Research Trends of Articles Published in the Journal of Korean Clinical Nursing Research from 2000 to 2017: Text Network Analysis of Keywords / 임상간호연구

PURPOSE: The aim of this study was to identify the research trends of articles published in the Journal of Korean Clinical Nursing Research from 2000 to 2017 by a text network analysis using keywords. METHODS: This study analyzed 600 articles. The R program was used for text mining that extracted frequency, centrality rank, and keyword network. RESULTS: From 2000 to 2009, keywords with high-frequency were ‘nurse’, ‘pain’, ‘anxiety’, ‘knowledge’, ‘attitude’, and so on. ‘Pain’, ‘nurse’, and ‘knowledge’ showed a high centrality. ‘Fatigue’ showed no high frequency but a high centrality. Keywords such as ‘nurse’, ‘knowledge’, and ‘pain’ also showed high frequency and centrality between 2010 and 2017. ‘Hemodialysis’ and ‘intensive care unit’ were added to keywords with high frequency and centrality during the period. CONCLUSION: The frequency and centrality of keywords such as ‘nurse’, ‘pain’, ‘knowledge’, ‘hemodialysis’, and ‘intensive care unit’ reflect the research trends in clinical nursing between 2000 and 2017. Further studies need to expand the keyword networks by connecting the main keywords.

The Factors of Pain and Pain Management after Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

PURPOSE: The purpose of this study was to identify the factors of pain and pain management after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). METHODS: Participants were 99 inpatients with HCC who underwent TACE at C University in Seoul from May to October 2016. The instruments used in this study were the Numerical Rating Scale (NRS), the Pain Management Index (PMI), and the modified Patient Outcome Questionnaire (American Pain Society). The data were analyzed using SPSS 24.0, specifically descriptive statistics, t-test, ANOVA, and multiple regression. RESULTS: The percentage of patients who experienced pain after TACE was 66.7%. The mean pain score immediately after TACE was 4.43±2.36 and the highest score on average was 6.58±2.32. The pain score was highest at 5.24±5.67 hours after TACE. Significant factors influencing pain after TACE were the extent of embolization and the ECOG (Eastern Cooperative Oncology Group) score, which explained 26% of the variance in pain. PMI scores revealed that 33.3% of the participants were inadequately treated for pain. CONCLUSION: In order to properly manage pain after TACE, medical staff need accurate understanding of pain and to administer the appropriate dosage of analgesics. The development of pain management protocol for patients who have undergone TACE would help achieve these goals.

Item development process and analysis of 50 case-based items for implementation on the Korean Nursing Licensing Examination / 보건의료교육평가

PURPOSE: The purpose of this study was to improve the quality of items on the Korean Nursing Licensing Examination by developing and evaluating case-based items that reflect integrated nursing knowledge. METHODS: We conducted a cross-sectional observational study to develop new case-based items. The methods for developing test items included expert workshops, brainstorming, and verification of content validity. After a mock examination of undergraduate nursing students using the newly developed case-based items, we evaluated the appropriateness of the items through classical test theory and item response theory. RESULTS: A total of 50 case-based items were developed for the mock examination, and content validity was evaluated. The question items integrated 34 discrete elements of integrated nursing knowledge. The mock examination was taken by 741 baccalaureate students in their fourth year of study at 13 universities. Their average score on the mock examination was 57.4, and the examination showed a reliability of 0.40. According to classical test theory, the average level of item difficulty of the items was 57.4% (80%–100% for 12 items; 60%–80% for 13 items; and less than 60% for 25 items). The mean discrimination index was 0.19, and was above 0.30 for 11 items and 0.20 to 0.29 for 15 items. According to item response theory, the item discrimination parameter (in the logistic model) was none for 10 items (0.00), very low for 20 items (0.01 to 0.34), low for 12 items (0.35 to 0.64), moderate for 6 items (0.65 to 1.34), high for 1 item (1.35 to 1.69), and very high for 1 item (above 1.70). The item difficulty was very easy for 24 items (below −2.0), easy for 8 items (−2.0 to −0.5), medium for 6 items (−0.5 to 0.5), hard for 3 items (0.5 to 2.0), and very hard for 9 items (2.0 or above). The goodness-of-fit test in terms of the 2-parameter item response model between the range of 2.0 to 0.5 revealed that 12 items had an ideal correct answer rate. CONCLUSION: We surmised that the low reliability of the mock examination was influenced by the timing of the test for the examinees and the inappropriate difficulty of the items. Our study suggested a methodology for the development of future case-based items for the Korean Nursing Licensing Examination.

