-
[show abstract]
[hide abstract]
ABSTRACT: Intradermal injections of indigo carmine for sentinel node mapping are considered safe and no report of an adverse reaction has been published. The authors described two cases of profound hypotension in women that underwent breast-conserving surgery after an intradermal injection of indigo carmine into the periareolar area for sentinel node mapping.
Journal of Breast Cancer 03/2013; 16(1):127-128. · 0.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: The purpose of this study was to determine the intubation time needed to facilitate tracheal intubation (Time(EI)) with a low dose of rocuronium (0.3 mg/kg) during propofol induction, and to determine whether this time was reduced by the administration of atropine. METHODS: Forty-six children, aged 3-10 years, were randomly assigned to receive either saline (control group) or atropine 10 μg/kg (atropine group). Anesthesia was induced with alfentanil 10 μg/kg, propofol 2.5 mg/kg, and rocuronium 0.3 mg/kg. Each Time(EI) at which tracheal intubation was attempted was predetermined according to the up-and-down method. The values of Time(EI) that provided excellent intubation conditions in 50 and 95 % of patients were defined as Time(EI)50 and Time(EI)95, respectively. RESULTS: Time(EI)50 ± SD was 160 ± 26.2 and 150 ± 13.7 s in the control and atropine groups, respectively. Using isotonic regression, Time(EI)95 in the control and atropine groups was 199 s (95 % CI 198.8-200.7 s) and 171 s (95 % CI 171.3-172.1 s), respectively. Time(EI)95 was significantly higher in the control group than in the atropine group (P < 0.001). HR was significantly higher in the atropine group than in the control group during the study period. CONCLUSIONS: This study demonstrated that the Time(EI)95 of a low dose of rocuronium (0.3 mg/kg) required for excellent tracheal intubation was 199 s during i.v. anesthesia induction using propofol and alfentanil in children. Also, i.v. atropine (10 μg/kg) before anesthesia induction was able to reduce Time(EI)95 by 28 s.
Journal of Anesthesia 09/2012; · 0.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Positive end-expiratory pressure (PEEP) can improve respiratory mechanics during pneumoperitoneum, but may influence intracranial and cerebral perfusion pressure. This study investigated the changes in hemodynamic parameters and cerebral oxygen saturation (rSO(2)) associated with 10 cmH(2)O PEEP during pneumoperitoneum while undergoing laparoscopic cholecystectomy under propofol anesthesia. METHODS: Sixty patients aged 18-60 years undergoing laparoscopic cholecystectomy were randomly allocated into two groups: application of no external PEEP (ZEEP group, n = 30) or PEEP = 10 cmH(2)O (PEEP group, n = 30). PEEP was applied after insufflation of CO(2). Except for the PEEP level, all other ventilator settings were identical for both groups. Hemodynamic variables, end-tidal carbon dioxide concentration (ETCO(2)), ventilatory parameters, and rSO(2) were measured. RESULTS: There was no significant difference in rSO(2), mean arterial pressure (MAP), heart rate (HR), and ETCO(2) between the groups throughout the study. When compared with baseline, MAP, HR, and ETCO(2) increased significantly after insufflation of CO(2) in both groups, whereas rSO(2) did not change. No patient had cerebral desaturation, defined as rSO(2) <80 % of baseline or <50 % in both groups throughout the study. CONCLUSION: Application of PEEP with 10 cmH(2)O during CO(2) pneumoperitoneum could preserve the rSO(2) value and hemodynamic stability in patients undergoing laparoscopic cholecystectomy under propofol anesthesia.
Surgical Endoscopy 06/2012; · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Antiphospholipid syndrome (APS) is defined as an autoimmune disorder characterized by recurrent thrombosis or obstetrical morbidity. A 29-year-old woman who was diagnosed with APS underwent emergency cesarean delivery at 23 weeks' gestation. She had a seizure attack and her laboratory findings were: AST/ALT 1459/1108 IU/L, LDH 1424 IU/L, 30% hematocrit, a platelet count of 43 × 10(3)/ml and urine protein (4+). We describe the anesthetic experience of catastrophic HELLP syndrome with antiphospholipid syndrome and we review the relevant literature.
Korean journal of anesthesiology 06/2012; 62(6):575-8.
