This report is concerned with our clinical experience of 150 cases of anesthesia for open heart surgery at department of anesthesiology, In chon Gil hospital from Februry, 1990 to April, 1993. The results were as follows ; 1) Among 150 cases, 68 cases (45.3%) were congenital heart disease and 82 cases (54.7%) were acquired heart disease. 62 cases (41.3%) were males and 88 cases (58.7%) were females. 2) Glycopyrrolate, diazepam, morphine, were used as premedicants. 3) Fentanyl, ketamine, diazepam, thiopental sodium were used as induction agents and injected singly or in combination. 4) In congenital cyanotic heart diseases, ketamine was used as main anesthetic agent. In other heart diseases, fentanyl, isoflurane, diazepam were used. 5) Vecuronium was used for intubation and maintenance of muscle relaxation. 6) Overall mortality rate was 3.3% (5 cases) and the causes of death were low cardiac output, respiratory insufficiency, mediastinal infection.
Anesthesia ; Anesthesiology ; Cardiac Output, Low ; Cause of Death ; Diazepam ; Female ; Fentanyl ; Glycopyrrolate ; Heart Defects, Congenital ; Heart Diseases ; Heart* ; Humans ; Incheon ; Intubation ; Isoflurane ; Ketamine ; Male ; Morphine ; Mortality ; Muscle Relaxation ; Respiratory Insufficiency ; Thiopental ; Thoracic Surgery* ; Vecuronium Bromide

General anesthesia has been improved technically and applied in a wide field of surgery, but the undesirable side effects of inhalational anesthetics and its adjuvants such as muscle relxants have frequently claimed our attention in current anesthetic practice. For these reasons, various techniques of brachial plexus block have been developed for the purpose of surgical, diagnostic and therapeutic procedures. The short duration of local anesthetics requires repeated drug administration for a long lasting operation, therefore drug overdosage may cause toxic reaction. Recently introduced bupivacaine hydrochloride(Marcain), an anilide derivative, has longer duration of action and higher potency than other local anesthetics. Brachial plexus block with bupivacaine hydrochloride and lidocaine was performed on 166 patients undertaking various surgical operations for upper extremities at the Department of Anesthesiology, Pusan National University Hospital form October, 1981 to Mary, 1982, the results were summarized as follows: 1) 156 cases of a total 166 patients had successful operations under brachial plexus block but remained the remaining 10 cases required general anesthesia. 2) There were 9 cases of pulmonary diseases, 17 cardiovascular diseases and 2 nephritis in the preoperative evaluation of the patients. 3) The average duration of analgesia for lidocaine and bupivacaine hydrochloride group was 180 and 360 minutes respectively. 4) Complications and side reaction of brachial plexus block included 3 cases of pneumothorax, 15 Horner's syndrome, 2 hematoma formation and 1 toxic sign.
Analgesia ; Anesthesia, General ; Anesthesiology ; Anesthetics ; Anesthetics, Local ; Brachial Plexus* ; Bupivacaine* ; Busan ; Cardiovascular Diseases ; Hematoma ; Horner Syndrome ; Humans ; Lidocaine ; Lung Diseases ; Mortuary Practice ; Nephritis ; Pneumothorax ; Upper Extremity

Supine exercise test was done with bicycle ergometer and echocardiography in 28 patients with chronic aortic regurgitation. Ejection fraction was measured before and immediately after exercise from echocardiography, wall stress and radius/thickness ratio was calculated from echocardiography and systolic blood pressure. 1. There was no difference in left ventricular end systolic and diastolic dimension, ejection fraction at rest, radius/thickness ratio, wall stress between NYHA functional class I, II, III. But work capacity was greater in NYHA class I than in class II, III(39712+/-10778 watt-sec, 23766+/-14280 watt-sec, 11968+/-6052 watt-sec respectively). Ejection fraction after exercise was significantly increased in class I(66.3+/-8.9% at rast vs 71.3+/-10.7% after exercise). 2. Ejection fraction was increased more than 5% in 12 patients(group I) and increased less than 5% or decreased in 16 patients(group II). There was no difference in basal E.F., Ded, Des and postexercise heart rate-blod pressure product between group I and II. But between group I and II, there was significant difference in diastolic redius/thickness ratio(2.55+/-0.30 vs 3.00+/-0.51), mean radius/thickness ratio(1.86+/-0.23 vs 2.18+/-0.30), systolic wall stress(192.3+/-38.6mmHg vs 240.2+/-57.7mmHg), mean wall stress(265.8mmHg vs 334.8+/-68.7mmHg) and work capacity(33848+/-12682 watt-sec vs 19210+/-12342 watt-sce). 3. Work capacity was more than 23800 watt-sec in 16 patients(group A), and less than 23800 watt-sec in 12 patients(group B). There was no difference in ejection fraction at rest, radius/thickness ratio, wall stress, and left ventricular dimension. But ejection fraction after exercise was significantly different between group A and B(68.6+/-14.6% vs 55.8+/-14.2%). 4. In nine patients with end systolic dimension greater than 50 mm ejection fraction was decreased or increased less than 5% in 7 patients. So mean ejection fraction was significantly decreased after exercise(56.8+/-7.5% at rest, 51.0+/-16.3% after exercise).
Aortic Valve Insufficiency* ; Blood Pressure ; Echocardiography* ; Exercise Test ; Heart ; Humans

