No abstract available.
Adult* ; Epiglottitis* ; Humans

BACKGROUND: Tracheal intubation for general anesthesia often leads to trauma of the airway mucosa, resulting in postoperative sore throat and hoarseness. Numerous studies have investigated the factors as contributing causes, but the influence of method of anesthesia induction and time for extubation of the endotracheal tube has not been systematically examined. The aim of this study was to establish the effects of the methods of anesthesia induction and timing of extubation on postoperative sore throat and hoarseness. METHODS: Eighty patients with ASA physical status 1 or 2 were randomly divided into four groups. Group 1 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and early extubated ; group 2 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and lately extubated ; group 3 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and early extubated ; group 4 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and lately extubated. All patients were interviewed 6, 24, 48, and 72 hrs after operation by an anesthesiologist in a double-blind manner. RESULTS: The incidence of sore throat at postoperative 6 and 24 hrs were decreased in group 3 compaired with group 1, 2, and 4 (p<0.05), respectively. The severity of sore throat at postoperative 6 hrs were decreased in group 3 compared with group 1, 2 and 4 (p<0.05), and that of postoperative 24 hrs were decreased in group 3 compared with group 1 and 2 (p<0.05), respectively. The severity of hoarseness at postoperative 6 hrs were decreased in group 3 compared with group 2 (p<0.05). CONCLUSIONS: We suggest that postoperative sore throat and hoarseness may be developed more when extubation was perfomed lately than early. Therefore, early extubation provide advantage in terms of reducing sore throat and hoarseness in limited cases of anesthesia.
Anesthesia* ; Anesthesia, General ; Hoarseness* ; Humans ; Incidence ; Intubation ; Mucous Membrane ; Pancuronium ; Pharyngitis* ; Succinylcholine

No abstract available.
Facial Nerve* ; Paralysis*

In the anesthesia for Cesarean section, the anesthetists should select the agent and technique which is safe for both the morther and baby. It seems to be a general tendency that delivery by Cesarean section has been increasing because of the development of anesthetic techniques and agents with which one can give a safter anesthesia than before and in turn, has led to increased anesthetic dependence. A small dose of ketamine with nitrous oxide was tried for the induction of anesthesia for Cesarean section in the first group. In the second group, thiopental was given intravenously and anesthesia was maintained with 2% halothane in 100% oxygen for the delivery. After delivery, morphine, diazepam, and muscle relaxant were added to 0.5~1.0% halothane if necessary. These two groups were compared with conventional thiopental N2O-O2 anesthesia and the results were as follws: 1) Changes in blood pressure were similar aspect in each group, but in the hypertensive mother, the ketamine caused a higher blood pressure than the other agents. 2) Changes in pulse rate also had a similar pattern in each group. 3) I-D and U-D interval was the shortest in the halothane group. 4) The Apgar score at 1 min after delivery wasrelatively higher in the ketamine and halothane group than in the thiopental group, while the score at 5 min was almost the same in each group. 5) The analgesic effect of ketamine was superior to that of other agents. The above data suggest that halothane seems to be superior when the fetal position is abnormal or in case when complicated intrauterine manipulation is expected. A small dose of ketamine with nitrous oxide is better in the hypertensive mother or when fetal distress exists.
Anesthesia* ; Apgar Score ; Blood Pressure ; Cesarean Section* ; Diazepam ; Female ; Fetal Distress ; Halothane ; Heart Rate ; Humans ; Ketamine ; Morphine ; Mothers ; Nitrous Oxide ; Oxygen ; Pregnancy ; Thiopental

BACKGROUND: Postoperative myalgia after administration of succinylcholine is a frequent complication after surgery. This study was designed to determine whether there was any association between postoperative myalgia and muscle relaxants. METHODS: Sixty patients were assigned to three groups of equal size. Group 1, the patients received succinylcholine, 1.0 mg/kg for tracheal intubation. Group 2, received pancuronium 0.01 mg/kg, 4 minutes before administration of succinylcholine 1.5 mg/kg. Group 3, received pancuronium 0.01 mg/kg, 4 minutes before administration of pancuronium 0.09 mg/kg. Blood samples for determination of serum potassium concentration were taken before the induction of anesthesia and 3 minutes after tracheal intubation. The incidence and severity of muscle fasciculation and myalgia were assessed in a double-blind manner. RESULTS: Serum potassium concentration was significantly increased in group 1. In group 2, incidence and severity of muscle fasciculation were significantly less than groups 1. Postoperative myalgia was significantly less in group 3 when compared with group 1 and 2. CONCLUSIONS: There was no significant correlation between succinylcholine induced fasciculation and postoperative myalgia. Pretreatment with pancuronium decreased the incidence of fasciculation and the changes of serum potassium concentration by succinylcholine, but has little effects on the succinylcholine induced postoperative myalgia.
Anesthesia ; Fasciculation ; Humans ; Incidence ; Intubation ; Myalgia* ; Pancuronium* ; Potassium ; Succinylcholine*

