BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

BACKGROUND: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A randomized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. METHODS: Forty-nine patients (ASA I-II) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupivacaine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. RESULTS: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean SD) was 18.9 7.0 minutes and 187.5 34.6 minutes respectively for ropivacaine, and was 15.2 8.8 minutes and 187.8 40.0 minutes respectively for bupivacaine. Maximum block height (mean SD) was T6.5 2.0 for ropivacaine and T6.4 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12/20 for bupivacaine. CONCLUSIONS: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine.
Analgesia ; Anesthesia ; Blood Pressure ; Bupivacaine* ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Lower Extremity*

BACKGROUND: Ropivacaine is an amide local anesthetic structurally related to bupivacaine. A randomized, double-blind study was performed to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. METHODS: Forty-nine patients (ASA I-II) were randomized to receive 15 ml of 0.5% ropivacaine or bupivacaine. Twenty patients received 15 ml of ropivacaine and 20 patients received 15 ml of bupivacaine at the L3,4 or L4,5 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anesthesia and the heart rate and blood pressure profile during the block onset. RESULTS: Demographic characteristics were similar among the groups. Seven patients were excluded from the study due to technical failure of the block, two patients were excluded due to insufficient data. The onset and duration of analgesia at T10 dermatome (mean SD) was 18.9 7.0 minutes and 187.5 34.6 minutes respectively for ropivacaine, and was 15.2 8.8 minutes and 187.8 40.0 minutes respectively for bupivacaine. Maximum block height (mean SD) was T6.5 2.0 for ropivacaine and T6.4 2.0 for bupivacaine. The incidence of complete motor block (Bromage scale 3) was low in the ropivacaine group, being 3/20 for ropivacaine and 12/20 for bupivacaine. CONCLUSIONS: The sensory blockade profile of ropivacaine, administered epidurally, is similar to that obtained with an equal dose of bupivacaine. However motor blockade with ropivacaine is less intense, less frequent, and of shorter duration than with bupivacaine.
Analgesia ; Anesthesia ; Blood Pressure ; Bupivacaine* ; Double-Blind Method ; Heart Rate ; Humans ; Incidence ; Lower Extremity*

A 30 years old female patient was diagnosed valvular heart disease and double valve replacement was ndertaken. After operation, mediastinitis developed and we had done continuous mediastinal irrigation and had used IV antibiotics for 3 weeks. During outpatient follow-up, infection signs developed, so she readmitted and was reoperated because CT revealed mediastinal abscess. No infected material was observed at the operation. Infection signs continued for 3 weeks. Chest CT revealed giant pseudoaneurysm of ascending aorta. We resected the pseudoaneurysm and performed an aortoplasty with bovine pericardium under deep hypothermia and total circulatroy arrest. She recovered well and was discharged without any complication.
Abscess ; Adult ; Aneurysm, False ; Anti-Bacterial Agents ; Aorta* ; Female ; Follow-Up Studies ; Heart Valve Diseases ; Humans ; Hypothermia ; Mediastinitis* ; Outpatients ; Pericardium ; Thoracic Surgery* ; Tomography, X-Ray Computed

BACKGROUND: The neuromuscular blocking effects of a nondepolarizing neuromuscular blocker (NDNM) during a nitroglycerin (NTG) infusion were significantly potentiated and prolonged. NTG reduced the requirement of a NDNM in surgical patients. We investigated the influence of a NTG single bolus injection on a mivacurium nuromuscular blockade. METHODS: We studied 36 adult surgical patients, ASA physical status I or II, between 15 and 53 years old. Neuromuscular monitoring was measured by TOF-GUARD (Biometer Co., Denmark). Anesthesia was induced by thiopental sodium 3-5 mg/kg and fentanyl 3 microgram/kg, and maintained with 3 L/min N2O, 2 L/min O2 and 1 vol.% isoflurane. Patients were randomly assigned to 3 groups: 1) Control group (mivacurium 0.16 mg/kg), 2) N100 group (mivacurium 0.16 mg/kg, NTG 100 microgram), 3) N200 group (mivacurium 0.16 mg/kg, NTG 200 microgram). We measured the train-of-four (TOF) response from the beginning of recovery to the complete regaining of muscle twitch. RESULTS: NTG produced a prolongation of the neuromuscular blocking effect by mivacurium. T1 (contro group: 12.1 +/- 0.5, N100 group: 15.8 +/- 0.4 and N200 group: 11.6 +/- 0.4 min), T25 (16.4 +/- 0.4, 20.5 +/- 0.5 and 14.9 +/- 1.0 min), T75 (22.5 +/- 0.9, 29.4 +/- 0.7 and 20.1 +/- 1.0 min), T95 (27.3 +/- 0.6, 39.6 +/- 0.7 and 24.6 +/- 1.5 min) and the recovery index (6.1 +/- 0.6, 9.0 +/- 0.4 and 5.3 +/- 0.7 min) were significantly prolonged in the N100 and N200 groups (P < 0.05). CONCLUSION: These results suggest that a NTG bolus injection prolonged the neuromuscular blocking effect of mivacurium, dose relatively.
Adult ; Anesthesia ; Fentanyl ; Humans ; Isoflurane ; Middle Aged ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Nitroglycerin* ; Thiopental

