BACKGROUND: Aprepitant is effective in prevention of chemotherapy-induced nausea and vomiting, when administrated with other antiemetics. We compared the effectiveness of aprepitant to ondansetron for prevention of post-operative nausea and vomiting (PONV) in patients who received a patient-controlled analgesia (PCA) containing opioids. METHODS: 198 patients were randomized into two groups. The treatment group was received an aprepitant, 80 mg, and the control group received a placebo. General anesthesia with inhalational anesthetics–N2O was performed, and PCA was supplied, which contained opioids-NSAIDs-ondansetron. The primary end-point was the incidence of PONV for postoperative 48 hours, and the secondary end-point was the changes in the relationship between PONV incidence and risk factors. RESULTS: PONV incidence in the treatment group was lower than in the control group (18.6% [95% CI: 10.8–26.3], 33.3% [95% CI: 23.6–43.1], respectively, P = 0.021). Relative risk of PONV in the control group was 1.80 (95% CI: 1.08–3.00, P = 0.010). PONV scores peaked at around postoperative 6 hours, then gradually decreased in the control group but not in the treatment group, which showed lower values than the control group (P = 0.001), and no changing patterns were observed (P < 0.001). Risk factors analyzed were sex, surgery type, history of motion sickness or PONV, and smoking habits. Their effects of all risk factors except sex were abolished in the treatment group. CONCLUSIONS: Prophylactic aprepitant with ondansetron was more effective than ondansetron-only regimen in preventing PONV after volatile anesthesia with opioid-containing PCA. Aprepitant abolished the effects of most of risk factors, so it could be efficacious in a high-risk PONV group.
Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Antiemetics ; Humans ; Incidence ; Motion Sickness ; Nausea ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting* ; Pre-Exposure Prophylaxis ; Risk Factors ; Smoke ; Smoking ; Vomiting

No abstract available.
Informed Consent* ; Malpractice*

Pneumocephalus is common after brain surgeries, but usually is not substantial enough to cause serious complications. We recently encountered a case of post-operative tachypnea after an endoscopic 3rd ventriculostomy. At first, we thought that the hyperventilation was the result of residual paralysis after emergence from anesthesia, but during further evaluation we found a massive pneumocephalus. In such unusual post-operative situations, physicians should consider surgery-related complications as the possible cause as well, along with the anesthetic factors.
Anesthesia ; Brain ; Hyperventilation* ; Paralysis ; Pneumocephalus* ; Postoperative Care ; Tachypnea ; Ventriculostomy*

Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man. The patient was also at risk of brain ischemia due to abnormal vessel status and a previous cerebrovascular accident with left-sided weakness. Successful perioperative anesthetic management was achieved by focusing on maintaining marginal upper normal blood pressure to ensure cerebral perfusion and to reduce the risk of false aneurysm rupture.
Aneurysm* ; Aneurysm, False* ; Blood Pressure ; Brain Ischemia ; Heart Failure ; Humans ; Middle Aged ; Myocardial Infarction ; Perfusion ; Rupture ; Stroke ; Thoracic Surgery

BACKGROUND: We investigated the effects of the combined administration of nefopam, a N-methyl-D-aspartate receptor antagonist and low dose remifentanil, on early postoperative pain and analgesic requirement. METHODS: Fifty patients scheduled to undergo mastoidectomy and tympanoplasty were randomized to be given either nefopam 40 mg mixed with normal saline 100 ml (Group N) or an equal amount of normal saline (Group C) before anesthesia induction. Anesthesia was maintained with 5-6 vol% desflurane and remifentanil 0.05-0.15 microg/kg/min during the surgery. Postoperative pain was controlled by titration of ketorolac in the postanesthesia care unit (PACU) and ward. We evaluated the intraoperative remifentanil dose, recovery profiles, ketorolac demand in the PACU and ward, numeric rating scale (NRS) for pain at time intervals of every 10 min for 1 h in the PACU, 6, 12, 18 and 24 h in a ward, as well as the time to first analgesic requirement in the PACU and ward. RESULTS: Ketorolac demand and NRS in the PACU were significantly lower in Group N than Group C (P = 0.002, P = 0.005, respectively). The time to first analgesic requirement in the PACU in Group N were significantly longer than Group C (P = 0.046). There were no significant differences in intraoperative remifentanil dose, ketorolac demand, NRS, and the time to first analgesic requirement in the ward between the groups. CONCLUSIONS: Nefopam administration combined with low dose remifentanil infusion reduces pain and analgesic consumption during the immediate postoperative period in patients undergoing middle ear surgery under desflurane anesthesia.
Anesthesia* ; Ear, Middle* ; Humans ; Ketorolac ; N-Methylaspartate ; Nefopam* ; Pain, Postoperative ; Postoperative Period ; Tympanoplasty

Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.
Accidents, Traffic ; Adult ; Anesthesia ; Anoxia ; Chest Tubes ; Female ; Humans ; Lacerations ; Lung ; One-Lung Ventilation ; Oxygen ; Pneumothorax* ; Respiration, Artificial ; Thorax ; Ventilation

No abstract available.
One-Lung Ventilation*

The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for managing such patients. We describe the successful management of combined spinal-epidural anesthesia in an asymptomatic severe aortic stenosis patient scheduled for lumbar discectomy.
Anesthesia* ; Anesthesia, Conduction ; Anesthesia, General ; Aortic Valve Stenosis* ; Cardiac Output ; Dexmedetomidine ; Diskectomy* ; Humans ; Muscle Relaxation ; Positive-Pressure Respiration ; Prone Position

BACKGROUND: This study was conducted to assess preoperative residual antiplatelet-induced platelet dysfunction using a platelet function assay to determine the optimal cessation period of aspirin during the preoperative period. METHODS: Patients older than 20 years, who were scheduled for elective surgery under general anesthesia, were enrolled prospectively. The last ingestion of the aspirin had occurred within the previous 10 days before surgery (aspirin 100 mg per day). No history of antiplatelet intake was documented in the control group. Platelet function was assessed using a platelet function analyzer-100 (PFA-100). Receiver operating characteristic (ROC) curves were plotted to determine the ability of aspirin cessation time in order to predict platelet function as assessed by the PFA. Patients were assigned to groups according to the period of aspirin discontinuation. RESULTS: Two hundred patients were enrolled in this study (100 control group and 100 aspirin group). The mean PFA value of the control group was significantly lower than that of the treated groups. The areas under the ROC curve (0.65, P = 0.03) of aspirin cessation period to discriminate PFA prolongation were significant. There were significant decreases in PFA values when aspirin medication was discontinued for 7 days, but not when the intake was discontinued for 5 days. CONCLUSIONS: Platelet function recovered if aspirin intake was discontinued > 7 days prior to surgery; therefore, in these patients, a preoperative platelet function test is not essential. However, the residual antiplatelet effect of aspirin should be assessed using the PFA in patients who discontinue aspirin less than 7 days prior to surgery.
Anesthesia, General ; Aspirin* ; Blood Platelets* ; Eating ; Humans ; Platelet Function Tests ; Preoperative Period ; Prospective Studies ; ROC Curve