BACKGROUND: As undergoing general anesthesia for Cesarean Section, we usually maintain a light anesthesia until delivery. It provokes the high incidence of waketulness for the mothers. We surveyed the incidence of maternal wakefulness when thiopental was used as an induction agent. METHODS: Forty pregnant women (ASA class I or II) at term who underwent general anesthesia and cesarean section received thiopental, 4mg/kg. As the 'isolated forearm technique', a pressure cuff was inflated to isolate one arm from the the effects of succinylcholine so that wakefulness during anesthesia could be assessed by asking the patient to move her hand. To assess wakefulness,the patient was commanded to squeeze the investigator's hand a specified number of times. If the patient promptly squeezed the investigator's hand the appropriate number of times, the command was repeated but a different number of times specified. Only if the patient responded correctly both times, then we noted as a positive response. This test was repeated at 1 minute intervals beginning 1 minute after thiopental injection through the delivery. RESULTS: Five of the forty patients (12.5%) showed wakefulness. Twenty nine of the forty patients showed 'reaching movements'. One patient showed both wakefulness and 'reaching movements'. CONCLUSIONS: When we undergo general anesthesia for Cesarean Section, especially using thiopental as an induction agent, we should consider the maternal wakefulness seriously.
Anesthesia ; Anesthesia, General ; Anesthesia, Obstetrical ; Arm ; Cesarean Section* ; Female ; Forearm* ; Hand ; Humans ; Incidence ; Mothers ; Pregnancy ; Pregnant Women ; Succinylcholine ; Thiopental ; Wakefulness*

Backgrounds: End-tidal CO2 (PETCO2) monitoring is becoming one of essential respiratory monitoring systems during anesthesia. In this study, the differences between PETCO2 values measured from the 4 different sites were evaluated. METHODS: Healthy adult patients were studied (n=30). During N2O-O2-Enflurane anesthesia, PETCO2 was measured from the 4 possible monitoring sites, 3 from the breathing circuit and 1 from the monitoring lumen site of the specialized endotracheal tube connected to the distal endotracheal tube. After intubation, repeated PETCO2 measurements at 15mins (T15), 30mins (T30), 60mins (T60) and 90mins (T90) and ABGAs at T30 and T90 were done and the differences between arterial Pco2 and PETCO2 (P (a-ET)CO2) were calculated. In addition, to study the effect of changing fresh gas flow rate upon the PETCO2 values, PETCO2 measurements were done by varying the total gas flow rate from 4 L/min to 2 L/min to 6 L/min at T60. RESULTS: The Y-connector area (PETCO2- (1)) showed the lowest PETCO2 value, the elbow connector (PETCO2- (2)) and heat-moisture exchanger (PETCO2- (3)) areas, the intermediate, and the distal endotracheal site (PETCO2- (4)), the highest. The difference between the most proximal and distal sites was varied 2.4 to 3.0 mmHg and not statistically significant. PETCO2 values showed significant decreasing trend with time at each site (p<0.05). At T30 and T90, PaCO2 was not significantly different from PETCO2- (4) but significantly different from PETCO2- (1), (2), (3). The effect of changing fresh gas flow rate upon the amount of PETCO2 values of the different sites was not statistically significant. CONCLUSION: PaCO2 was significantly different from PETCO2 values measured from the breathing circuit sites but not significantly different from those measured from the distal endotracheal tube. It might be said that we have to pay special attention to these differences if we want to estimate real P (a-ET)CO2 difference.
Adult ; Anesthesia ; Elbow ; Humans ; Intubation ; Respiration

