Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

CT signs of small intracranial aneurysm and application of MSCTA before and after clipping surgery and in follow-up / 医疗卫生装备

Objective To investigate the CT signs of small intracranial aneurysm and the application value of multi-slice spiral CT angiography (MSCTA) before and after clipping surgery and in follow-up.Methods MSCTA imaging data of 81 patients with highly suspected small intracranial aneurysms from March 2013 to March 2015 were analyzed retrospectively.The confirmed patients underwent clipping surgery of small intracranial aneurysms.The imaging findings before and after clipping surgery were analyzed and compared with those by DSA and what observed during surgery.Results The relative accuracy,sensitivity and specificity of MSCTA over DSA and surgical diagnosis were 93.83％,93.75％ and 94.12％respectively,and MSCTA gained high relative consistency over DSA and surgical diagnosis (Kappa=0.825).The accuracy of MSCTA for diagnosing small intracranial aneurysm was not significantly different from those by DSA and surgical diagnosis.MSCT plain scan mainly showed subarachnoid or intracranial hemorrhage,and found 71 rhomboic or saccular aneurysms in 60 patients before operation.Totally 64 patients went through clipping surgery,60 ones had satisfactory results in the reexamination by MSCTA 2 weeks after surgery,and there were no abnormality found in 36 patients in 6 to 12-month follow-up.Conclusion MSCTA can provide abundant information for clipping surgery of small intracranial aneurysms,and can be used as the preferred imaging method for postoperative evaluation and follow-up.

Radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation / 实用放射学杂志

Objective To study radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation.Methods 74 patients with tarsometatarsal joint dislocation were included in this study.Tarsometatarsal joint dislocations were classified by the Myerson fracture displacements classification.All patients were evaluated according to the American Orthopedics Foot & Ankle Society (AOFAS)clinical rating systems.Results There were 19 patients with Myerson A,46 patients with Myerson B and 9 patients with Myerson C tarsometatarsal joint dislocation.39 distal tarsal bone fractures and 156 metatarsal fractures,with simultaneous scaphoid fractures in 10 patients were showed.All patients who were followed up and no infection.The AOFAS scale was categorized as excellent,good,fair or poor,and 22 patients were considered as excellent,29 patients as good,17 patients as fair and 6 patients as poor.Postoperative imaging evaluation required anatomical reduction of tarsometatarsal joint.On the anteroanterior radiogragh,the base medial edge of the second metatarsal bone and the medial edge of intermediate cuneiform were combined to form a straight line.The shortest distance between the base of the first metatarsal bone and the second metatarsal bone should be less than 2 mm.On the medial oblique radiogragh,a smooth line connecting the medial edge of the fourth metatarsal bone with the medial edge of cuboid bone always appeared.On the lateral radiogragh,the dorsal edge of the second metatarsal bone and intermediate cuneiform formed a smooth line.The height of metatarsus should not exceed the dorsal edge of corresponding cuneiform.The longitudinal arch angle was restored within normal limits.Conclusion The type-B tarsometatarsal joint dislocation is the most common type and frequently accompanies by multiple fractures.Intraoperative and postoperative multidirectional observation of anatomical reduction of tarsometatarsal joint dislocation can reduce incidence of posttraumatic arthritis.

Postoperative evaluation of MSCT three-dimensional reconstruction for distal radius autogenous bone transplantation / 实用放射学杂志

Objective To evaluate the clinical value of three-dimensional MSCT reconstruction in autogenous bone transplantation surgery.Methods 72 cases with complex wrist fractures were performed X-ray and three-dimensional MSCT reconstruction before and after articular distal radial autogenous bone transplantation surgery.Results Among 72 cases of X-ray diagnosis,62 cases obtained clear imaging to make a diagnosis;however,the other 10 cases need to use again three-dimensional reconstruction with MSCT to make a diagnosis.The X-ray accuracy of diagnosis was 87％,the three-dimensional reconstruction of MSCT accuracy of diagnosis was 100％, and the difference was statistically significant (P <0.05 ).Postoperative patients were followed up,with reference to the fracture healing efficacy standard,the treatment by autogenous bone graft after MSCT three-dimensional reconstruction allows patients to fracture healing well.Conclusion MSCT scanning and three-dimensional reconstruction are organically combined.A three-dimensional image can comprehensively and accurately display the three-dimensional structure and anatomical relationship of various parts of the distal radius,be valuable for preoperative intra-articular distal radius comminuted fracture,select the appropriate surgical approach and evaluate the postoperative values.

