Clinical Efficacy of Iris Cystostomy Using a Yttrium Aluminum Garnet Laser

Purpose@#To report the clinical efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iris cystotomy in iris cysts. @*Methods@#We examined three eyes with primary iris cysts diagnosed by ultrasound biomicroscopy that had fewer cornea endothelial cells or reduced visual acuity due to an occluded visual axis. Nd:YAG laser cystotomy was done. The logarithm of the minimum angle of resolution (logMAR) visual acuity, intraocular pressure (IOP), and specular microscopy test at baseline and last follow-up were reviewed. @*Results@#The average patient age was 54.0 ± 5.3 years; the mean follow-up was 11.7 ± 2.1 months. The baseline and final logMAR visual acuity were 0.23 ± 0.25 and 0.16 ± 0.15, respectively. Visual acuity improved, although not significantly (p = 0.317). The baseline and final IOP were 14.7 ± 2.3 and 13.7 ± 0.6 mmHg, respectively (p = 0.276). The corneal endothelial cell density (p = 0.109), hexagonality (p > 0.999), and coefficient of variation (p = 0.285) were not significantly different after treatment. There were no serious complications or recurrence. @*Conclusions@#After Nd:YAG laser cystotomy, the cell density and morphology of corneal endothelial cells changed little. It can be considered an effective treatment when there is a decrease in corneal endothelial cells or occlusion of the visual axis.

Propofol and remifentanil total intravenous anesthesia and the preservation of spontaneous respiration for a patient with mediastinal mass / 대한마취과학회지

No abstract available.

The effect of remifentanil and ketamine on intraoperative hemodynamics and postoperative pain in gastrectomy with sevoflurane based anesthesia

BACKGROUND: Remifentanil could require an appropriate pain strategy to prevent unacceptable pain in the postoperative period. We investigated the effect of perioperative ketamine for nociception and remifentanil hyperalgesia after gastrectomy when we used intraoperative remifentanil infusion for hemodynamic control. METHODS: Eighty patients scheduled for gastrectomy were randomly included in this trial. In control group (C), patients received normal saline. In ketamine group (K), patients received ketamine perioperatively. In remifentanil group (R), patients received remifentanil during operation. In remifentanil and ketamine group (RK) patients received remifentanil intraoperatively and ketamine perioperatively. Hemodynamic indexes were recorded during anesthesia. Visual analogue scale (VAS), cumulative analgesic requirement, and side effects were recorded during 36 h after operation. RESULTS: The requirement of vasodepressants was significantly increased in C and K group. Morphine consumption and agitation were significantly increased in R group at the postanesthetic recovery room. The analgesic demand of R group was greater than that in other groups. The VAS scores of K group were significantly lower than those of other groups at the ward. CONCLUSIONS: Intraoperative use of remifentanil with sevoflurane may be related to increased pain during early postanesthetic period. Perioperative low-dose ketamine decreased intraoperative remifentanil use and postoperative morphine consumption without increasing the incidence of side effects.

Muscular Rigidity and Pulmonary Edema Following Administration of Low Dose Fentanyl: A Case Report / 대한구급학회지

Fentanyl-induced muscular rigidity has been reported exclusively in patients when large fentanyl dosages were employed in the operating room or in the pediatric intensive care unit. Rigidity and pulmonary edema after analgesic doses of fentanyl had not been reported previously. A 25-year-old man underwent removal of a foreign body and application of an Ilizarov frame of tibia under general anesthesia. The patient received 100 microg of fentanyl during emergence of anesthesia and the procedure of dressing. On arrival to the anesthetic recovery room, the patient presented with muscular rigidity and about 1 hour later, developed pulmonary edema. The notable predisposing factors were rapid injection of fentanyl and history of treatment with antidepressants and haloperidol, modifiers of serotonin and dopamine levels. From this case, we suggest the need for careful observation for the development of muscle rigidity complicating airway management in patients taking antidepressants and antipsychotics, especially after administration of an analgesic dose of fentanyl.