Changes of peripheral perfusion index in very low birth weight infants with late-onset sepsis / 中国小儿急救医学

Objective:To analyze the changes of peripheral perfusion index (PPI) with late-onset sepsis (LOS) in very low birth weight infants during hospitalization.Methods:Very low birth weight infants admitted to the neonatal intensive care unit of Children′s Hospital of Fudan University from August 1, 2021 to August 31, 2022 were consecutively included.Infants with admission age ≥three days and unstable circulation, or positive blood culture within three days after birth were excluded.From the day of admission, the PPI values of the right hand and either foot of the infants were measured with Masimo SET Radical-7 everyday while whether LOS occurred during hospitalization was observed.The mean PPI curve of very and extremely low birth weight infants without LOS was plotted.For those with LOS confirmed by blood culture, the PPI change trajectory three days before and after the occurrence of LOS was drawn, and the change trend of PPI before the occurrence of LOS was analyzed by trend chi-square test.Non-parametric test was used to analyze the effect of LOS on pre- and post-ductal PPI values.Results:A total of 107 very low birth weight infants were included in the final analysis.Among them, there were 11 infants confirmed as LOS by blood culture, 37 infants diagnosed as clinical LOS, and 59 infants without LOS.Pre-and post-ductal PPI values of very low birth weight infants without LOS were 2.06±1.30 and 1.72±0.92, respectively; those with clinical LOS were 1.90±0.94 and 1.58±0.83, respectively; those with LOS confirmed by blood culture were 1.92±1.11 and 1.62±0.82, respectively.For infants with LOS confirmed by blood culture, the pre-and post-ductal PPI values showed a continuous downward trend during three days before the onset of disease, with the lowest PPI values on the first day before the diagnosis of blood culture.The downtrend of pre-ductal PPI was statistically significant ( χtrend2=5.57, P<0.05). Conclusion:The PPI value of very low birth weight infants show a downward trend when LOS occurs.It should be observed dynamically in clinical practice, which is helpful to suspect or identify LOS as early as possible.

The effect of alternate nostril breathing exercise in vital signs of congestive heart failure patients

Background: Changes in vital signs such as tachycardia, dyspnea, tachipnea, decreased oxygenation, caused by the inability of the heart to pump enough blood to meet the needs of oxygen and nutrients needed by the tissue, so that alternative therapies are needed: alternate nostril breathing exercise (ANBE) as a companion to pharmacological therapy for congestive heart failure (CHF) patients. The purpose of this study was to see the effect of ANBE on the vital sign of CHF patients.Methods: This Quasy experimental study was used one group pretest and Posttes design, conducted at one of the Padang City Hospitals from March to August 2019. Study population includes CHF sufferers, with a sample of 16 people, using accidental sampling technique. Univariate data analysis to get the mean of vital sign and bivariate measurements using parametric test i.e. Paired t-test to see the effect of this therapy.Results: Mean vital signs pretest and posttest was given in a row The observations are: respiratory rate (RR): 5.4978; 4.6078, pulse: 10.1804; 8,7770, systolic blood pressure (SBP): 12,5963; 11,1481, and diastolic blood pressure (DBP): 10,3009; 8.8606. Paired t-test obtained p-value of RR, pulse, SBP and DBP: 0.000, and existing t count> from t table (t count> 2.13145), so that there is an effect of ANBE on vital signs.Conclusions: ANBE affects the vital sign of CHF patients and can be continued as an intervention that can be carried out independently by CHF sufferers.

Limited Health Literacy And Its Associated Factors Among Overweight And Obese Housewives Living In Klang Valley Low Cost Flats: Findings From The My Body Is Fit And Fabulous At Home (Mybff@Home) Study

@#Limited health literacy is highly associated with poor health status. The concept of health literacy in public health relates to the concern that people with lower health literacy were also less likely to engage in health promoting behaviours. This is an analysis on health literacy and its associated factors among housewives and also a sub analysis of the Malaysian My Body is Fit and Fabulous at Home (MyBFF@home) study involving 328 overweight and obese housewives living in low cost flats in Klang Valley, part of a weight loss programme recruited using convenient sampling. Health literacy was measured using the Malay version of Newest Vital Sign (NVS) test with scores ranging from 0 to 6. Total score of ≤2 indicate limited health literacy and total scores of >2 indicate adequate health literacy. Descriptive analysis, chi-square test and multiple logistic regression were used to analyse the data.The mean(SD) NVS score was 1.07(1.19) with most (87.5%) housewives having limited health literacy. Factors that were significantly associated with limited health literacy were older age of 45 to 59 years old (p = 0.040), primary education and below (p = 0.001) and absence of internet connectivity (p = 0.001). In the final model, absence of internet connectivity (OR 2.61; 95%CI 1.31 to 5.22) was associated with limited health literacy. Majority of the housewives have limited health literacy and providing internet connectivity to housewives may increase their health literacy.

