BACKGROUNDS: This study was investigated for assessing of the sedative dose of midazolam and its influence on neonatal Apgar score that intravenously injected immediately before operation during epidural anesthesia for cesarean section. METHODS: Midazolam, 1 mg, was given into a freely running IV line every 30s 2 min after 2 mg of midazolam was initiately injected. Ten seconds prior to each injection patients were asked to open the eye. No response, as determined by the anesthesiologists, to three promptly repeated and increasingly louder commands was considered the end-point for the study and no further midazolam was given. RESULTS: The sedative dose of midazolam in our study was 3.3 1.1 mg and interindividual variation (range: 2~7 mg) were wide. Respiratory depression was occurred in one of pregnant women with midazolam. All of the Apgar scores of the newborn infants at 1 and 5 min in both groups were higher than seven. CONCLUSIONS: When the intravenous injection of midazolam for sedation immediately before operation is required in pregnant women during epidural anesthesia for cesarean section, we would like to suggest that one should initiately administer the small dose and then inject the incremental dose with careful observation of the respiratory status.
Anesthesia, Epidural* ; Apgar Score ; Cesarean Section* ; Female ; Humans ; Infant, Newborn ; Injections, Intravenous ; Midazolam* ; Pregnancy ; Pregnant Women* ; Respiratory Insufficiency ; Running

The birth of conjoined twins remains an extremely rare event. Most of such twins are stillborn and one third of the live births die within first day of life. In Korea, there are only three reports on the anesthesia for separation of different kinds of conjoined twins. In view of anesthesia for separation of such twins prematurity, low birth weight, and anomalous shared organ play the major role on the perioperative morbidity and mortality. Such anesthesia therefore is one of the exceedingly complex fields among the pediatric anesthesia and require mobilization of all possible methods and monitoring devices used for pediatric anesthesia. We performed careful preoperative evaluation of extent of joining, discussion and rehearsal of separation procedure between separation team, and anesthetic care such as all possible monitoring, preservation of body temperature, appropriate fluid therapy, awake intubation, avoid neuromuscular blockers, and thorough separation of duty. The separated twins showed normal weight gain postoperatively and discharged postoperative 31th day without any complications.
Anesthesia* ; Body Temperature ; Fluid Therapy ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intubation ; Korea ; Live Birth ; Mortality ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Parturition ; Twins, Conjoined ; Weight Gain

BACKGROUND: Recently, measurement of heart rate variability and the nonlinear complexity of heart rate dynamics have been used as indicators of cardiovascular health. Hypertensive patients showed alternation of cardiovascular homeostasis. We designed this study to evaluate the effect of anesthesia in hypertensive patients with approximate entropy (ApEn), representing the nonlinear complexity. METHODS: With informed consent, none premedicated normotensive (n=18) and hypertensive patients (n=18) were included in this study. ECG data were collected from 10 minutes before induction to 15 minutes after induction. Collected ECG data were stored into computer binary files. We calculated ApEn from the collected ECG data. RESULTS: Before induction, ApEn of hypertensive patients was significantly lower than that of normotensive patients (p<0.05). During induction and maintenance of anesthesia, there was no difference of ApEn between the two groups. ApEn of normotensive patients during induction and maintenance of anesthesia was significantly lower than that of pre-induction (p<0.05). ApEn during maintenance of anesthesia was lower than that of induction of anesthesia (p<0.05). ApEn of hypertensive group during maintenace of anesthesia was significantly lower than that of pre-induction of anesthesia (p<0.05). CONCLUSIONS: As the ApEn of hypertensive patients is lower than that of normotensive patients during pre-inducton period, the heart rate dynamics of hypertensive patients is more regular normotensive patients. The anesthesia is deepened, the heart rate dynamics of the both group is more regular. During the maintenance of anesthesia, the regularity of the heart rate dynamics that not different in both group from the results.
Anesthesia* ; Electrocardiography ; Entropy* ; Heart Rate ; Homeostasis ; Humans ; Hypertension* ; Informed Consent