Bibliographic Analysis of Articles Published in Journal of Korean Clinical Nursing Research from 2009 to 2015 / 임상간호연구

PURPOSE: The aimof this study was to identify bibliographic characteristics and research trends of articles published in the Journal of Korean Clinical Nursing Research from2009 to 2015. METHODS: Descriptive statistics were used to analyze 268 articles. Bibliographic characteristics, appropriateness ofmethods for quantitative and qualitative studies, and key concepts of articles were analyzed. RESULTS: A clinical nurse was the first author for 184 (66.7%) articles. The number of collaborative works between hospital and university was 184 (68.7%). Study participants were patients (120, 38.1%), nurses (115, 36.5%) and others. IRB approval was given for 156 articles (58.2%). Written informed consent was obtained in 125 articles (46.7%). Quantitative research accounted for 98.6% of the articles but qualitative studies only 4 (1.4%). Types of interventions in the experimental studies were nursing skills (43, 42.6%) and health education (32, 31.7%). Major keywords were nurses, pain, knowledge, intensive care unit, anxiety, depression, fatigue, and stress. CONCLUSION: Articles in this journal deal with topics and concepts confronted in nursing practice so experimental studies on applicability of nursing interventions were frequently published. Findings in this study indicate that the authors published in the journal contribute to the development of nursing with characteristics distinctive from other nursing journals published in Korea.

Nationwide Survey for Current Status of Cancer Centers in Korea

PURPOSE: This study to identify the current status of cancer centers in Korea in terms of organization ofhospital. METHODS: 21 cancer centers, from regional cancer centers to the largest hospitals, were surveyed from October to November 2014. The questionnaire was developed by the board members of the Oncology Nursing Society. RESULTS: Centers specializing in cancer treatment were either cancer hospitals or centers affiliated with larger hospitals. 81% operated wards solely for cancer patients. The average number of beds was 354.2, and each center had independent laboratories, chemotherapy infusion rooms and pharmacies. Degree of nursing staff varied from grades 1 to 3. The nursing department and ward were jointly responsible for educating new nurses. In cancer nursing, the policy varied according to institution. For patient education, the oncology Advanced Practice Nurse (APN) mainly informed patients of the adverse effects of chemotherapy and central line care. 90.5% appointed oncology APNs, who were variously designated (47.6%). 10.5% of APNs held concurrent positions. CONCLUSION: As cancer has increased medical professional organizations have shown a variety of forms of organization and human resources management. A political approach seems to be required for institutions for nursing care, patient education, the role and qualifications of APN.

Relevance of the test content of the Korean Nursing Licensing Examination to nursing job / 보건의료교육평가

PURPOSE: This study aimed at identifying if there is a relevance of content of the Korean Nursing Licensing Examination (KNLE) revised in 2014 to nursing job. It will be able to provide the validity of revised content of the KNLE. METHODS: From October 13 to November 13, 2015, print version of 8 duties with 49-tasks, 155-job item questionnaires were distributed to 1,305 hospital nurses and 202 nursing faculties in Korea. Results were treated by descriptive statistics and comparison analysis. There were responses from 946 nurses or professors (72.5%). RESULTS: The relevance of test content of KNLE to nursing job was shown to be valid with over 3 points out of 4 point Likert scale in all items: from 3.23 at lowest to 3.64 at top. CONCLUSION: Above results showed that the revised version of KNLE in 2014 was valid to test the nursing students' knowledge for job performance.

Physical, Psychological and Social Symptoms, Activity and Education of Children and Adolescents with Acute Lymphoblastic Leukemia Receiving Maintenance Chemotherapy

PURPOSE: This study was to identify the physical, psychological and social symptoms of ALL (acute lymphoblastic leukemia) children and adolescents receiving maintenance chemotherapy to build a basic data set to produce effective nursing intervention and ultimately help their early return to school and social adaptation. METHODS: Fifty ALL children and adolescents between 4 and 18, who were receiving maintenance chemotherapy were surveyed on days 2, 7, and 28. For younger children, between the age of 4 and the 3rd year in elementary school, their primary caregivers answered the survey and those between the 4th year in elementary school and the age of 18 answered the survey themselves. RESULTS: During maintenance chemotherapy, ALL children and adolescents experience diverse physical, psychological and social symptoms. On days 7 and 28, physical and social symptoms were greater than physical symptoms. Physical symptoms were greatest on day 2 and the most psychological and social symptoms were observed on day 7. During the maintenance chemotherapy period, 40% of the children and adolescents could not attend regular educational institutions. CONCLUSION: Since each point in the maintenance chemotherapy period shows different symptomatic characteristics, nursing intervention can be provided appropriately for each specific point to help the patients' social adaptation and early return to school.