BACKGROUND: An electrical patient-controlled analgesia (PCA) pump enabled us to collect infusion history of opioid analgesic and other efficacy parameters of PCA, including delivery-to-attempt (D/A) ratio. This study evaluated the effectiveness of PCA in a large population of surgical patients using numerical rating scale (NRS) for pain and D/A ratio. METHODS: A total of 6,847 patients were enrolled in this study. All patients received intravenous bolus of fentanyl (0.2 microg /kg) one hour before the end of the surgery. Basal infusion rate, demand bolus, and lockout time of the PCA pump was set as 1 ml/h, 1 ml, and 15 minutes, respectively. The concentration of fentanyl in the analgesic solution was 15 microg/ml. RESULTS: NRS scores for pain and D/A ratios for the first 6 hours after operations were as follows (median, 25-75%): open colorectal surgery (NRS: 6.5, 5.0-8.0; D/A: 62.5, 46.2-77.8%), laparoscopic colorectal surgery (NRS: 6.0, 4.5-7.0; D/A: 69.2, 50.0-81.9%), open hepato-biliary-pancreas surgery (NRS: 6.0, 4.5-7.0; D/A: 59.2, 38.7-75.0%), open stomach surgery (NRS: 5.0, 4.0-6.7; D/A: 58.1, 41.2-75.0%), open abdominal vascular surgery (NRS: 5.0, 3.5-6.5; D/A: 58.3, 40.0-81.3%), laparoscopic stomach surgery (NRS: 5.0, 4.0-6.0; D/A: 63.6, 45.5-80.0%), laparoscopic hepato-biliary-pancreas surgery (NRS: 5.0, 4.0-6.0; D/A: 66.7, 50.0-80.8%), vascular bypass surgery (NRS: 4.0, 3.0-6.0; D/A: 64.5, 42.7-84.0%), anal surgery (NRS: 4.0, 3.0-5.8; D/A: 71.4, 60.0-100%), and breast surgery (NRS: 3.0, 3.0-4.0; D/A: 86.6, 67.2-100%). CONCLUSIONS: Mean D/A ratios for the first 6 hours after all operations except anal and breast surgeries were below 70%, suggesting that a higher amount of fentanyl should be administered during this period.
Analgesia, Patient-Controlled* ; Breast ; Cohort Studies* ; Colorectal Surgery ; Fentanyl ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies* ; Stomach

Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

BACKGROUND: Recently, laparoscopic cholecystectomy becomes more favorite method than traditional open cholecystectomy. But postoperative pain control is still remaining problem. METHOD: Patients scheduled for elective laparoscopic cholecystectomy were assigned to two groups by simple randomization (15 patients per group). Group C (control) had no specific treatment and group B (bupivacaine) received 20 ml of 0.5% bupivacaine with epinephrine 1:200,000 before surgery. Immediately after the creation of a pneumoperitoneum, the surgeon sprayed the bupivacaine near and above the operation field. Operation was started 10 minutes after then. We attempted to investigate that the degree of postoperative pain which was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) in the recovery room at postoperative 1 h., as well as the analgesic requirements during the first 24 h. postoperatively. RESULT: VRS of group B was significantly lower than group C (p<0.05), but VAS was not significantly different. Six patients in group B and only one in group C requested no analgesics. Group C had statistically more frequent request for analgesics than group B (p<0.05). CONCLUSION: The topical intraperitoneal anesthesia of 20 ml of 0.5% bupivacaine with epinephrine 1 : 200,000 before laparoscopic cholecystectomy is effective on the postoperative pain control. So, we recommmend that this simple and effective management is routinely treated in patients undergoing laparoscopic cholecystectomy.
Analgesics ; Anesthesia* ; Bupivacaine* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Epinephrine ; Humans ; Pain, Postoperative* ; Pneumoperitoneum ; Random Allocation ; Recovery Room

In order to evaluate the hypotensive effect of the lisinopril, a long acting angiotensin converting enzyme inhibitor, 10 to 30mg of lisinopril were administered in 35 hypertensive Korean adults during six weeks after a week observation for washout with stepwise increments of the dose according to the response of the patients blood pressure in every two weeks. The results were ; 1) The supine blood pressures were decreased from 163.7+/-16.6/99.8+/-9.3mmHg to 140.7+/-15.5/87.4+/-9.9mmHg at the end of six weeks' drug therapy(p<0.001). The standing blood pressures were also decreased conferrably and to the some lower levels. 2) In 14 patients to whom the drug was administered longer period(12 to 28 weeks) the blood pressure lowering effects were maintained at the level of that of 6th week. 3) Hematologic examination and blood chemistry revealed no discernible abnormal findings before and after the treatment. 4) In those patients who showed no adequate blood pressure control with other classes of antihypertensive drugs the lisinopril was effective in lowering their blood pressures by adding small doses. 5) During the period of the study a few probably drug-related symptoms developed but not troublesome except dry cough and dry mouth shich forced to stop administering the drug after completion of six weeks' period in one patients. From above results we concluded that lisnopril is effective and safe for the treatment of hypertension in Korean adults.
Adult ; Antihypertensive Agents ; Blood Pressure ; Chemistry ; Cough ; Humans ; Hypertension ; Lisinopril* ; Mouth ; Peptidyl-Dipeptidase A