-
[show abstract]
[hide abstract]
ABSTRACT: Carbon dioxide (CO(2)) has different biophysical properties under different thermal conditions, which may affect its rate of absorption in the blood and the related adverse events. The present study was aimed to investigate the effects of heating of CO(2) on acid-base balance using Stewart's physiochemical approach, and body temperature during laparoscopy.
Thirty adult patients undergoing laparoscopic major abdominal surgery were randomized to receive either room temperature CO(2) (control group, n = 15) or heated CO(2) (heated group, n = 15). The acid-base parameters were measured 10 min after the induction of anesthesia (T1), 40 min after pneumoperitoneum (T2), at the end of surgery (T3) and 1 h after surgery (T4). Body temperature was measured at 15-min intervals until the end of the surgery.
There were no significant differences in pH, PaCO(2), the apparent strong ion difference, the strong ion gap, bicarbonate ion, or lactate between two groups throughout the whole investigation period. At T2, pH was decreased whereas PaCO(2) was increased in both groups compared with T1 but these changes were not significantly different. Body temperatures in the heated group were significantly higher than those in the control group from 30 to 90 min after pneumoperitoneum.
The heating of insufflating CO(2) did not affect changes in the acid-base status and PaCO(2) in patients undergoing laparoscopic abdominal surgery when the ventilator was set to maintain constant end-tidal CO(2). However, the heated CO(2) reduced the decrease in the core body temperature 30 min after the pneumoperitoneum.
Korean journal of anesthesiology 10/2011; 61(4):275-80.
-
[show abstract]
[hide abstract]
ABSTRACT: Several ventilatory strategies have been introduced to minimize the respiratory and hemodynamic effects of carbon dioxide pneumoperitoneum during laparoscopic surgery. The purpose of this study was to compare the effects of pressure-controlled ventilation (PCV) with that of volume-controlled ventilation (VCV) on the ventilatory and hemodynamic parameters in children undergoing laparoscopic appendectomy.
Thirty-four children undergoing laparoscopic appendectomy were randomly allocated to receive mechanical ventilation using either VCV (n=17) or PCV (n=17) mode. Positive end-expiratory pressure (PEEP) 5 cm H(2)O was applied to all patients. Hemodynamic and ventilatory parameters were measured 10 minutes before pneumoperitoneum (T1) and 30 minutes after pneumoperitoneum (T2).
Peak and mean airway pressures were significantly increased at T2 from T1 in both groups. Mean airway pressure was significantly higher in the PCV group compared with that in the VCV group. Dynamic compliance was significantly higher in the PCV group than in the VCV group at T2, although it was decreased at T2 from T1 in both groups. Mean blood pressure was significantly increased at T2 from T1 in both groups without intergroup difference. During the study period, SpO(2) remained constant without intergroup or within-group differences.
During laparoscopy, mean airway pressure and dynamic compliance were significantly higher during PCV with 5 cm H(2)O PEEP compared with that in VCV with 5 cm H(2)O PEEP. And, as there were no differences in other ventilatory parameters and oxygen saturation, both VCV and PCV can be used safely in children undergoing laparoscopic surgery.
Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2011; 21(7):655-8. · 1.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane.
Twenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 microg/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation.
The 50% clinical effective dose (cED(50)) of rocuronium for tracheal intubation using a lightwand was 0.20 +/- 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED(50) and cED(95) (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively.
The cED(50) and cED(95) of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.
Korean journal of anesthesiology 08/2010; 59(2):82-6.
-
[show abstract]
[hide abstract]
ABSTRACT: A 63-year-old woman with amyotrophic lateral sclerosis (ALS) was scheduled for open reduction and internal fixation of the right tibia. Total intravenous anesthesia using propofol and remifentanil without muscle relaxant was selected as the anesthetic method, in order to avoid the possible occurrence of ventilatory depression due to abnormal responses to muscle relaxants and exacerbation of the motor neuron disease. After standard and neuromuscular monitoring devices were applied, anesthesia was induced and maintained with target controlled infusion of propofol and remifentanil in the range of 2.5-5.0 microg x ml(-1) and 2.5-5.0 ng x ml(-1), respectively. To avoid delayed neuromuscular recovery, we did not use any muscle relaxant at all. Intubation was successful and there were no remarkable events during anesthesia, except for three brief hypotensive events; there was no exacerbation of ALS itself during or after the anesthesia. She was discharged on postoperative day 3, without any discomfort.
