No abstract available.
Parathyroid Neoplasms*

The incidence of conjoined twins is so rare that few anesthesiologists have an opportunity of managing them. Especially in Korea, there are only a few reports describing the anesthetic management for surgical separation of newborn conjoined twins. We experienced the successful anesthetic management for surgical separation of thoraco-xiphopagus conjoined twins without any particular problems. After applying the noninvasive monitors (ECG, pulse oximeter), one of the twins (twinA) with congenital heart disease was administered with intravenous ketamine for induction of anesthesia and intubated without neuromuscular blocker. Anesthesia was maintained with N2O-O2 and hand ventilation using Mapleson D breathing circuit. After maintaining airway of the twinA, the twinB was intubated and maintained with the same manner. Eighteen days after the separation procedure, the twinA with congenital heart disease died and the other one, twinB has been alive with normal growth and development.
Anesthesia ; Growth and Development ; Hand ; Heart Defects, Congenital ; Humans ; Incidence ; Infant, Newborn ; Ketamine ; Korea ; Neuromuscular Blockade ; Respiration ; Twins, Conjoined* ; Ventilation

Seventy-seven patients who were treated regularly for more than 5 years in the Taegu Leprosy Mission were investigated with regard to the change of the bacillary index(BI) after treatment of either dapsone(DDS) alone or a combination of DDS and clofazimine. The results were as follows: 1) In the group that took only DDS 400-500 mg per week, the BI conversion to negative took average 51 months. 2) In the group that took only 600-700 mg per week, the BI conversion to negative took average 34 months. 3) In the group that took only DDS 400 mg per week initially and 600-700mg per week secondarily, the BI conversion to negative took average 64 months, the last 33 months of which marked the time period that 600-700 mg were taken per week. 4) In the group that took only DDS 400-500mg per week initially and a combination of DDS gpp 700 mg per week and clofazimine. 3pp-4pp mg per week secondarily, the BI conversion to negative took average 63 months, the last 35 months of which marked the time period for the combined therapy. 5) In the group that took a combination of DDS 600- 700 mg per week and clofazimine 400 mg per week, the BI conversion to negative took average 42 months.
Clofazimine* ; Daegu ; Dapsone* ; Humans ; Leprosy* ; Missions and Missionaries

STUDY DESIGN: A prospective clinical study with radiologic assessment was conducted. OBJECTIVES: To analyze the height changes of the intervertebral disc and neural foramen and width changes of the neural foramen after anterior lumbar interbody fusion and posterior fixation in the lumbar spine. SUMMARY OF LITERATURE REVIEW : Anterior lumbar interbody fusion distracts the height of the intervertebral disc and neural foramen and the width of the neural foramen. MATERIALS AND METHODS: Minimal anterior lumbar interbody fusion and posterior fixation were performed in 20 cases from January 1999 to January 2001. The measuring factors were the height of the anterior and posterior discs, and the height and width of the neural foramen, measured with a caliper in 1mm reconstructive, computed tomography, sagittal images before and 6 months after anterior lumbar interbody fusion. The factors were independently measured by three different persons. RESULTS: The height of the anterior and posterior discs was increased by mean 32.2% and 40.5%, respectively. The height of the right and left neural foramen was increased by mean 15.7% and 18.3%, respectively. The width of the superior, middle and inferior neural foramen was increased by mean 20.6%, 30.3% and 38.6%, respectively. There were significant increases in all measuring factors after minimal anterior lumbar interbody fusion. CONCLUSIONS: Minimal anterior lumbar interbody fusion significantly increased the height of the anterior and posterior intervertebral discs, and the height and width of the neural foramen, and produced neural decompression.
Decompression ; Humans ; Intervertebral Disc* ; Prospective Studies ; Spine*

