PURPOSE: To determine (1) the relationship between the cortical defects seen on 99 mTc-DMSA renal scans and age, and (2) the presence and degree of vesicoureteral reflux, and then to depict the risk factors for cortical defects in children with acute urinary tract infection (UTI). Furthermore, to assess the diagnostic value of VCUG in predicting a defect on 99 mTc-DMSA renal scans. MATERIALS AND METHODS: We studied 134 kidneys in 67 children aged 15 days-10 years (M:F=39:28) in whom symptomatic UTI was present. In all these children, both DMSA renal scans and voiding cystourethrography (VCUG) were performed. Scanning took place within 7 days of diagnosis and VCUG was performed after one month of diagnosis. Scintigraphic findings were graded according to the extent and number of cortical defects. We evaluated the relationships between the cortical defects seen on DMSA scans and age, and the grade of vesicoureteral reflux. The diagnostic value of VCUG in predicting cortical defects was analysed. Results: The prevalence of cortical defects was greater in patients older than two years (38/54, 70%) than in those aged less than two (38/80, 48%). The frequency of cortical defects was related to vesicoureteral reflux (p<0.05) and grade of reflux (p<0.05). As this latter increased, the extent of cortical defects also increased (p<0.05), and DMSA scans revealed the presence of these in 76 of the 134 kidneys (57%) with acute UTI. In 30 of these 76 (39.5%), VCUG demonstrated the presence of vesicoureteral reflex. On the other hand, vesi-coureteral reflex was found in 36 of the 134 kidneys (27%), and in 30 of these 36 (83%), cortical defects were noted. The sensitivity of VCUG in predicting cortical defect was 39.5%, while specificity was 89.7%. The positive predictive value for defects was 83.3%, and the negative predictive value was 53.1%. The relative risk of cortical defect in the presence of vesicoureteral reflux was 1.78. CONCLUSION: Renal cortical defects are significantly related to age and grade of vesicoureteral reflux. Risk factors for developing cortical defects were older age (> or =2yrs) at the time of acute UTI, and high grade of vesicoureteral reflux. The specificity of VCUG in predicting cortical defects is relatively high but the sensitivitiy is low, and a significant proportion of cortical defects therefore occurred in the absence of vesicoureteral reflux.
Child* ; Diagnosis ; Hand ; Humans ; Kidney ; Prevalence ; Radionuclide Imaging* ; Reflex ; Risk Factors* ; Sensitivity and Specificity ; Succimer* ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

The changes in heart rate, systolic, mean and diastolic arterial blood pressure, and the plasma concentration of epinephrine and norepinephrine were measured before and thmughout the induction periods of anesthesia in 60 elective surgical patients in a randomized, double-blind manner to evaluate the effects of continuous intravenous infusion of esmolol for 1 minute at 500 ug/kg/min as a loading dose and for 4 minutes at 100 ug/kg/min as a maintenance dose. The control group (n=30) was given the continuous infusion of normal saline at the same volume-rate. During the study, anesthesia was maintained with N2O-O2-enflurane-vecuronium and controlled ventilation. In the esmolol group, statisticaUy, the heart rate at 1 minute after the intubation was less increased and systolic and diastolic pressure after 11 minutes were more decreased than the control group. And plasma norepinephrine concentration was elevated more than the control group at 3 minutes after the intubation. We concluded that the used infusion rate of esmolol blunted the hemodynamic changes following the laryngoscopy and endotracheal intubation but it is still needed to find the dosage for complete blocking the adrenergic response.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Norepinephrine ; Plasma ; Ventilation

