Thermal burn injury associated with a forced-air warming device / 대한마취과학회지

No abstract available.

Delayed hypoxemia due to endobronchial intubation as a result of positioning the patient under general anesthesia: A case report

Undetected endobronchial intubation during general anesthesia can cause serious complications. However, it is very difficult to determine the exact location of the endotracheal tube when it is positioned in the middle of the trachea. We experienced a patient who showed hypoxia caused by the positioning of the endobronchial tube. We think that the tube might have been advanced from the upper part of the carina into the right main bronchus while the neck was being flexed by the neurosurgeon for achieving better surgical exposure.

Prolonged effect of nicardipine used for deliberate hypotension in scoliosis surgery: A case report

Postoperative respiratory complications following scoliosis surgery are high incidence. In this case, fifty year-old male patient was admitted for thoracolumbar screw fixations and developed postoperative pulmonary edema. This was most likely due to prolonged administration of nicardipine, which over time may inadvertently cause hypotension. As a result of volume overload, interstitial pulmonary edema and pleural effusion occurred. Moreover, pulmonary edema and pleural effusion appeared on the right side first and spread to the left. This phenomenon could be explained by the positioning of scoliosis patient. The cause of pulmonary edema was volume overload initiated by prolonged effect of nicardipine.

Relationship between neuronal nitric oxide synthase and NADPH-diaphorase in the dorsal root ganglia during neuropathic pain / 대한마취과학회지

BACKGROUND: Changes in nitric oxide (NO) production in the dorsal root ganglia (DRG) may contribute to allodynia after nerve injury. It is known that the histochemistry of NADPH-diaphorase (NADPH-d) is known to be not always coincident with NOS. This study was conducted to investigate the relationship between nNOS and NADPH-d expression in the DRG in a spinal nerve injury model of neuropathic pain, and to elucidate role that NO plays in neuropathic pain. METHODS: nNOS immunohistochemistry and/or NADHP-d histochemistry were conducted in the DRG of a spinal nerve transection model of neuropathic pain, and the pain behavior was then measured by a von Frey filament test of the hindpaws of wild type and nNOS knock-out mice. RESULTS: nNOS immunoreactive neurons and NADPH-d stained neurons were not always identical. Additionally NADPH-d increased, but nNOS did not increase significantly in the DRG after spinal nerve transection. Neuropathic pain behavior increased in the hindpaw of nNOS(-/-) mice after spinal nerve transection, but was lower than that of wild type mice after spinal nerve transection. CONCLUSIONS: nNOS immunoreactive neurons and NADPH-d stained neurons were not always identical in the DRG, and a novel NADPH-d positive source may be involved in neuropathic pain after spinal nerve transection. Changes in nNOS expression in the DRG were not the primary cause of neuropathic pain behavior in a spinal nerve transection model of neuropathic pain.

Cauda equina syndrome after spinal anesthesia in a patient with severe spinal stenosis: A case report / 대한마취과학회지

Cauda equina syndrome is a well-known but rare complication of spinal anesthesia. An 80-year-old man was scheduled for both herniorrhaphy. Spinal anesthesia was performed at the L3-4 interspinous space with 0.5% hyperbaric bupivacaine 12 mg. Eight hours after anesthesia, the patient complained bilateral sensorimotor deficits of the lower extremities and peroneal region. Urinary and fecal incontinence were also observed. MRI and myelography showed severe central spinal stenosis at L3-4 and L4-5. EMG showed cauda equina syndrome. Seven weeks after the procedure, left decompressive subtotal laminectomy L2-L5 was done. The patient still complains the neuropathic pain in the both lower extremities and ambulates using a walker. The local anesthetic was injected into thecal sac between maximum stenoses, and it is likely that there was poor upward spread leading to maldistribution of local anesthetic and resultant local anesthetic toxicity.