Femoral nerve block with tumescent anesthesia is used to perform the radiofrequency ablation of varicose veins. The surgery can be done as day-case. But if recovery from motor block is delayed, it can make hospital discharge difficult. Prolonged femoral nerve blocks with motor blockade of the quadriceps have been noted after the use of bupivacaine. The motor blockade lasted up to 30–40 hours when 15–30 mL of 0.5% bupivacaine was used. However, it was rarely reported in ropivacaine. We report that femoral nerve block with 15 mL of 0.375% ropivacaine induced prolonged motor blockade up to 30 hours.
Anesthesia* ; Bupivacaine ; Catheter Ablation* ; Femoral Nerve* ; Sodium Bicarbonate ; Varicose Veins*

Problems of birth defects and low birth weight are important issues of public health because most infant mortality are caused by these two. To discover the etiology of birth defects and low birth weight, it is necessary to establish epidemiological birth defects monitoring system in Korea. With the rapid growing of internet usage in korea, the computer network has become the popular means of communicating and sharing of information. Our aim was to develop web-based reporting and database management system in Incheon to establish birth defects monitoring system to evaluate the incidence rate and patterns of birth defects in Korea. Public health center and private hospitals and clinics participated in this monitoring system. Web based reporting system have been built and operated during 2 years (first year: December 1st, 1998-November. 31, 1999; second year: January 1st, 2000 - December 31th, 2000). Trained nurses actively collected the records obtained from delivery units in the participating hospitals. During first and second year, the incidence rate of birth defect per thousand person was 10.0 and 8.0 respectively. In conclusion, we could build web-based monitoring system for birth defects successfully in Yonsu gu, Incheon. It could be a model of national standard for population-based monitoring system for birth defects in Korea.
Congenital Abnormalities* ; Database Management Systems ; Hospitals, Private ; Humans ; Incheon* ; Incidence ; Infant ; Infant Mortality ; Infant, Low Birth Weight ; Infant, Newborn ; Internet ; Korea ; Parturition* ; Public Health

BACKGROUND: Malposition of a central venous catheter may cause several complications such as poor function of the catheter or cardiac tamponade. This study was designed to determine the incidence of malposition after subclavian venous catheterization at the university hospital. METHODS: We prospectively examined catheter locations from 367 subclavian vein catheterizations by an infraclavicular approach using postoperative chest X-rays to analyze the rate of catheter malposition. RESULTS: Primary misplacement was observed in 29 cases (7.9%). Seventeen cases were located in the right internal jugular vein, 8 cases (2.2%) were located in the left subclavian vein, 2 cases (0.5%) were located inside the right atrium, 1 catheter (0.3%) was kinking in the right subclavian vein and 1 catheter (0.3%) was located in the right brachiocephalic vein. CONCLUSIONS: Using the infraclavicular approach for subclavian catheterization, a central venous catheter was most commonly misplaced in the ipsilateral internal jugular vein. Operators must keep in mind that even experienced practitioners may cause a considerable number of malpositions and it is very important to check the chest X-ray to locate the catheter malposition after central venous catheterization.
Cardiac Tamponade ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Heart Atria ; Incidence ; Jugular Veins ; Prospective Studies ; Subclavian Vein ; Thorax

Central venous catheterization is typically used for the anesthetic management of patients undergoing a major surgery or care of patients in Intensive Care Unit (ICU). The occurrence of complications associated with central venous catheterization such as pneumothorax or vascular injury have decreased, while delayed complications such as hydrothorax, hydromediastinum, or cardiac tamponade have risen recently. We report a case of complications of bilateral hydrothorax with cardiac tamponade by superior vena cava perforation due to continuous mechanical force of the looped central venous catheter tip against SVC wall after subclavian vein cannulation.
Cardiac Tamponade ; Catheterization ; Catheterization, Central Venous ; Central Venous Catheters ; Humans ; Hydrothorax ; Intensive Care Units ; Pneumothorax ; Subclavian Vein ; Vascular System Injuries ; Vena Cava, Superior

BACKGROUND: Local anesthetics combined with an opioid are frequently used as a postoperative epidural analgesia, to minimize individual doses and to reduce unwanted side effects. The aims of this study were to compare analgesic effectiveness, occurrence of motor block and other side effects of a 48 hr postoperative continuous epidural infusion of 0.1% bupivacaine/morphine or 0.1% ropivacaine/ morphine. METHODS: Forty female patients scheduled for an elective total abdominal hysterectomy under general anesthesia were randomized in a double-blind fashion to receive either 0.1% bupivacaine with 0.02 mg/ml morphine or 0.1% ropivacaine with 0.02 mg/ml morphine using a continuous epidural analgesia pump at a rate of 4 ml/hr during the postoperative 48 hours. After the operation, we assessed the blood pressure, heart rate, visual analog scale (VAS), side effects, additional analgesic requirement and time to ambulation for 48 hours in 12-hour intervals. RESULTS: There were no significant differences in VAS on rest and cough between the groups, but VAS on deep breathing and position change were significantly lower in the bupivacaine group compared to the ropivacaine group. Side effects were similar in both groups except paresthesia. Time to ambulation was earlier in the ropivacaine group compared to the bupivacaine group. CONCLUSIONS: Both the postoperative continuous epidural infusion of 0.1% bupivacaine with morphine and 0.1% ropivacaine with morphine provided similar pain relief and side effects. However, earlier recovery of ambulation in patients receiving ropivacaine/morphine will improve outcome after abdominal surgery.
Analgesia, Epidural* ; Anesthesia, General ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Cough ; Female ; Heart Rate ; Humans ; Hysterectomy* ; Morphine ; Paresthesia ; Respiration ; Visual Analog Scale ; Walking