the sixth vital sign in foreign countries:a review / 中国实用护理杂志

The purpose of this paper is to know about the review for the Sixth Vital Sign and evaluation tools in foreign countries, and to explore the important role on patients′ basic physiological state, clinical treatment and diagnosis when the different indicators as the sixth vital signs, as to better serve individual and medical services.

Desarrollo de un prototipo para su uso como herramienta de apoyo al personal médico en la gradación de triaje para pacientes en los servicios de urgencias basado en sus signos vitales

Se presenta el desarrollo de un prototipo para su uso como herramienta de apoyo al personal médico en la gradación de triaje para pacientes en los servicios de urgencias basado en sus signos vitales. El prototipo consta principalmente de un módulo de instrumentación que mide los signos vitales luego de adquirir y procesar bioseñales presentes en los pacientes. Consta también de una interfaz en plataforma web donde se almacenan y procesan las medidas para gradar en un nivel de urgencia a los pacientes. Para enlazar el módulo de instrumentación y la interfaz de usuario se construye un módulo de comunicaciones basado en la tecnología inalámbrica wifi. Se indican las características principales de los elementos utilizados, configuraciones y protocolos. Se realizan pruebas con el módulo de instrumentación comparando las medidas con las obtenidas por los métodos convencionales usados por los profesionales médicos. Las pruebas se someten a 29 pacientes distintos, 72,4% de los cuales eran del género femenino y 27,6% masculino. El promedio de edad en total fue de 29,4 años; los porcentajes de error que se consiguen son admisibles. Se concluye indicando cómo el sistema descrito puede ser de gran ayuda al personal médico en la toma de decisiones al momento de asignar un nivel de triaje a los pacientes, disminuyendo así el tiempo de clasificación de estos en los servicios de urgencia.

We present the development of a prototype for use as a personal medical support tool in triage grading for patients in emergency services based on their vital signs. The prototype consists of an instrumentation module that measures vital signs after acquiring and processing biosignals present in patients. It also consists of an interface on the web platform where the measures are stored and processed to classify patients at an emergency level; To link the instrumentation module and the user interface, a communications module based on wireless Wi-Fi technology is built. The main characteristics of the elements used, configurations and protocols are indicated. The tests are performed with the instrumentation module that compares the measurements with those obtained by the conventional methods used by medical professionals, the tests are submitted to 29 different patients, 72.4% of which were female and 27.6% male, the average age was 29.4 years; The percentages of error that are obtained are admissible. It can be identified how the treatment system can be of great personal medical help in the decision making when assigning a level of triage to the patients, thus reducing the time of classification of these in the emergency services.

Apresenta-se o desenvolvimento de um protótipo para seu uso como ferramenta de apoio pessoa médico na gradação da triagem para pacientes nos serviços de urgências com base nos seus sinais vitais logo de adquirir e processar bio-sinais presentes nos pacientes. Além disso, o protótipo tem uma interface na plataforma web onde armazene os dados e processam as medidas para gerar um nível da triagem para os pacientes. Para ligar o modulo de instrumentação e a interface do usuário construiu-se um modulo de comunicações com base na tecnologia sem fio wifi. Indica-se as características principais dos elementos usados, configurações e protocolos. Realizam-se provas com o modulo de instrumentação comparado com as medidas obtidas pelos métodos convencionais usados pelos profissionais médicos. As provas foram sometidas a 29 pacientes diferentes, 72,4% mulheres e 27,6% homens. A media de idade foi de 29,4 anos; as porcentagens do erro são admissíveis. As conclusões encontram que o sistema descrito pode ser de ajuda para o pessoal médico na toma de decisões no memento de assignar o nível da triagem para os pacientes, diminuindo o tempo de classificação destes serviços de urgência.

