BACKGROUND: Various kinds of methods had been tried to reduce pain on injection of propofol. In this study, the effect of lidocaine pretreatment and that of temperature controlled injections were compared and evaluated its clinical utility. METHODS: One hundred and twenty patients were randomly allocated into 4 groups after permission. Room temperature propofol was used as induction agent in group P,. In group C, cooling (4 degrees C) propofol was used and warming propofol (37 degrees C) in group H. And room temperature propofol following lidocaine (1 mg/kg) was used in group L. Injection dosage of propofol was 2 mg/kg and injection speed was 2 ml/sec in all groups. In each patients, pain score and visual analog scale were measured and tested by ANOVA or Kruskal-Wallis test. RESULTS: There were no statistical significant difference in pain score among the 4 groups. But in visual analog scale analysis, group L markedly reduced values than the other groups by statistically significant manner (in Duncan grouping). CONCLUSION: The alleviating effect of lidocaine pretreatment on painful injection was better than that of changing temperature of propofol itself. More over effectiveness, in view of simplicity, we recommend lidocaine pretreatment.
Humans ; Lidocaine ; Propofol* ; Visual Analog Scale

BACKGROUND: Better effect of antiemetic drugs can be obtained by combination of multiple antiemetic drugs that have different mechanisms of action. However, if the combined drugs have similar mechanisms of action, the incidence of side effects may be increase. This study was conducted to evaluate the ability of using combination therapy consisting of metoclopramide and dexamethasone in control of postoperative nausea and vomiting. METHODS: Sixty adult female patients undergoing major gynecological operation under the general anesthesia were randomly divided into two groups according to administered drugs. The patients received a single IV dose of metoclopramide (10 mg, Group I) or metoclopramide plus dexamethasone (10 mg 8 mg, Group II) when as operator sutured the skin wound. The incidences of nausea and vomiting were assessed during the first 12, 24, and 48 hours after recovery from anesthesia. RESULTS: There were no prominent incidences of postoperative nausea and vomiting between two groups within postoperative 12 hours. But there were significantly increased incidences of nausea and vomiting in Group I (26.7%, 13.3%) compared to Group II ( 8.0%, 3.2%) during postoperative 24 hours and 48 hours. CONCLUSIONS: Combination therapy of metoclopramide with dexamethasone seemes to have no synergic effect in control of postoperative nausea and vomiting.
Adult ; Anesthesia ; Anesthesia, General ; Antiemetics ; Dexamethasone* ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Metoclopramide* ; Nausea ; Postoperative Nausea and Vomiting* ; Skin ; Vomiting ; Wounds and Injuries

A 25-year-old woman transferred to pain clinic complaining of severe throbbing eye ball pain, eyelid edema and severe tearing in her left eye under the diagnosis of herpes zoster ophthalmicus that was developed 3months ago. In addtion to conventional medication, she had been taken stellate ganglion block, supraorbital and supratrochlear nerve block to contol of pain, but the response was poor. So we tried to administer ketamine subcutaneously, because not only ketamine, NMDA receptor antagonist, played a significant role to reduce neuropathic pain and pain caused by nerve injury, but also she wanted to work in her office during the treatment. We used subcutaneous ketamine 3 mg/hr (0.06 mg/kg/hr) in patient with postherpetic neuralgia of the ophthalmic nerve, and accomplished almost complete pain relief without any sign of side effect.
Adult ; Diagnosis ; Edema ; Eyelids ; Female ; Herpes Zoster Ophthalmicus ; Humans ; Infusions, Subcutaneous* ; Ketamine* ; N-Methylaspartate ; Nerve Block ; Neuralgia ; Neuralgia, Postherpetic* ; Ophthalmic Nerve* ; Pain Clinics ; Pain Management* ; Stellate Ganglion

BACKGROUND: Postintubational sore throat and hoarseness are usually mild symptoms but they are very common complaints among the patients after endotracheal general anesthesia. In addition, some might have severe discomfort and need invasive procedure to relieve these problems. We tried new method of endotracheal tube cuff filling with local anesthetics to reduce postoperative sore throat and hoarseness and evaluated the results. METHODS: Endotracheal cuff filling was done with air 5 ml in healthy 20 patients (ASA I-II, control group). And in another healthy (ASA I-II) 35 patients, the cuffs were filled with 4% lidocaine 3.5 ml and 8.4% sodium bicarbonate 1.5 ml mixture. After 24 hours following general anesthesia, patients were visited and asked whether there were sore throat or hoarseness, if any, how the degree was. RESULTS: In lidocaine-treated group, the incidence of postintubational sore throat was less compared to control group significantly. There was no difference in incidence of hoarseness between two groups. CONCLUSION: Endotracheal cuff filled with lidocaine and sodium bicarbonate mixture is suggested as an effective protective method that reduces the frequency of postintubational sore throat.
Anesthesia* ; Anesthesia, General ; Anesthetics, Local ; Hoarseness* ; Humans ; Incidence ; Lidocaine* ; Pharyngitis* ; Sodium Bicarbonate* ; Sodium*

