Endolymphatic sac tumor with intralabyrinthine hemorrhage: a case report / 临床耳鼻咽喉头颈外科杂志

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.

Features of an Ergonomic Chair Designed for Surgeons Performing Microscopic Surgeries

@#Introduction: This study aimed at ergonomic assessment of the risk of musculoskeletal disorders among microscopic surgeons , investigate the specification of ergonomic chairs and designing one for use during microscopic surgeries. Methods: This descriptive study was performed on 27 micro surgeons out of 4 surgeons (ear, nose and throat), eye surgery, neurosurgery and plastic surgery in Khalili, Namazi, Shahid Chamran and Shahid Faghihi hospitals in Shiraz, Iran. The study was carried out in 4 steps. Objective evaluations included posture assessment by RULA and assessment of postural angles of the body (during performing microscopic surgeries) by Digimizer software. Subjective evaluation included the assessment of pain intensity and chair comfort using a visual analogue scale. next step was to determine the necessary anthropometric dimensions of the micro-surgeons. The fourth step was 3D modeling of the initial idea using Sketch Up 2017. Results: The mean and standard deviation of the final RULA scores of the surgeons’ postures were obtained 6.75 ± 0.5 and 6.5 ± 0.57 for the right and left sides of the body, respectively. Pain VAS scores after using normal chairs for microscopic surgeries were 5.32 (low-back pain), 4.42 (right shoulder/ arm pain) and 4.15 (left shoulder/ arm pain) which were their highest pain scores. The results of the assessment of postural angles by Digimizer software also showed a high risk of musculoskeletal disorders in the arm, forearm, wrist, neck, and trunk. Conclusion: In terms of ergonomics, the chair with the specifications listed may reduce physical fatigue and a potentially safer working environment for surgeons to create.

Corneal curvature and refractive state changes after microscopically extraocular muscle surgery in adults / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the corneal curvature and refractive changes after microscopically extraocular muscle surgery in adults.<p>METHODS: To observe 62 cases of 85 eyes underwent microscopic extraocular muscle surgery in the Second People's Hospital of Yunnan Province from December 2016 to May 2017, age 18 to 43, according to the surgical method, patients were divided into horizontal rectus surgery: Ⅰ group(simple migration group)32 eyes, Ⅱ group(rectus monocular migration combined with its antagonist muscle excision group)34 eyes, the oblique muscle group: Ⅲ group(single oblique muscle tendon broken group)10 eyes, Ⅳ group(oblique muscle transposition group)9 eyes; Subjective optometry was performed preoperatively and postoperatively at 1d, 1wk, 1mo, 3mo and 6mo, respectively, to obtain the refractive state changes and the curvature value of the anterior surface of the cornea(0-3mm, 5mm, 7mm)collected by corneal topography. The dynamic changes of the refractive state and corneal morphology of the patients in each group at different time points were compared. Anova and LSD-<i>t</i> test were used for comparison among time points and within each group.<p>RESULTS: Changes of corneal curvature in horizontal rectus muscle can be induced in a short period after the operation, which is limited to the central 5mm area of the cornea, and basically restored to the preoperative level 1mo after the operation. There was no significant effect on corneal curvature after inferior oblique operation. Astigmatism value increased in the early postoperative period of horizontal rectus muscle; Myopic drift occurred and recovered to preoperative level 1mo after surgery. After the operation of the inferior oblique muscle, there was no significant change in the spheroscopy and astigmatism.<p>CONCLUSION:Corneal curvature and refractive changes may occur after extraocular muscle in adults.

Establishment of male rat models for fertility after liver transplantation / 器官移植

Objective To establish male rat models for fertility following liver transplantation. Methods Male Sprague-Dawley (SD) rats were used as the donors and recipients of liver transplantation. The donor liver was transplanted with two-cuff technique. Liver transplantation was performed in 15 male SD rats. At 3 weeks after liver transplantation, 5 rats were randomly sacrificed for detection of sperm deformity rate. The remaining male rats were mixed bred and mated with healthy female SD rats at a ratio of 1︰2. General conditions of the rats undergoing liver transplantation were recorded. Liver function parameters were detected after liver transplantation. Postoperative sperm deformity rate was observed. The pregnant status of female rats and health situation of their offsprings was monitored. Results All 15 rats (100%) underwent liver transplantation successfully. Nine rats (9/10) survived longer than 8 weeks. Liver function parameters were normal in male rats following liver transplantation. The sperm deformity rate was ranged from 0.5% to 1.3%. Ten male rats undergoing liver transplantation were mixed bred with female rats at a ratio of 1︰2 for 1 week. All female rats were successfully mated and delivered their offsprings after 3 weeks. The offsprings had no evident physiological deformity. Conclusions Male rat models for fertility are successfully established after liver transplantation, which serve as an animal model to evaluate the fertility performance in male patients undergoing liver transplantation.