Postoperative evaluation of MSCT three-dimensional reconstruction for distal radius autogenous bone transplantation / 实用放射学杂志

Objective To evaluate the clinical value of three-dimensional MSCT reconstruction in autogenous bone transplantation surgery.Methods 72 cases with complex wrist fractures were performed X-ray and three-dimensional MSCT reconstruction before and after articular distal radial autogenous bone transplantation surgery.Results Among 72 cases of X-ray diagnosis,62 cases obtained clear imaging to make a diagnosis;however,the other 10 cases need to use again three-dimensional reconstruction with MSCT to make a diagnosis.The X-ray accuracy of diagnosis was 87％,the three-dimensional reconstruction of MSCT accuracy of diagnosis was 100％, and the difference was statistically significant (P <0.05 ).Postoperative patients were followed up,with reference to the fracture healing efficacy standard,the treatment by autogenous bone graft after MSCT three-dimensional reconstruction allows patients to fracture healing well.Conclusion MSCT scanning and three-dimensional reconstruction are organically combined.A three-dimensional image can comprehensively and accurately display the three-dimensional structure and anatomical relationship of various parts of the distal radius,be valuable for preoperative intra-articular distal radius comminuted fracture,select the appropriate surgical approach and evaluate the postoperative values.

Quality of life assessment in the late postoperative period of patients with rectal cancer submitted to total mesorectal excision / Avaliação da qualidade de vida de pacientes com câncer de reto submetidos a excisão total do mesorreto em pós-operatório tardio

After the introduction of total mesorectal excision (TME) and radiochemotherapy, excellent results have been achieved in the treatment of patients with rectal cancer. With better oncologic control of the disease, the functional results of this type of therapeutic approach and their impact on the quality of life (QOL) of patients started to be increasingly valued. The aims of this study were to evaluate the QOL of patients with rectal cancer submitted to TME in the late postoperative period and the possible factors that directly influence their quality of life. A total of 72 patients submitted to TME due to extraperitoneal rectal tumor were assessed, after at least one postoperative year, by applying QOL questionnaires (EORTC QLQ-C30 and EORTC QLQ-CR38), in addition to a specific clinical questionnaire and rectal examination. Patients were evaluated regarding gender, age, indication of radiotherapy and chemotherapy preoperatively, length of postoperative period, distance from the anastomosis to the anal verge and general health status. The mean overall health status of patients was satisfactory (82.06). There was no difference in overall health status between patients with respect to gender, but the male patients had less insomnia (p = 0.002), better future prospects (p = 0.011), fewer effects of chemotherapy (p = 0.020) and better sexual function (p < 0.0001). Patients younger than 50 years had fewer urinary problems (p = 0.035), whereas those older than 65 years reported poorer sexual function (p = 0.012). Patients who underwent neoadjuvant therapy had more diarrhea (p = 0.012). Quality of life did not change significantly with time after surgery and the distance from the anastomosis to the anal verge. We conclude that patients undergoing TME have a good quality of life one year after the surgery and that the factors capable of affecting QOL should be identified and improved. (AU)