BACKGROUND: Recently, using propofol as intravenous anesthetic agent is increasing. And it is known that propofol has little effects on liver function even after long operation such as plastic surgery. But its effect on liver functon after hepatobilliary operation which may damage liver was not studied. Thus, authors carried out this study to evaluate the effect of propofol on liver function by comparing with enflurane in the patients who had laparoscopic cholecystectomy. METHODS: Patients's anesthesia records and hospital charts from January 1994 to June 1996 were anlaysed retrospectively. Three hundred and thirty three patients who had normal liver function preoperatively and had no complications during and after operation were selected. They were divided into two groups ; propofol group (n=191) and enflurane group (n=142). The preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those of 1 and 3 days after operation. RESULTS: One day after operation, both propofol and enflurane group showed significant increase in AST and ALT (p<0.05) and decrease in ALP (p<0.05). But there was no difference between two groups. CONCLUSION: Concerned to liver function, propofol is as useful as enflurane to the patients who scheduled for laparoscopic cholecystectomy.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Cholecystectomy, Laparoscopic* ; Enflurane* ; Humans ; Liver* ; Propofol* ; Retrospective Studies ; Surgery, Plastic

OBJECTIVE: The purpose of the current series of experiments were to assess the effect of GM-CSF, as a medium supplement, on the development of mouse embryos and the expression of LIF and IL-1beta mRNA. MATERIALS AND METHODS: Mouse 2-cell embryos were collected from the oviducts of 6 weeks old ICR mice at 48 hours after hCG injection. Embryos were cultured in P-1 medium supplemented with mouse GM-CSF(0,1,5,10 ng/ml). The embryo development to blastocysts and hatching blastocysts was assessed and the cell number in blastocyst was also examined. Using RT-PCR, the expressions of LIF and IL-1beta mRNA in blastocyst were evaluated in the GM-CSF supplemented group and control group. RESULTS: In mouse, the addition of GM-CSF increased the percentage of blastocysts(65.5%, 68.6%, 73.0% and 76.1% for control and 1, 5 and 10 ng/ml, respectively), and increased the proportion of hatching blastocysts(35.2%, 36.4%, 43.2% and 53.0% for control and 1, 5 and 10 ng/ml, respectively). The mean cell numbers in blastocyst were significantly increased in GM-CSF supplemented groups compared to control group. LIF and IL-1beta expression in blastocysts were significantly higher in GM-CSF supplemented group than in control group. CONCLUSION: The results of experiment by mouse embryos showed beneficial effects of GM-CSF as a medium supplement. Furthermore, the addition of GM-CSF significantly increased the expression of LIF and IL-1beta in mouse embryos. These results suggest that GM-CSF might be a important molecule in embryo implantation.
Animals ; Blastocyst ; Cell Count ; Embryo Implantation ; Embryonic Development* ; Embryonic Structures* ; Female ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Mice* ; Mice, Inbred ICR ; Oviducts ; Pregnancy ; RNA, Messenger

BACKGROUND: Management of patients with massive hemorrhage often requires the massive blood transfusions. However, few studies have investigated the effects of massive transfusions on non-traumatic patients. Therefore, this study analyzed mortality and descriptive data for patients receiving massive transfusion, including non-trauma patients and trauma patients. METHODS: We reviewed a retrospective audit of massive transfusions to investigate the major causes, patient characteristics, ratio of the blood components, and the mortality of massively transfused patients. The analysis was performed using electronic medical records collected from January 2010 to December 2013. Patients who had received a massive transfusion (≥10 units of RBCs within 24-hours) were categorized into trauma and non-trauma patients. We calculated the ratio of blood components and investigated the relationship between ratio and mortality. Descriptive statistics were used to characterize the patients and the indications. RESULTS: A total of 532 massive transfusions were performed, including 187 trauma and 345 non-trauma patients. The overall mortality rate was 32.0%, encompassing 36.4% of the trauma patients and 29.6% of the non-trauma patients. The mortality in trauma patients was significantly reduced (P<0.001) within the first 48-hours compared with that in non-trauma patients, which was due to the high FFP: RBC ratio transfusion. The annual FFP: RBC ratio in trauma patients showed an increasing trend. Non-trauma patients showed no relationship between mortality and procedure indication/blood component ratio. CONCLUSION: We report clinical data pertaining to massive transfusions. Annual increasing FFP: RBC ratio in trauma patients was associated with a decreasing mortality. Non-trauma patients showed heterogeneous characteristics and a lower FFP: RBC ratio than trauma patients.
Blood Transfusion ; Electronic Health Records ; Hemorrhage ; Humans ; Mortality ; Retrospective Studies ; Tertiary Care Centers*

