PURPOSE: This study investigated the preemptive analgesic effects of Morphine and Ketorolac on postoperative pain, cortisol, O2 saturation and heart rate for the first 24 hr after abdominal surgery. METHODS: Data collection was performed from April 1 to September 30, 2006. Forty patients undergoing a gastrectomy under general anesthesia were randomly allocated to the experimental or control group. The experimental group (20 patients) was administered Morphine and Ketorolac approximately 1 hr prior to skin incision, but the control group (20 patients) was administered Morphine and Ketorolac at peritoneum closure through a patient-controlled analgesia (PCA) pump. Postoperative pain, blood pressure, heart rate, cortisol, O2 saturation, frequency of the PCA button pressed and doses of additional analgesics were observed through post operative 24 hr. Collected data was analyzed using t-test, chi-square test, repeated measures ANOVA, and Bonferroni methods. RESULTS: Postoperative pain, cortisol, the frequency of PCA button pressed, and dose of additional analgesics of the experimental group were significantly lower than the control group. There were no statistical differences in blood pressure, heart rate and O2 saturation between the experimental group and control group. CONCLUSIONS: We concluded that administration of morphine and ketorolac at 1 hr prior to skin incision resulted in decreasing postoperative pain, but it didn't affect blood pressure, heart rate or O2 saturation for 24 hr after abdominal surgery.
Aged ; Analgesics/*administration & dosage ; Blood Pressure ; Female ; Heart Rate ; Humans ; Hydrocortisone/analysis ; Injections, Intravenous ; Ketorolac/*administration & dosage ; Male ; Middle Aged ; Morphine/*administration & dosage ; Oximetry ; Pain Measurement ; Pain, Postoperative/*prevention & control

PURPOSE: This study was done to identify job tasks and task elements of Korean nurse anesthetists according to type of medical institution. METHODS: A job task scale which consisted of 9 job tasks and 40 task elements was developed. Data were collected from December, 2009 to February, 2010 from 182 nurse anesthetists who were working in medical institutions (response rate: 75.8%). RESULTS: Forty-eight percent of nurse anesthetists were independent from anesthesiologists in anesthetic practice. Preanesthetic nursing assessment was much more frequent in small hospitals than in general hospitals (p<.05), and anesthetic nursing intervention, administering the anesthetics, monitoring the patient's status during anesthesia, and provision of safety and compliance with anesthetic ethics were much more frequent in general hospitals than medical centers (p<.001). There were no differences among the medical institutions for job tasks in post-anesthetic nursing interventions (p=.229), administering anesthetics (p=.354) and monitoring patients' status during anesthesia (p=.099), providing safe anesthetic environment (p=.896), and management of ancillary personnel/equipment (p=.617). CONCLUSION: Results indicate that nurse anesthetists contribute significantly to anesthetic practice in small hospitals and general hospitals. Therefore, it recommended that nursing leaders make efforts to enact legal nurse anesthetist-related policies for safe and high quality anesthetic nursing care.
Anesthesia ; Anesthetics ; Compliance ; Hospitals, General ; Humans ; Job Description ; Nurse Anesthetists ; Nurse Practitioners ; Nursing Assessment ; Nursing Care

PURPOSE: This study was carried out to investigate perception and experience of medication errors by nurses. METHOD: Data collection through a survey was performed using structured questionnaires over the period of September 1 to October 15, 2004. Questionnaire were delivered to 222 nurses from 15 hospitals; thereafter, 205 questionnaires were responded (i.e., 92% response rate). The subject in the study was a nurse who had been working in the hospital for less than one year. RESULTS: The average perception rate was 87.5%. The perception rates of subjects in medication errors from four areas are 62% in wrong dosage form for drug administration, 61.5% in air into an IV set, 63% in crystals in an IV lines, and 83.5% in wrong time. The experience rates of subjects in medication errors from four areas are 85.5% in wrong time, 39.5% in wrong injection site, 34.5% in omission error, and 28% in wrong patient. CONCLUSION: The average perception rate and experience rates of medication errors were 87.5% and 23.5%, respectively. Education about the Five right in medication and knowledges about drugs would improve the perception of medication errors of nurses whose work experience is less than one year, and prevent them from medication errors.
Surveys and Questionnaires ; Dosage Forms ; Education ; Humans ; Medication Errors* ; Questionnaires