The inhibitory effects, according to infusion rate of remifentanil, on the hemodynamic responses during laryngeal microscopic surgery / 대한마취과학회지

BACKGROUND: The hemodynamic responses to tracheal intubation and placement of a suspension rigid laryngoscope are increases of the heart rate and blood pressure during laryngeal microscopic surgery (LMS).Therefore, several methods have been used to attenuate these responses. The aim of the present study was to compare the effects of three different infusion rate of remifentanil on the hemodynamic responses and recovery characteristics of patients who are under going LMS. METHODS: Forty-five patients (ASA class 1 and 2) who were scheduled for LMS were randomly allocated to three groups. The patients received propofol 3microgram/ml (the effective target concentration) with remifentanil 0.2microgram/kg/min (Group R0.2), 0.3microgram/kg/min (Group R0.3), or 0.4microgram/kg/min (Group R0.4), respectively.The patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were measured at baseline, 1 minute before and after tracheal intubation and 1 minute after placement of a suspension rigid laryngoscope.The patients' recovery characteristics (spontaneous respiration and eye opening) were assessed at 15 to 30 seconds intervals after discontinuation of the anesthetics. RESULTS: The blood pressure and heart rate at the time of tracheal intubation and placement of the suspension rigid laryngoscope were unchanged in Group R0.3, yet they were increased in Group R0.2 and they were decreased in Group R0.4. The emergence time was significantly shorter for the R0.2 and R0.3 Groups than that for Group R0.4. CONCLUSIONS: We concluded that TIVA with using propofol and remifentanil (0.3microgram/kg/min) can provide a stable hemodynamic status during LMS.

Optimal dosages of propofol and remifentanil for minimizing hemodynamic changes during laryngeal microscopic surgery / 대한마취과학회지

BACKGROUND: Laryngeal microscopic surgery (LMS) is stressful to the patient due to intubation and suspension laryngoscopy. The aim of this study was to determine the optimal dosages of propofol and remifentanil for minimizing hemodynamic changes during LMS. METHODS: Eighty outpatients undergoing LMS were randomly divided into four groups. In all patients, endotracheal intubation was done with an effect-site concentration of propofol at 3 or 4microgram/ml. Group I (propofol 3microgram/ml) and II (propofol 4microgram/ml) patients received remifentanil 0.5microgram/kg and an infusion at 0.1microgram/kg/min. Group III (propofol 3microgram/ml) and IV (propofol 4microgram/ml) patients received remifentanil 1.0microgram/kg and an infusion at 0.2microgram/kg/min. Hemodynamic changes and bispectral index (BIS) values during intubation and suspension laryngoscopy were compared among the groups. In addition, extubation time, emergence time, and state of recovery (Steward score) were compared. RESULTS: After intubation and suspension laryngoscopy, the mean arterial pressure (MAP) was significantly lower than baseline values in groups II and IV (P < 0.05). After suspension laryngoscopy, the heart rate (HR) was significantly lower than baseline value in group II (P < 0.05). Extubation time was significantly shorter in groups I, II, and III compared to group IV, and the time for responding to verbal commands was significantly shorter in groups I and II compared to group IV (P < 0.05). The incidence of hypotension was higher in group IV than in the other groups (P < 0.05). CONCLUSIONS: The results suggest that an effect-site concentration of propofol at 4microgram/ml with remifentanil 0.5microgram/kg and infusion of 0.1microgram/kg/min provide proper anesthesia with minimal hemodynamic changes during LMS.