PURPOSE: Infective endocarditis (IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis. METHODS: The clinical records of children diagnosed as IE at the Seoul National University Children's Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG. RESULTS: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG (early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease (CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases (33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram (-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG (23.5% versus 0%, P=0.033). CONCLUSION: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.
Candida albicans ; Child* ; Diagnosis ; Endocarditis* ; Female ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Male ; Mortality ; Prognosis ; Retrospective Studies ; Rheumatic Heart Disease ; Seoul ; Thoracic Surgery ; Viridans Streptococci

PURPOSE: Though acute pyogenic infections of musculoskeletal system are infrequent in children, delayed diagnosis or inadequate management may cause serious chronic sequelae. We analysed 40 cases of children who were affected by acute septic osteomyelitis and/or septic arthritis to find etiologic agents and to establish proper initial antimicrobial therapy. METHODS: Medical records of 40 cases of microbiologically confirmed acute pyogenic osteomyelitis and/or septic arthritis diagnosed at the Seoul National University Children's Hospital from January 1985 to September 1998 were reviewed. RESULTS: There were 12 cases of acute osteomyelitis, 28 of acute septic arthritis, and 4 of concurrent cases of two diseases. Of 12 cases of acute pyogenic osteomyelitis, there were 7 boys and 5 girls whose average age was 75.4 months. Calcaneus was infected in 4 cases and it was the most common site. Ten cases (83.3%) of them were attributable to Staphylococcus aureus, 1 to Streptococcus viridans and 1 to Pseudomonas aeruginosa. Among the 28 cases of acute septic arthritis, male to female ratio was 16 : 12. The hip joint was the most frequent site involved in 13 cases (46.3%), followed by the ankle joint, which was involved in 6 cases (21.4%). The majority of the children were infected by S. aureus (20 cases, 71.4%). Two cases were infected by S. viridans or Salmonella (group D) species, and 1 by Haemophilus influenzae. CONCLUSION: S. aureus was the most common pathogen of acute pyogenic osteoarthritis, and H. influenzae was an infrequent cause of septic arthritis. Regarding initial empirical anibiotic therapy, anti-staphylococcal agent should be included.
Ankle Joint ; Arthritis ; Arthritis, Infectious ; Calcaneus ; Child* ; Delayed Diagnosis ; Female ; Haemophilus influenzae ; Hip Joint ; Humans ; Influenza, Human ; Male ; Medical Records ; Musculoskeletal System ; Osteoarthritis* ; Osteomyelitis ; Pseudomonas aeruginosa ; Salmonella ; Seoul ; Staphylococcus aureus ; Viridans Streptococci

PURPOSE: Pigmented spindle cell tumor of the palpebral conjunctiva is very rare, and most of the tumors arise at extremities or trunk. To our best knowledge, no case has been repoted in Korea so far. We report one case of pigmented spindle cell nevus with literature review. METHODS: A 21 years-old male patient complaining of mass on the left upper palpebral conjunctiva underwent excisional biopsy with minimal touch technique. RESULTS: On histopathologic examination, the mass consisted of small, regular and spindle cells with pigmentation. And HMB-45 and CD-34 stains were negative, while S-100 stain was weakly positive. CONCLUSIONS: We report one case of pigmented spindle cell nevus as the first case in Korea.
Biopsy ; Coloring Agents ; Conjunctiva* ; Extremities ; Humans ; Korea ; Male ; Nevus, Spindle Cell* ; Pigmentation ; Young Adult