Job Analysis Based on Working Hours and Activities of Oncology Advanced Practice Nurses

PURPOSE: The purpose of this study was to analyze the actual working hours of an oncology advanced practice nurse (APN) at a university hospital according to the duties and tasks outlined in the job description. METHODS: An assessment tool for this study was created based on the job description of APN as defined by the Korean Nurses Association, and was later verified by a specialist party. Twenty-three oncology APNs recorded their nursing activity on the assessment tool. The working hours and distribution were analyzed according to specific duty and task. RESULTS: Average working hours per day for APNs totaled 9.3 hours. Time for duties was allocated as follows in order of priority: 28.0% for therapeutic intervention and 19.8% for clinical decision making. Time allotted for tasks was distributed as follows: 19.5% for special nursing care and 9.8% for planning treatment and nursing interventions. CONCLUSION: This study allowed insight into the actual time spent by oncology APNs on duties and tasks outlined in the job description. These findings should contribute to management of the changing role of oncology APNs. Furthermore, the results may be used as a basic resource for the continued professional development of the work of oncology APNs.

Late Effects, Social Adjustment, and Quality of Life in Adolescent Survivors of Childhood Leukemia

PURPOSE: This study was conducted to examine the late effects, social adjustment, and quality of life in adolescents who had been completely treated for childhood leukemia and their parents. METHODS: Participants consisted of 41 pairs of adolescent survivors (13-18 years) and their parents. Parents checked for their child's physical late effects. The Korean Version of Post-Traumatic Symptoms for psychological late effects, social functioning questionnaire for social adjustment and the PedsQL 4.0 Generic Core Scales for quality of life were completed by adolescents and parents. Data were analyzed using SPSS. RESULTS: Twenty out of 41 adolescents had one or more physical late effects. Adolescents showed more serious psychological late effect than parents. Five children and seven parents had above cut-off scores and they were considered the high risk group for posttraumatic symptoms. Parent-reported scores were significantly higher than child-reported scores in terms of social adjustment and emotional functioning of quality of life. Low school functioning in adolescents was associated with physical late effects. CONCLUSION: The results indicate that long-term and systematic management for childhood leukemia survivors affect positive social adjustment and can further improve quality of life.

Current status of human papillomavirus vaccines

Cervical cancer is a malignant neoplasm arising from cells that originate in the cervix uteri. It is the second most prevalent cancer among women. It can have several causes; an infection with some type of human papillomavirus (HPV) is the greatest risk factor for cervical cancer. Over 100 types of HPVs have been identified, and more than 40 types of HPVs are typically transmitted through sexual contact and infect the anogenital region. Among these, a number of HPVs types, containing types 16 and 18, are classified as "high-risk" HPVs that can cause cervical cancer. The HPVs vaccine prevents infection with certain species of HPVs associated with the development of cervical cancer, genital warts, and some less common cancers. Two HPVs vaccines are currently on the global market: quadrivalent HPVs vaccine and bivalent HPV vaccine that use virus-like particles as a vaccine antigen. This review discusses the current status of HPVs vaccines on the global market, clinical trials, and the future of HPVs vaccine development.

Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia

PURPOSE: Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a range of childhood and adult cancers. High dose MTX (HD-MTX) requires aggressive care to prevent toxicity. Limited inpatient conditions are forcing major changes in health care delivery patterns and decisions. We conducted a retrospective study to describe the safety, feasibility and cost-effectiveness of HD-MTX administration in the outpatient setting. METHODS: Patients with acute lymphoblastic leukemia who underwent HD-MTX (3 g/m2) administration in either the inpatient (N=70) or outpatient setting (N=70) from January to July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydration with sodium bicarbonate (2000 ml/m2/for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24 hours after MTX at a standard dose (15 mg/m2 IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologic and renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expenses and duration of hospital stay between the two groups. RESULTS: HD-MTX administrations were successfully completed in both groups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX in the inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatient recipients. CONCLUSION: This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient setting is safe and efficient, without a greater incidence of major toxicities.