Comparison of the Effects on Sleep and Vital Signs of the Elderly Between the Hand Bath Group and the Foot Bath Group

PURPOSE: The purpose of this study was to identify the effects of hand and foot baths on sleep and body temperature of the elderly. METHODS: The research was designed for a nonequivalent control group before and after the test design. The subjects of this study totaled 43, aged 65 and over (23 people in hand bath group and 20 people in a foot bath group), who received a written voluntary consent to participate in experimental treatment and are in the W care center, S Nursing Home, and H care center in Seoul. Data were collected with questionnaires and observations, and were analyzed on the basis of frequency, percentage, mean, standard deviation, χχ2-test, Fisher exact test, t-test and paired t-test. RESULTS: There are no significant differences in homogeneity test of a dependent variable between groups (hand bath, foot bath). The differences between 2 groups on the sleep quality score and systolic blood pressure, diastolic blood pressure temperature were not significant statistically except on the pulse. CONCLUSION: Based on the results of this study, hand bath is as efficient as foot bath. Therefore, a hand bath can be a nursing intervention in order to enrich sleep quality for the elderly because a hand bath is more convenient than foot bath.

Clinical validation study of the SignCare Vital Signs Monitor of Fundación Cardiovascular de Colombia / Estudio de validación clínica del monitor de signos vitales SignCare de la Fundación Cardiovascular de Colombia

Abstract Introduction: In Colombia, due to the difficult access to health services and to geographic conditions, the implementation and innovation of telemedicine technological tools is a priority. Having a validated vital signs monitor (VSM) improves proper medical treatment and diagnosis. Objective: To design and perform clinical trials for the SignCare VSM. Materials and methods: A device for continuous monitoring of electrocardiography, respiration, oxygen saturation, temperature and noninvasive blood pressure (NIBP) was designed. This device was validated in a laboratory in order to ensure a robust prototype, close to the level of commercial medical devices. Clinical trials were performed through a cross -section study with 98 patients, whose vital signs were measured using the SignCare monitor and a commercial monitor. These two measurements were compared using Pearson's correlation coefficients. Results: There were no statistically significant differences between the results obtained with the SignCare VSM and the commercial monitor. The highest correlations were found for the following items: heart rate by electrocardiogram (r=0.844), heart rate by oxymetry (r=0.821), body temperature (r=0.895), systolic blood pressure (r=0.780), and diastolic blood pressure (r=0.811). Conclusions: The SignCare device is as reliable as the commercial monitor in the qualitative detection of morphologic alterations of electrocardiogram records, as well as in breathing, temperature, oxygen saturation and blood pressure parameters, which makes it recommendable for clinical use in adult population.

Resumen Introducción. Debido a las dificultades geográficas y de acceso a los servicios de salud en Colombia, la implementación e innovación con herramientas de telemedicina se convierte en un tema prioritario; contar con un monitor de signos vitales validado favorece el tratamiento médico oportuno. Objetivos Diseñar y realizar la validación clínica del monitor de signos vitales SignCare. Materiales y métodos. Se diseñó un equipo para el monitoreo constante de las señales de electrocardiografía, respiración, saturación de oxígeno, temperatura y presión arterial no invasiva. El dispositivo fue validado en el laboratorio para asegurar un prototipo robusto a nivel de dispositivos médicos comerciales. La validación clínica se hizo mediante un estudio de corte transversal en 98 pacientes a los que se les realizaron mediciones con el monitor SignCare y con un monitor comercial. Se compararon estas dos mediciones mediante coeficientes de correlación de Pearson. Resultados. No hubo diferencias estadísticamente significativas en cuanto a los resultados obtenidos con el monitor SignCare y con el monitor comercial. Las mayores correlaciones se presentaron en la frecuencia cardíaca por electrocardiograma (r=0.844), frecuencia cardíaca por oximetría (r=0.821), temperatura corporal (r=0.895), tensión arterial sistólica (r=0.780) y tensión arterial diastólica (0.811). Conclusiones. El monitor SignCare es tan confiable como el monitor comercial para la detección cualitativa de alteraciones morfológicas del registro electrocardiográfico, lo que hace posible su recomendación para uso clínico en población adulta.

Implementação de um programa de controle da dor em hospital de traumatologia e ortopedia. Relato de caso / Implementation of pain control program in a traumatology and orthopedics hospital. Case report

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é uma das mais frequentes queixas clínicas na prática diária, ambulatorial e hospitalar. Independentemente da sua causa, permanece subvalorizada e, consequentemente, sem tratamento adequado, resultando em insucessos no seu controle, prejudicando uma proposta de reabilitação física e social. O objetivo deste estudo foi apresentar o programa de controle da dor e divulgar as reais vantagens de sua implementação. RELATO DO CASO: Trata-se de um estudo descritivo com relato de experiência, em um hospital cirúrgico ortopédico, de referência nacional que atende exclusivamente pacientes do sistema único de saúde. CONCLUSÃO: Essa experiência e seus resultados incentivam a manutenção da Política de Controle da Dor e contribuem para referenciar a outras instituições de saúde os benefícios da implementação de programas e políticas semelhantes.