Hemodynamic Changes according to the Remifentanil Effect Site Concentration for Patients under Total Intravenous Anesthesia during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngeal microscopic surgery directly stimulates an airway via endotracheal intubation and insertion of a suspension laryngoscope, and this can result in acute elevation of the blood pressure and heart rate. Therefore, an anesthesia that can maintain a sufficient depth of anesthesia and simultaneously makes awakening and recovery possible in a short period is required. We wanted to present the effect site concentration of remifentanil for achieving the best anesthesia by observing the hemodynamic changes according to the effect site concentration of remifentanil. METHODS: 36 patients, who corresponded with the ASA physical status classification 1 and 2 and who were from 20 to 70 years old, were the subjects of this study. They were randomly classified into three groups according to the effect site concentration of remifentanil. Propofol 4microgram/ml was infused continuously, and remifentanil was continuously infused for each group to achieve an effect site concentration of 4 ng/ml, 6 ng/ml, and 8 ng/ml, respectively. Rocuronium 0.5 mg/kg was used. The arterial blood pressures and heart rates were measured before induction of anesthesia, before endotracheal intubation, after endotracheal intubation and after insertion of a suspension laryngoscope. RESULTS: In comparison with the other groups, the 4 ng/ml remifentanil group was able to prevent acute elevation of blood pressure and heart rate. CONCLUSIONS: For total intravenous anesthesia using propofol and remifentanil, 4 ng/ml of remifentanil is proposed to be the effect site concentration that is able to stably maintain blood pressure and heart rate during laryngeal microscopic surgery.

Comparision of Total Intravenous Anesthesia and Sevoflurane-N2O-Alfentanil Anesthesia for Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the clinical properties of sevoflurane-N2O-alfentanil with propofol- remifentanil anesthesia for patients undergoing laryngeal microscopic surgery. METHODS: Sixty patients scheduled for elective ambulatory surgery received either total intravenous anesthesia (TIVA group) with remifentanil and propofol or balanced anesthesia with sevoflurane-N2O-alfentanil (sevoflurane-N2O-alfentanil group). The TIVA group patients were induced with an effective-site concentration of 4microgram/ml propofol and a bolus dose of 0.5microgram/ml remifentanil. The anesthesia was maintained with a continuous infusions with an effective-site concentration of 2-5microgram/kg propofol and 0.05-0.5microgram/kg/min remifentanil, according to the hemodynamic response. The sevoflurane-N2O-alfentanil group patients were induced with 5 mg/kg thiopental and 20microgram/kg IV alfentanil. Maintenance was obtained with 1.5-3.0 vol% sevoflurane and a bolus dose of 10microgram/kg IV alfentanil if needed. The anesthetic depth was controlled under bispectral index (BIS) monitoring: propofol and sevoflurane concentrations were adjusted to achieve target BIS values, and were between levels of 40-60 during surgery. RESULTS: Both anesthetic methods provided acceptable hemodynamic responses during surgery. The late recovery times (postanesthetic discharge scoring system), patient satisfaction and postoperative side effects were similar between patients in the two groups. Early recovery times (eye opening and the aldrete score) were shorter in the TIVA group patients, but this difference was not associated with a shorter hospital length of stay. CONCLUSIONS: Total intravenous anesthesia with remifentanil-propofol and balanced anesthesia with sevoflurane-N2O-alfentanil both provided satisfactory anesthesia for laryngeal microscopic surgeryd

Comparison of Sevoflurane-N2O and Propofol-N2O Anesthesia for Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngeal microscopic surgery is stressful as a result of the intubation and suspension laryngoscopy during the short operation time. Therefore, the objectives of the anesthesiologist are to maintain sufficient anesthetic depth, promote rapid awakening, and return the protective airway reflexes. This study compared the hemodynamic responses and recovery patterns between propofol-N2O and sevoflurane-N2O anesthesia. METHODS: Sixty outpatients undergoing laryngeal microscopic surgery were randomly divided into three groups: Endotracheal intubation with the effect-site concentration of propofol fixed at 3 ug/ml (Group P3), 4 ug/ml (Group P4) or endotracheal intubation with sevoflurane anesthesia (Group S). In all groups, the anesthesia was supplemented with up to 50% of N2O. The hemodynamic responses during intubation and suspension laryngoscopy were compared. In addition, extubation time, emergence time and the state of recovery (Steward score) were compared. RESULTS: After intubation and suspension laryngoscopy, the mean arterial pressure was significantly higher in Group S than in Groups P3 and P4 (P < 0.05). The heart rate was significantly higher in Group S than in the Group P4 (P < 0.05). The extubation times were not significantly different. However, the time for responding to a verbal command was significantly faster in Groups P3 (7.8 +/- 2.3 min) and P4 (8.8 +/- 1.9 min) than in Group S (10.6 +/- 1.8 min). The Steward score 1 min after extubation was significantly higher in Group S (P < 0.05). CONCLUSIONS: Propofol-N2O anesthesia can be useful in laryngeal microscopic surgery.