The effect of priming with rocuronium on onset time and intubation conditions during endotracheal intubation with low-dose rocuronium / 대한마취과학회지

BACKGROUND: A priming dose of rocuronium can shorten the onset time of neuromuscular blockade. The purpose of this study was to evaluate the effect of priming with rocuronium on the onset time and intubation conditions during tracheal intubation with low-dose rocuronium (0.35 mg/kg) and to compare results with those for rocuronium 0.45 mg/kg. METHODS: One hundred twenty four patients were randomly allocated to three groups. Following induction of anesthesia, groups I and III received normal saline while group II received a priming dose of rocuronium (0.05 mg/kg). Three minutes after priming, groups I, II and III received, respectively, 0.45 mg/kg, 0.3 mg/kg and 0.35 mg/kg rocuronium. Intubation was performed 2 minutes after the administration of an intubating dose and intubation conditions were evaluated. Neuromuscular blockade was assessed by accelerography. RESULTS: The proportion of cases having optimal intubation conditions in group I was higher than in groups II and III. There was no significant difference in the onset times among groups. Neuromuscular blockade at 60, 90 and 120 seconds after an intubating dose was similar among all groups except at 60 sec. Maximal blockade for group I was deep compared to groups II and III. CONCLUSIONS: Rocuronium 0.35 mg/kg does not provide satisfactory intubation conditions. There are no effects on onset time and intubation conditions due to priming during tracheal intubation with rocuronium 0.35 mg/kg.

Comparative acute toxicity of quaternary ammonium lidocaine derivative QX-314 to lidocaine in mice

BACKGROUND: The current study examined the acute systemic toxicity of QX-314 that there have been few research results for this so far. In order to be useful as a drug, it must be shown to have minimal toxicities. Hence, we compared the CNS and cardiac toxicities of QX-314 to the conventional local anesthetic lidocaine. METHODS: Acute toxicity was evaluated by determining the individual intravenous CD50 and LD50 of QX-314 and lidocaine. There were four doses for each LD50 determination and 8 animals per dose level. Animals were observed for several hours immediately following drug administration and recorded overt effects and fatalities. Both lidocaine and QX-314 were dissolved in saline. Lidocaine and QX-314 were diluted to 1, 2, 4, 6 and 0.5, 1, 2, 4%, respectively with saline and injected at the same volume to minimized cardiovascular effect. RESULTS: The intravenous CD50 and LD50 were 12.7 and 14.1 mg/kg for QX-314 and 15.7 and 28.8 mg/kg for lidocaine. Electrocardiograms showed intraventricular block (widened QRS complex) at high doses of lidocaine compared to AV block (loss of QRS complex) at high concentrations of QX-314. There are no evidence that CNS toxicity led mouse to death. CONCLUSIONS: QX-314 is about 1.5 times as toxic as lidocaine. Although QX-314 may still be useful clinically as a long-lasting local anesthetic, its safety relative to other available local anesthetics must be considered.

The Change of Bispectral Index in Endotracheal Intubation with Propofol and Remifentanil without Muscle Relaxant

BACKGROUND: There have been conflicting reports about the effect of muscle relaxant to bispectral index during propofol anesthesia. The purpose of this study was to investigate the change of bispectral index (BIS) in endotracheal intubation with propofol and remifentanil without muscle relaxant and to compare with those in endotracheal intubation with muscle relaxant. METHODS: Forty-eight ASA physical status I or II patients were randomly allocated to 2 groups. Each patient were anesthetized with propofol at target effect site concentration of 4.0microg/ml with remifentanil 3.0microg/kg. Saline was injected in Group S and rocuronium 0.6 mg/kg was injected in Group R. Intubation was attempted, and the BIS, intubating condition, mean arterial pressure and heart rate were observed up to 5 minutes after intubation. RESULTS: BIS was elevated after intubation in Group S. BIS after intubation in group S were significantly higher than group R. BIS after injection of rocuronium in group R was significantly decreased. There were no significant differences in hemodynamic datas in two groups. Intubation condition was acceptable in all patients. CONCLUSIONS: The BIS in endotracheal intubation with propofol and remifentanil without muscle relaxantI can be higher than in endotracheal intubation with muscle relaxant.

The Use of a Continuous Interscalene Brachial Plexus Block for Pain Control following Shoulder Surgery / 대한마취과학회지

BACKGROUND: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. METHODS: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat's modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. RESULTS: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor's syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. CONCLUSIONS: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery.

