OBJECTIVE: In order to confirm the local production of total and specific IgE antibodies in the nasal polyp tissues. MATERIAL AND METHOD: We measured total IgE and house dust mite(Dermatophagoides pteronpssinus .' DP)-specific IgE antibody using enzyme-linked immunosorbent assay(ELISA) in the supernatant of nasal polyp homogenates from 72 subjects undergoing nasal polypectomy. The subjects were divided into three groups according to skin reactivity to DP: 20 strongly atopic subjects to group I(mean wheal diameter) 3mm), 19 weakly atopic subjects to group II (mean wheal diameter 1-3mm) and 33 negative skin responders to group III. RESULT: Group I showed significantly higher levels of total and DP-specific IgE levels in the nasa
Antibodies ; Dust* ; Immunoglobulin E* ; Nasal Polyps* ; Pyroglyphidae* ; Skin ; United States National Aeronautics and Space Administration

BACKGROUND: Intrathecal morphine provides good pain relief after anorectal surgery, but often associated with unpleasant side effects. Ondansetron, a selective 5-hydroxytryptamine3 (5-HT3) receptor antagonist, have been introduced for the prevention and treatment of emesis after chemotherapy in cancer patients and after general anesthesia. METHODS: Thus we studied the effect of ondansetron on the postoperative analgesic and side effects of spinal morphine in 60 patiens. The patients were given subarachnoid injection of 0.5% tetracaine 5 mg mixed with morphine 0.3 mg and positioned to jack-knife after fixation of anesthetic level. Either simple 5% dextrose solution 1000 ml or dextrose solution 1000 ml mixed with ondansetron 8 mg was injected intravenously in a rate of 100 ml/hr. The visual analog scale (VAS) of pain and incidence and severity of postoperative nausea, vomiting, pruritus and urinary retention were evaluated at 12 hour, 24 hour and 48 hour after injection of spinal morphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between groups. Also, the VAS and the incidence and severity of other side effects such as pruritus and urinary retention did not differ significantly between groups. CONCLUSION: Ondansetron administered intravenously, did not prevent side effects of intrathecal morphine.
Analgesics ; Anesthesia, General ; Drug Therapy ; Glucose ; Humans ; Incidence ; Morphine* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Pruritus ; Serotonin ; Tetracaine ; Urinary Retention ; Visual Analog Scale ; Vomiting

Aprotinin is a serine protease inhibitor that improves the hemostatic function and modulates the anti-inflammatory responses. Recently, aprotinin has been widely used in various surgical procedures including open heart surgery. One of the complications of aprotinin is anaphylactic reaction and the incidence increases with re-exposure. We experienced a case of anaphylactic reaction in a 5-year-old female during open heart surgery. After cardiopulmonary bypass weaning, during aprotinin i.v. infusion for reducing blood loss, sudden hypotension and bradycardia occurred. After re-institution of CPB, the patient recovered. In the post-operative review of the chart and patient, we found that this patient had been exposed to aprotinin 20 days ago. In conclusion, we recommend some preventable methods for anaphylaxis of aprotinin; aprotinin should be used after a skin test or i.v. infusion test and used by mixing with CPB priming solution.
Anaphylaxis ; Aprotinin* ; Bradycardia ; Cardiopulmonary Bypass ; Child, Preschool ; Female ; Heart* ; Humans ; Hypotension ; Incidence ; Serine Proteases ; Skin Tests ; Thoracic Surgery* ; Weaning

No abstract available.
Blood Pressure*

A pulmonary artery catheter (PAC) is a useful monitoring device for measuring pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications including pulmonary artery rupture, infarction, thrombosis and infection. This case concerns the knotting of a PAC in a 27 year-old female patient who had undergone cardiac transplantation due to dilated cardiomyopathy. The PAC was inserted via the right subclavian vein to the pulmonary artery and withdrawn to the superior vena cava before heart was removed. After the weaning of the cardiopulmonary bypass (CPB), we tried to reinsert the PAC, which was neither advanced nor withdrawn. Postoperative chest x-ray revealed that the PAC appeared to be knotted in the subclavian vein. Two days later, we loosened the knot of the PAC and removed it via femoral and bracheal cineangiography techniques guided by fluoroscopy without any complications. In this case, we thought the knotting of the PAC occurred at insertion due to severe tricuspid regurgitation, and its size was reduced at withdrawal before the CPB and wedging to the subclavian vein. Knotting of PAC is very rare and unpredictable, but once it or other complications of the PAC is suspected, we recommend that the manipulation of the PAC should be stopped and x-ray should be checked.
Adult ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiopulmonary Bypass ; Catheters* ; Cineangiography ; Female ; Fluoroscopy ; Heart ; Heart Transplantation* ; Humans ; Infarction ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Rupture ; Subclavian Vein ; Thorax ; Thrombosis ; Tricuspid Valve Insufficiency ; Vena Cava, Superior ; Weaning