There are many predisposing factors for acute pulmonary edema, namely, left ventricular failure due to cardiac disease or fluid overloading, hypoalbuminemia, pulmonary capillary endothelial damage from bacterial toxins or irritant gases, rare central nervous system injuries pulmonary hyersensitivity reactions, etc. Acute pulmonary edema following operations is a rare complication especially in a patient whose preoperative cardiopulmonary status was within normal limits. We present a case of unilateral pulmonary edema immediately following operation in a 46 year old male patient who had a modified pull-through operation due to tongue cancer and who had no evidence of preoperative cardiopulmonary disorders. The edema was relieved after 9 hours with intensive care of pulmonary edema such as IPPB with Omorphine, diuretics, corticosteroid, asemi-sitting position and frequent tracheal suction.
Bacterial Toxins ; Capillaries ; Causality ; Central Nervous System ; Diuretics ; Edema ; Heart Diseases ; Humans ; Hypoalbuminemia ; Critical Care ; Intermittent Positive-Pressure Breathing ; Male ; Middle Aged ; Noble Gases ; Pulmonary Edema* ; Suction ; Tongue Neoplasms

To evaluate the technique to provide rapid onset of anesthesia and postoperative pain control for cesarean section, we have used spinal anesthesia and epidural analgesia with a 26-gauge, long spinal needle through a 18-gauge Tuohy needle(Espocan) for elective cesarean section in twenty cases, 0.5% heavy bupivacaine 8-12mg was injected through spinal needle for anesthesia during operation, and then spinal needle was removed and epidural catheter was inserted into the epidural space for postoperative pain control. Ten milliliters of bupivacaine 0.125% with 0.45 mg buprenorphine was injected into epidural space through epidural catheter at the time of pain recognition in postoperative period. The results were as follows; 1) There were 5 cases(25%) of hypotension after spinal anesthesia. 2) There were 4 cases(20%) of complaint of pain during operation. 3) The time from injection of 0.5% heavy bupivacaine to onset of anethesia to T4 level is 3.8+/-1.5 minutes and the time from induction of spinal anesthesia to deliverly of infant is 10.1+/-2.9 minutes. 4) Two cases of postoperative headache were noted, but they were mild and relieved spontaneously. 5) Other analgesics were needed in two cases at postoperative periods. The technique is recommended for the anesthesia of cesarean section because it allows rapid onset of anesthesia with spinal anesthesia and gives advantages of postoperative pain control with epidural catheter.
Analgesia, Epidural* ; Analgesics ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine ; Buprenorphine ; Catheters ; Cesarean Section* ; Epidural Space ; Female ; Headache ; Humans ; Hypotension ; Infant ; Needles ; Pain, Postoperative ; Postoperative Period ; Pregnancy

In the modern practice of general anesthesia, endotracheal intubation is routinely used for controlled ventilation. To facilitating intubation, succinlycholine is the most valuable muscle relaxant. But succinylcholine has many untoward reactions such as elevation of intraocular pressure, increased plasma potassium, increased intragastric pressure, bradycardia and the development of postperative muscle pain, etc. Several attempts have study was intended to determine adequate doses of gallamine triethiodide for endotracheal intubation in patients to avoid the development of bradycardis. The authors measured the heart rate just beofre, immediately after and 5 minutes after intubation. The total number of patients in this study was 67, and the patients were divided into five groups: Group 1: consisting of 10 patients, receiving 1.5 mg/kg of gallamine triethiodide. Group 2: of 10 patients, receiving 2.0 mg/kg of gallamine. Group 3: of 22 patients, receiving 2.5 mg/kg of gallamine. Group 4: of 15 patients, receiving 3.0 mg/kg of gallamine. Group 5: of 10 patients, receiving 3.5 mg/kg of gallamine. The authors tried to choose the least difficult intubation after gallamine triethiodide, the amount administered and the patient's reaction to stimulation. The conclusions are summarized as follows: 1) The adequate dose of gallamine triethiodide for endotracheal intubation is 2.5mg/kg. 2) The duraion of action of gallamine triethiodide is dose dependent. 3) Increase of heart rate in each group is significant after gallamine triethiodide.
Anesthesia, General ; Bradycardia ; Gallamine Triethiodide* ; Heart Rate ; Humans ; Intraocular Pressure ; Intubation ; Intubation, Intratracheal* ; Myalgia ; Plasma ; Potassium ; Succinylcholine ; Ventilation

