Evaluation of Minimal Dose of Midazolam for Sedation in Geriatric Spinal Anesthesia / 대한마취과학회지

BACKGROUND: It is stated that spinal anesthesia may alter susceptibility to the soporific effects of sedatives. In the geriatric patients who are susceptible to midazolam, the adequate dosage of midazolam for sedation was evaluated in spinal anesthesia. METHODS: ASA 1 or 2 50 elderly patients (over 65 years old) who were scheduled for lower abdominal or extremities operations, were randomly assigned into two groups. Midazolam 0.01 mg/kg was administered every 5 minutes until becoming sedated before general anesthesia in the control group, while 0.01 mg/kg was administered every 5 minutes after stabilized for 15 minutes after spinal anesthesia in the study group. RESULTS: It took 15 +/- 5.0 minutes for the control group to fall asleep while the spinal anesthesia group showed significantly less time with 11 +/- 4.2 minutes. The total amount of midazolam administered were 1.5 +/- 0.6 mg in the control group and 1.2 +/- 0.5 mg in the study group, which showed no significance. However, the amount of midazolam compared with the body weight revealed 0.031 mg in the control group and 0.023 mg in the spinal anesthesia group suggesting significantly decreased dosage in the study group. CONCLUSIONS: Midazolam revealed significant sensitivity as well as sedative susceptibility in the elderly patients who underwent spinal anesthesia. Therefore, the dosage titration of midazolam for the elderly patients in spinal anesthesia should be carefully considered.

"Jammed Leg" Injury of Short-Fronted Vehicle Drivers in Frontal Collision Accidents / 대한정형외과학회잡지

PURPOSE: To Investigate the patterns and to document the clinical and technical significances of the leg injuries of drivers of short-fronted vehicles in frontal collision accidents. MATERIALS AND METHODS: Twelve cases of jammed leg injury were chosen from hospitals in the Chungcheong Province area and investigated in terms of nature of the accident, distribution of injuries, methods and duration of treatment and final sequelae. RESULTS: The patients had multiple injuries on the lower extremities, such as, fractures of the femoral shaft, tibial shaft, foot and ankle and soft tissue injuries, requiring an average 8.3 surgical procedures and 7 months admission, and from which permanent sequlae resulted, though associated injuries of the head, chest, abdomen were not significant. CONCLUSION: "Jammed leg injury" seemed to be related with the design of short-fronted vehicles. As these injuries can cause considerable functional and socioeconomic loss with long treatment periods and permanent residual sequelae. Preventive measures appear to be necessary, possibly involving vehicle design modification.