BACKGROUND: Preemptive treatment with ketamine, a noncompetitive NMDA antagonist, may prevent establishment of postoperative hypersensitivity by blocking the sensory input that induces the central sensitization. The aim of this study was to determine if continuous preemptive administration of intravenous (IV) ketamine decreases postoperative pain. METHODS: Sixty healthy informed patients scheduled for elective abdominal hysterectomy were randomly divided into two groups of equal size and studied in a double-blind manner. Before surgical incision, patients were given 1 mg/kg of ketamine or equal volume of saline followed by IV infusion of 0.01 mg/kg/min, which was discontinued at peritoneal closure. IV morphine patient-controlled analgesia (PCA) was started in all patients at peritoneal closure. Visual analogue scale (VAS) pain scores and total morphine consumption were recorded at 1, 3, 6, 9, 12, 24, 36, and 48 hours postoperatively. RESULTS: VAS pain scores at rest were significantly less in the ketamine group than in the saline group at 1, 3, 24, 36, and 48 hr postoperatively. VAS at moving status were less in the ketamine group at 1, 3, 12, 24, 36, 48 hr postoperatively. Patients in the ketamine group had significantly lower morphine consumption throughout the study period, about 20-50% reduction in postoperative total morphine was observed. Only ketamine group experienced severe headache (10 cases), while there were no intergroup differences in other side effects such as pruritus, bad dream, and backache. CONCLUSION: These results suggest that preemptive continuous IV ketamine decreases postoperative pain intensity and IV morphine requirement, and its action lasts longer than the normal expected duration of action of ketamine.
Analgesia, Patient-Controlled ; Back Pain ; Central Nervous System Sensitization ; Dreams ; Headache ; Humans ; Hypersensitivity ; Hysterectomy ; Ketamine* ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Pruritus

Since ether was first introduced in Boston in 1846, many kinds of anesthetic techniques and agents have been developed. At the same time, there have been many controversies about the side effects following the use of anesthetic agents and they are studied actively by many investigators at the present time. The author chose 355 patients randomly who had received elective operation at the Pusan National University Hospital from October 1980 to March 1981 and made a study of their preand post-operative liver function test. The patients were divided into 3 groups and 214 the patients belonging to group l were anesthetized with general anesthesia and group 2 comprising 118 patients had spinal anesthesia and brachial plexus block was used in the group 3 of 23 patients. The results obtained were as follows: 1) The male to female ratio was about 3 to 2 (209 cases: 146 cases) and age distribution showed a range from 20 to 50 years(210 cases). 2) Pre-operative liver function test of group 1,2, and 3 proved to be abnormal in 75 cases, 23 cases, 6 cases respectively. 3) In patients of group 1, halothane alone(54 cases) and halothane with nitrous oxide(111 cases) were the most commonly used anesthetics. 4) Post-operative checkup of liver function test of 10 patients who were randomly selected from each group and who had previously had normal liver functions, 4 cases of group 1 turned out to be abnormal, but patients in group 2, and 3 showed no significant abnormality in the post-operative liver function test. 5) Anesthesia aggravated liver dysfunction of the patients of group l who had abnormal liver function prior to operation, but it returned to the pre-operative level within 10 days after operation.
Age Distribution ; Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Anesthetics ; Brachial Plexus ; Busan ; Ether ; Female ; Halothane ; Humans ; Liver Diseases ; Liver Function Tests ; Liver* ; Male ; Research Personnel

This a case report of airway obstruction due to mucous plug which occurred. as a complication of endotracheal intubation. This 16-year old patient was performed on endotracheal intubation for cardio-pulmonary resuscitation of cardiac arrest due to traume. He was comatous, tachypneic and increased pulse rate at 6 hours after intubation, then we found the uneven ventilation of both lung fields. We exchanged endotracheal tube after failure of suction and found airway obstruction due to mucous plug. After exchange of tube, suction of secretion and trachecstomy was performed. 3 days afterward, the patient was recovered from his poor pulmonary function, then transferred to the ward.
Airway Obstruction* ; Cardiopulmonary Resuscitation ; Heart Arrest ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal* ; Lung ; Suction ; Ventilation

