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Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to medical response. Alternative uses of two- and one-lung ventilations have been required during VATS. This study evaluated the efficacy of alternating one- and two-lung ventilation through intraoperatively through the same single-lumen endobronchial tube using a tube exchanger during a thoracoscopic procedure for pediatric empyema.Between May 1995 and August 2001, 62 consecutive pediatric patients undergoing VATS for evacuation of the loculated empyema cavity were studied. The same single-lumen endobronchial tube was used, with an indwelling endotracheal tube exchanger in place for readjustment of the tube position to provide alternation of one- and two-lung ventilations in a thoracosopic procedure. Duration of operation, heart rate, mean arterial pressure, peak airway pressure, an partial pressure of oxygen (PaO(2)) and carbon dioxide (PaCO(2)) changes during one- and two-lung ventilations were recorded. The quality of lung deflation and inflation was rated by the surgeon using direct visualization as excellent, fair or poor.The mean operating time was 90 min (range, 50-120 min). No differences were found in heart rate, mean arterial pressure, or PaO(2) during one- and two-lung ventilations. Peak airway pressure and PaCO(2) during two-lung ventilation were significantly higher than during one-lung ventilation. The quality of lung deflation and inflation was judged excellent for all the patients.The VATS procedure can be performed safely and effectively in children using proper anesthetic technique. Retention of a tube exchanger within a single-lumen endobronchial tube an easily provide alternative one- and two-lung ventilations without inducing any significant airway flow obstruction during the operation.

Neuromuscular blocking agents (NMBAs) are widely used during the induction and maintenance of anesthesia. Postoperative residual curarization (PORC) following the use of NMBAs still occurs even though intermediate-acting NMBAs were used. Train-of-four (TOF) stimulation is used to quantify the degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductor pollicis muscle was associated with normal respiratory function. Pharyngeal function returned to normal while the TOF ratio reached 0.9. The aim of this study was to survey the PORC in the post-anesthesia care unit (PACU).In this observational study, 308 patients who received general anesthesia with NMBAs were enrolled. Residual curarization was evaluated using the TOF-Watch acceleromyograph upon arrival in the PACU. Three consecutive TOF stimulations were applied and recorded at 15-second intervals. Two thresholds of TOF ratios (0.9 and 0.7) were used to assess the presence of residual curarization.TOF ratios less than 0.7 and 0.9 were observed in 15 (5%), and 97 (31%) patients, respectively. The differences of the TOF ratios between the male and female patients were significant (p = 0.014). In terms of weight, the differences between the patients with ratios0.9 andor = 0.9 were significant (p = 0.013). There were 67, 49, 15, and three patients who received reversal medication in the0.9 group,or = 0.9 and0.7 group, andor = 0.7 group, respectively. The differences of the TOF ratios between the patients who received and those who did not receive reversal medication were not significant (p = 0.91).PORC is still a clinical problem in the modern PACU. Objective neuromuscular monitoring needs to be performed to ensure patient safety.

This study investigated the effect of baicalein, silymarin, and their combination, on two human liver-derived cell lines, HepG2 (hepatocellular carcinoma) and Chang liver (non-tumor liver cells). It was found that 6.75 microg/ml baicalein or 100 microg/ml silymarin alone significantly inhibited the growth of HepG2. When baicalein was used in combination with silymarin on HepG2, an additive effect at 24 h and a synergistic effect at 48 h were observed. The viability at 48 h was 85.62% from 6.75 microg/ml baicalein treatment; but the viability reduced to 49.67%, 38.56%, and 19.61% when 25, 50, and 100 microg/ml silymarin respectively, was added to the treatment. By contrast, each treatment had little or no effect on Chang liver. Compared to treatment of baicalein or silymarin alone on HepG2, combination of both drugs synergistically increased the percentages of cells in G0/G1 phase and decreased those in S-phase, which were associated with up-regulation of Rb, p53, p21(Cip1) and p27(Kip1) and down-regulation of cyclin D1, cyclin E, CDK4 and phospho-Rb. The results indicate that the combination of baicalein and silymarin eradicates tumor cells efficiently, has minimal deleterious effects to the surrounding normal cells, and offers mechanistic insight for further exploitation of HCC treatment.

Postoperative nausea and vomiting (PONV) is still a common and major complication for surgical patients, which may delay post-anesthetic care unit discharge, prolong hospital stay and thus increase the cost of hospitalization. It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods. Prophylactic administration of antihistamines, antidopaminergics, anticholinergics, phenothiazines, serotonin antagonist, steroids and even acupuncture has been shown to be effective. However, expenses and side effects of these agents have also been a concern for clinical doctors. The aim for this prospective study was to find an agent that is cost effective and side effect free (or at least with a low incidence of side effects) for the prevention of PONV.A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded, randomized and placebo-controlled study. Group P received the placebo (0.9% normal saline 2 ml) and Group D received 10 mg dexamethasone intravenously right before the induction of anesthesia.We found that during the postoperative period of 1-8 h, patients in Group D reported a lower incidence of PONV (24%) than those in Group P (39%, p0.001). Patients in Group D also requested less rescue anti-emetic (17%) than those in Group P (30%, p0.05). The same phenomenon was also noted in the 8-to-24-hour interval (PONV 4% vs. 12%, p0.05 and rescue anti-emetic 3% vs. 9%, p0.05 in Group D vs. Group P, respectively.)We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population.

One-lung ventilation (OLV) with a double-lumen endotracheal tube or Univent may be achieved difficulty in morbidly obese, mouth opening-limited or critically ill patients. Now, a new fiberoptically directed wire-guided endobronchial blocker (WEB) can be applied for these conditions. We report the use of a new endobronchial blocker in a pharyngeal cancer patient after pharyngectomy. The original 10# Shiley endotracheal tube was exchanged with reinforced cuffed tracheal tube. Then we use the WEB to achieve OLV. The WEB was guided by a loop, and through the appropriate position of left main bronchus by pediatric fiberoptic bronchoscope. Finally, OLV was accomplished smoothly with combination of a non-kinking endotracheal tube and a WEB.

We report a case of delayed hypoxemia in an aged healthy male patient, which developed 2 hours after cementation of the prosthesis in total hip replacement (THR) under spinal anesthesia. The patient was doing well throughout the operation but unfortunately, progressive tachypnea was noted 1 h after he was transferred to the recovery room (i.e. 2 h after the application of bone cement into the femur). An hour further, distinct wheeze was heard bilaterally on auscultation, which signified bronchospasm. Arterial blood gases analysis revealed a low PaO2 of 71 mmHg and a decrease of oxygen saturation to 91% with supplement of fractional oxygen of 35%. Aerosolization of bronchodilator with terbutaline was administered and supplemental fractional oxygen was increased to 50%. Although wheezing soon subsided, tachypnea and desaturation persisted. He was then transferred to the surgical intensive care unit for further management. Ventilation-perfusion lung scan was performed, which was suggestive of multiple pulmonary embolism.

We describe a patient who developed embolic stroke after coronary artery bypass grafting (CABG) associated with intraaortic balloon pump (IABP) insertion. Intraoperative transesophageal echocardiography (TEE) revealed marked irregular mass and disruption of the intimal surface of the thoracic aorta with overlying shaggy echogenic material on the intimal surface of the descending thoracic aortic lumen. This case of stroke after IABP insertion suggested that the balloon inflation fragmented some mobile components on the inner surface of the aorta, and this floating debris entered the systemic circulation. TEE might be able to predict the risk of stroke in such a patient.