BACKGROUND: Core hypothermia after induction of anesthesia results from an core-to-peripheral redistribution of body heat and a loss of body heat to environment. The purpose of this study is finding body temperatures during operation by either general of epidural anesthesia and evaluates content of total body heat. METHODS: We measured tympanic membrane temperature, 4 point skin temperature (mid calf, mid thigh, upper extremity, nipple). And we calculate mean skin temperature, mean body temperature, total body heat content changes based on tympanic membrane temperature and 4 point skin temperature. RESULTS: Tympanic membrane temperature of the first group decreased significantly after 10 minutes of induction (p<0.005), the second group decreased after 45 minutes of induction. Although upper extremity temperature has continuously increased as time passed, there was no significant difference in both group. Lower extremity temperature has significantly increased after 30 minutes of induction in the first group, and the second group has significantly increased after 10 minutes of induction (p<0.05). Mean skin temperature hasdecreasd temperaturily in both group after 10 minutes of induction and increased as time passed. Mean body temperature of the first group has significantly decreased after 10 minutes of induction (p<0.05) and second group has no significant changes. Total body heat content has continuously decreased after induction with no significance. CONCLUSIONS: General anesthesia reveals more significant decrease than epidural anesthesia. Both groups show significant decrease of body temperature after induction. We think that we need to close attention to temperature changes after induction for preventing possible side effects due to core hypothermia.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Body Temperature Changes* ; Body Temperature* ; Hot Temperature ; Hypothermia ; Lower Extremity ; Skin Temperature ; Thigh ; Tympanic Membrane ; Upper Extremity

The purpose of this study is to demonstrate a new postoperative analgesic which minimize the physiological changes of patients. Recently, it has become popular to administer opioids to epidural space rather than intravenously or by intramuscular administration. However, the side effects of opioids have limited the usefulness of this procedure. We tried to find out a way of providing postoperative analgesia while minimizing the side effects of opioids. This study has tested the effects of administering a mixture of small doses of morphine, fentanyl and bupivacaine and epidural morphine alone. The data of this study has taken from 20 paturients who have scheduled for cesarean section. We have classified into two groups which consist of 10 paturients each. We have administered epidural morphine alone to the first group and a small doses of morphine-fentanyl-bupivacaine mixture to second group. We have evaluated analgesic effects by comparing both groups' pain scores of the operative day and of the first postoperative day and evaluated such side effects as the degree of itching, nausea, vomiting, dizziness and respiratory depression by asking to paturients. This study has found the followings: 1) Pain scores of the first group in the operative day and the first postoperative day are 1.2+/-0.4 and 0.4+/-0.5. The second group's pain scores are 0.2+/-0.4 and 0, and the second group's pain scores have significantly reduced (p<0.05). 2) Frequencies of such side effects as itching, nausea and vomiting are higher in the first group (8) than in the second group(4). In conclusion, small doses of morphine-fentanyl-bupivacaine mixture has demonstrated a more effective postoperative analgesia with minimum side effects in pain controlling after cesarean section than epidural morphine alone.
Analgesia* ; Analgesics, Opioid ; Bupivacaine ; Cesarean Section* ; Dizziness ; Epidural Space ; Female ; Fentanyl ; Humans ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Vomiting

PURPOSE: To provide for popularization of out-patient surgery, we investigated actual problems occurring after minimally invasive surgery in children. MATERIALS AND METHODS: We reviewed the medical records of 132 patients(154 operations) who performed minimal invasive surgery from January, 1996 to June 1998. All problems following operation were identified in terms of kinds, degrees, and their correlations, including fever, pain, nausea, vomiting, and wound condition, etc. RESULTS: The age of the patients were 0.1 to 16 years(mean, 4.5 years). Of 154 operations hydrocelectomy were 84, orchiopexy 41, and they were 81.2% of all. Operation time were 25 minutes to 150minutes(mean, 63minutes). There were 170 postoperative problems including mild ones, among whom 100 patients revealed changes in body temperature over 37.0degrees C and 43 patients high fever over 37.5degrees C and these fevers were resolved spontaneously even with conservative treatment in short duration excluding one patient who took 39.3degrees C sustaining for 3 days and had a mild touch of flu before operation. 5 patients complained severe wound pain to be injected analgesics without actual wound problem such as bleeding or hematoma, etc. One patient couldn`t void urine to need nelaton catherization one time. CONCLUSIONS: With proper selection and strict preoperative preparation of patients, meticulous anesthesia and operation, careful postoperative check and easy call to doctor, there would be no critical problems following minimally invasive urologic surgery in children.
Analgesics ; Anesthesia ; Body Temperature ; Child* ; Fever ; Hematoma ; Hemorrhage ; Humans ; Medical Records ; Nausea ; Orchiopexy ; Outpatients ; Surgical Procedures, Minimally Invasive* ; Vomiting ; Wounds and Injuries

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.
Anesthesia, General* ; Anoxia ; Arrhythmias, Cardiac ; Blood Pressure ; Carbon Dioxide ; Cardiovascular System ; Head-Down Tilt* ; Heart Rate ; Hypotension ; Insufflation* ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Tidal Volume ; Vital Signs

