BACKGROUND: The administration of 100% oxygen at the end of general anesthesia before tracheal extubation has been shown to worsen postanesthetic pulmonary gas exchange. Because the laryngeal mask airway (LMA) and the endotracheal tube (ETT) are very different, it remains uncertain whether emergence on oxygen has the same results on lung function as ETT. Therefore, the aim of this study was to evaluate whether the use of 100% oxygen before LMA removal worsens gas exchange after inhalation or total intravenous general anesthesia. METHODS: Eighty ASA physical status I-II patients scheduled for elective surgery of the extremities were randomly assigned to receive either sevoflurane or propofol during general anesthesia with LMA. At the end of surgery, patients were randomized to an inspiratory fraction of oxygen of 0.3 in sevoflurane (n = 20), of 0.3 propofol (n = 20) or of 1.0 in sevoflurane (n = 20) or of 1.0 in propofol (n = 20) during emergence from anesthesia and LMA removal. Postoperative blood gas measurements were taken immediately and 60 min after arrival in the recovery room. RESULTS: No significant differences in PaO2 (propofol groups: 87.5 +/- 14.4 vs 88.5 +/- 10.5 mmHg, sevoflurane groups: 86.7 +/- 11.3 vs 90.7 +/- 9.9 mmHg) or alveolar - arterial oxygen tension difference (AaDO2) were found between the two groups at 30 min after LMA removal (propofol groups: 12.0 +/- 12.4 vs 10.3 +/- 8.3 mmHg, sevoflurane groups: 8.6 +/- 7.1 vs 7.1 +/- 9.4 mmHg). No differences were observed between the sevoflurane and propofol groups when FIO2 levels were similar. CONCLUSIONS: Breathing 100% oxygen during emergence from general anesthesia does not worsen postanesthetic pulmonary gas exchange when an LMA is used.
Airway Extubation ; Anesthesia ; Anesthesia, General ; Extremities ; Humans ; Inhalation ; Laryngeal Masks* ; Lung ; Oxygen* ; Propofol ; Pulmonary Gas Exchange ; Recovery Room ; Respiration

BACKGROUND: BIS monitoring has been found to decrease the requirements for volatile anesthetics and to improve recovery. We wanted to assess the effect of BIS monitoring on intraoperative sevoflurane consumption, early recovery profile, and on postoperative nausea and vomiting. METHODS: Forty ASA class 1 or 2 female patients undergoing mastectomy or thyroidectomy were studied. General anesthesia was induced with propofol (2.0 mg/kg) and fentanyl (1.5microgram/kg), and maintained with 50% nitrous oxide-oxygen and sevoflurane inhalation. In the control group, sevoflurane was administered according to standard clinical practice. In the BIS group, sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery and of more than 65 during the last 15 minutes prior to the end of surgery. Sevoflurane consumption was measured. Time to response, time to self respiration, time to extubation, and time to orientation were recorded. Postoperative nausea and vomiting were evaluated by incidence and by using a visual analogue scale (VAS). RESULTS: Sevoflurane consumption in the BIS group was 30.4% lower than in the control group (P < 0.05). All recovery times were significantly shorter in the BIS group than in the control group (P < 0.05), but, no differences in postoperative nausea and vomiting were observed between the groups. CONCLUSIONS: BIS monitoring decreased and sevoflurane consumption and promoted early recovery. But BIS monitoring did not decrease postoperative nausea and vomiting.
Anesthesia, General ; Anesthetics ; Consciousness Monitors* ; Female ; Fentanyl ; Humans ; Incidence ; Inhalation ; Mastectomy ; Postoperative Nausea and Vomiting* ; Propofol ; Respiration ; Thyroidectomy

BACKGROUND: Diabetes mellitus is the most common endocrinopathy encountered in the perioperative period and has long been assumed to increase perioperative risk. However, when diabetes mellitus was segregated from old age and the complications of it, it was questioned that diabetes mellitus itself increased perioperative risk. In this study, we investigated the influence of hyperglycemia on the length of postoperative hospital stay. METHODS: We studied 100 patients undergone intra-abdominal operations with general anesthesia. These patients were divided into the hyperglycemic group (n = 20) with postoperative blood glucose level higher than 10 mM and the non-hyperglycemic group (n = 80) with glucose level lower than 10 mM and we investigated the length of postoperative hospital stay, serum electrolyte, serum chemistry, arterial blood gas values, and base excess by unmeasured anions. We also divided these patients into the diabetic patients group (n = 15) and the non-diabetic patients group (n = 85) and compared the same variables. RESULTS: The length of postoperative hospital stay was significantly prolonged in the hyperglycemic group (20.9 +/- 9.0 days) compared with the non-hyperglycemic group (16.2 +/-8.5 days), and the cumulative postoperative hospital stay curves based on Kaplan-Meier method also showed significant difference between the two groups. When we compared the length of postoperative hospital stay between the diabetic and the non-diabetic patients, there was no significant difference. CONCLUSIONS: This study demonstrated that hyperglycemia prolonged the length of postoperative hospital stay. This finding suggests that the patient's glucose level should be monitored and controlled within an adequate range perioperatively.
Anesthesia, General ; Anions ; Blood Glucose ; Chemistry ; Diabetes Mellitus ; Glucose ; Humans ; Hyperglycemia* ; Length of Stay* ; Perioperative Period