BACKGROUND: Streptococcus pyogenes causes most often pharyngitis or tonsillitis but may also be responsible for severe diseases including bacteremia and pneumonia. Recent publications from several geographic areas showed high rates of resistance to erythromycin and newer macrolides, often used in patients allergic to penicillin, in clinical isolates of S. pyogenes. METHODS: Minimum inhibitory concentration of 31 strains of S. pyogenes, isolated at the Seoul National University Children's Hospital from October 1991 through April 1998, were determined for penicillin, ceftriaxone, vancomycin, clindamycin, erythromycin, roxythromycin, and clarithromycin by agar dilution method or E-test. In addition, clinical features of the patients from whom the organisms were isolated were reviewed retrospectively. RESULTS: Of the 28 patients whose medical records were reviewed, the most common clinical presentations were soft-tissue infection (8 cases) and pharyngitis (5 cases). Other presentations included bacteremia without focus, pneumonia, vaginitis, lymphadenitis, omphalitis (two of each); primary peritonitis, rheumatic fever with carditis, scarlet fever, acute otitis media, and disseminated disease (one of each). All of the isolates were susceptible to penicillin, ceftriaxone, and vancomycin. However, 5 isolates (16%) were resistant to erythromycin, and all of the erythromycin-resistant strains were resistant to roxythromycin and clarithromycin as well. Three of these erythromycin-resistant strains were also resistant to clindamycin. CONCLUSION: S. pyogenes may cause serious infections in children. Emergence of resistance in clinical isolates of S. pyogenes to macrolides and clindamycin should be considered in empirical antimicrobial therapy of suspected group A streptococcal infections and in establishment of antibiotic policy in Korea.
Agar ; Bacteremia ; Ceftriaxone ; Child* ; Clarithromycin ; Clindamycin ; Erythromycin ; Humans ; Korea ; Lymphadenitis ; Macrolides ; Medical Records ; Microbial Sensitivity Tests ; Myocarditis ; Otitis Media ; Palatine Tonsil ; Penicillins ; Peritonitis ; Pharyngitis ; Pneumonia ; Retrospective Studies ; Rheumatic Fever ; Scarlet Fever ; Seoul ; Streptococcal Infections ; Streptococcus pyogenes* ; Streptococcus* ; Tonsillitis ; Vaginitis ; Vancomycin

Postoperative pain may be associated with shallow breathing, inability to cough, and reduction in spirometric values which lead to restrictive pattern of ventiltion with hypoxemia and/or hypercapnea. Therfore postoperative pain should be maneged by using appropriate methods. To investigate the analgesic effect of interpleural block with 0.25% or 0.375% bupivacaine hydrochloride, 30 patients were randomly divided into one of three groups(saline group, 0.25% bupivacaine group and 0.375% bupivacaine group). In the saline group, 0.9% saline with 1: 200, 000 epinephrine(0.5 ml/kg) was injected into the pleural cavity via the chest drainage tube, either 0.25% or 0.375% bupivacaine with 1: 200,000 epinephrine(0.5 ml/kg) was injected with the same manner of the saline group in the bupivacaine groups, respectively. Respiratory parameters(minute volume, tidal volume, respiratory rate, forced vital capacity, incentive spirometric volume, cough score, deep inspiratory score), numeric pain rating score and hemodynamic changes were measured before anesthetic induction, 10 minutes before the study drug injection, 30 and 60 minutes after the study drug administration, respectively. Postoperative respiratory parameters were decreased at l0 minutes before the drug injection compared to the preanesthetic values in all groups. There were no statistically significant differences of all parameters after the drug administration among three groups. There was a tendency of improvement in the respiratory parameters after the drug injection in saline and 0.25 % bupivacaine groups and a greater tendency of improvement of respiratory parameters and numeric pain rating score in 0.375% bupivacaine group than the other groups. Only one case of tachycardia was developed in the saline group. These results suggest that the postoperative pain after thoracotomy is not appropriately manged by using the interpleural block with 0.25% or 0.375% bupivacaine hydrochloride (0.5 ml/kg) administrated via the drainage tube of the chest.
Anoxia ; Bupivacaine* ; Cough ; Drainage ; Hemodynamics ; Humans ; Motivation ; Pain, Postoperative ; Pleural Cavity ; Respiration ; Respiratory Rate ; Tachycardia ; Thoracotomy* ; Thorax ; Tidal Volume ; Vital Capacity