The Effect of Butorphanol on the Bispectral Index during Intravenous Anesthesia with Propofol and Remifentanil

BACKGROUND: The aim of this study was to investigate the effect of butorphanol on the Bispectral Index (BIS) during the administration of intravenous anesthesia with propofol and remifentanil. METHODS: Forty adult patients, ASA I-II, scheduled for an emergency laparoscopic appendectomy were studied. The doses for the anesthetics were adjusted to keep the BIS value between 40 and 50. After 20 minutes of stable anesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or 0.02 mg/kg butorphanol (butorphanol group). The BIS values, mean arterial pressure, and heart ratewere recorded every five minutes for a period of 20 minutes. RESULTS: The mean BIS values after butorphanol administration were not significantly different from the values following the administration of saline, throughout the observation period. No patients were able to recall explicitly any events under anesthesia. No significant changes in mean arterial pressure and heart rate were noted after butorphanol administration. CONCLUSIONS: Butorphanol given to prevent postoperative pain does not modify the BIS value during anesthesia maintained with remifentanil and propofol.

Effect of Low-dose Rocuronium on Tracheal Intubating Conditions during Induction of 8 vol% Sevoflurane with Remifentanil

BACKGROUND: We evaluated the effect of low doses of rocuronium on tracheal intubating conditions and hemodynamic changes during induction of anesthesia with 8 vol% sevoflurane and remifentanil 1microg/kg. METHODS: Eighty four patients were randomized into one of three groups; Group I, II, III. Each group received normal saline, 0.3, 0.45 mg/kg of rocuronium respectively. Predetermined drugs for each group and remifentanil 1microg/kg were administered during induction of 8 vol% sevoflurane. After induction of 8 vol% sevoflurane, tracheal intubation was preformed. The tracheal intubation conditions and hemodynamic responses to tracheal intubation were assessed. RESULTS: Tracheal intubation was successful in all patients. The incidence of clinically acceptable intubating conditions was 79% in Group I, 100% in Group II, and 100% in Group III. There was no significant difference in intubating condition between Group II and Group III. The hemodynamic responses to tracheal intubation were blunted in all groups. CONCLUSIONS: After induction with 8 vol% sevoflurane and remifentanil 1microg/kg, low-dose rocuronium provides more satisfactory tracheal intubation conditions.

Anesthetic Experience of Acquired Distal Tracheoesophageal Fistula: A case report / 대한마취과학회지

A tracheoesophageal fistula (TEF) was detected in a woman who received chemotherapy for acute lymphoblastic leukemia. The fistula biopsy confirmed the aspergillus infection. A large fistula was located at the lateral wall of the carina involving the proximal left main bronchus, and the orifice of left main bronchus was almost completely obstructed by white mass-like plaque. Primary repair was planned using the right thoracotomy approach. We originally planned to selectively intubate the left lung with the aid of fiberoptic bronchoscope without success. Therefore, we selectively intubated the right lung. Hypoxemia developed during surgery and the level of oxygenation was improved by selectively intubating the left bronchus from the surgical field once the defect had been exposed. We review the ventilation technique and anesthetic problems encountered in patients with a large distal TEF.

Anesthesia for a Sturge-Weber Syndrome Patient with Severe Facial Hemangioma: A case report / 대한마취과학회지

Sturge-Weber syndrome is characterized by congenital skin angiomas throughout the facio-trigeminal region, which can cause difficulty in airway management in the case of general anesthesia. The problems with this syndrome include glaucoma, seizures, severe mental retardation, intracranial cavernous hemangioma, etc. We report a case of a patient with Sturge-Weber syndrome with severe facial hemangioma who underwent septoplasty and inferior turbinectomy under general anesthesia. We also review the literature on the anesthetic management for the Sturge-Weber syndrome and discuss methods for avoiding complications.

The Effect of Injection Speed of Local Anesthetic on Success Rate of Unilateral Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The relationship between the injection speed of a local anesthetic and the success rate of unilateral spinal anesthesia has been a controversial issue. The aim of this thesis was to identify any significant effects of the drug injection speed on the success rate of unilateral spinal anesthesia. METHODS: Forty patients were randomly allocated into 2 groups, group R and S. The injection speed was 4 ml/min in group R (n = 20) and 1 ml/min in group S (n = 20). Hyperbaric 0.5% bupivacaine 10 mg was injected via a syringe pump. The drug was administered at the L3-4 intervertebral space with the patient in the lateral decubitus position, which was maintained for 20 minutes after the injection. A spinal sensory block was assessed by examining the temperature sensation using an alcohol-sponge. The motor block was evaluated using the modified Bromage scale and the dependent and non-dependent sides were compared. RESULTS: Significant differences (P<0.05) were observed in the success rate of unilateral motor paralysis (45% in group R vs 90% in group S). There were no significant blood pressure differences between the two groups 5, 10, 15, 30 and 60 minutes after injecting the hyperbaric 0.5% bupivacaine. CONCLUSIONS: The injection speed of local anesthetics is one of the crucial factors for achieving a unilateral spinal anesthesia. Therefore, it is important to maintain a slow injection speed of a local anesthetic in unilateral spinal anesthesia.

