The Effects of Oral Clonidine on the Cytokines and Stress Hormone Responses in Patients Undergoing Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Surgery cause alterations in immune and neuroendocrine responses. Cytokines and stress hormones are importanat mediators which modulate the various immune reactions. The aim of present study is to investigate whether clonidine premedication can affect on the concentrations of cytokines and stress hormones in abdominal hysterectomy patients. METHODS: Twenty two healthy women undergoing abdominal hysterectomy were randomly allocated to two groups: eleven control patients and eleven clonidine(0.15 mg) pretreated patients. Variations in blood cytokines, Interleukin-1beta(IL-1beta), IL-2, IL-6 and tumor necrosis factor-alpha(TNF-alpha), and stress hormones, cortisol and ACTH were studied. Blood sampling were conducted 4 times in each patient: after induction, after incision, after surgery 1 h and 3 h. Cytokines assays were carried out with commercially available ELISA kits, and cortisol with radioimmunoassay and ACTH with immunoradiometric assay. RESULTS: IL-1beta increased early and the concentrations of IL-1beta in clonidine treated group were significantly lower than control. The mean concentrations of IL-2 at 1 and 3 h after surgery were slightly higher than after induction in clonidine treated group. IL-6 increased significantly at 3 h after surgery in both groups. Clonidine lowered IL-6 during the whole period. TNF-alpha, and cortisol and ACTH concentraitons were not affected by clonidin. CONCLUSIONS: Clonidine pretreatment decreased IL-1beta and IL-6 concentrations, but not stress hormones in response to abdominal hysterectomy.

Evaluation for Understanding and Satisfaction of Ambulatory Surgery and Anesthesia / 대한마취과학회지

BACKGROUND: During last 20 years, ambulatory surgery has been recognized as a convenient and highly efficient medical field due to improved medical skill and new anesthetics suitable for ambulatory patients. Therefore, it has become to popular in United States and Europe. Recently Korean doctors began to recognize the importance of ambulatory surgery and run Day Surgery Center(DSC) at several hospitals. The aim of this study is therefore to share our experience in management of DSC. METHODS: The analysis of information about DSC of Samsung Medical Center was based on questionnaire by 213 people(patients and their family) and 299 people who involved in our survey from August to September in 1995 and 1997, respectively. The contents of questionnaire were as follows: prerequisite knowledge of DSC, satisfactory levels of telephone visit, appointment and registration process, kindness of medical personnel, medical cost, medical technique and service of DSC, and problems to be improved. RESULTS: Prerequisite understanding of DSC was 30 and 32.8% in 1995 and 1997, respectively, indicating small increase in two years. however, 92.8% of people involved in the survey in 1997 showed positive response to the system of DSC and also 94% were content with the whole medical technique and service of DSC in 1997, comparable with 66% in 1995. CONCLUSIONS: We report that ambulatory surgery is a promising medical area by reducing medical cost, increasing efficiency of hospital management and conferring satisfaction to patients. We expect that such a qualified medical service as ambulatory surgery will be settled down in our country in near future.

A Case of high-Frequency Oscillatory Ventilation / 대한마취과학회지

Neonates with severe respiratory distress syndrome who require high levels of assisted ventilation have a high mortality and morbidity rate. Morbidity is mainly composed of bronchopulmonary dysplasia which is a result of air leak syndrome(ALS), oxygen toxicity. Even with unsolved controversy, there is a possibility that high-frequency oscillatory ventilation would decrease the development or progression of ALS in infants with severe respiratory distress syndrome. ALS is defined as pulmonary interstitial emphysema or gross air leak such as pneumothorax. We experienced HFOV to be effective in the treatment of newborn infant with pneumothorax.