BACKGROUND: This study was designed to determine the optimal dose range of epidural naloxone that can preserve analgesia while minimizing nausea, one of the most common side effects caused by epidural morphine. METHODS: Seventy-four patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of three groups. All received 2 mg epidural morphine bolus just before closing abdominal cavity and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n = 24), 0.167 mg/kg/hr of naloxone (Group 2, n = 19) or 0.412 mg/kg/hr of naloxone (Group 3, n = 31) for postoperative pain control. Analgesia and nausea were evaluated by blinded observers. RESULTS: The combination of epidural morphine and bupivacaine provided good analgesia. Pain scores in group 3 were lower than in group 1 after surgery, but there were no significant statistical differences except at 16 hr. Group 2 showed the lowest pain scores at 8, 16 and 24 hr (P < 0.05). Nausea scores were lower in group 2 and 3 than in group 1 at 16 and 24 hr (P < 0.05). CONCLUSIONS: Epidural administration of naloxone below 0.412 mg/kg/hr was optimal and safe dose range that maintained the analgesic effects of morphine while minimizing nausea.
Abdominal Cavity ; Analgesia ; Anesthesia, General ; Bupivacaine ; Humans ; Hysterectomy ; Morphine* ; Naloxone* ; Nausea* ; Pain, Postoperative

BACKGROUND: The acute physiology and chronic health evaluation (APACHE) II score is considered to be a precise predictor of mortality and a useful basic research tool. A lower APACHE II score means a better prognosis of patients, which means that these relatively low risk patients are more likely to benefit from the improved patient management than the higher predicted mortality admissions. Therefore, these patients are obvious targets for intensive care and for decreasing the level of intensive care unit (ICU) mortality. METHODS: This study reviewed the medical records of 729 patients, whose APACHE II scores on the ICU admission day were 10 or less, from June 1, 2001 to May 31, 2002 in University Hospital. The data of the patient's age, gender, disease category, first admission or readmission, APACHE II score, length of stay at the ICU and the hospital were reviewed. RESULTS: The average mortality rate of the patients who had an APACHE II score of 10 or less was 4.1%. The mortality of the cancer patients (8%) was significantly higher than the other disease groups. The mortality of the readmitted patients was significantly higher than the mortality of the patients who were admitted to the ICU for the first time. CONCLUSIONS: Among the patients in the ICU with a low APACHE II score, the mortality of cancer patients was high. The mortality of the readmitted patients was significantly higher than in those on the first admission.
APACHE* ; Humans ; Intensive Care Units ; Critical Care* ; Length of Stay ; Medical Records ; Mortality ; Prognosis

BACKGROUND: Intensive care units (ICUs) provide a service for patients with potentially recoverable disease who might potentially benefit from closer observation and treatment. However, a number of patients who are successfully discharged from ICU subsequently die during their hospital admission. The aim of this study was to identify the incidence and characteristics of these deaths in general wards after discharge from ICUs. METHODS: Patients who were admitted to our ICU were classified in the following manner; Group 1, patients who survived to hospital discharge; Group 2, patients who died in the ICU; Group 3, patients who died in general wards after discharge from the ICU. Data was collected and patients age, sex, main diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II scores on the admission, and number of days in the ICU were compared. RESULTS: 1498 consecutive patients were admitted to the general ICU, and 1339 patients were discharged alive from hospital, 114 patients died in the ICU and 45 patients died during their post ICU hospital stay. 28% of the deaths after intensive care occurred in general wards before discharge from hospital. Among those patients who died in general wards, 7 (15.5%) were expected to survive. 29 (64%) had been withdrawn from sustained therapy before discharge from the ICU. CONCLUSIONS: Although some deaths following ICU discharge were inevitable, others were unexpected, and may have been preventable.
APACHE ; Diagnosis ; Humans ; Incidence ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Patients' Rooms*

BACKGROUND: Although there are many studies of hypo- or hyperglycemia on gastric function, no studies have been conducted to determine the effect of glycemic status on preoperative gastric contents especially in pregnant women. We investigated the effect of dextrose infusion on preoperative gastric contents and serum gastrin in overfasting pregnant patients. METHODS: After six hours of fasting, forty pregnant patients scheduled for elective cesarean section were randomly assigned to one of two groups to receive either 120 ml/h of 5% dextrose fluid (Dextrose group, n = 20) or same rate of normal saline (Control group) until the induction of anesthesia. Before the start of combined spinal-epidural anesthesia, gastric contents were gently aspirated using a 14-F multiorifice nasogastric tube (Levin tube, Yushin Medical, Shiheung, Korea). Blood samples for the serum gastrin and glucose concentrations were taken. RESULTS: Aspirated gastric pH (2.7 vs. 2.9) and volumes (28.5 vs. 26.5 ml) were similar in the two groups. However, significantly more patients (40%) in the control group were found to be at risk of aspiration syndrome, pH < 2.5 and volume > 25 ml, than in the dextrose group (20%). The serum gastrin concentrations of the two groups were not significantly different (32.8 vs. 27.1 pg/ml). Preoperative glucose concentration did not correlate with gastric pH or volumes, but with serum gastrin concentration (tau-b = -0.347, vs. -0.466, P = 0.02). CONCLUSIONS: Preoperative dextrose infusion can decrease the number of patients at risk for pulmonary acid aspiration in overfasting pregnant women undergoing cesarean delivery.
Anesthesia ; Cesarean Section ; Fasting ; Female ; Gastrins ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hyperglycemia ; Pneumonia, Aspiration* ; Pregnancy ; Pregnant Women