BACKGROUND: Intrathecal (IT) neostigmine produces analgesia in animal and human. This study was designed to evaluate the efficacy and safety of IT neostigmine for post-cesarean section analgesia. METHODS: Forty-five women undergoing cesarean section under spinal anesthesia were randomly assigned into 3 groups to receive; normal saline 0.2 ml, or neostigmine 12.5 microgram, or neostigmine 25 microgram intrathecally with 0.5% hyperbaric bupivacaine 12 mg. Degrees of sensory and motor blocks, maternal hemodynamic changes, and side effects were recorded. Apgar scores and umbilical vein blood gas analysis (UVBGA) were checked for evaluation of fetal status. Postoperative analgesia was provided by intravenous patient-controlled analgesia (PCA) using fentanyl 500 microgram and ketorolac 150 mg in 100 ml. Pain scores with 10-cm visual analogue scale (VAS), time to first PCA use, cumulative PCA consumptions, and side effects were assessed at 1, 2, 4, 8, 12, 24, and 48 hr after IT injection. RESULTS: There were no significant differences among the three groups in characteristics of spinal anesthesia, maternal blood pressure and heart rate, Apgar scores, and UVBGA data. Compared to saline group, IT neostigmine significantly prolonged time to first PCA use and decreased 24 hr- and 48 hr-PCA consumptions (P<0.05). Pain scores in neostigmine groups were significantly lower than those in saline group for first 4 hr after which there were no differences among the three groups. There were significantly higher incidences of nausea and vomiting in neostigmine groups than in saline group. CONCLUSIONS: These data indicate that IT neostigmine can be an alternative postoperative analgesic without adverse fetal effects for cesarean section. However, high incidence of nausea and vomiting seem to limit its clinical usefulness. Further studies are necessary to enhance its analgesic effects and to decrease its adverse effects.
Analgesia* ; Analgesia, Patient-Controlled ; Anesthesia, Spinal ; Animals ; Blood Gas Analysis ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Female ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Ketorolac ; Nausea ; Neostigmine* ; Passive Cutaneous Anaphylaxis ; Pregnancy ; Umbilical Veins ; Vomiting

BACKGROUND: Hypertension and tachycardia usually accompany laryngoscopy and tracheal intubation. Topical and intravenous lidocaine are used in an attempt to blunt these potentially adverse hemodynamic responses, but these effects of lidocaine are controversial. The purpose of this study is to evaluate whether intratracheal nebulized lidocaine and/or intravenous lidocaine attenuate circulatory stimulating response to tracheal intubation. METHODS: Sixty patients, ASA physical status I, scheduled elective surgery, were randomly assigned to receive a preintubation dose of either 5 mL of normal saline intravenously, 4 mL of 4% lidocaine by intratracheal nebulizer, 1.5 mg/kg of 2% lidocaine intravenously, or 4 mL of 4% lidocaine intratracheal nebulizer and 2% lidocaine of 1.5 mg/kg intravenouly. Induction of anesthesia was accomplished with 5 mg/kg of thiopental IV, and 1 mg/kg of succinylcholine was given. Laryngoscopy and intubation was performed, and anesthesia maintained with 2% enflurane in 50% nitrous oxide in oxygen. Blood pressure and heart rate were recorded at preinduction, after induction, and every minute until 5 min after intubation. RESULTS: Intratracheal nebulized lidocaine and/or intravenous lidocaine were effective in attenuating increases in systolic pressure with no detectable difference between them, and failed to attenuate increases in diastolic pressure and heart rate. And significant decrease in systolic pressure 3 min after intubation was detected in intratracheal and intravenous lidocaine group. CONCLUSIONS: These data suggest that intratracheal nebulized lidocaine or intravenous lidocaine is effective in attenuating increase in systolic pressure to tracheal intubation, but intratracheal and intravenous lidocaine has not synergistic effect.
Anesthesia ; Blood Pressure ; Carbon Dioxide ; Enflurane ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation* ; Laryngoscopy ; Lidocaine* ; Nebulizers and Vaporizers ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Tachycardia ; Thiopental

Hemodynamic variables in 8 verapamil pretreated patients(the verapamil pretreated group) were compared with those in 10 patients without pretreatment(the control group) during nitroglycerin(NTG) induced hypotension under halothane-N2O anesthesis. The results were as follows: 1) In the control group, there were statistically significant decreases in mean arterial pressure (MAP)(25%), pulmonary arterial pressure(PAP)(32%), pulmonary capillary wedge pressure(PCWP)(30%), central venous pressure(CVP)(33%), but the heart rate(HR), cardiac output(CO), cardiac index(CI) and stroke volume index(SVI) remained unchanged. After discontinuance of NTG, all parameters returned to baseline levels. 2) Verapamil alone produced a small decrease in MAP(6%) and CVP(9%), but other hemodynamic values did not change. 3) In the verapamil pretreated group, there were significant decreases in MAP(23%), PAP(30%), PCWP(27%), CVP(20%), SVR(24%) and PVR(31%), but HR, CO, CI, and SVI remained unchanged. 4) These results indicated that verapamil did not significantly affect the hemodynamic response to NTG under halothane-N2O Anesthesis.
Anesthesia* ; Arterial Pressure ; Capillaries ; Heart ; Hemodynamics* ; Humans ; Hypotension ; Nitroglycerin* ; Stroke Volume ; Verapamil*