Background: The highly lipid soluble opioid, fentanyl, has a rapid onset and short duration of action. The present study was designed to examine the analgesic efficacy and side effects of the combination of fentanyl with morphine in patients using intravenous PCA. Methods: Patients were randomly assigned to receive one of three PCA regimens: M4 group (40 mg morphine+90 mg ketorolac+1.5 mg dorperidol), M2F2 group (20 mg morphine+200 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol), or M2F4 group (20 mg morphine+400 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol). All patients were given initial loading dose of 0.1 mg/kg morphine plus 1 mg droperidol at the end of surgery. Pain score, side effects, and overall satisfaction were assessed at 30 min, 1 hr, 8 hr, 24 hr, and 48 hr postoperatively. Results: The pain score was significantly higher in the M2F2 group than in the M4 group and M2F4 group during 1 hr and 8 hr postoperatively. The total opioid consumption was significantly greater in the M2F4 group than in the M4 group. Patient satisfaction was better in the M2F4 than other two groups. There were no differences in the overall incidence of side effects among three groups. Conclusions: The present results suggest that the combination of fentanyl with morphine for intravenous patient-controlled analgesia is a useful method, and the double dose of fentanyl in comparison with the equipotent morphine dose is recommended in the early postoperative period.
Analgesia, Patient-Controlled* ; Droperidol ; Fentanyl* ; Humans ; Incidence ; Morphine* ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Postoperative Period

Background: We hypothesized that intravenous lidocaine mixed with propofol may have an influence on anesthesia induction and hemodynamic responses to propofol induction and endotracheal intubation as well as propofol-induced pain on injection. Methods: Seventy-five patients were allocated to group L1 (2% lidocaine 1.5 mg/kg, n=25), group L2 (2% lidocaine 2 mg/kg, n=25) or group C (normal saline 0.05 mL/kg, n=25) according to the lidocaine dosage mixed with propofol 2 mg/kg. The pain on injection was scored as none, mild, moderate, and severe. The site of pain and recall of pain were also recorded. Loss of verbal response was observed during induction. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded before anesthetic induction (baseline value), immediately before and after endotracheal intubation, and every min until 5 min thereafter. Results: Ninety-two percent of patients reported pain upon injection in group C, whereas 8% of the patients in group L1 and no patient in group L2. Loss of verbal response before injection of total dose of propofol was observed in 44% in group L2, 36% in group L1 and 28% in group C. Lowered MAP caused by propofol increased significantly after endotracheal intubation in all three groups (p<0.05). HR increased immediately and 1 min after endotracheal intubation in all three groups (p<0.05). Conclusions: Our results indicate that intravenous lidocaine 1.5 mg/kg or 2 mg/kg mixed with propofol 2 mg/kg significantly reduces the incidence and the degree of pain, but does not affect anesthesia induction and hemodynamic responses to propofol and tracheal intubation.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Lidocaine* ; Propofol*

Rapid eeonomic divelopment and attendent technological advances have influenced the practice of anesthesia as well as other medical fields. Our fields such as CPR, respiratory care, critical role of an anesthesilogist has been extended beyond the confines of the operating theater in the developed countries. In Korea, the chronic shortage of manpower tends to restrict anesthesiologists to operating theater providing minimal time for preoperative assessment and more active contact with patients. In our survey to 150 senior medical students, opportunity for direct patient contact is the most important determinant in the choice of a career. The medical graduates interests in clerkship in College of Medicine, Seoul National Universty, in order, are respiratory care/mechanical ventilation, endo- tracheal intubation, arterial blood gas/it's interpretation, cardiopulmonary resuseitation and anesthesia per se. Their most favorite specialties in order as a career choice are internal medicine, ENT, et., and anesthesiology is ranked between 7th and 11th specialty.
Anesthesia ; Anesthesiology* ; Cardiopulmonary Resuscitation ; Career Choice ; Critical Care ; Developed Countries ; Humans ; Internal Medicine ; Intubation ; Korea ; Seoul ; Students, Medical ; Ventilation