BACKGROUND: The present study was designed to assess the effects of preemptive epidural analgesia on postoperative peripheral WBC response and pain in patients undergoing laparoscopic hysterectomy under general anesthesia. METHODS: Patients were randomly assigned to one of two groups; a preemptive epidural group (Pre-E group, n = 25) or a postoperative epidural group (Post-E group, n = 25). In the Pre-E group, 10 ml of 1% lidocaine and 2 mg morphine were given to achieve T6-level sensory block via an epidural catheter before the induction of anesthesia, but this was not done in the Post-E group. Postoperative pain was assessed by patients using VAS, and venous blood samples were collected four times throughout the study period (30 minutes before induction, immediately after surgery, and on postoperative days 1, and 3). RESULTS: Pain scores 1, 3, and 6 hours after surgery were significantly lower in the Pre-E group than in the Post-E group, but became similar 12 hours after surgery. Significantly more patients requested additional analgesics in the Post-E group (24%) than in the Pre-E group (0%). Monocyte percentages differed significantly in the two groups at 1 day after surgery. However, total WBC counts and percentages of neutrophils, lymphocytes, eosinophils, and basophils were similar in the two groups. CONCLUSIONS: Preemptive epidural analgesia provides more effective postoperative pain control, but shows no significant beneficial effect with respect to postoperative WBC response in patients undergoing general anesthesia for laparoscopic hysterectomy.
Analgesia, Epidural* ; Analgesics ; Anesthesia ; Anesthesia, General ; Basophils ; Catheters ; Eosinophils ; Humans ; Hysterectomy* ; Laparoscopy ; Leukocytes* ; Lidocaine ; Lymphocytes ; Monocytes ; Morphine ; Neutrophils ; Pain, Postoperative*

BACKGROUND: Complaints of chest symptoms including pressure, tightness, or pain frequently occur during cesarean delivery under regional anesthesia. The aim of this study was to test whether methergine (methylergonovine maleate) aggravates chest symptoms and/or ECG changes during cesarean section under spinal anesthesia, and to determine if these changes are associated with any discernable intraoperative event. METHODS: After delivery, patients were given intravenous methergine 0.2 mg and diluted oxytocin 10 i.u. in 1000 ml Ringer's lactate solution (Methergine group, n = 30) or diluted oxytocin 20 i.u. (Control group, n = 29). ECG and hemodynamic responses were monitored continuously on 12 leads perioperatively. RESULTS: Methergine significantly increased the incidence of chest symptoms compared to the control group (30% vs. 3.4%, P < 0.05), but this increase was not correlated with ECG ST segment changes or with other intraoperative events. ECG changes suggestive of myocardial ischemia occurred in the two groups to similar extents (34.5% vs. 30%, P > 0.05). CONCLUSIONS: Methergine-induced chest symptoms per se do not signify evident myocardial ischemia during cesarean delivery. However, anesthesiologists must not overlook the possibility of a small coronary arteriolar spasm, especially in high-risk patients.
Anesthesia, Conduction ; Anesthesia, Spinal* ; Cesarean Section ; Electrocardiography* ; Female ; Hemodynamics ; Humans ; Incidence ; Lactic Acid ; Methylergonovine* ; Myocardial Ischemia ; Oxytocin ; Pregnancy ; Spasm ; Thorax*

BACKGROUND: Incorrect positioning of central venous catheter leads to serious complications. To prevent these complications, catheter tip should be at the superior vena cava and right atrial junction. METHODS: We studied 60 right internal jugular catheterizations in infants and children undergoing surgery for congenital heart disease. To confirm the optimal depth of central venous catheter, we measured the distance from the skin puncture site to subclavian vein-right atrial junction using transesophageal echocardiography. RESULTS: The measured distance highly correlated with the patient height. Based on these data, following guideline could avoid intra-atrial placement in 94% of the time: optimal depth of insertion (cm) = 2.5 + (0.06 x height). CONCLUSIONS: We postulate that initial using a simple practical guideline could prevent malposition of central venous catheter.
Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Child ; Echocardiography, Transesophageal* ; Heart Defects, Congenital ; Humans ; Infant ; Punctures ; Skin ; Vena Cava, Superior