Cardiac transplantation has become an acceptable therapy for patients with end stage heart disease over the last decade. We experienced a case of heart transplantation to the 50 year old female patient. We used sterile technique all the time to reduce the incidence of infection. Anesthesia was induced and maintained with fentanyl 100 ug/kg. After cardiopulmonary bypass, blood products, inotropics and vasodilators were given to maintain myocardial contractility and cardiac output. The patient recovered uneventfully and discharged on 29th postoperative day.
Anesthesia* ; Cardiac Output ; Cardiopulmonary Bypass ; Female ; Fentanyl ; Heart Diseases ; Heart Transplantation* ; Heart* ; Humans ; Incidence ; Middle Aged ; Vasodilator Agents

BACKGREOUND: Hyperthermia is currently effective treatment against numerous cancer gastric cells' seeding on the peritoneal surface and floating in the cancerous ascites. We evaluated changes in hemodynamics during continuous hyperthermic intraperitoneal perfusion (CHPP) to determine strategies for safer general management during this procedure. METHODS: Ten patients with far-advanced gastric cancer were given surgical treatment followed by CHPP with anticancer drug. The body temperature, blood pressure, heart rate, central venous pressure, pulmonary artery pressure, cardiac output, electrolyte and blood gas were measured during pre-CHPP, CHPP and post-CHPP period. RESULTS: The blood temperature reached 39.3 +/- 0.4 degrees C(mean SD) during CHPP. Heart rate increased to 104.4 +/- 14.2 bpm and the cardiac index to 5.3 +/- 1.5 l.min 1.m 2 during CHPP. The mean arterial pressure remained stable during the study period. The systemic vascular resistance index decreased to 996.7 +/- 324.0 dynes.s.cm 5.m2. The mixed venous oxygen saturation fell during the first part of the CHPP period. CONCLUSIONS: This study suggest that the CHPP with anticancer drug may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied.
Arterial Pressure ; Ascites ; Blood Pressure ; Body Temperature ; Cardiac Output ; Central Venous Pressure ; Fever ; Heart Rate ; Hemodynamics* ; Humans ; Oxygen ; Perfusion* ; Pulmonary Artery ; Stomach Neoplasms* ; Vascular Resistance

BACKGROUND: Whether intraoperative fluid therapy should contain glucose for the pediatric outpatient surgery remains controversial. This study was designed to compare the effects of glucose and glucose-free solutions on perioperative blood glucose change. METHODS: Healthy pediatric outpatients (n = 130) for minor procedure were randomly assigned to one of two fluid therapy groups. Patients in the group H (n = 65) received lactated Ringer's solution, and patients in the group D (n = 65) received 5% dextrose perioperatively. Blood glucose was checked before infusion (a), 10 minutes after induction (b), 30 minutes after induction (c), and at the time of discharge (d). RESULTS: The preoperative fasting glucose concentrations were 97.6 +/- 12.1 mg/dl and 97.7 +/- 11.3 mg/dl for the group H and D, respectively. The patients in the group D showed significantly increased blood glucose level after induction (135.9 +/- 42.7, 150.3 +/- 36.0, 123.6 +/- 26.8 mg/dl). The patients in the group H also showed significantly increased blood glucose levels (112.2 +/- 14.0, 121.4 +/- 11.4 and 105.8 +/- 18.3 mg/dl). The glucose level of group D was significantly higher than the glucose level of group H at b, c and d. Seven patients in the group D showed hyperglycemia (> 200 mg/dl). CONCLUSIONS: Dextrose containing fluid therapy resulted dangerous hyperglycemia in the pediatric outpatient surgery. We recommend lactated Ringer's solution or other glucose-free crystalloid for the healthy outpatient pediatric population undergoing minor procedures.
Ambulatory Surgical Procedures ; Blood Glucose* ; Fasting ; Fluid Therapy* ; Glucose ; Humans ; Hyperglycemia ; Outpatients*