Impact of Lower Urinary Tract Symptoms and Depression on Health-Related Quality of Life in Older Adults / 대한배뇨장애요실금학회지

PURPOSE: We aimed primarily to investigate the level of health-related quality of life (HRQoL), lower urinary tract symptoms (LUTS), and depression in older adults and secondly to identify the impact of LUTS and depression on HRQoL. METHODS: A community-based cross-sectional study was conducted from April to November 2010. Participants were recruited from five community senior centers serving community dwelling older adults in Jeju city. Data analysis was based on 171 respondents. A structured questionnaire was used to guide interviews; the data were collected including demographic characteristics, body mass index, adherence to regular exercise, comorbidities (hypertension, diabetes mellitus, and osteoarthritis), depression, urinary incontinence, LUTS (measured via the International Prostate Symptom Score [IPSS]), and HRQoL as assessed by use of the EQ-5D Index. Stepwise multiple regression analysis was used to test predictors of HRQoL. RESULTS: Eighteen percent (18.6%) of the respondents reported depressive symptoms. The mean LUTS score was 8.9 (IPSS range, 0 to 35). The severity of LUTS, was reported to be mild (score, 0 to 7) by 53% of the respondents, moderate (score, 8 to 19) by 34.5%, and severe (score, 20 to 35) by 12.5%. HRQoL was significantly predicted by depression (Partial R2=0.193, P<0.01) and LUTS (Partial R2=0.048, P=0.0047), and 24% of the variance in HRQoL was explained. CONCLUSIONS: LUTS and depression were the principal predictors of HRQoL in older adults.

The Real Picture of the Care Costs Paid to Korean Oncology Advanced Practice Nurses / 종양간호학회지

PURPOSE: The purpose of this study was to examine the actual care costs paid to Korean Oncology Advanced Practice Nurses (KOAPN). METHODS: We collected data using a group discussion and questionnaire identified 115 tasks from job descriptions developed by the Korean Accreditation Board of Nursing. Forty-two KOAPN working at three university hospitals in Seoul were asked to evaluate each task as to type and whether the cost is paid or not. They were also asked to indicate the tasks in urgent need of development of a care cost with high priority. RESULTS: Only five tasks (4.3%) related to treatment and complication related interventions or education were paid, and they were paid only once during the entire treatment period and were not covered by national health insurance. It was approved as a medical fee by health insurance review & assessment service. Furthermore, the names of the authority (doctor) and the actual provider (nurse) of the prescriptions were different for three of those tasks. Most of the suggested tasks needing development of care costs were actions specifically performed by nurses (physical-psychosocial-spiritual assessment, independent nursing interventions). CONCLUSION: KOAPN are currently paid for few tasks. To maximize the utilization of KOAPN, the establishment of a clear rational payment system directly related to their actual activities is needed.

Factors Influencing Peripheral Blood Stem Cell Collection / 종양간호학회지

PURPOSE: Peripheral blood stem cell transplantation (PBSCT) has been widely used. The optimal time for collection is a critical factor to obtain proper counts of CD34 cell by peripheral blood stem cell collection (PBSC). The purpose of this study was to identify the factors influencing peripheral blood stem cell collection in order to figure out the more effective timing for PBSC. METHOD: The subjects of this study were 189 patients undergoing 3 leukapheresis from January 28, 2005 to December 31, 2006. Group's characteristics, checkup opinion of pre-peripheral blood on the day of harvest & outcome of PBSC were analyzed and evaluated using SAS statistics program after grouping patients as below; group 1-CD34 cell counts or =4x10(6)/kg (n=63). RESULTS: Based on outcome of peripheral blood stem cell according to diagnosis, acute myelocytic leukemia (AML) was 65.5% at Group 1, Lymphoma was 21.7% at Group 2 and multiple myeloma (MM) was 70.8% at Group 3. There were significant differences in CD34 cell counts according to diagnosis (p=0.00004). Type of cytokine mobilization according to diagnosis, Lenograsim was using 62.5% of MM & 38.2% of AML and filgrastim is using 22.0% of AML only. Circular peripheral blood CD34 cell counts prior to harvest was 258.1/microliter at Group 3 which was much higher comparing to Group 1 (10.5/microliter) and Group 2 (39.9/microliter) (p<0.001). TNC counts of collected peripheral blood stem cell was 15.36x10(6)/kg at Group 3 microliter and it's much higher than Group 2 (13.16x10(6)/kg) and Group 1 (12.36x10(6)/kg) (p=0.083). There was no significant difference in MNC counts inbetween 3 groups. CONCLUSIONS: Circular peripheral blood CD34+ cell counts prior to harvest was much higher at Group 3 than Group 1 and Group 2. Therefore, the number of CD34+ cells on the day of harvest can be used as an accurate predictor for peripheral blood stem cell.