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the most frequent clinical complaint in daily, ambulatory and hospital practice. Regardless of its cause, it remains undervalued and, as a consequence, without adequate management, resulting in poor control, thus impairing a physical and social rehabilitation proposal. This study aimed at presenting a pain control program and at spreading the real advantages of its implementation. CASE REPORT: This is a descriptive study with experience report of a national reference orthopedic surgical hospital exclusively assisting Single Health System patients. CONCLUSION: This experience and its results encourage the maintenance of the Pain Control Policy and contribute to reference to other health institutions the benefits of implementing similar programs and policies.

Physical assessment training to change the opinions of pharmacy students about physical assessment / 医学教育

Introduction: Physical assessment training is included in many 6-year training programs for pharmacists.<br>Method: To clarify the effects of this training for developing the professional abilities of pharmacists and for increasing the students’ motivation for learning, we investigated changes in students’ attitudes before and after physical assessment training by means of a questionnaire, whose free descriptions were evaluated with a text-mining approach.<br>Results: After training, the percentage of students who believed they needed to acquire the knowledge and skills of physical assessment increased significantly. Furthermore, the motivation for learning increased.<br>Discussion: We believe that physical assessment training makes students aware of the importance of the contribution of physical assessment to drug therapy and increases students’ motivation for learning.

Effect of Music Therapy on Anxiety and Vital Sign of Nasal Closed Reduction Under General Anesthesia

PURPOSE: Most of the patients who underwent surgery feels variable kinds of fear or anxiety; an uncomfortable mood state that happens without specific object affects patient's satisfaction before and after the surgery. As music therapy is rather noninvasive method generally used in reducing patient's anxiety, the authors researched about the extent of anxiety with the change of vital sign before the operation while comparing with the cases of patients who took the music therapy at closed reduction under general anesthesia. METHODS: We divided the patients in 4 groups; A with the premedication(Midazolam, Dormicum(R)) before the operation, B with the premedication and music therapy, C with only music therapy, D with no premedication or therapy. And we measured the vital signs after the arrival at the operation room, after induction and 20 minutes after the operation. Also we observed the changes of anxiety index with the STAI(State Trait Anxiety Inventory)-K(Korea)YZ 1 hour before and 8 hours after the surgery. RESULTS: The group B showed the least changes in blood pressure as the group D showed the highest change. Both group C and A showed increase in blood pressure but the upswing in group A was lower than group C. At the change of pulse rate group B showed the lowest upswing also group D showing the highest. Group B showed quite a few upswing but lower than group D, but, at the same time, group A showed lower upswing when comparing two cases. After analysis of STAI-KYZ score, the anxiety relatively decreased in group B and C in comparison with group D. And the index of anxiety state of group A showed just as much to group D. CONCLUSION: The music therapy is better healthcare method compared to other therapies in reducing anxiety also with satisfying effect who underwent operation. The authors recommend music therapy assisted with use of premedication for better relief of anxiety.

Vital Sign Change after Placement in the Prone Position in an Obese Patient: A case report / 대한마취과학회지

When performing spine surgery, placement of the patient in the prone position with longitudinal padding is most frequently utilized.However, hemodynamics could be compromised by compression of the internal organs, particularly if surgery is being conducted on an morbidly obese patient or on a patient with a soft frame.An increase in the intraabdominal and intrathoracic pressure might cause a perfusion defect of major venous return, a decrease in cardiac output and a defect in pulmonary ventilation and venous congestion within the spinal canal.Accordingly, serious alteration of vital signs or significant expected consequences can occur.We briefly report a case of life-threatening hemodynamic change after placement in the prone position of a morbidly obese patient during general anesthesia.Placing a risky patient on a semi-rigid, stable Wilson frame can be a promising alternative to avoid such intraoperative mishaps.