BACKGROUND: The purpose of this study was to evaluate the historical anesthetic trends for last 35 years at Chonnam National University Hospital (CNUH). METHODS: The anesthetic records of total 101,637 anesthetic cases performed at CNUH from January 1961 to December 1996 were reviewed and analyzed according to age, sex, department, operation site, physical status, preoperative findings, anesthetic methods and agents, duration of operation, etc. RESULTS: Annual anesthetic cases was increased remarkably year by year; annual surgical patients increased 19 times for 35 years. The ratio of male to female was 1.18:1. The percent of geriatric anesthesia was increased year by year. In preoperative physical status from ASA definitions, 83.6 % of total patients was assigned class I and II. The average departmental distributions in descending order were surgery, orthopedic surgery, obstetrics and gynecology, neurosurgery, urology, ENT, thoracic surgery, ophthalmology, plastic surgery, oral and maxillofacial surgery, and others. The distributions of operation site in descending order were lower abdomen, neck, upper abdomen, lower extremities, head, chest, spine, upper extremities, and breast. Inhalational anesthesia was the most frequent used methods. Ether was abandoned from 1983, and major volatile anesthetics was halothane from 1981 to 1991. The use of enflurane has steadily increased and isoflurane has also been used with increasing frequency since 1992. CONCLUSIONS: Anesthetic cases are markedly increased year by year, and major volatile anesthetics and neuromuscular blocker were changed from halothane to enflurane and from pancuronium to vecuronium, respectively.
Abdomen ; Anesthesia ; Anesthetics ; Breast ; Enflurane ; Ether ; Female ; Gynecology ; Halothane ; Head ; Humans ; Isoflurane ; Jeollanam-do* ; Lower Extremity ; Male ; Neck ; Neuromuscular Blockade ; Neurosurgery ; Obstetrics ; Ophthalmology ; Orthopedics ; Pancuronium ; Retrospective Studies* ; Spine ; Surgery, Oral ; Surgery, Plastic ; Thoracic Surgery ; Thorax ; Upper Extremity ; Urology ; Vecuronium Bromide

No abstract available.

BACKGROUND: Lidocaine has been used for spinal anesthesia in short surgical procedure. However, transient neurologic symptoms (TNS) frequently occur after spinal anesthesia with lidocaine. Mepivacaine which has a silimar duration of action and rare incidence of TNS may be an alternative to lidocaine for spinal anesthesia. This study was designed to compare the efficacy of hyperbaric 1.5% lidocaine and 1.5% mepivacaine for spinal anesthesia. METHODS: Sixty patients, ASA physical status I or II, scheduled for lower abdominal or lower extremity procedures under spinal anesthesia were randomly allocated into two groups. Lidocaine group received 2% lidocaine 75 mg with 10% dextrose 1.25 ml. Mepivacaine group received 2% mepivacaine 75 mg with 10% dextrose 1.25 ml. After intrathecal injection of the anesthetics, sensorimotor block and recovery, cardiovascular effect and quality of surgical anesthesia were evaluated. TNS was evaluated 1 day after the operation. RESULTS: Both groups were similar with regard to demographic data and surgical procedures. The onset of sensory and motor blocks was similar in both groups. Time to regression to L5 sensory level and complete resolution of motor blockade were significantly prolonged in mepivacaine group than in lidocaine group (p<0.05). The effect of cardiovascular system was similar in both groups. Fentanyl was required for 4 cases only in the lidocaine group. None of both groups developed TNS. CONCLUSIONS: Hyperbaric 1.5% mepivacaine produced longer duration of action than hyperbaric 1.5% lidocaine in spinal anesthesia. This study didn't prove what drug develops a higher incidence of TNS.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Cardiovascular System ; Fentanyl ; Glucose ; Humans ; Incidence ; Injections, Spinal ; Lidocaine* ; Lower Extremity ; Mepivacaine* ; Neurologic Manifestations