Pulmonary Thromboembolism during Femur Surgery under General Anesthesia -A case report- / 대한마취과학회지

Although perioperative pulmonary thromboembolisms (PTEs) are not rare, most anesthetists are unfamilar with the condition. We experience a case, which showed a sudden capnographic score drop, increased pumonary arterial pressure, and a D-shaped right ventricle by echocardiography in a femur surgery patient under general anesthesia. The case described provides an example of PTE and should remind anesthetists of the clinical course and treatment of this condition.

The Influence of Lidocaine on the Onset of Rocuronium-induced Neuromuscular Block in Rapid-sequence Tracheal Intubation / 대한마취과학회지

BACKGROUND: Most local anesthetics decrease neuromuscular transmission and potentiate the neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the influence of lidocaine on it effects rocuronium onset and intubation conditions in rapid-sequence intubation and to compare with those of succinylcholine. METHODS: Seventy five ASA physical status 1 and 2 patients were randomly allocated to three groups. Group S received succinylcholine (1.0 mg/kg), Group R received rocuronium (0.6 mg/kg) and additional lidocaine (1.5 mg/kg) was given intravenously prior to the administration of rocuronium 0.6 mg/kg in Group RL. Anesthesia was induced with midazolam 0.03 mg/kg, fentanyl 2microgram/kg, and thiopental 5 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxants and intubation conditions were evaluated. Neuromuscular blockades were assessed by single twitch responses of the adductor pollicis after ulnar nerve stimulation by accelerography (0.1 Hz, 0.2 ms supramaximal stimuli). RESULTS: The onset time of Group S (47.8+/-11.3) was shorter than those of Group R (87.8+/-30.2) and Group RL (75.4+/-21.5), but no differences was observed between the onset times of Group R and Group RL. Intubation conditions were good or excellent in all groups. CONCLUSIONS: Additional lidocaine to rocuronium neither influences intubation condition nor accelerate the rocuronium onset, and it is cannot be viewed as an alternative for succinylcholine in rapid-sequence tracheal intubation.

The Effects of Esmolol on BIS, Patient Movement, and Hemodynamic Changes during General Anesthesia with Propofol / 대한마취과학회지

BACKGROUND: Lidocaine, alpha, beta-adrenergic blocker, angiotensin converting enzyme inhibitor, and various other analgesics have been used for blocking awakening, movements, and hemodynamic instability during general anesthesia. The purpose of this study was to evaluate the ability of esmolol to attenuate the cardiovascular, motor, and central nervous system responses to nociceptive stimulation, such as intubation, during general anesthesia. METHODS: Forty randomly selected patients participated in this study either as a control (n = 20) or as a study (n = 20) group, respectively. As soon as patients lost consciousness, at a propofol effect-site concentration of 4 microgram /ml, a touniquet was applied to one arm and inflated to 150 mmHg higher than the systolic pressure, and then vecuronium (1 mg/kg) was injected. Simultaneously esmolol (1 mg/kg + 250 microgram /kg/min) or normal saline were injected in the study and control groups respectively. Four minutes after starting esmolol, orotracheal intubation was administered. We monitered the BP, HR, BIS and gross movement during the study. RESULTS: Statistically significant differences were observed in mean BP, HR, and BIS between the two groups during esmolol injection. CONCLUSIONS: Esmolol can reduce anesthetic requirements during general anesthesia with propofol.