PURPOSE: This study compared the effect of music and noise blocking on the vital signs, postoperative pain, analgesic use, length of stay in the Post Anesthesia Care Unit (PACU) and satisfaction after a laparoscopic colectomy. METHODS: This randomized controlled trial was performed in a 555-bed National Cancer Center, from February 13 through May 31, 2012. Subjects consisted of 69 patients who underwent a laparoscopic colectomy under general anesthesia, and were recruited by informed notices. The inclusion criteria were patients between the ages of 35-75, with an American Society Anesthesiologist physical classification I or II. The subjects were randomly allocated to three groups; music therapy group (MTG), noise blocking group (NBG) and control group (CG). Collected data were analyzed using Repeated measures ANOVA, one-way ANOVA and Kruskal-Wallis test through IBM SPSS (Version 19.0). RESULTS: There were no significant differences in vital signs among the three groups. Postoperative pain in MTG (p<.05) and NBG (p<.05) was significantly decreased compared to CG. The amount of analgesics (p=.030) and length of stay at PACU (p=.021) in MTG was significantly decreased compared to NBG or CG; satisfaction in MTG and NBG was significantly higher compared to CG. CONCLUSION: Music seems to reduce postoperative pain, the amount of analgesics, and the length of stay at PACU. Therefore, music therapy is considered to be included in nursing intervention for postoperative patients at PACU.
Analgesics ; Anesthesia ; Anesthesia, General ; Classification ; Colectomy* ; Humans ; Length of Stay* ; Music Therapy ; Music* ; Noise* ; Nursing ; Pain, Postoperative* ; Vital Signs

PURPOSE: This study aimed to identify factors influencing intra-operative core body temperature (CBT), and to develop a predictive model for intra-operative CBT in laparoscopic abdominal surgery. METHODS: The prospective observational study involved 161 subjects, whose age, weight, and height were collected. The basal pre-operative CBT, pre-operative blood pressure, and heartbeat were measured. CBT was measured 1 hour and 2 hours after pneumoperitoneum. RESULTS: Explanatory factors of intra-operative hypothermia (<36℃) were weight (β=.361, p<.001) and pre-operative CBT (β=.280, p=.001) 1 hour after pneumoperitoneum (Adjusted R2=.198, F=7.56, p<.001). Weight was (β=.423, p<.001) and pre-operative CBT was (β=.206, p=.011) 2 hours after pneumoperitoneum (Adjusted R2=.177, F=5.93, p<.001). The researchers developed a predictive model for intra-operative CBT (℃) by observing intra-operative CBT, body weight, and pre-operative CBT. The predictive model revealed that intra-operative CBT was positively correlated with body weight and pre-operative CBT. CONCLUSION: Influence of weight on intra-operative hypothermia increased over time from 1 hour to 2 hours after pneumoperitoneum, whereas influence of pre-operative CBT on intraoperative hypothermia decreased over time from 1 hour to 2 hours after pneumoperitoneum. The research recommends pre-warming for laparoscopic surgical patients to guard against intra-operative hypothermia.
Anesthesia, General* ; Blood Pressure ; Body Temperature* ; Body Weight ; Cohort Studies* ; Colectomy* ; Humans ; Hypothermia ; Laparoscopy ; Observational Study ; Pneumoperitoneum ; Prospective Studies