BACKGROUNDS: Pancreaticoduodenectomy has been applied to diseases of periampullary region since 1935 by Whipple and associates, but this procedure is so complexed that associated with high morbidity and mortality. In the treatment of periampullary cancer, curative surgical resection only promises the possibilities of cure, because other methods of treatment including chemotherapy and radiation therapy have been of little or no benefit to improve the survival rate. METHODS: We performed the clinical analysis on 123 cases of pancreaticoduodenectomies at the department of Surgery, Chonnam University Hospital, during the past 11 years from June 1986 to May 1997 to assess the associated factors with postoperative complications and the survival rate. RESULTS: Among 123 cases, 104 cases(84.6%) were malignant tumor of periampullary region, 16 cases were benign lesion, and 3 cases were type IV pancreatic injury. Pancreaticoduodenectomy was performed in 115 cases, pylorus-preserving pancreaticoduodenectomy in 4 cases, total pancreatectomy in 2 cases and extended pancreaticoduodenectomy in 2 cases. Postoperative complications were developed in 28 cases(22.8%) and the major cause of postoperative complication was the anastomotic leakage, especially in the pancreatico-jejunostomy site. The overall operative and hospital mortality rate was 7.3%. Preoperative percutaneous transhepatic biliary drainage(PTBD) and the serum level of albumin and bilirubin were not related to the development of postoperative complications. Factors affecting survival after resection of malignant tumor were the size of tumor, presence of lymph node metastasis and tumor infiltration to adjacent tissue, but the level of CEA, alphaFP, and CA 19-9 and tumor differentiation were not related to the survival rate statistically. CONCLUSION: Optimal preoperative preparation of the patient and a meticulous and standarized operative technique are mandatory to minimize the operative morbidity and mortality after pancreaticoduodenectomy. In the treatment of periampullary cancer, radical surgical resection is recommended for long-term survival, as well as the development of other treatment modalities to prevent the postoperative recurrence.
Anastomotic Leak ; Bilirubin ; Drug Therapy ; Hospital Mortality ; Humans ; Jeollanam-do ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatectomy ; Pancreaticoduodenectomy* ; Postoperative Complications ; Recurrence ; Survival Rate

PURPOSE: To evaluate the CT findings of patients with surgically confirmed perforated appendicitis and to compare the characteristics between children and adults. METHOD AND MATERIALS: Patients in whom complicated appendicitis was clinically suspected underwent contrast enhanced CT scanning. The scans of 50 patients (19children and 31 adults) with surgically confirmed perforated appendicitis were analysed. Without knowledge of operative findings, we retrospectively analyzed the CT findings with regard to : 1) the detection of the appendiceal wall thickening; 2) the presence of appendicolith; 3) the size, features, and location of periappendical abscess; 4) mesenteric fat infiltration and lymphadenopathy; 5) wall thickening of the cecum and terminal ileum; and 6) ascites and free air. RESULTS: Appendiceal wall thickening was detected in seven children(37%) and 13 adults (42%) (p>0.05). Appendicolith was detected in 21 patients (42%) and was more frequent in children (13 cases, 68%) than in adults (8 cases, 26%). There were statistically significant differences between the two groups (p<0.05). The mean diameter of periappendiceal abscesses was 3.7+/-1.9 cm (3.2+/-1.9 cm in children and 4.0+/-1.8 cm in adults), with no stastistically significant differences between the two groups (p>0.05). Periappendiceal abscess with well-defined cyst was more frequent in children (17/19, 89%) than in adults (13/31,42%) (p<0.05). The most commonly involved site was the midabdomen and pelvis in children (9/19, 47%), and the right lower quadrant in adults (18/31, 58%), (p <.05). Mesenteric lymph nodes were commonly detected in children, and cecal wall thickening in adults. CONCLUSION: The CT findings of perforated appendicitis included appendiceal wall thickening, appendicolith, periappendiceal abscess, mesenteric fat infiltration and enlargement of mesentericlymph nodes, and thickening of the cecum wall Periappendiceal abscess with well-defined cyst in the midabdomen or pelvis was more frequent in children, as were appendicolith and enlargement of mesenteric lymph nodes.
Abscess ; Adult* ; Appendicitis* ; Ascites ; Cecum ; Child* ; Humans ; Ileum ; Lymph Nodes ; Lymphatic Diseases ; Pelvis ; Retrospective Studies ; Tomography, X-Ray Computed

Until several years ago it was generally agreed that anihypertensive medication should be stopped a few weeks before anesthesia and surgery in order to regain the compensatory function of cardiovascular system during anesthesia and surgical stress. However the present concept is that the better the hypertension is controled the more the patient's chances of surving anesthesia and it is recommended that antihypertensive medication should be continued to the time of anesthesia. The authors have experienced cases of hypertensive patients undergoing various kinds of operation and have-analyzed these cases according to the degree of hypertension, sex, department, anesthetic agent and technique, previous anesthetic medication, abnormal ECG finding and arterial blood pressure changes after anesthesia, at Jeonbug National University Hospital from January 1977 to June 1979. The results were as follows: 1) The number of hypertensive cases was 326 (12. 3%) out of 2664 total patient who received various surgical operations. 2) Only a few patients(16cases, 0. 5%) received antihypertensive medication before surgery. 3) The degree of hypertension was mostly class 1 or 2(274 patients, 78%) according to the severity index of Elwood 4) Most of the patients (253 cases, 74%) revealed elevated blood pressure after induction of anesthesia.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Electrocardiography ; Humans ; Hypertension ; Jeollabuk-do