An Analysis of Learning Objectives and Test Items in Fundamentals of Nursing in Korea / 기본간호학회지

PURPOSE: To analyze the learning objectives and test items for Fundamentals in Nursing which were established between 1999 and 2000 and to develop these items toward a nationwide faculty workshop for national board examination for Korean nurses. RESULTS: 1. According to Bloom's taxonomy, learning objectives established in 1999 mainly consisted of two domains, comprehension (56.1%), and knowledge (27.7%). The learning objectives established in 2000, mainly consisted of comprehension (45.2%) and application (25.4%). 2. According to McGuire's taxonomy, domain of test items established in 1999 consisted of recall (66.7%), interpretation (28.0%) and problem solving (4.9%). Domain of test items established in 2000, consisted of recall (65.1%), interpretation (22.0%) and problem solving (12.9%). 1) Department of Nursing, Chung-Ang University 2) College of Nursing, Yonsei University 3) College of Nursing, Seoul National University 4) Department of Nursing, Kyung-Hee University 5) College of Nursing, Ewha University 6) College of Nursing, The Catholic University of Korea(corresponding author, Email: sky@catholic.ac.kr) 7) National Medical Center Nursing College 8) Red Cross Nursing College 9) Department of Nursing, Gachun Gil College 3. The proportion of learning objectives in the knowledge and comprehension domains established in 200, decreased from 27.7% to 13.5%, and from 56.1% to 45.2% respectively over that of 1999. But the domain of application increased from 5.3% to 25.4% over that of 1999. 4. With regard to McGuire's taxonomy, the proportion for the recall and interpretation domains established in 2000 decreased from 66.7% to 65.1%, and from 28.0% to 22.0% respectively. But the proportion for the problem solving domain increased from 4.9% to 12.9% over that of 1999. For type of test items, the proportion of A type established in 2000 decreased from 47.2% to 37.6%, and K type increased from 52.1% to 60.8% over that of 1999. CONCLUSION: The learning objectives and test items established in 2000 showed remarkable improvement compared to those established in 1999. For better learning objectives and test items in Fundamentals of Nursing, further research is recommended on essential content and standardization of job analysis for national board examination for nurses in Korea.

Analgesic Effect of IV-PCA with Nalbuphine-Ketorolac for Upper Abdominal Surgical Patients / 대한마취과학회지

BACKGROUND: Ketorolac is a potent anlagesic drug which has anti-inflammatory action and this drug may decrease the needed amount of opioids when used together with them for postoperative pain control. Preemptive analgesia with these drugs is still controversial. The analgesic effect and the presence of preemptive analgesia of a nalbuphine-ketorolac combination were examined in upper abdominal surgical patients. METHODS: Thirty patients undergoing elective upper abdominal surgery were randomly allocated into two groups. Each group received 10 mg of nalbuphine as a bolus dose just before starting IV-PCA which contained nalbuphine 70 mg and ketorolac 150 mg in 88 ml of 5% dextrose water. Group I (n=15) received drugs before starting the operation and group II received them at the end of the operation. The basal rate, PCA dose and lock-out interval were 1.5 ml, 1.5 ml and 10 minutes, respectively. In each group, the postoperative visual analogue scale (VAS) score, degree of satisfaction, total amount of drug used and side effects were checked and compared with corresponding figures in the other group for two postoperative days. RESULTS: Postoperative pain after upper abdominal surgery was controlled well in all patients and there were no significant differences in VAS scores between the two groups. Most patients were satisfied with this regimen. There were no remarkable side effects. Preemptive analgesia of nalbuphine-ketorolac combination was not found. CONCLUSIONS: IV-PCA administration of nalbuphine 70 mg and ketorolac 150 mg combination is an effective method to control postoperative pain in upper abdominal surgical patients. Preemptive analgesia is not found with this regimen.

An Analyses of Research Trend and Proposition Related to Self-care / 간호학회지

This study was performed to analyse the tendency of the self-care studies, to investigate the variables related to self-care, which could be applied for the data establishing the theory of self-care. to accomplish the objectives of this study, the researchers analyzed 83 studies, available that contained the area of self-care, which was published in local and foreign areas between 1981 and Feb. 1997. The findings of this study are as follows: 1) Studies published in Korea were about twice more than foreign studies. According to the statistics, the number of studies in this study tended to increase year by year. Between 1991 and 1995 were most. Analysis on the subject of this studies showed, that they were most dealt with chronic diseases an adults. 2) The theoretical definition of self-care were most referred to Orem's self-care. For the main concept of studies, self care performance was the most. 3) The correlational study was most often used design and experimental study is tended to increase. The questionnaires were the most often used data collection method. There was lots of different variable measuring technique to evaluate main concepts. 4) In the results of analysis on the propositions related to the self-care performance, a client's education, social support, self-efficacy, and level of knowledge as a causal variable were found. Also, the physiological index improved and quality of life were fond to be significant effective variables.