Renal calcifications are a recognized complication of furosemide therapy in premature infants. Particularly in infants with chronic lung disease, the use of this potent diuretic is associated with hypercalciuria, which may predispose the infant to medullary nephrocalcinosis and renal calculi, We experienced two cases of nephrocalcinosis in very low birth weight infants. One had bronchopulmonary dysplasia, pneumonia, patent ductus arteriosus, ventricular septal defect and congestive heart failure and the other had systemic cytomegalovirus infection with cytomegalovirus pneumonitis and ricket of prematurity. Both patients received a large amount of furosemide. We presented these cases with brief review of literatures.
Bronchopulmonary Dysplasia ; Cytomegalovirus ; Cytomegalovirus Infections ; Ductus Arteriosus, Patent ; Furosemide ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Hypercalciuria ; Infant* ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Kidney Calculi ; Lung Diseases ; Nephrocalcinosis* ; Pneumonia

A 20 years old male patient was transferred to the operating room for mandibulo-maxillary reconstruction. We planned general anesthesia with nasotracheal intubation. Reinforced endotracheal tube was inserted through right nasal os and progressed to the epiglottic region. But the first trial was not successful because of the profuse bleeding from the nasal cavity. After suctioning, the second trial through the same route was successful. But at the time of skin incision, we found the lips of the patient were becoming pale, the SpO2 was falling down to lower than 70%. We found the patients left chest wall was motionless. The chest A-P film showed total atelectasis of the left lung. When a large blood clot was removed by the flexible bronchoscopy, the chest wall started to move well and the SpO2 came up to 99%. The following chest A-P film confirmed the resolution of the atelectasis.
Anesthesia, General ; Bronchoscopy ; Epistaxis* ; Hemorrhage ; Humans ; Intubation* ; Lip ; Lung ; Male ; Nasal Cavity ; Operating Rooms ; Pulmonary Atelectasis* ; Skin ; Suction ; Thoracic Wall ; Thorax ; Young Adult

It has been known that more than 5% of cancer patients experience severe pain refractory to medical treatments. So it is necessary to use epidural or intrathecal analgesia with opioids and local anesthetics when systemic trial has failed. Although intrathecal catheter placement and drug infusion has some risks, it shows better pain control with least amount of analgesics. The authors managed a patient who had suffered from intractable cancer pain due to metastatic pancreatic cancer. His pain was spreading to his upper body area including chest wall and interscapular region as well as original abdomen and back pain. Pain severity became extreme reaching VAS (visual analogue scale) score to above 9. Cervical epidural catheterization and continuous drug infusion was not effective in this case. So the authors chose to give analgesics intrathecally, and placed the intrathecal catheter on 5th cervical vertebral level and connected it to subcutaneous port so that drugs could be infused continuously. The effect was dramatic by 5 mg/day morphine and 20 mg/day lidocaine, VAS score decreased to below 3 without any possible complications.
Abdomen ; Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthetics, Local ; Back Pain ; Catheterization ; Catheters ; Humans ; Lidocaine ; Morphine ; Pain Management ; Pancreatic Neoplasms ; Thoracic Wall

Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy that manifests with acute and massive bleeding. We present a patient who deveoloped a TIF and underwent a division of the fistula, interrupting the innominate artery. Successful management of a patient with TIF requires the rapid institution of specific resuscitative and operative measures. The patient arrived at the emergency room with acute massive tracheal bleeding, respiratory difficulty, decreased consciousness and ensuing cardiac arrest. After the tracheal cuff was fully inflated, cardiopulmonary resuscitation was started. Fortunately, the bleeding was stopped and heart rate and blood pressure were normalized. Before performing the cerebral angiography, the patient was intubated orally for rebleeding. The patient was admitted to the intensive care unit and stayed for 29 days due to weaning failure from the ventilator. After repair of tracheal stenosis, a permanent tracheostomy was instituted. The patient had no respiratory difficulty or massive tracheal bleeding during the 2 months after discharge except one episode of minor bleeding.
Arteries* ; Blood Pressure ; Brachiocephalic Trunk ; Cardiopulmonary Resuscitation ; Cerebral Angiography ; Consciousness ; Emergency Service, Hospital ; Fistula* ; Heart Arrest ; Heart Rate ; Hemorrhage ; Humans ; Intensive Care Units ; Tracheal Stenosis ; Tracheostomy* ; Ventilators, Mechanical ; Weaning