Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.

Anesthetic management with neuromuscular monitoring and bispectral index in an amyotrophic lateral sclerosis patient: A case report / 대한마취과학회지

Amyotrophic lateral sclerosis is a neurodegenerative disease caused by the degeneration of upper and lower motor neurons. The disorder causes muscle weakness and atrophy throughout the body. There is an unexpected response to depolarizing or nondepolarizing muscle relaxants, and risk of perioperative respiratory failure is high. Careful monitoring and minimal doses of anesthetics are needed. We report a case of general anesthesia in a patient with amyotrophic lateral sclerosis. We used proper doses of muscle relaxant and inhalation anesthetics with neuromuscular monitoring and bispectral index. The patient early recovered from anesthesia without any respiratory complications.

Comparison of the Effects of Intrathecal Fentanyl and Meperidine on Shivering after Cesarean Delivery under Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Meperidine has proved a far more effective treatment for shivering after spinal anesthesia than equianalgesic doses of opioid agonist. We performed this prospective, double-blinded, randomized study to compare the antishivering effect of fentanyl and meperidine when added to intrathecal hyperbaric bupivacaine during Cesarean delivery under spinal anesthesia. METHODS: Sixty ASA I or II patients undergoing Cesarean delivery under spinal anesthesia were randomly assigned into three groups. Fentanyl 12.5 ug (group F) or meperidine 12.5 mg (group M) or normal saline 2.5 ml (group C) were added to 0.5% hyperbaric bupivacaine 8.5 mg for spinal anesthesia. Data including mean arterial pressure, heart rate, sensory block level, core temperature, shivering incidence and intensity were collected every 2 min for 10 min and then every 5 min until the end of surgery. RESULTS: There were no significant statistical differences in patient characteristics, the mean arterial pressure, heart rate and core temperature among the groups. The incidences of shivering in fentanyl and meperidine group were significantly lower than in the control group, but there were no significant differences between fentanyl and meperidine group. Shivering intensity was significantly lower in fentanyl and meperidine group than in the control group. CONCLUSIONS: Intrathecal fentanyl and meperidine added to 0.5% hyperbaric bupivacaine are effective in reducing the incidence and intensity of shivering associated with spinal anesthesia.

Effects of Intrathecal Meperidine on Prevention of Shivering during Spinal Anesthesia for Herniorrhaphy / 대한마취과학회지

BACKGROUND: Shivering associated with spinal anesthesia is uncomfortable to the patient and may interfere the monitoring of patient. Hence, we have investigated whether intrathecal meperidine could decrease the incidence and intensity of shivering during spinal anesthesia for unilateral herniorrhaphy. METHODS: Forty ASA class 1 or 2 patients undergoing unilateral herniorrhaphy were randomly allocated into two groups (group C and M). The patients of group C (n = 20) received hyperbaric bupivacaine (0.5%; 13 mg) and normal saline (0.004 ml/kg), and the patients of group M (n = 20) received hyperbaric bupivacaine (0.5%; 13 mg) and meperidine (0.2 mg/kg). After spinal block, the incidence and intensity of shivering were determined objectively by observing involuntary muscle activity. The measurement of the mean arterial pressures and heart rates of the patients, for every two minutes for ten minutes, and subsequently for every five minutes for thirty minutes were carried out. We have also checked the highest sensory block level, and other side effects. RESULTS: There were no significant differences in age, height, weight and duration of surgery between the two groups. Also, the mean arterial pressures, heart rates, and the highest sensory block levels exhibited no differences between the two groups. But, the incidence and intensity of shivering in group M were significantly less than in group C (P<0.05). CONCLUSIONS: Intrathecal meperidine (0.2 mg/kg) was effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for herniorrhaphy.