Quality of Life in Patients with Hematopoietic Stem Cell Transplant / 종양간호학회지

PURPOSE: This descriptive study was to investigate the quality of life in patients with hematopoietic stem cell transplantation (HSCT) from June 1 to October 13, 2007. METHOD: The survey was conducted in 6 different university hospitals which located in Seoul and Jellanamdo province using the Functional Assessment of Cancer Therapy-BMT Scale (FACT-BMT) version 4. We collected a total of 155 questionnaires and analyzed 149 among them. RESULTS: The average score of quality of life was 2.53 out of 5. Physical well being score was highest among sub-domains, followed by emotional well-being, additional concerns, social/family well-being, and functional well-being. Study subjects worried that their conditions would get worse. However study subjects didn't regret having been received HSCT. Age, duration from HSCT, age at diagnosis, income, readmission, HSCT type, educational background, marital status, and the level of activities of daily living were related to quality of life. CONCLUSIONS: The findings of this study indicates that the HSCT survivor's quality of life issue is still important and have to be investigated repeatedly in the future. That is necessary for generalizing QOL outcomes for clinical use. We also suggest to develop interventions to improve QOL.

Hematopoietic Stem Cell Transplantation with Using Multinational Unrelated Donors for Acute Myelogenous Leukemia

BACKGROUND: Many AML patients have received hematopoietic stem cell transplantation (HSCT) from HLA-matched unrelated donors. According to many of the previous reports, those patients could achieve long-term, disease-free survival after HSCT from multinational unrelated donors with tolerable transplant-related complications, even when there are HLA-mismatches. METHODS: We present the results of 35 unrelated hematopoietic stem cell transplantations from multiple international donor banks including the Korean (n=24), and Japan Marrow Donor Program (n=3), the Taiwan Tzu Chi Marrow Donation Registry (n=6), as well as using Caucasian donors from the National Marrow Donor Program (n=2), for the treatment of AML patients. RESULTS: The median age of patients was 36 (range: 16~53) and the median follow-up duration was 21 months (range: 5~60). Also, the median age of the donors was 28 (range: 20~53). The majority of the patients had intermediate or unfavorable cytogenetic features. The main conditioning regimen we used consisted of cyclophosphamide plus TBI (n=31) with our standard GvHD prophylaxis that contained tacrolimus plus a short course of methotrexate. Some patients (n=10) received an additional two-day course of ATG (thymoglobulin, Sangstat) in addition to the standard regimen. All the transplanted patients achieved engraftment. The incidence of acute GvHD was 42%, and that of chronic GvHD was 56%. Four (11%) patients have relapsed to date. The two-year non-relapse transplant-related mortality was 26%. The estimated probability of DFS and the event-free survival at five-years were 80% and 53%, respectively. CONCLUSION: These results suggest that multinational unrelated donors HSCT may provide a feasible option for the treatment of high-risk Korean AML patients.