Efficacy of Sufentanil during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Various anesthetic agents have been used in laryngeal microscopic surgery, because the airway is shared with the surgeon, there is a short operation duration and intense cardiovascular stimulation occurs during the surgery. Sufentanil is superior than other anesthetic agents in blocking the cardiovascular response to the airway stimulation and a short duration of effects. METHODS: Thirty patients undergoing elective laryngeal microscopic surgery were randomized to receive sufentanil 0.125 microgram/kg (group 1, n = 10), sufentanil 0.25 microgram/kg (group 2, n = 10) or sufentanil 0.5 microgram/kg (group 3, n = 10). The bispectral index score, blood pressure, heart rate, recovery time from general anesthesia, the need for additional analgesics and naloxone and the postoperative complications associated with sufentanil were measured. RESULTS: The bispectral index, blood pressure and heart rate were similar in the three groups. Only four patients in group 3 required naloxone (P < 0.05). Three patients in group 1, one in group 2 and 0 in group 3 required an additional dose of sufentanil. Postoperative sore throat was detected in 6 patients in the immediate postoperative period and in 8 patients 6 hours after the end of anesthesia in group 1 (P < 0.05). CONCLUSIONS: Sufentanil is an effective analgesic for attenuating the cardiovascular responses of airway stimulation in laryngeal microscopic surgery. In addition, sufentanil 0.25 microgram/kg is an appropriate dose for the rapid recovery and attenuation of the cardiovascular response in laryngeal microscopic surgery.

Airway Management by Extended Endotracheal Tube for a Patient with Tracheal Stenosis during Laryngeal Microscopic Surgery: A case report / 대한마취과학회지

A small sized tube can be used for a patient with tracheal stenosis. However, an ordinary endotracheal tube may be not long enough to pass over stenotic lesion of trachea in adult patient for nasotracheal intubation, when stenotic lesion is located distally. We experienced a patient with severe tracheal stenotic lesion 5 cm above the carina and 3.1 cm length of stenotic lesion scheduled for laryngeal microscopic surgery. The two 4.0 mm tubes-connected tube using modified connector was designed and prepared. We performed fiberoptic-guided awake nasotracheal intubation using the extended endotracheal tube and the patient was successfully managed without complications until the surgery was completed.

Effects of Nicardipine on Changes of Blood Pressure and Heart Rate during Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngoscopy, tracheal intubation and the suspension laryngoscopy often provoke an undesirable increase in blood pressure and/or heart rate during laryngeal microscopic surgery. Thus, the anesthesiologist's objectives are to maintain sufficient anesthetic depth and to promote rapid awakening. Nicardipine, a direct arterial dilator, can be used to attenuate increasing blood pressure. We investigated the effects of nicardipine on changes of blood pressure and heart rate during laryngeal microscopic surgery. METHODS: Eighty patients of ASA class 1 or 2 scheduled for laryngeal microscopic surgery were randomly allocated into 4 groups. For anesthetic induction, IV propofol 1.5 mg/kg, rocuronium 0.4 mg/kg, and glycopyrrolate 0.2 mg were administered followed by mask ventilation for 5 minutes with isoflurane. One minute before tracheal intubation and suspension laryngoscopy saline, nicardipine 10, 20, or 30microgram/kg was injected in each group. Thereafter we measured blood pressure and heart rate one minute after each procedure. RESULTS: Increases in blood pressure were blunted in the nicardipine 20 and 30microgram/kg group. In the nicardipine 30microgram/kg group, heart rates were significantly increased and facial flushing was observed in two patients. CONCLUSIONS: We suggest that nicardipine 20microgram/kg can alleviate blood pressure increases with little effect on heart rate during laryngeal microscopic surgery. However, although nicardipine 30microgram/kg could blunt blood pressure increases, it produces tachycardia and perhaps overdose.