The change of vital signs in steps when it is extracted a third molor of mandible

PURPOSE: The 3rd molar extraction of mandible is common in out-patient office of oral and maxillofacial surgery. And it is dynamic minor operation with changes of vital signs. most of patients are already sensitive about their dental treatment. The changes of emotion are reached to the highest level when patients is laid down to be treated on unit chair. It can be induced to undesirable accidents as to this fear. The undesirable complications are nausea, vomiting, hyperventilation, dyspnea, syncope, shock and so on. The severe changes of vital signs may influence their behavior and make serious medical malpractice or suit such as fracture of dental instruments and injury of proximal area. METHOD AND PATIENTS: A total of 99 selected normal patients were reviewed. Among this, 70 patients(43 men , 27 women with statistical significance) were included in this study. Each steps(pre-anesthesis, 5 minutes after anesthesis, just after mucogingival incision, just after tooth section, just after suture and gauze biting) were investigated for a change of a vital signs. It is analyzed to 2 categories, "Means"and "Tendency". The "Means"is the amount of vital signs changed in comparison with pre-step during operation. That means is the amount of vital changes by each step operation. Next, "Tendency"is changes of vital signs in comparison with step1 during operation. RESULT: This is the changing tendency of vital signs with time. That is active effect of fear and pain. Thus this "Means" and "Tendency"will present a sudden changes of vital signs and it can lead to more safe treatment. CONCLUSION: Thus, the purpose of this study is, through careful operation in each step, to less on patients' complication and increase trust between patient and OMFS. This study is a first article shown with the amount of "Means"and "Tendency" in vital signs, when a third molar of mandible is extracted. This study will be base study of patients with general diseases, because it selected only patients without general diseases.

The change of vital signs in steps when it is extracted a third molor of mandible

PURPOSE: The 3rd molar extraction of mandible is common in out-patient office of oral and maxillofacial surgery. And it is dynamic minor operation with changes of vital signs. most of patients are already sensitive about their dental treatment. The changes of emotion are reached to the highest level when patients is laid down to be treated on unit chair. It can be induced to undesirable accidents as to this fear. The undesirable complications are nausea, vomiting, hyperventilation, dyspnea, syncope, shock and so on. The severe changes of vital signs may influence their behavior and make serious medical malpractice or suit such as fracture of dental instruments and injury of proximal area. METHOD AND PATIENTS: A total of 99 selected normal patients were reviewed. Among this, 70 patients(43 men , 27 women with statistical significance) were included in this study. Each steps(pre-anesthesis, 5 minutes after anesthesis, just after mucogingival incision, just after tooth section, just after suture and gauze biting) were investigated for a change of a vital signs. It is analyzed to 2 categories, "Means"and "Tendency". The "Means"is the amount of vital signs changed in comparison with pre-step during operation. That means is the amount of vital changes by each step operation. Next, "Tendency"is changes of vital signs in comparison with step1 during operation. RESULT: This is the changing tendency of vital signs with time. That is active effect of fear and pain. Thus this "Means" and "Tendency"will present a sudden changes of vital signs and it can lead to more safe treatment. CONCLUSION: Thus, the purpose of this study is, through careful operation in each step, to less on patients' complication and increase trust between patient and OMFS. This study is a first article shown with the amount of "Means"and "Tendency" in vital signs, when a third molar of mandible is extracted. This study will be base study of patients with general diseases, because it selected only patients without general diseases.

A Study on Sandbag Management, vital sign, Pain and Hemorrhage after Kidney Biopsy in Children with Nephrotic Syndrome / 아동간호학회지

PURPOSE: The purpose of this study is to investigate correlations in vital sign changes, the severity of pain, signs of complications, and the duration of sandbag management in order to suggest a standardized practice related to sandbag management in children with Nephrotic Syndrome(NS). METHOD: From October 2000 to May 2001, seventy children with NS who underwent kidney biopsy were interviewed at one hospital in Seoul Korea, and participated in this study. RESULT: 1) The average sandbag applying time after kidney biopsy was 18.1 hours. 2) Systolic blood pressure and respiration increased until 15 minutes after kidney biopsy, after then, they decreased significantly (systolic BP, p= .006; respiration, p= .029). However, no significant changes were noted in diastolic blood pressure and pulse. 3) Pain was reported minimal for 1 hour after kidney biopsy. The severity of pain increased until 12 hours after the procedure, then, decreased significantly(p= .0001). 4) Reported complications were hematuria (74.7%) and abnormal sonogram (32.9%). No apparent bleeding on the biopsy region was reported in any children. CONCLUSION: From these findings, it is possible to change the protocols of the duration of absolute bed rest time and sandbag application management shortly after kidney biopsy. But it is needed to study the fit protocols for kidney biopsy. Several implications in nursing practice are suggested. 1) Replicated studies for more participants are needed. 2) Further research on the effect of sandbag application after kidney biopsy is required. 3) The best duration of sandbag application management after kidney biopsy need to be investigated.