A introdução da cirurgia de excisão total do mesorreto (ETM) e da radioquimioterapia propiciaram excelentes resultados no tratamento do câncer de reto. Com o melhor controle oncológico da doença, os resultados funcionais deste tipo de abordagem terapêutica e seu impacto na qualidade de vida (QV) dos pacientes passaram a ser cada vez mais valorizados. Os objetivos do presente estudo foram avaliar a QV dos pacientes portadores de câncer retal submetidos à ETM, em pós-operatório tardio e os possíveis fatores capazes de influenciar diretamente na qualidade de vida dos mesmos. Foram avaliados 72 pacientes submetidos à ETM por tumor de reto extraperitoneal, com no mínimo, um ano de pós-operatório, por meio da aplicação de questionários de QV (EORTC QLQ-C30 e EORTC QLQ-CR38), além de questionário clínico específico e exame proctológico. Os pacientes foram avaliados quanto a gênero, idade, realização de radioterapia e quimioterapia pré-operatórias, tempo de pós-operatório, distância da anastomose à margem anal e estado global de saúde. A média do estado global de saúde dos pacientes avaliados foi satisfatória (82,06). Não se observou diferença na saúde global entre os pacientes com relação ao gênero, porém os pacientes do sexo masculino apresentaram menos insônia (p = 0,002), melhores perspectivas futuras (p = 0,011), menos efeitos da quimioterapia (p = 0,020) e melhor função sexual (p < 0,0001). Os pacientes com menos de 50 anos apresentaram menos problemas miccionais (p = 0,035), já os com mais de 65 anos relataram uma pior função sexual (p = 0,012). Os pacientes que realizaram neoadjuvância apresentaram mais diarreia (p = 0,012). A qualidade de vida não se alterou significativamente de acordo com o tempo de pós-operatório e distância da anastomose à margem anal. Conclui-se que os pacientes submetidos à ETM apresentam uma boa qualidade de vida após um ano de cirurgia e que os fatores envolvidos capazes de influenciar a QV devem ser identificados e otimizados. (AU)

Hiperparatiroidismo primario: Evolución postoperatoria a largo plazo / Primary hyperparathyrodism: Postoperative long-term evolution

Presentamos la evolución postoperatoria a largo plazo de 87 pacientes con hiperparatiroidismo primario. Del total, 78 mujeres y 9 varones, relación: 8.7:1. Edad media 55.3 ± 10.2 años. Antes de la cirugía el 44% presentó litiasis renal, el 70% osteopenia u osteoporosis y un 71.2% tuvo hipercalciuria. Se encontró disminución del filtrado glomerular en el 12.6%. Del total, 72 pacientes presentaron un adenoma único, dos un doble adenoma, dos hiperplasia, cuatro histología normal y en siete no se pudo disponer del resultado. El calcio sérico, el calcio iónico, el fósforo y la parathormona intacta se normalizaron en todos los pacientes postcirugía. La densitometría ósea aumentó un 6.9% en columna lumbar y un 3% en cuello de fémur. Los marcadores del remodelado óseo se normalizaron y persistieron normales a los 23 meses del seguimiento, coincidiendo con la parathormona intacta. Lo mismo sucedió con los valores de 25 OH D. Cuando se compararon pacientes con hipercalciuria inicial vs. aquellos con normocalciuria, no se encontraron diferencias en los valores basales y postcirugía en ambos grupos. En 11 pacientes con filtrado glomerular previo < 60 ml/min, encontramos una parathormona intacta más elevada que el resto y menor densidad mineral ósea. El filtrado glomerular no cambió en forma significativa luego de la cirugía. En conclusión, el hiperparatiroidismo primario operado por cirujanos especializados tiene una excelente evolución a largo plazo, con normalización de todos los parámetros del metabolismo fosfocálcico y del remodelado óseo y mejoría significativa en la densidad mineral ósea. Los efectos adversos son escasos y de resolución espontánea.

The long-term postoperative outcome of 87 patients with primary hyperparathyrodism is here presented. Of the total 78 were females and 9 males, ratio: 8.7:1. Mean age 55.3 ± 10.2 years. Before surgery, 44% had kidney stones, 70% had osteopenia or osteoporosis and 71.2% had hypercalciuria. Decrease renal glomerular filtration was found in 12.6%. Of the total, 72 patients had a single adenoma, two double adenoma, two hyperplasia, four had normal histology and seven could not dispose of the result. Serum calcium, ionized calcium, phosphorus and intact parathyroid hormone were normalized in all post surgery patients. Bone mineral density increased by 6.9% in lumbar spine and 3% in femoral neck. Markers of bone remodeling were normalized and persisted normal 23 months of follow-up, coinciding with the normal intact parathyroid hormone. Same thing happened with the values of 25 OH D. When patients whith initial hypercalciuria were compared with those with normocalciuria, no differences were found in the basal values and postsurgery in both groups. In 11 patients with previous renal glomerular filtration < 60 ml / min, we found a higher intact parathyroid hormone and lower bone mineral density than the rest. The glomerular filtration rate did not change significantly after surgery. In conclusion, the surgical primary hyperparathyroidism, operated by specialized surgeons has an excellent long-term outcome, with normalization of all parameters of phosphocalcic metabolism and bone remodeling and significant improvement in bone mineral density. Adverse effects were scarce and had spontaneous resolution.