PURPOSE: The purpose of this study was to identify the effects of cuff pressure on postoperative sore throat. METHODS: Data were collected from January 4 through May 15, 2008. Among the 60 patients, 30 patients were randomly assigned to the control group and the rest to the experimental group. Initial cuff pressure of both groups was set at 20 cmH2O. The experimental group was maintained at 20 cmH2O throughout the anesthesia, while the control group was not regulated further. Sore throat was assessed at postoperative 1, 24 and 72 hours. Data were analyzed using Mann-Whitney U test and Spearman's rho coefficients. RESULTS: Cuff pressure in the control group increased from 20 to 43 cmH2O within 3 hours after induction. However, the experimental group showed that there was apparently a reduced rate of sore throat at postoperative 24 hours (p = .048), and 72 hours (p = .002) than in the control group. However, no outstanding differences between both groups at postoperative 1 hour (p = .081) were detected. The correlation between cuff pressure and sore throat was statistically significant (r(s) = .590, p < .001). CONCLUSION: We conclude that maintaining cuff pressure at 20 cmH2O could be an effective means to reduce sore throat in surgical patients with inhalation anesthesia.
Air Pressure ; Anesthesia ; Anesthesia, Inhalation ; Humans ; Intubation, Intratracheal ; Nitrous Oxide ; Pharyngitis

PURPOSE: The purpose of this study was to compare the effects of 21℃ CO₂ and 37℃ CO₂ pneumoperitoneum on body temperature, blood pressure, heart rate, and acid-base balance. METHODS: Data were collected at a 1300-bed university hospital in Incheon, from February through September 2012. A total of 74 patients who underwent laparoscopic colectomy under general anesthesia with desflurane were randomly allocated to either a control group or an experimental group. The control group received 21℃ CO₂ pneumoperitoneum; the experimental group received 37℃ CO₂ pneumoperitoneum. The pneumoperitoneum of the two groups was under abdominal pressure 15 mmHg. Body temperature, systolic blood pressure, heart rate and acid-base balance were assessed at 30 minutes and 90 minutes after pneumoperitoneum, and again at 30 minutes after arriving at the Post Anesthesia Care Unit. RESULTS: Body temperature in the 37℃ CO2 pneumoperitoneum group was significantly higher (F=9.43, p<.001) compared to the 21℃ CO₂ group. However, there were no statistically significant differences in systolic blood pressure (p=.895), heart rate (p=.340), pH (p=.231), PaCO₂ (p=.490) and HCO3- (p=.768) between the two groups. CONCLUSION: Pneumoperitoneum of 37℃ CO₂ is effective for the increase of body temperature compared to pneumoperitonium of 21℃ CO₂, and it does not result in a decrease of blood pressure, heart rate or acid-base imbalance.
Acid-Base Equilibrium* ; Acid-Base Imbalance ; Anesthesia ; Anesthesia, General ; Blood Pressure* ; Body Temperature Changes ; Body Temperature* ; Carbon Dioxide* ; Carbon* ; Colectomy ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Incheon ; Laparoscopy ; Pneumoperitoneum*

PURPOSE: The study was conducted to identify factors affecting the intraoperative core body temperature (CBT) of surgical patients under general anesthesia. METHODS: This study was performed through a prospective descriptive research design. The sample consisted of 138 patients who had undergone elective laparotomy surgery. Age, weight, height, the basal preoperative CBT, blood pressure, and heart rate were collected. CBT was again measured at induction of anesthesia, 1 hour, 2 hours, and 3 hours following induction of general anesthesia. RESULTS: Factors affecting intraoperative hypothermia <36degrees C at 1 hour following induction, were CBT at induction and total body fat (TBF) (R2=.569, p<.001); at 2 hours after induction, CBT at induction and TBF (R2=.507, p<.001); at 3 hours after induction, CBT at induction (beta=0.34), TBF, age and the ambient temperature in the operating room (R2=.449, p<.001). CONCLUSION: CBT at induction and TBF appear to be factors affecting intraoperative CBT within 2 hours after induction of anesthesia; CBT at induction, TBF, advanced age and the ambient temperature after 3 hours following induction. We recommend keeping surgical patients warm before induction of anesthesia and providing intraoperative warming for surgical patients of advanced age with low TBF and when the duration of general anesthesia will last more than 3 hours.
Adipose Tissue ; Anesthesia ; Anesthesia, General* ; Blood Pressure ; Body Temperature* ; Heart Rate ; Humans ; Hypothermia ; Laparotomy* ; Operating Rooms ; Prospective Studies ; Research Design

