Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.
Anesthesia, General ; Anoxia ; Ascites* ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Colon ; Female ; Head-Down Tilt* ; Humans ; Lung ; Ovarian Neoplasms* ; Ovary ; Pleural Effusion* ; Round Ligament of Uterus ; Thorax ; Uterus

BACKGROUND: Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation. METHODS: Ninety patients classified as American Society of Anesthesiologists physical status I–II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused. RESULTS: At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively). CONCLUSIONS: Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia.
Anesthesia, Spinal* ; Anoxia ; Blood Pressure ; Bradycardia ; Dexmedetomidine* ; Heart Rate ; Humans ; Hypotension ; Methods ; Midazolam* ; Prevalence

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.
Anesthesia, General ; Felodipine ; Fentanyl* ; Meperidine* ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin Syndrome* ; Serotonin*

BACKGROUND: Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. METHODS: Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. RESULTS: No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 +/- 8.5 ml vs. 16.6 +/- 12.0 ml, P = 0.013). CONCLUSIONS: Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics, Opioid ; Dizziness ; Female ; Fentanyl* ; Gynecologic Surgical Procedures* ; Humans ; Hysterectomy ; Oxycodone* ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Period

Trigeminal neuralgia is a severe pain disorder characterized by recurrent paroxysms of unilateral facial pain that is typically lancinating or stabbing, and is activated by cutaneous stimulation. Trigeminal alcohol neurolysis is an accepted treatment for trigeminal neuralgia. However, injections of alcohol must be placed accurately because alcohol is highly toxic. In this study, infraorbital alcohol neurolysises were performed under an ultrasound guidance. Ultrasound imaging is a safe, simple and non-invasive modality. This imaging tool allows fine adjustment of the needle tip and direct observation of the injectate. Two patients suffering from trigeminal neuralgia were treated with ultrasound-guided trigeminal alcohol neurolysis. They showed favorable pain relief without any serious complications over the 5- and 7-month follow-up, respectively.
Facial Pain ; Follow-Up Studies ; Humans ; Needles ; Nerve Block ; Somatoform Disorders ; Trigeminal Neuralgia* ; Ultrasonography

No abstract available.
Hemodynamics* ; Humans

No abstract available.
Hemodynamics* ; Humans

No abstract available.
Anesthesia, General* ; Shoulder* ; Tachycardia, Supraventricular*

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.
Anoxia ; Cystic Adenomatoid Malformation of Lung, Congenital ; Humans ; Infant, Newborn ; Intubation ; One-Lung Ventilation ; Oxygen ; Thoracic Surgery

The I-gel(TM) is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel(TM) supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel(TM) supraglottic airway. The authors suggest that I-gel(TM) is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.
Airway Management ; Bronchoscopes ; Goldenhar Syndrome ; Humans ; Intubation ; Laryngeal Masks ; Laryngoscopes ; Tonsillectomy ; Ventilation