OBJECTIVE: Anxiolytics and antidepressants are commonly used to treat depressive disorders in pregnant women. Specific and clear evidence is required when managing pregnant patients with such medications to ensure safety. However, information provided by approval label information is insufficient and often different among many countries. By analyzing label information of approval label and other references, this study aims to show the limitations and suggest appropriate directions for retrieving safety information. METHODS: We selected five anxiolytics and eleven antidepressants, which belongs to Korea drug classification codes 117 (psychotropic agents). We chose four countries, Korea, the United States of America (USA), the United Kingdom, Japan and collected safety information for pregnant women in label information. We evaluated the safety information based on recommendation level and evidence level. Then, kappa value and overall agreement were calculated using SAS 9.3. to assess data homogeneity. We further searched Reprotox and a textbook about contraindicated drugs in label information. RESULTS: Recommendation level and evidence level was different in each country. The number of commonly contraindicated drug in label information of four countries was none, and contraindicated drugs in labels were different respectively. Kappa value of evidence level between label information of Korea and Japan, the USA and Japan was 0.61, 0.43 respectively, corresponding to 'substantial agreement' and 'moderate agreement'. The overall agreement was 75%, 62.5% respectively. The information of label was different from that of other references, Reprotox and a textbook in terms of the clinical evidences and recommendation levels. CONCLUSION: Safety information of anxiolytics and antidepressants in label information needs to be updated on a regular basis both for health professionals and patients. With the implication of the inconsistent guidance for the safety information in pregnant women, reliable safety information in pregnant women would be needed.
Americas ; Anti-Anxiety Agents* ; Antidepressive Agents* ; Classification ; Depressive Disorder ; Female ; Great Britain ; Health Occupations ; Humans ; Japan* ; Korea* ; Pregnancy ; Pregnant Women* ; United States

Tuberous sclerosis is an autosomal dominant disorder characterized by facial skin lesions, epilepsy, and mental retardation. Pulmonary involvement in tuberous sclerosis is rare and shows characteristic reticulonodular infiltration and cystic changes. Lymphangioleiomyomatosis is characterized by the progressive proliferation of smooth muscle cells and occurs in 0.1-1% of patients with tuberous sclerosis. We encountered a case of pulmonary lymphangioleiomyomatosis associated with tuberous sclerosis and bilateral renal angiomyolipoma in a 31-year-old female patient. This case is reported here along with a brief review of the literature.
Adult ; Angiomyolipoma ; Epilepsy ; Female ; Humans ; Intellectual Disability ; Lymphangioleiomyomatosis ; Myocytes, Smooth Muscle ; Skin ; Tuberous Sclerosis

Tuberous sclerosis is an autosomal dominant disorder characterized by facial skin lesions, epilepsy, and mental retardation. Pulmonary involvement in tuberous sclerosis is rare and shows characteristic reticulonodular infiltration and cystic changes. Lymphangioleiomyomatosis is characterized by the progressive proliferation of smooth muscle cells and occurs in 0.1-1% of patients with tuberous sclerosis. We encountered a case of pulmonary lymphangioleiomyomatosis associated with tuberous sclerosis and bilateral renal angiomyolipoma in a 31-year-old female patient. This case is reported here along with a brief review of the literature.
Adult ; Angiomyolipoma ; Epilepsy ; Female ; Humans ; Intellectual Disability ; Lymphangioleiomyomatosis ; Myocytes, Smooth Muscle ; Skin ; Tuberous Sclerosis

PURPOSE: To investigate predictors of progression to castration-resistant prostate cancer (CRPC) and cancer-specific mortality (CSM) in patients with metastatic prostate cancer (mPCa). MATERIALS AND METHODS: A retrospective analysis was performed on 440 consecutive treatment-naive patients initially diagnosed with mPCa between August 2000 and June 2012. Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performance score (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed. Cox-proportional hazards regression analyses were used to evaluate survivals and predictive variables of men with bone metastasis stratified according to the presence of pain, compared to men with visceral metastasis. RESULTS: Metastases were most often found in bone (75.4%), followed by lung (16.3%) and liver (8.3%) tissues. Bone metastasis, pain, and high BMI were associated with increased risks of progression to CRPC, and bone metastasis, pain, PSA nadir, and ECOG PS> or =1 were significant predictors of CSM. During the median follow-up of 32.0 (interquartile range 14.7-55.9) months, patients with bone metastasis with pain and patients with both bone and visceral metastases showed the worst median progression to CRPC-free and cancer-specific survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals. CONCLUSION: Metastatic spread and pain patterns confer different prognosis in patients with mPCa. Bone may serve as a crucial microenvironment in the development of CRPC and disease progression.
Aged ; Bone Neoplasms/secondary ; *Disease Progression ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Metastasis ; Pain/diagnosis/etiology/prevention & control ; Pain Measurement ; Prognosis ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/mortality/*pathology ; Prostatic Neoplasms, Castration-Resistant/mortality/*pathology ; Retrospective Studies ; Risk ; Treatment Outcome