BACKGROUND: Distribution of local anesthetics injected into subarachnoid space is determined by many intrinsic & extrinsic factors. The purpose of this study was to compare the spread of spinal anesthetic agent according to the direction of bevel and addition of epinephrine. METHOD: Eighty nine consenting patients, undergoing orthopedic surgery of lower extremities were divided into eight groups to direction of bevel and addition of epinephrine in each direction. In lateral decubitus position, 25-gauge spinal needle was introduced into the subarachnoid space and 1% tetracaine with the same volume of 10% dextrose was injected through the spinal needle. Patients were turned to the supine position and checked sensory block level by pin-prick test at anterior axillary line every 5 minutes. Degree of motor block was measured by Bromage scale and two-segment regression time was measured by pin-prick test every 15 minutes interval after maximal sensory block level was reached. RESULTS: No significant difference in maximum level of sensory block was found among groups. But two segment regression time was significantly prolonged in epinephrine added cephalad and down groups. CONCLUSION: Direction of bevel did not affect maximum level of sensory block and duration of spinal anesthesia but, epinephrine prolonged the duration of local anesthetics in special directions.
Anesthesia, Spinal* ; Anesthetics ; Anesthetics, Local ; Epinephrine* ; Glucose ; Humans ; Lower Extremity ; Needles* ; Orthopedics ; Subarachnoid Space ; Supine Position ; Sympathetic Nervous System ; Tetracaine

BACKGROUND: In both infants and children, increased hormonal and metabolic responses to open heart surgery may be directly related to postoperative complications. Anesthestic management including regional anesthesia can substantially attenuate a perioperative stress response and targeted therapy may improve the outcome. In this study, our objectives were to quantify the extent of pain control, and to evaluate the safety and efficacy of caudal morphine or meperidine. METHODS: Seventy-five pediatric patients undergoing a open heart surgery were randomly assigned to three groups according to receiving morphine (group M, n = 25), or meperidine (group D, n = 25) caudally, and a control group (group C). Caudal morphine 30ng/kg with 0.15% bupivacaine 1 ml/kg or meperidine 2 mg/kg with 0.15% bupivacaine 1 ml/kg was injected after anesthetic induction. Pain score and side effects were evaluated immediate postoperatively, 12, 24, and 48 hr postoperatively in the intensive care unit and consciousness recovery and extubation time were checked. RESULTS: Patients in the groups M and D had significantly lower pain scores than the group C. Recovery and extubation time were shorter in the groups M and D. Incidence of nausea and vomiting was significantly higher in the group M than in the groups D and C. CONCLUSIONS: Caudal morphine and meperidine reduced postoperative pain and facilitated extubation.
Anesthesia, Conduction ; Bupivacaine* ; Child ; Consciousness ; Heart* ; Humans ; Incidence ; Infant ; Intensive Care Units ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Complications ; Thoracic Surgery* ; Vomiting

BACKGROUND: All medical conduct should be practiced under the permission of patients or guardians. Because anesthetic procedures have high risk, every anesthesia practice is done under verbal and/or written consent. However, collecting anesthetic permission is not common in Korean medical anesthesiologists. The purpose of this article is to survey current anesthetic status and to provide some suggestions. METHODS: We had given questionnaire sheet to anesthesiologists participating in an annual meeting of the Korean Society of anesthesiologists. It included the percentage of receiving the anesthetic consent, the reasons why they received the informed consent or not, and the conditions to improve to receive it. RESULTS: The total number of responded anesthesiologists was 187. More than half of the responders had received the informed consents from less than 25% of their patients. And only thirty percent of them had taken the consents from more than 75% of their patients. To increase this rate, they replied, it is needed to strengthen the legal validity of the consent and to improve working conditions. CONCLUSIONS: The rate of receiving the informed consent is very low for the anesthesia practice in Korea. There are some procedures that are needed to improve the current situation so that anesthesiologists can provide better quality to the patients.
Anesthesia* ; Humans ; Informed Consent* ; Jurisprudence ; Korea* ; Patient Rights

BACKGROUND: Acute isovolemic hemodilution is one of the autologous transfusion which diminishes intraoperative blood loss and avoids homologous transfusion. A method of assessment of hemostatic function by whole blood is thrombelastography, which is a sensitive indicator of platelet interreaction with protein coagulation cascade. We investigated the effect of intraoperative isovolemic hemodilution on blood coagulation as measured by thrombelastography. METHODS: We studied in twenty-one patients undergoing elective total hip replacement arthroplasty. Hemodilution was done with Hartmann's solution and pentastarch and prothrombin time, activated partial thromboplastin time and native whole blood thrombelastography were performed preoperatively, immediate postoperative and days 2 postoperatively. RESULTS: The Hb, Hct and platelet count decreased significantly after hemodilution. The thrombelastographic changes included decreases in r and k with concurrent increases in alpha angle and MA in immediate postoperative time. On days 2, there were further increase in alpha angle and MA. These changes indicate enhanced procoagulant activity and progressive increase in maximum clot strength. Conclusion: Acute isovolemic hemodilution with Hartmann's solution and pentastarch induced hypercoagulable state without any serious complication in total hip replacement arthroplastic surgery.
Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Blood Coagulation ; Blood Platelets ; Hemodilution* ; Humans ; Hydroxyethyl Starch Derivatives ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Thrombelastography*

No abstract available.