Effect of Foot Massage on Sleep, Vital Sign and Fatigue in the Elderly who live in their Home / 기본간호학회지

PURPOSE: This study aimed to investigate the effect of foot massage on sleep, vital signs and fatigue in the elderly who live in their Home. METHOD: Data were collected from 20 elderly who live in the Seoul-Kyunggi province area by convenience sampling and analyzed the change of sleep and sleep satisfaction, vital signs(pulse, respiration, systolic and diastolic blood pressure) and general fatigue between pre and post foot massage using Paired t-test at 0.05 of significance level. RESULT: There were very significant difference in the sleep and fatigue between pre and post foot massage. CONCLUSION: Foot massage can improve the sleep and decrease fatigue, therefore we recommend to use foot massage as a effective sleep related nursing intervention in the elderly who live in their home.

The Effects of Music Therapy on recovery of consciousness and vital signs in post operative patient in the recovery room / 기본간호학회지

The purpose of this study was to demonstrate the effect of music therapy as a nursing intervention on changes in recovery of consciousness and vital signs for postoperative patients in the recovery room. The subject for this study were fifty three of postoperative patients who were transferred from the OR to the RR at Kwangju Christian Hospital in Kwangju City. Thirty of them were assigned to the experimental group, and twenty three, to the control group. The age of the subject was between twenty and sixty years of age. The subject had a general anesthesia without any special complications, and they were not completely awake . The data were collected for six months from July 1999 to February 2000. The method used was to compare the condition of the subjects in each group at the beginning and at certain times repeatedly. The features observed were the level of consciousness, the frequency of complaints of pain, and vital signs of the subject before and 15 minutes, 30 minutes, and 60 minutes after hearing their favorite music for 30 minutes. The results are as follows 1. The recovery of consciousness was revealed through significant changes in facial expression, facial color, and grip strength in the experimental group more strongly than in the control group. No significant changes were shown in verbal order. The differences in recovery of consciousness in the pre-post music therapy between the two groups was not significant in verbal order, facial expression, or grip strength. However, significant changes were seen in facial color. 2. There were no significant differences between the two groups in changes in the frequency of pain complaints after music therapy. However, a significant difference was shown in the pre-post music therapy scres. 3. Vital signs did not show a significant difference between the two groups. However, the SPO2 of the experimental group was significantly elevated after 60 minutes. The difference pre-post to the music therapy in the vital signs between two groups was significant only in body temperature. This study showed that the effect of music therapy given to postoperative patients is that it promotes changes in facial expression, facial color, and grip strength helping recovery of consciousness, stabilizing vital signs, elevating levels of SPO2, and reducing complaints of pain. It is recommended that if the patient wants it music therapy be given right after surgery in the recovery room as a nursing intervention.

Is the Administration of Fentanyl Useful for Hemodynamic Stability during Propofol Induction Using Target Controlled Infusion(TCI) Mode? / 대한마취과학회지

BACKGROUND: Because the propofol TCI software commands the syringe pump to deliver a rapid infusion at a rate of 1200 ml/hr until the pharmacokinetic model predicts that the selected target concentration has been reached, the hemodynamic changes are predicted. To this change, several methods could be considered and the fentanyl injection is one of them. METHODS: Sixty adult patients scheduled for orthopedic surgery were randomly alldegrees Cated into four groups according to amount of fentanyl injected during induction period(group 1: no fentanyl, group 2: 0.75 microgram/kg, group 3: 1.5 microgram/kg, group 4: 3.0 microgram/kg). Target plasma concentration of propofol was selected as 4.0 microgram/ml and this concentration was achieved using modification of Prys-Roberts method. We evaluated the hemodynamic effect of various doses of fentanyl that injected at Vdpeak effect time and determined the optimal dose of fentanyl during propofol induction using TCI mode. RESULTS: Induction dose(range: 1.25~1.31 mg/kg) of propofol and induction time(range: 46~76 sec) showed no difference among groups. Use of fentanyl was effective for blood pressure stability immediately after intubation, but not effective before and 3 min following intubation. The higher the dosage of fentanyl, the more stable the heart rate. CONCLUSION: It suggest that use of fentanyl for the prevention of abrupt hemodynamic change during propofol induction using target controlled infusion mode is not necessary.

Changes of the Vital Sign, Cerebral Perfusion Pressure and Intracranial Pressure in Variable Degree of Head Elevation

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the developement of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(7.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who were managed in the position of 30degrees and 50degrees head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sign and central venous pressure.