Because central venous O2 saturation (superior vena cava, ScvO2) can be monitored with less risk of the patients than mixed venous O2 saturation (pulmonary artery, SvO2), there have been studies to see if ScvO2 could replace SvO2. But previous studies showed that these two measurements were correlated but "not interchangeable. Therefore the authors compared right atrial C#b saturation (SraO2) with S vO2 over a wide range of cardiorespiratory status including control, hemorrhage, resuscitation, and hypoxia in anesthetized cats. We performed thoracotomy and inserted cannulae directly into the right atrium and the pulmonary artery. Blood sampling were obtained synchronously through the cannulae and tested immediately. The correlation coefficients in control, hemorrhage, resuscitation, and hypoxia groups were 0.876, 0.794, 0.946, 0.948 respectively and the two measurements in each group showed statistically significant correlations (p<0.05). But the biases of the two measurements in each group were 0.11+/-2.9, 0.35+/-4.2, -0.55+/-3.2, 0.23+/-4.2 respectively and the limits of agreement ( 2 standard deviation) in all groups exceeded permissible (5%) to conclude that the two measurements were in agreement. Thus, we reached the conclusion that the absolute values of SraO2, though not being sufficiently identical to S vO2 to calculate O2 uptake or pulmonary shunt precisely, can reflect the S vO2 trend following the O2 supply / demand change. Further clinical studies are needed.
Animals ; Anoxia* ; Arteries ; Bias (Epidemiology) ; Catheters ; Cats* ; Heart Atria* ; Hemorrhage ; Humans ; Oxygen* ; Pulmonary Artery* ; Resuscitation* ; Shock, Hemorrhagic* ; Thoracotomy

No abstract available.
Catheters ; Paralysis ; Phrenic Nerve

PURPOSE: The purpose of this study was to develop a simulation module for teaching home health care and evaluate the applicability of the program to nursing students' practical training. METHODS: The simulation module was developed based on the National League for Nursing Jeffries Simulation Theory. The theme of the developed scenario was teaching nasogastric tube feeding to the caregiver of patient with Parkinson disease. Participants were 61 nursing students who had learned tube feeding, and participated in the questionnaire survey after the simulation training. RESULTS: The evaluation of simulation design showed the highest score on feedback/guided reflection, and was highly evaluated in the order of objectives/information, problem solving and fidelity. The educational practice of the simulation was highly evaluated in the order of active learning, high expectation and diversity of learning. The nursing students showed high satisfaction and self-confidence after the simulation education. CONCLUSION: We suggest that the developed simulation module can be applied to practical training for home health care. In the future, the change of self-efficacy, clinical judgment and performance ability of the students after the simulation education should be identified. Also, various simulation modules related to the community health nursing competencies should be continuously developed and verified.
Caregivers ; Community Health Nursing ; Delivery of Health Care ; Education ; Enteral Nutrition* ; Home Health Nursing ; Humans ; Judgment ; Learning ; Nursing* ; Parkinson Disease ; Problem Solving ; Problem-Based Learning ; Simulation Training ; Students, Nursing*

BACKGROUND: We hypothesized that induction of general anesthesia using sevoflurane improves the accuracy of non-invasive hemoglobin (SpHb) measurement of Masimo Radical-7(R) Pulse CO-Oximetry by inducing peripheral vasodilation and increasing the perfusion index (PI). The aim of this study is to investigate the change in the SpHb and the PI measured by Rad7 during induction of general anesthesia using sevoflurane. METHODS: The laboratory hemoglobin (Hb(lab)) was measured before surgery by venous blood sampling. The SpHb and the PI was measured twice; before and after the induction of general anesthesia using sevoflurane. The changes of SpHb, Hb(bias) (Hb(bias) = SpHb - Hb(lab)), and PI before and after the induction of general anesthesia were analyzed using a paired t-test. Also, a Pearson correlation coefficient analysis was used to analyze the correlation between the Hb(bias) and the PI. RESULTS: The SpHb and the PI were increased after the induction of general anesthesia using sevoflurane. There was a statistically significant change in the Hb(bias) from -2.8 to -0.7 after the induction of general anesthesia. However, the limit of agreement (2 SD) of the Hb(bias) did not change after the induction of general anesthesia. The Pearson correlation coefficient between the Hb(bias) and the PI was not statistically significant. CONCLUSIONS: During induction of general anesthesia using sevoflurane, the accuracy of SpHb measurement was improved and precision was not changed. The correlation between Hb(bias) and PI was not significant.
Anesthesia, General* ; Perfusion* ; Vasodilation