Memory alloy embracing fixator in treatment of multiple fractured ribs and flail chest / 世界急诊医学杂志（英文）

BACKGROUND: With the development of internal fixation materials, simple operation with internal fixation has become a tendency. Ni-Ti shape memory alloy embracing fixator has such advantages as slight injury, easy operation, security, reliable fixation, and better histocompatibility. The present study was to explore curative effect and postoperative results of Ti-Ni shape memory alloy embracing fixator in patients with multiple fractured ribs and flail chest. METHODS: The curative effect and long-term follow-up results were observed after internal fixation with a shape memory alloy embracing fixator in patients with multiple fractured ribs and flail chest from January 2006 to December 2009. RESULTS: All patients were cured with an average hospital stay of 10.31±3.14 days. Post-operative pain was less severe than preoperative pain (P=0.02).The rate of postoperative complications such as atelectasis, pulmonary infection, etc was 17.65％. There were fewer long-term complications and less influence on daily work and life. CONCLUSIONS: It is practical to perform an operation for fracture of multiple ribs using a Ti-Ni shape memory alloy embracing fixator. The fixator, which is less traumatic, simple, safe, and reliable, has a good-histocompatibility and fewer postoperative complications.

The Effects of Preoperative Information and Hand Massage on Postoperative Satisfaction Score after Cesarean Section under Combind Spinal-Epidural Anesthesia / 대한마취과학회지

BACKGROUND: In an outcome-based health care environment, the demonstration of patient satisfaction with postoperative care has become an important criterion for quality of care assessment. The purpose of this study was to evaluate the effects of hand massage therapy and preoperative information on postoperative patient satisfaction. METHODS: One hundred full term patients scheduled for elective cesarean section under combined spinal- epidural anesthesia were randomly assigned to either the control group (n = 50) or the experimental group (n = 50). The experimental group received a hand massage and preoperative information about their surgery and anesthesia, whereas the control group did not. Twenty-four h after surgery, postoperative patient satisfaction was assessed with questionnaire consisting of 20 items in a blind manner. RESULTS: The mean postoperative satisfaction score of the experimental group was significantly higher than that of the control group (94.9 +/- 15.6 vs. 52.2 +/- 8.5). The pain score postoperatively of the experimental group was significantly lower than that of the control group (0.4 +/- 2.1 vs. 2.1 +/- 0.6), but the pain score at a postoperative 24 h and total analgesic requirement were similar in the two groups. CONCLUSIONS: Preoperative information supply and hand massage therapy are useful interventions that improve postoperative patient satisfaction.

Undesirable Symptoms of Patients in the Postanesthesia Recovery Situation / 대한마취과학회지

BACKGROUND: Healthcare quality can be improved by avoiding patient discomforts and customizing care to meet the needs of the patient. Therefore, the goal of this study was to quantify patients' discomfort for postoperative anesthesia outcomes for healthcare quality improvement. METHODS: One hundred orthopedic surgical patients were asked to tell possible undesirable postoperative outcomes preoperatively. In addition, they were also asked to tell undesirable postoperative outcomes from their most undesirable to least undesirable outcomes that they have experienced postoperatively. RESULTS: Patients expressed the following undesirable outcomes from most frequent to least frequent (in order); incisional pain, nausea/vomiting, shivering, headache, dizziness, sore throat, residual weakness, generalized myalgia, and somnolence. However, the severity of the symptoms were in the following order; nausea/vomiting, incisional pain, headache, dizziness, shivering, generalized myalgia residual weakness, sore throat, and somnolence. CONCLUSIONS: Although there is variability in how patients expressed postoperative outcomes, anesthesiologists can improve the quality of anesthesia by designing anesthesia regimens and methods that most closely meet each individual patient's preferences.

Comparison of Epidural Buprenorphine and Morphine for Postoperative Pain Control in Combined Spinal Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. METHODS: The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. RESULTS: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. CONCLUSION: The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.