BACKGROUND: There are many objective and subjective methods for measuring the level of preoperative anxiety, but commonly used methods, such as HADS (hospital anxiety depression scale) and VAS (visual analogue scale), are not simple and easily used by patients. APAIS (Amsterdam preoperative anxiety and information scale) is a newly developed preoperative anxiety measuring instrument. The object of this study was to evaluate the ability of APAIS to overcome the limitations of other anxiety measuring instruments. METHODS: 105 adult patients were asked to fill out the questionnaires in APAIS and HADS and also to mark on a 100 mm line in VAS in the range of 0 (calm) to 100 (terrified) how tense they felt at that moment in the evening before surgery. 95 patients responded to the questionnaire. We compared APAIS with the other subjective measurements of anxiety according to patients' sex, ASA class, past history of surgery and level of education, and evaluated the equivalence of the three methods. RESULTS: APAIS has a significant relationship with the other two methods (P < 0.05), but the other two methods have no significant relationship. The data of the APAIS showed a nearly symmetrical distribution as compared with that of HADS and VAS. Women and patients who had had no surgery were significantly anxious as opposed to men and to patients with previous experience of surgery, respectively (P < 0.05). The HADS and APAIS were in good agreement in defining patients as having normal AFFECT or anxiety and there were significant correlations between the three instruments (P < 0.05). CONCLUSIONS: We conclude that the three scales were equivalent in their assessment of anxiety before surgery. Therefore, APAIS will be useful alternative method of measuring subjective preoperative anxiety.
Adult ; Anxiety* ; Depression* ; Education ; Female ; Humans ; Male ; Transcutaneous Electric Nerve Stimulation ; Weights and Measures

BACKGROUND: There are many objective and subjective methods for measuring the level of preoperative anxiety, but commonly used methods, such as HADS (hospital anxiety depression scale) and VAS (visual analogue scale), are not simple and easily used by patients. APAIS (Amsterdam preoperative anxiety and information scale) is a newly developed preoperative anxiety measuring instrument. The object of this study was to evaluate the ability of APAIS to overcome the limitations of other anxiety measuring instruments. METHODS: 105 adult patients were asked to fill out the questionnaires in APAIS and HADS and also to mark on a 100 mm line in VAS in the range of 0 (calm) to 100 (terrified) how tense they felt at that moment in the evening before surgery. 95 patients responded to the questionnaire. We compared APAIS with the other subjective measurements of anxiety according to patients' sex, ASA class, past history of surgery and level of education, and evaluated the equivalence of the three methods. RESULTS: APAIS has a significant relationship with the other two methods (P < 0.05), but the other two methods have no significant relationship. The data of the APAIS showed a nearly symmetrical distribution as compared with that of HADS and VAS. Women and patients who had had no surgery were significantly anxious as opposed to men and to patients with previous experience of surgery, respectively (P < 0.05). The HADS and APAIS were in good agreement in defining patients as having normal AFFECT or anxiety and there were significant correlations between the three instruments (P < 0.05). CONCLUSIONS: We conclude that the three scales were equivalent in their assessment of anxiety before surgery. Therefore, APAIS will be useful alternative method of measuring subjective preoperative anxiety.
Adult ; Anxiety* ; Depression* ; Education ; Female ; Humans ; Male ; Transcutaneous Electric Nerve Stimulation ; Weights and Measures

The incidence of airway difficulty in the general surgical population varies greatly depending on the degree of airway difficulty. Much of the anesthesia related morbidity attributable to managing a difficult airway comes from an interurruption of gas exchange (hypoxia and hypercarbia) which may cause cardiovascular instability and brain damage. Most airway catastrophes ocurrs when possible difficulty with the airway was not recognized. Although fiberoptic intubation is reliable method in patients with difficult airways, there are many cases of difficulty in visualizing the structure of the larynx with conventional fiberoptic technique due to copious secretion, swelling and hemorrhage in the pharyngeal cavity. Recently, we experienced a success in difficult tracheal intubation with LMA in the 27 year old male patient diagnosed ankylosing spondylitis. We hope that using a #4 LMA as a conduit for 6.0 mm cuffed endotracheal tube with the aid of fiberscope attached to the video camera system would be an alternative method for difficult intubation.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental

Thrombospondin-1 (TSP-1) level is tightly regulated at the transcriptional level. To determine the detailed molecular mechanisms of TSP-1 expression, nine serial 5'-deletion constructs of the human genomic tsp-1 promoter (nucleotides -2,220 to +756) were prepared, inserted into luciferase reporter plasmids, and transiently transfected into the Hep3B human hepatocarcinoma cell. Among the nine 5'-deletion constructs, pTSP-Luc-4 (-767~+756) had consistently decreased luciferase activity with or without PMA stimulation, whereas a further truncated construct [pTSP-Luc-4' (-407~+756)] had increased levels of expression. By searching the nucleotides from -767 to -407, a consensus binding sequence (5'-CCATTTT-3') for the repressor Yin Yang-1 (YY-1) at nucleotide -440 was identified. The suppression induced by this site was weakened in the presence of the region upstream of nucleotide -767 (pTSP-Luc-1 and -2). Nuclear protein directly bound to an oligonucleotide containing the repressive YY-1 sequence but the binding capacity of the sequence was decreased by the increased c-Jun levels. Moreover, proteins immunoprecipitated with anti-YY-1 revealed an interaction between c-Jun and YY-1 factor. These data suggest that the repressive YY-1 site of the tsp-1 promoter could not be functional via activating positive cis-elements on the upstream from this site and weakened via c-Jun/YY-1 interactions.
Binding Sites/genetics ; Cell Line, Tumor ; DNA-Binding Proteins/*metabolism ; Down-Regulation/genetics ; Electrophoretic Mobility Shift Assay ; Genes, Reporter/genetics ; Humans ; Luciferases/analysis/genetics ; Promoter Regions (Genetics)/*genetics ; Proto-Oncogene Proteins c-jun/genetics/*metabolism ; Repressor Proteins/*metabolism ; Research Support, Non-U.S. Gov't ; Sequence Deletion/genetics ; Thrombospondin 1/*genetics/metabolism ; Transcription Factor AP-1/metabolism ; Transcription Factors/*metabolism