BACKGOUND: Postoperative complications in the geriatric patients undergoing radical neck dissection are generally considered to be more severe than young patients. The incidence of carotid sinus hypersensitivity in elderly patients is also considered to be higher than the young. The comparison between old (above 65 years) and young (below 65 years) aged groups about intraoperative carotid sinus hypersensitivity and postoperative complication is necessary for safe anesthesia. METHODS: Sixty five adult patients, of either sex, regardless of age, given radical neck dissection from January 1990 to January 1998, were investigated for the incidence of intraoperative carotid sinus hypersensitivity and postoperative hypertension by way of retrospective chart review. The authors also examined the postoperative complications such as high fever, pulmonary, cardiac and renal complications, cerebrovascular diseases and neurologic injuries. RESULTS: The incidence of intraoperative carotid sinus hypersensitivity were 28% in elderly patients (n=25), 10% in young patients (n=40) but there was no statistical significance. The incidence of postoperative hypertension were 79.1% in patients with hypertension history, 34.1% in patients without hypertension history and there was statistical significance between the two groups (P=0.001). The incidence of postoperative pulmonary complication were 44% in elderly patients, 20% in young patients, and there was also statistical significance between the two groups (P=0.038). There was no statistical significance in the incidence of postoperative high fever above 38.5degrees C between the two groups (p=0.059). CONCLUSION: After the radical neck dissection, the geriatric patients had a greater incidence of postoperative pulmonary complications than young patients and the most relating factor to postoperative hypertension was previous history of hypertension. Therefore optimal preoperative preparations for the hypertensive patients and the prevention and immediate treatment of the postoperative pulmonary complications in geriatric patients are very important during the radical neck dissection.
Adult ; Aged ; Anesthesia ; Blood Pressure ; Carotid Sinus* ; Fever ; Humans ; Hypersensitivity* ; Hypertension ; Incidence ; Neck Dissection* ; Postoperative Complications* ; Retrospective Studies*

BACKGROUND: For pediatric anesthesia we frequently use rocuronium bromide, which is often associated with a localized withdrawal of the arm or generalized movements, that may cause harm to the patient. Lidocaine is said to be one of the better agents and reduce the incidence of movement associated with rocuronium injection in adults. The purpose of this study was to compare the effects on movement associated with rocuronium injection according to the method of lidocaine administration in children. METHODS: Two hundreds and four pediatric patients undergoing general anesthesia were randomly assigned to one of six groups (each group n = 34). Fifty seconds after the injection of thiopental sodium 5 mg/kg, the SM group was given mixture of rocuronium bromide 0.6 mg/kg and normal saline 0.05 ml/kg (same amount of 2% lidocaine 1 mg/kg) for 5-10 seconds. The LM 1.0 and LM 2.0 groups were given a mixture of rocuronium bromide 0.6 mg/kg and 2% lidocaine 1 mg/kg or 2 mg/kg, respectively. The LS 1.0, LS 1.5 and the LS 2.0 groups were given 2% lidocaine 1.0 mg/kg, 1.5 mg/kg, and 2.0 mg/kg respectively, 50 seconds after the injection of thiopental sodium, and rocuronium was given 5 seconds after the administration of lidocaine. Withdrawal movements after the injection of rocuronium were investigated. RESULTS: All of the SM group showed withdrawal movement and the LM 2.0, LS 1.0, LS 1.5, and LS 2.0 groups showed less withdrawal movement than the SM group. And the LS 1.0, LS 1.5, and LS 2.0 groups showed less movement than the LM 1.0 group. LS 2.0 group showed less withdrawal movement than LM 2.0 group. CONCLUSIONS: The sequential administration of lidocaine and rocuronium produced a better result than the administration of a mixture in terms of reducing withdrawal movement on rocuronium injection.
Adult ; Anesthesia ; Anesthesia, General ; Arm ; Child* ; Humans ; Incidence ; Lidocaine* ; Neuromuscular Blockade ; Thiopental