Journal of Anesthesia 02/2008; 22(4):443-5. · 0.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is both in vitro and clinical evidence that high-dose propofol can inhibit mitochondrial respiration, resulting in metabolic acidosis. The purpose of this study was to evaluate the effects of propofol anesthesia on the acid-base status in neurosurgical patients with large amount of normal saline administration. Thirty patients undergoing clipping of cerebral aneurysm were randomly assigned to receive propofol (n=15) or isoflurane (n=15). Propofol dose (mean+/-standard error) infused for maintenance was 5.7+/-0.2 mg/kg/h in propofol group. Acid-base parameters such as PaCO2, pH, serum bicarbonate concentration, standard base excess, serum electrolyte concentration, total protein, albumin, lactate, and phosphate were measured before and 4 hours after the induction of anesthesia, and after surgery. The apparent strong ion difference (SIDa), the effective SID (SIDe), and the amount of weak plasma acid were calculated using the Stewart equation. There were no significant differences in pH, PaCO2, bicarbonate, and lactate between 2 groups throughout the whole investigation period. After surgery, standard base excess significantly decreased in both groups without intergroup difference. SIDa and SIDe significantly decreased in both groups, and lactate and strong ion gap significantly increased after surgery in propofol group, but there were no significant differences between 2 groups. Both propofol and isoflurane were associated with hyperchloremic metabolic acidosis in neurosurgical patients with large amount of normal saline administration. The acid-base balance between the 2 anesthetics was similar using Stewart's physicochemical approach.
Journal of Neurosurgical Anesthesiology 02/2008; 20(1):1-7. · 2.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The spinal expression of the c-Fos immediate early gene in response to formalin pain of the hind paw of rat was used as a marker of neuronal activity. Ketamine, a Nmethyl-D-aspartate (NMDA) receptor antagonist produces analgesic action due to the blockade of glutamate action at the NMDA receptor. Earlier study showed that ketamine acts differently depending on its route of administration. We undertook this study to compare a preemptive suppression of noxious stimulation induced spinal Fos-like immunoreactivity (FLI) after receiving intrathecal ketamine before or after formalin pain.
Male Sprague-Dawley rats received ketamine 1 mg/kg or saline (control group) intrathecally either 5 min before (pre-treatment group) formalin or 5 min after (post-treatment group) formalin (5%, 50 microl) injection. Animals were killed 2 h after the formalin injection, and the lumbar spinal cord was dissected, and processed by immunoperoxidase staining using an antibody against Fos protein.
The FLI was significantly reduced in the pre-treatment group, only laminae I-II of the side ipsilateral to the formalin injection (P < 0.05 vs. control). In laminae V-VI, neither of the ketamine treatment groups showed a significant decrease than the control group.
The results provide evidence that intrathecal ketamine does not have a preemptive blocking effect of FLI expression in whole spinal laminae area. FLI expression of laminae I-II only might not be a good predictor of the ability of agents to produce preemptive effect. The central patterns of activity generated during central sensitization differ regionally in the spinal dorsal horn.
The Indian journal of medical research 01/2005; 120(6):527-33. · 1.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We investigated the effects of fenofibrate, peroxisome proliferator-activated receptors (PPARs) agonist, on endothelial function in patients with hypertriglyceridemia. We administered placebo or fenofibrate 200 mg daily to 25 patients with hypertriglyceridemia for 8 weeks. This study was randomized, double-blind, placebo-controlled, crossover in design. Compared with placebo, fenofibrate significantly changed lipoprotein levels including non-HDL cholesterol and significantly improved the percent flow-mediated dilator response to hyperemia by 13 +/- 6% (P < 0.001) and lowered plasma levels of tumor necrosis factor-alpha by 13 +/- 3% (P < 0.001). Fenofibrate reduced fibrinogen and plasminogen activator inhibitor type 1 antigen levels by 17 +/- 3 and 10 +/- 3%, respectively (P < 0.001 and P = 0.014, respectively). However, fenofibrate did not significantly change plasma levels of nitrate, malondialdehyde, tissue factor activity, and serological markers of plaque stabilization. Fenofibrate significantly changed lipoprotein levels and improved the percent flow-mediated dilator response to hyperemia as well as lowered levels of tumor necrosis factor-alpha (TNF-alpha), fibrinogen, and plasminogen activator inhibitor type 1 antigen.
Atherosclerosis 07/2004; 174(2):379-83. · 3.79 Impact Factor
