Effects of sevoflurane and desflurane on respiratory mechanics after tracheal intubation in children / 대한마취과학회지

BACKGROUND: Tracheal intubation causes a reflex tracheal constriction that leads to increased airway resistance. Inhalation anesthetics can prevent or minimize this response. Therefore, this study was conducted to evaluate the effect of 1 MAC sevoflurane or desflurane on respiratory mechanics in children after anesthetic induction using propofol and tracheal intubation. METHODS: Sixty children undergoing elective surgery with tracheal intubation were assigned into two groups at random, a 1 MAC concentration of sevoflurane (n = 30) and a desflurane (n = 30) group. Anesthesia was induced using propofol (1.5 mg/kg) and tracheal intubation was facilitated using rocuronium (0.6 mg/kg). A respiratory profile monitor was used to measure the respiratory resistance, dynamic compliance and peak inspiratory airway pressure. The measurements were made at three time points, after three inspirations from the beginning of mechanical ventilation (baseline) and at 5 and 10 min after the administration of inhalation anesthetics. RESULTS: Sevoflurane and desflurane led to a significant decrease in respiratory resistance and increased dynamic compliance at 5 and 10 min when compared to baseline. There were no significant differences in respiratory resistance and dynamic compliance between the two groups. CONCLUSIONS: A 1 MAC concentration of sevoflurane and desflurane has a similar bronchodilatory effect after tracheal intubation in children.

Comparison of intubating conditions according to different doses of rocuronium during propofol-remifentanil target controlled infusion / 대한마취과학회지

BACKGROUND: Many studies have shown that tracheal intubation can be facilitated by propofol-remifentanil without muscle relaxant. But low dose of rocuronium can improve intubating condition and reduce the requirement of remifentanil. This study evaluated the optimal dose of rocuronium for tracheal intubation according to different doses of rocuronium during propofol-remifentanil target controlled infusion (TCI). METHODS: Sixty, ASA I-II patients were randomly divided into three groups (n = 20). Anesthesia was induced with remifentanil 3.0 ng/ml and propofol 3.5 microgram /ml target controlled infusion. After patients lost consciousness, rocuronium was administrated 0.6 mg/kg (R0.6), 0.45 mg/kg (R0.45), 0.3 mg/kg (R0.3) for each group. Three minutes later, a laryngoscope and tracheal intubation were tried, intubating condition were measured. Also blood pressure and heart rate were measured before induction, preintubation, postintubation. RESULTS: Clinically acceptable intubation condition (excellent or good) were observed 100%, 100%, 85% of patients in the R0.6, R0.45, and R0.3 groups. Eighty five percents of patients in groups R0.6, R0.45 had excellent intubation condition. But only 35% in group R0.3 showed excellent intubating condition (P < 0.05) and 15% in group R0.3 showed poor intubating condition. There were no significant elevation mean blood pressure (MBP), heart rate (HR) after tracheal intubation in all groups. And there were no significant differences among groups. CONCLUSIONS: The optimal dose of rocuronium for clinical acceptable intubating condition could be reduced to 1.5 x ED(95) under total intravenous anesthesia with remifentanil 3.0 ng/ml and propofol 3.5 microgram/ml target controlled infusion.

The effects of nurse education on physical restraint use in the ICU / 대한마취과학회지

BACKGROUND: Physical restraint is widely used to prevent self-harm and treatment interference in the intensive care unit (ICU)s, but it can cause adverse effects such as physical, psychological, and ethical problems. We examined the effect of nurse education on physical restraint use in the ICU. METHODS: For 3 months before an ICU patient restraining program (IPRP), we investigated the application ratio of physical restraint, the incidence of complications and self-medical device breakage (self-extubation, self removal of intravenous line, etc.) Then we educated the 49 ICU nurses with an IPRP. The same data was collected again for 3 months after IPRP, and we also collected data from ICU nurses on their knowledge, attitude, and intention when applying physical restraint using questionnaires before and after IPRP education. RESULTS: After IPRP education, the nurses' knowledge about physical restraint use improved significantly and their intension for restraint decreased. The physical restraint application ratio did not change significantly in the period before IPRP (146/475, 30.7%) compared to the period after IPRP (110/399, 27.6%). Significant decreases were shown in the incidence of physical injury and self-medical device breakage after restraint removal. There were no significant differences on the site, duration, or cause of physical restraints. CONCLUSIONS: Although the IPRP education did not decrease the restraint application ratio, there were significant decreases on patient physical injuries and medical device breakage after restraint removal. We suggest that education should be performed continuously to both nurses and doctors to decrease the application of physical restraints.

The effects of nurse education on physical restraint use in the ICU / 대한마취과학회지

BACKGROUND: Physical restraint is widely used to prevent self-harm and treatment interference in the intensive care unit (ICU)s, but it can cause adverse effects such as physical, psychological, and ethical problems. We examined the effect of nurse education on physical restraint use in the ICU. METHODS: For 3 months before an ICU patient restraining program (IPRP), we investigated the application ratio of physical restraint, the incidence of complications and self-medical device breakage (self-extubation, self removal of intravenous line, etc.) Then we educated the 49 ICU nurses with an IPRP. The same data was collected again for 3 months after IPRP, and we also collected data from ICU nurses on their knowledge, attitude, and intention when applying physical restraint using questionnaires before and after IPRP education. RESULTS: After IPRP education, the nurses' knowledge about physical restraint use improved significantly and their intension for restraint decreased. The physical restraint application ratio did not change significantly in the period before IPRP (146/475, 30.7%) compared to the period after IPRP (110/399, 27.6%). Significant decreases were shown in the incidence of physical injury and self-medical device breakage after restraint removal. There were no significant differences on the site, duration, or cause of physical restraints. CONCLUSIONS: Although the IPRP education did not decrease the restraint application ratio, there were significant decreases on patient physical injuries and medical device breakage after restraint removal. We suggest that education should be performed continuously to both nurses and doctors to decrease the application of physical restraints.