar subarachnoid catheter was inserted for CSFP (cerebrospinal fluid pressure) measurement. An IV bolus of either fentanyl (2micro gram/kg) or lidocaine (1.5 mg/kg) was administered prior to insertion of the skull pin by a randomized method. CSFP, MAP (mean arterial pressure), and HR (heart rate) were measured before and 5 min after induction of anesthesia, immediately before and each mininute for five measurements after skull pin insertion. RESULTS: There were no intergroup differences in the values of CSFP and HR. The MAP increased 9+/-14 (mean+/-SD) mmHg and 4+/-12 (mean+/-SD) mmHg 1 min after the skull pin insertion compared with immediately before skull pin insertion in the fentanyl group and lidocaine group respectively. The MAP recovered 2 min after the skull pin insertion in both groups. CPP (cerebral perfusion pressure) recovered 3 min and 2 min after the skull pin insertion in the fentanyl group and lidocaine group respectively. CONCLUSIONS: An IV bolus of either fentanyl or lidocaine before skull pin insertion resulted in a stable value of CSFP, CPP and HR.
Anesthesia ; Catheters ; Cerebrospinal Fluid Pressure* ; Cerebrospinal Fluid* ; Craniotomy ; Fentanyl* ; Hemodynamics ; Humans ; Intracranial Pressure ; Isoflurane ; Lidocaine* ; Mortality ; Nitrous Oxide ; Oxygen ; Pathology ; Perfusion* ; Skull* ; Thiopental ; Vecuronium Bromide

Facial Bones ; Humans ; Intubation ; Intubation, Intratracheal ; Surgery, Oral ; Tracheostomy

Airway management for patients who have suffered multiple facial fractures and skull base fractures is complicated. Nasal intubation can interfere with centralization and stabilization of nasal fractures and may lead to cranial intubation. Restoring the dental occlusion by means of intraoperative maxillo- mandibular fixation is a prerequisite to the corrrect anatomical reduction of multiple facial fractures. This fixation precludes oral endotracheal intubation. In the past, it has been overcome by a tracheostomy. Complications of a tracheostomy include infection, hemorrhage, subcutaneous emphysema, pneumothorax, pneumomediastinum, recurrent laryngeal nerve damage, tracheal stenosis, and tracheoesophageal fistula. The technique of submental intubation was originally described by Altemir. This technique provide secure airway, an unobstructed intraoral airway field. and allows maxillomandibular fixation while avoiding the drawbacks and complications of naso-endotracheal intubation or tracheostomy. With this technique, the multiple facial fractures were corrected successfully.
Airway Management ; Dental Occlusion ; Hemorrhage ; Humans ; Intubation* ; Intubation, Intratracheal ; Jaw Fixation Techniques ; Mediastinal Emphysema ; Pneumothorax ; Recurrent Laryngeal Nerve ; Skull Base ; Subcutaneous Emphysema ; Surgery, Oral* ; Tracheal Stenosis ; Tracheoesophageal Fistula ; Tracheostomy

BACKGROUND: There is a suggestion that tissue acidosis may contribute to the induction of pain in inflammation and ischemia. High local proton concentrations have been found in painful inflammatory and ischemic conditions. We assessed tissue pH and pain behavior in a rat model for postoperative pain. METHODS: An incision of skin, fascia, and muscle was performed in the right foot. Pain behaviors to von Frey, blunt probe stimulation, and resting pain were evaluated on the incised feet. Then tissue pH was measured in each of the five rats at 4 hours, 1, 2, 4, and 7 days after incision. RESULTS: The withdrawal threshold to von Frey was decreased, the response frequency to blunt probe and pain scores were elevated from 4 hours to 1 - 2 days after the incision. The deep tissue pH decreased from pH 7.16 in sham to pH 6.95, 6.90, 6.89, and 6.95 at 4 h and 1, 2, and 4 days after incision respectively. CONCLUSIONS: In this study, the tissue pH of the wound decreased after surgery. However, the change of tissue pH was not always consistent with pain behaviors. Our results suggest that tissue acidosis may relate partially to the induction of pain after tissue injury.
Acidosis ; Acute Pain* ; Animals ; Fascia ; Foot ; Hydrogen-Ion Concentration* ; Inflammation ; Ischemia ; Models, Animal ; Pain, Postoperative ; Protons ; Rats* ; Skin ; Wounds and Injuries*

There are a few case reports describing conversion to normal sinus rhythm after a propofol injection in tachyarrhythmic patients. We managed two cases of 52 year old males complaining of chest pain and dyspnea. We diagnosed them with atrial flutter and idiopathic ventricular tachycardia respectively. Initially they were treated with antiarrhythmic drugs but conversion to normal sinus rhythm was not achieved. Therefore, we decided to use electrical cardioversion. For sedation during electrical cardioversion, we injected propofol 2 mg/kg and 2% lidocaine 1 mg/kg. A few seconds later, conversion to normal sinus rhythm was achieved without electrical cardioversion in both cases. Thereafter normal sinus rhythm continued on the ECG and they were discharged.
Anti-Arrhythmia Agents ; Atrial Flutter* ; Chest Pain ; Dyspnea ; Electric Countershock* ; Electrocardiography ; Humans ; Lidocaine ; Male ; Middle Aged ; Propofol* ; Tachycardia, Ventricular