Background: Many reports with hypnotics and opiates have been published for nonrelaxant tracheal intubation.In addition to its immediate onset and short duration time, remifentanil can well prevent responses against short and strong stimulation like tracheal intubation.However, the high concentration of remifentanil for nonrelaxant tracheal intubation can cause hemodynamic instability, thus we tried to estimate the predicted effect-site concentration of remifentanil for smooth intubation and provoking hypotension.Methods: Forty three ASA I and II patients were randomly selected to receive an effect-site-controlled infusion of remifentanil 0, 2, 4, 6 ng/ml and propofol 2 mg/kg.Trachea was intubated after 3 minutes of manual breathing support with desflurane 6 vol%.The vital signs, end-tidal concentration of desflurane and responses of patients were recorded before intubation for 3 minutes and until 2 minutes after intubation every minute.The effective effect-site concentration (ECe) was calculated at 95% successful rate of smooth intubation and at 50% of provoking hypotension (equal to or under 55 mmHg).Results: The estimation results of the logistic regression stated that 95% ECe of remifentanil for smooth intubation was 8.0 (5.0-14.3)ng/ml and 50% ECe for provoking hypotension equal to or under 55 mmHg before intubation was 5.0 (2.6-9.7)ng/ml.Conclusions: Remifentanil at 8.0 ng/ml provided good conditions for smooth intubation without muscle relaxants but could provoked hypotension.Consequently, we recommend the careful observation of the blood pressure with the use of remifentanil and the evaluation of the suitable measures to maintain the blood pressure for nonrelaxant tracheal intubation.(Korean J Anesthesiol 2008; 55: 31∼5)
Hysteroscopic surgery has become a routine gynecologic procedure. The advantages are associated with more accurate removal of lesion, its short operating time, rapid post-operative recovery and low morbidity. However, there are potentially serious complications which can be occured during and following hysteroscopic surgery. The complications are uterine perforation, fluid overload and electrolyte disturbance due to intravasation and absorption of uterine distention media, hemorrhage and, rarely, gas or air embolism. We experienced pulmonary edema during hysteroscopic surgery in three consecutive patients. Therefore, we report these cases of fluid overload with uterine distention media resulting acute pulmonary edema during hysteroscopic surgery.
An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction.A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age.From anesthesiologists' point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern.Unexpectedly, it can cause difficult airway such as 'cannnot intubate' or 'cannot intubate and cannot ventilate' situation during anesthesia.Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae.Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation.He was discharged 10 days later with no harmful events.(
Jamu sticks are used in some Southeast Asian cultures especially Indonesia for vaginal health and tightening. However, there is no scientific evidence supporting the safety or effectiveness of Jamu sticks for vaginal tightening or health. Chemical reactions caused by these foreign substances can lead chemical vaginitis, increasing the risk of secondary infection through the disrupted vaginal wall. I report a case of a patient successfully treated for vaginal stenosis due to chemical vaginitis caused by Jamu sticks experienced in our hospital and advise caution against indiscriminate folk remedies.
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