BACKGROUND: The purpose of this study is to investigate the frequency of and errors in citation of references in articles from the Korean Journal of Anesthesiology (KJA) from the first application of the present contribution rules (1996) to 1998 and to suggest a clue to improve the quality of our journal. METHODS: All references cited from KJA were reviewed using a computerized searching system. If any differences are found during the review, we compare it with the original article. Errors on the contribution rules were examined according to the instructions for the authors revised in 1995. RESULTS: Overall 74% of the articles had more than one reference cited from KJA. The average number of the references cited from KJA per article was 1.73. In such references, citation errors were found in 48% of articles published in 1996, 44% in 1997, and 43% in 1998. The percentages of general errors and errors involving the contribution rules were 62% and 38%, respectively. Common general errors were found in titles (164 cases), pages (102 cases), and name (60 cases). Those involving the contribution rules found in the notation of name (120 cases), pages (54 cases), and inadequate notation of the number of issue (49 cases). CONCLUSIONS: Despite numerous efforts, the incidence of citation errors was still high when the articles of KJA were cited as references. Improvement in the quality of our journal will be possible only by rigid adherence to contribution rules, thorough review of the articles, and a lucid explanation of contribution rules.
Anesthesiology* ; Incidence

BACKGROUND: To evaluate the effects of thoracic epidural anesthesia, with or without bilateral vagotomy, epinephrine-induced arrhythmias were studied in 31 rabbits anesthetized with 1 MAC enflurane. METHODS: Logdose protocol was used for the infusion of epinephrine; its arrhythmic dose being defined as the smallest infusion rate produced four or more continuous or intermittent arrhythmias within 15 seconds. RESULTS: The values (geometric mean) of arrhythmic doses and the plasma concentration of epinephrine during arrhythmia were as follows: 10.21 g.kg 1.min 1 and 83.16 ng/ml in epidural control group; 118.90 g.kg 1.min 1 and 677.76 ng/ml in epidural lidocaine group (p<0.05); 6.34 g.kg-1.min 1 and 96.42 ng/ml in intravenous lidocaine group; 8.65 g.kg 1.min-1 and 44.64 ng/ml in vagotomized-epidural control group; and 12.03 g.kg 1.min 1 and 95.35 ng/ml in vagotomized- epidural lidocaine group. CONCLUSIONS: The data suggest that thoracic epidural anesthesia raises the threshold for enflurane- epinephrine arrhythmias in rabbits and that this effect is eliminated by bilateral vagotomy.
Anesthesia, Epidural* ; Arrhythmias, Cardiac* ; Enflurane ; Epinephrine ; Lidocaine ; Plasma ; Rabbits* ; Vagotomy*

BACKGROUND: Postoperative nausea and vomiting are common postoperative complaints. The purpose of this study was to assess the effect of preoperative midazolam on vomiting after appendectomy. METHODS: Sixty patients, aged 10 64 yr, undergoing emergency appendectomy were randomly allocated to receive midazolam 30, 50, 75 microgram/kg or placebo after induction of anesthesia. Anesthesia consisted of 67% nitrous oxide, 33% oxygen and propofol infusion 6 10 mg/kg/h. Postoperative vomiting was checked by the recovery room nurse at 1 h after operation and we examined the incidence of postoperative vomiting at 24 h after operation. RESULTS: Midazolam reduced the overall incidence of vomiting, especially in the midazolam 50 and 75 microgram/kg groups, completely abolishing vomiting (P< 0.05). However, in the midazolam 75 microgram/kg group, there was a delay in eye opening time (P< 0.05). CONCLUSIONS: Preoperative injections of midazolam 30 or 50 microgram/kg were useful to prevent postoperative vomiting in patients undergoing appendectomy without delayed recovery.
Anesthesia ; Antiemetics* ; Appendectomy* ; Emergencies ; Humans ; Incidence ; Midazolam* ; Nitrous Oxide ; Oxygen ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Vomiting