Analysis of the Process for Unrelated Stem Cell Donor Search / 대한혈액학회지

BACKGROUND: Between 1994 and 1999, 38,264 potential marrow donors typed for HLA- A, -B, and -DRB1 antigens had been recruited in the Korean registries. During the same period, 131 unrelated transplants have been carried out in Korea. In present study, the search procedure within the last two years for an unrelated donor at the Catholic University of Korea is analyzed. METHODS: The search for an unrelated donor for 287 patients was performed. Low resolutional HLA-A and -B typing was performed by serology and HLA-DRB1 typing was done by DNA-typing. We analyzed HLA match rate, the intervals between search activation and transplant, coordination success rate, and the reasons of coordination failure. We also investigated the RESULTS of donor search process through the Japan Marrow Donor Program (JMDP) and Tzu-Chi Taiwan Marrow Donor Registry (TCTMDR). RESULTS: At least one HLA-identical donor has been found for 54.7% of 287 patients in the first search using the Korean registries. As of the end of July 2000, 53 patients had received unrelated transplants and the coordination success rate was 33.8%. The average interval to transplant with the Korean registries was 128 days. The most common diagnosis in the patients who underwent transplantation was CML. Among 47 patients who registered in the JMDP, 25 patients found at least one HLA- identical donor. Twelve of them were transplanted. The average time to transplants was 149 days. Since February 2000, we have registered 22 patients in the TCTMDR. Four of them had one HLA-matched donor and transplants are now in progress. CONCLUSION: The donor pool is rapidly expanding and the patients who receive unrelated transplant are also increasing in Korea. From these data, we realized that the international collaboration of Asian countries would be very important for facilitating unrelated transplants for patients who could not find suitable donor in their national registries.

Comparative Study of Spinal Anesthesia with Bupivcaine and Tetracaine / 대한마취과학회지

BACKGROUND: Tetracaine has been the most commonly used long-acting spinal anesthetic agent. Recently, hyperbaric bupivacaine was introduced to be useful agent, and has been reported to produce the better quality of anesthesia. The aim of the present investigation was to compare the anesthetic effects of 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine spinal anesthesia. METHODS: 40 ASA Class I patients undergoing lower extremity operation were randomly distributed to two groups. Group A (n=20) received 15mg, 0.5% bupivacaine in 8% glucose, while Group B (n=20) received 15mg, 0.5% tetracaine in 10% glucose in the lateral decubitus position (L3,4 interspace). We evaluated the sensory and motor blockade, cardiovascular effects and the incidence of tourniquet pain. RESULTS: The mean maximum cephalad spread of analgesia was higher in bupivacaine group (T5) than in tetracaine group (T6) and the spread time was more rapid in bupivacaine group (13.1 +/- 3.3min.) than in tetracaine group (15.8 +/- 4.3min.), but there were no statistical significances. Tetracaine group was earlier onset of motor block and the duration of complete motor block in tetracaine group was significantly longer than in bupivacaine group. The mean decrease in systolic and diastolic blood pressure was 10% to 25% in both groups and more marked in tetracaine group. The incidence of tourniquet pain was greater in tetracaine group than in bupivacaine group. CONCLUSIONS: The quality of anesthesia obtained with bupivacaine may be superior to that produced by tetracaine. We concluded that 0.5% hyperbaric bupivacaine was suitable for short orthopedic or lower abdominal surgery because of less incidence of hypotension, shorter duration of motor block and lower incidence of tourniquet pain.

Transurethral Prostatectomy Syndrome / 대한마취과학회지

Water intoxication from intravascular absorption of non-electrolyte irrigating fluid is a well-known and often serious complication of TURP(transurethral resection of the prostate). The amount of fluid absorbed is related to the time elapsed, number of venous sinuses opening during resection and the height of the irrigation container. A 78-year-old male patient was performed TURP under spinal anesthesia. During the operation, chest discomfort, peripheral cyanosis, sinus bradycardia, drowsy mental state, hypoxemia, metabolic acidosis, severe hyponatremia, and pulmonary edema appeared. We had made a decision to stop operation immediately and transported to ICU. Endotracheal intubation and controlled mechanical ventilation with positive end expiratory pressure were performed and NaCI 240mEq, NaHCO3 240mEq, furosemide 20mg and 20% mannitol 200ml were injected for four hours. Three hours and forties minutes. after operation, reoperation was done for bleeding control. In consequence of reoperation, the patient began to improve in condition and came to settle in vital signs. We could extubate at dawn on the following day without any problem. We report this case and its management with the review of the relevant literatures.

A Case Report of Status Myoclonic Seizure after Spinal Anesthesia with Tetracaine / 대한마취과학회지

The subarachnoid injection of local anesthetics to obtain lower limbs anesthesia has been used since 1899 by first August Bier. Transient neurologic complications during and immediately after spinal anesthesia are rare ; however we recently encountered a case of CNS toxicity that was nonspecific and severe in a 30 year old man who had a hemiorrhaphy under spinal anesthesia using tetracaine with epinephrine. The exact cause of seizure attack was unknown, but we suspected it tetracaine induced CNS toxicity due to vascular absorption or cephalard movement in CSF.