As the use of laparoscopy in urologic surgery gradually increase, the possibility of complication is also increasing. Pneumothorax from many complications is more likely to occur in the urologic surgery than other surgery. A 64-year-old male patient was admitted for laparoscopic multiple renal cysts marsupialization under general anesthesia. About 80 minutes after beginning the operation, the peak airway pressure was suddenly increased and the oxygen saturation was decreased. We suspected the pneumothorax based on decreasing breath sounds in the right chest area and checked for the diaphragmatic injury through communicating with surgeon. Positive end expiratory pressure and hyperventilation was applied to the patient. Surgeon sutured the diaphragmatic injure site, and the chest tube was placed. In conclusion, iatrogenic pneumothorax occurrence during the laparoscopic surgery can be early detected and treated through appropriate monitoring, risk awareness, and close communication with surgeon.
Anesthesia, General ; Chest Tubes ; Humans ; Hyperventilation ; Laparoscopy* ; Male ; Middle Aged ; Oxygen ; Pneumothorax ; Positive-Pressure Respiration ; Thorax ; Urology

BACKGROUND/AIMS: Low grade inflammation has been suggested to be a risk factor for development of atherosclerosis. C-reactive protein (CRP) is very sensitive acute phase reactant, and it is considered as an important marker of atherosclerosis and related disorder. Insulin resistance is also known to be associated with atherosclerosis. However, the relationship between insulin resistance and CRP has not been thoroughly studied in patients with type 2 diabetes. This study aimed to determine whether insulin resistance in type 2 diabetes is related with CRP. METHODS: 102 subjects with type 2 diabetes were included in the study. Fasting blood samples were taken for measurement for CRP, insulin and glucose. To estimate insulin resistance, the HOMA (homeostasis model assessment)-IR (insulin resistance) was calculated by the standard formula. We divided the subjects into two groups depending on their CRP levels (Group A: <1 mg/L, Group B: > or =1 mg/L), and analyzed HOMA-IR indexes in each group. RESULTS: There was significant correlation between CRP and HOMA-IR (r=0.4, p<0.01). HOMA-IR and fasting insulin levels in group B were higher than that of group A on the univariate analysis. On the multivariate analysis, among several variables such as fasting insulin, HOMA-IR, total cholesterol, and triglyceride, HOMA-IR were significantly related with CRP level independently. CONCLUSIONS: The serum CRP level, even if existed in normal range, was positively correlated with HOMA-IR in type 2 diabetes. Further studies are needed to determine the CRP level considered as clinically significant, and relating HOMA -IR.
Atherosclerosis ; C-Reactive Protein ; Cholesterol ; Fasting ; Glucose ; Humans ; Inflammation ; Insulin ; Insulin Resistance ; Multivariate Analysis ; Reference Values ; Risk Factors

BACKGROUND: Both ondansetron and granisetron exert their antiemetic effects via a blockade of the 5-hydroxytryptamine 3 receptor (5-HT(3)R). Because the 5-HT(3)R is a member of a superfamily of ligand-gated ion channels and has structural similarities to the nicotinic acetylcholine receptor (nAChR), a 5-HT(3)R antagonist may also inhibit the nAChR. This study examined the effects of 5-HT(3)R antagonists, ondansetron and granisetron, on rocuronium-induced neuromuscular blockade in vitro. METHODS: Rat phrenic nerve-hemidiaphragm preparations were isolated and allocated randomly into seven groups (control, 1, 10, 100 microgram/ml of ondansetron, 0.1, 1, 10 microgram/ml of granisetron). Two studies were carried out using single twitch responses. In the cumulative dose-response study, rocuronium 1 microgram/ml and each doses of ondansetron or granisetron were administered simultaneously, and incremental 0.5 microgram/ml doses of rocuronium were added to obtain more than 95% neuromuscular twitch inhibition. ED(5), ED(50), ED(90), and ED(95) of rocuronium in each group were calculated using a logistic model. In the partial curarization study, the twitch heights were measured after administering ondansetron or granisetron (10 minutes after administering 3 microgram/ml rocuronium) and were measured 10 minutes later. The 2 twitch heights were then compared. RESULTS: In the cumulative dose-response study, ondansetron 100 microgram/ml and granisetron 10 microgram/ml significantly reduced the ED50 of rocuronium (P < 0.05). There were no intergroup differences in the partial curarization study. CONCLUSIONS: High concentration of ondansetron and granisetron enhanced the neuromuscular blockade of rocuronium. Granisetron enhanced the neuromuscular blockade of rocuronium more potently than ondansetron.
Animals ; Antiemetics ; Drug Interactions ; Granisetron* ; Ligand-Gated Ion Channels ; Logistic Models ; Neuromuscular Blockade* ; Ondansetron* ; Rats* ; Receptors, Nicotinic ; Serotonin