Comparison of Epidural Buprenorphine and Morphine for Postoperative Pain Control in Combined Spinal Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. METHODS: The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. RESULTS: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. CONCLUSION: The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.

A Comparison of the Effects on Postoperative Course of Hypothermic Circulatory Arrest Versus Continuous Cardiopulmonary Bypass in Infants Arterial Switch Operation / 대한마취과학회지

BACKGROUND: Hypothermic circulatory arrest is a widely used support technique during heart surgery in neonate and infants, but the difference in the effects of perfusion methods, total arrest versus continuous flow, on postoperative course has been controversial. METHODS: This study was retrospectively designed to examine the difference in effects of deep hypothermic circulatory arrest or continuous flow perfusion on postoperative courses including mortality and neurologic morbidity after arterial switch operation through chart review. We also examined the relationship between intraoperative data and postoperative outcomes. RESULTS: Of 72 patients, 44 patients (Total Circulatory Arrest (TCA) group; 26 patients had intact ventricular septum, 18 patients had ventricular septal defect) were treated with total arrest, and 28 patients (Continuous Perfusion Flow (CPF) group; 13 patients had intact ventricular septum, and 15 patients had ventricular septal defect) were treated with continuous flow. Hospital course, postoperative hemodynamic profiles, incidence of complications excluding neurology and mortality were not different between two groups. The incidence of neurologic abnormalities was higher two times in TCA group than in CPF group but was not significantly different. CONCLUSIONS: We could not confirm the differences in postoperative outcomes between both techniques, total circulatory arrest and continuous flow perfusion during arterial switch operation in neonates and infants.

Emergence from Anesthesia is Dependent on Age and Physical Status, but not on Operation Site and Operation Time / 대한마취과학회지

BACKGROUND: For most patients, recovery from anesthesia is a smooth uneventful. But for some, recovery can be life threatening. To prevent this, adequate and prompt evaluation of patients on recovery state is essential. Activity, respiration, circulation, awareness, and color are comprehensively assessed by PAR score. So we performed this clinical study to compare ongoing changes in PAR score and the effects of age, physical status, operation site and operation time on PAR score were evaluated. METHODS: Two hundred and fifty-four patients (ASA 1, 2) undergoing elective surgery under general anesthesia were evaluated in our recovery room. They were anesthetized with enflurane or isoflurane, and nitrous oxide, and were transferred to the recovery room when SpO2 was more than 97% and there was no supplemental oxygen during transport. Once there, O2 5 l/min was administered via a face mask to all the patients. Assessment of each patient's PAR score was made at ten-minute intervals by the same anesthesiologist. RESULTS: Emergence from anesthesia was significantly dependent on patient's age, preoperative physical status but not on operation site and time. PAR score was significantly increased according to PAR-stay time regardless of age, physical status, operation site or time. CONCLUSION: In evaluating the postanesthetic recovery state, it seems to be important to consider patient's age and physical status.

The Relationship between Periadmission Blood Pressure and Periinduction Blood Pressure / 대한마취과학회지

BACKGROUND: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. METHODS: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group 1(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or antihypertensives perioperatively were checked. RESULTS: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. CONCLUSIONS: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.

The incidence of Awareness with Recall and Dreams during General Anesthesia / 대한마취과학회지

BACKGROUND: Experience of awareness with recall during general anesthesia can be most distressing for patients. The psychological sequelae of subsequent recall of intraoperative events have been highlighted recently, but the incidence of awareness with recall is uncertain. METHODS: Randomly selected 451 patients, who received elective operation under general anesthesia and were able to communicate with anesthesiologists and follow up for 5 days between December 1995 and February 1996 at Korea Cancer Center Hospital, were interviewed on the 2nd day after their operation. RESULTS: The incidence of explicit memory for events during general anesthesia has been estimated at 0.4% by interviewing patients postoperatively. Auditory perception and the sensation of paralysis were most frequently mentioned. 1.1% of patients had been dreaming during general anesthesia. CONCLUSIONS: Under the influence of anesthetic drugs, the brain is capable of limited processing of information and memory function. Everyone in the operating room must be mindful of conversations during the course of anesthesia and all patients should be given an opportunity to discuss any awareness in detail.