PURPOSE: The purpose of this study was to compare the effects of intravenous fluid warming and skin surface warming on peri-operative body temperature and acid base balance of abdominal surgical patients under general anesthesia. METHOD: Data collection was performed from January 4th, to May 31, 2004. The intravenous fluid warming(IFW) group(30 elderly patients) was warmed through an IV line by an Animec set to 37 degrees C. The skin surface warming(SSW) group(30 elderly patients) was warmed by a circulating-water blanket set to 38 degrees C under the back and a 60W heating lamp 40 cm above the chest. The warming continued from induction of general anesthesia to two hours after completion of surgery. Collected data was analyzed using Repeated Measures ANOVA, and Bonferroni methods. RESULTS: SSW was more effective than IFW in preventing hypothermia(p= .043), preventing a decrease of HCO3-(p= .000) and preventing base excess(p= .000) respectively. However, there was no difference in pH between the SSW and IFW(p= .401) groups. CONCLUSION: We conclude that skin surface warming is more effective in preventing hypothermia, and HCO3- and base excess during general anesthesia, and returning to normal body temperature after surgery than intravenous fluid warming; however, skin surface warming wasn't able to sustain a normal body temperature in elderly patients undergoing abdominal surgery under general anesthesia.
Abdomen/*surgery ; Acid-Base Equilibrium ; Aged ; Anesthesia, General ; *Body Temperature Regulation ; Female ; *Hot Temperature ; Humans ; Hypothermia/etiology ; Infusions, Intravenous ; Intraoperative Complications/prevention & control ; Male ; Middle Aged ; Oximetry ; Preoperative Care/*methods ; *Skin Temperature

PURPOSE: This study was performed to identify changes in blood glucose at preoperative fasting time in surgical patients over 60 yr. METHODS: Data collection was performed from July, 2008 through July, 2009. Participants consisted of 80 nondiabetic surgical patients. Blood glucose was checked from 3 to 5 times. The 5 times were 2-hr fasting on the pre-operative day (T1, n=80), 8 hr (T2, n=80), 10 hr (T3, n=17), 12 hr (T4, n=34) and 14 hr fasting on the day of the operation (T5, n=29). RESULTS: Of the patients, 27.5% had a blood glucose level of less than 79 mg/dL at T2; 17.6% at T3; 32.4% at T4; and 17.2% at T5. Mean blood glucose levels were 93.8 mg/dL at T1; 88.4 mg/dL at T2; 91.7 mg/dL at T3; 87.4 mg/dL at T4: and 94.1 mg/dL at T5. Blood glucose was the lowest at T2 (p<.001). CONCLUSION: As 17.6-32.4% of the patients showed the blood glucose level of less than 79 mg/dL at 8-14 hr pre-operative fasting, the authors recommend that surgical patients >60 yr-of-age be observed for hypoglycemia during pre-operative fasting of more than 10 hr and that surgical patients >60 yr-of-age with risks for hypoglycemia be scheduled for operation within 10 hr preoperative fasting.
Aged ; Aged, 80 and over ; Blood Glucose/*analysis ; Body Mass Index ; *Fasting ; Female ; Hemoglobins/analysis ; Humans ; Hypoglycemia/blood/prevention & control ; Male ; Middle Aged ; Preoperative Care ; Risk ; Serum Albumin/analysis ; Sex Factors ; Time Factors