BACKGROUND: Doppler ultrasound has recently been used to assess change in blood velocity in the uterine and umbilical arteries. Alterations in the ratio of systolic to diastolic velocity (= S/D ratio) are believed to reflect changes in placental vascular resistance. We have used this technique to assess potential beneficial or detrimental effects of epidural anesthesia on blood flow to the placenta. METHODS: Continuous wave Doppler ultrasound was used to measure the S/D ratio in the uterine and umbilical arteries of 40 patients undergoing epidural anesthesia prior to elective cesarean section. Left uterine displacement was employed throughout. Doppler ultrasound obtained at the level of umbilical artery and uterine artery. Prior to induction of anesthesia each patient received 800~1,000 ml of lactated Ringer's solution within 20~30 minutes. For epidural anesthesia 2% lidocaine 10 ml and 0.5% bupivacaine 10 ml were used. An upper level of sensory anesthesia to at least T10 was confirmed before umbilical and uterine artery waveform measurement. RESULTS: Epidural anesthesia was followed by a reduction in umbilical artery systolic : diastolic ratio from 2.48+/-0.5 to 2.24+/-0.40 (p<0.05) and in uterine artery systolic : diastolic ratio from 2.29+/-0.41 to 1.96+/- 0.25 (p<0.05). CONCLUSIONS: Epidural anesthesia for cesarean section resulted in a significant decrease in the maternal uterine artery S/D ratio and fetal umbilical artery S/D ratio. This study suggests beneficial fetal effect from the improved maternal uterine perfusion after epidural anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Blood Flow Velocity* ; Bupivacaine ; Cesarean Section* ; Female ; Humans ; Lidocaine ; Perfusion ; Placenta ; Pregnancy ; Ultrasonography ; Umbilical Arteries ; Uterine Artery ; Vascular Resistance

A 77-year-old woman was scheduled for a coronary artery bypass graft. Her preoperative transthoracic echocardiographic (TTE) examination revealed an enlarged left atrium with reduced systolic dysfunction (ejection fraction: 38%), moderate global hypokinesia of the left ventricle, and moderate mitral and tricuspid regurgitation. No thrombus was visualized on the preoperative TTE. However, the intraoperative transesophageal echocardiography performed before the cardiopulmonary bypass revealed a thrombus of approximately 1.3 × 1.8 cm in the left atrial appendage (LAA). The LAA thrombus was removed, an internal suture was placed on the LAA before the coronary artery bypass grafting, and the main operation was performed successfully. The patient was transferred to the intensive care unit to receive postoperative care. She was extubated 4 h after the surgery and was transferred to the general ward on postoperative day 3 without any neurological sequelae.
Aged ; Atrial Appendage* ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Atria ; Heart Ventricles ; Humans ; Hypokinesia ; Intensive Care Units ; Patients' Rooms ; Postoperative Care ; Sutures ; Thrombosis* ; Transplants ; Tricuspid Valve Insufficiency

A 4year old female admitted for the management of degloving injury of popliteal area. The patient was injuried by traffic accident, and underwent emergency sugery for irrigation and debriment of wound area under halothane anesthesia. She has the 2nd administration of halothane in a period of 18days Two days after the 2nd anesthesia, the patient began to suffer from acute hepatitis with increasing SGOT/SGPT. The patient was cared for at the department of pediatrics and had 3rd operation after 38days and was discharged after 71 days hospitalization.
Accidents, Traffic ; Anesthesia ; Anesthesia, General* ; Child* ; Emergencies ; Female ; Halothane ; Hepatitis* ; Hospitalization ; Humans ; Pediatrics ; Wounds and Injuries

BACKGROUND: We evaluated the performance and analysis time of HLC-723 G7 (Tosoh corp. Tokyo, Japan) hemoglobin (Hb) A1c autoanalyzer. It utilizes cation exchange high performance liquid chromatography (HPLC) method and has a reduced analysis time compared with that of an earlier model HLC-723GHb V A1c 2.2(TM) (HLC-723GHb V, Tosoh corp. Tokyo, Japan). METHODS: We evaluated linearity, precision and comparison with HLC-723GHb V following NCCLS guidelines and counted the number of tests per hour to estimate analysis time. RESULTS: Linearity through the range from 5.8% to 13.9% was good (r2=0.9930, relative nonlinearity <2.5%). The within-run coefficients of variation (CVs) for groups of low, middle, and high level were 1.09%, 0.76%, and 0.68% and total CVs for each group were 1.60%, 0.91%, and 1.00%, respectively. Correlation equation between HLC-723 G7 and HLC-723GHb V was HLC-723 G7=1.0308 (HLC-723GHb V)-0.2896 %Hb A1c (r=0.9992, P<0.0001). Analysis time of HLC-723 G7 was 1.2 minutes per test compared with 2.1 minutes of HLC-723GHb V. CONCLUSIONS: HLC-723 G7 showed the acceptable performance and shortening analysis time therefore, it was suitable for reducing turn around time of Hb A1c assay.
Chromatography, Liquid ; Hemoglobin A, Glycosylated

BACKGROUND: Recently Escherichia coli isolates with extended-spectrum beta-lactamase(ESBL) have been increased in Korea. ESBLs confer variable levels of resistance to cefotaxime, ceftazidime and other broad-spectrum cephalosporins as well as to monobactams such as aztreonam, but they have no detectable activity against cephamycins and carbapenems. The aim of this study was to characterize the ESBL produced by E. coli strains isolated from clinical specimens. METHODS: From March to July, 1998, a total of 93 clinical isolates of E. coli, which was produced ESBL, were collected from patients of the Asan Medical Center. The isolates flagged as ESBL producers by microbroth dilution antibiotic susceptibility test were confirmed by the double disk synergy test. Minimal inhibitory concentration(MIC) of beta-lactams were determined by agar dilution method. The presence of TEM, SHV or CMY-1 gene was determined by polymerase chain reaction. The types of beta-lactamase gene were determined by isoelectric focusing and nucleotide sequence analysis. RESULTS: Sixty-two strains carried plasmid-mediated TEM-52 gene, which sequence showed the substitution of 3 amino acids compared to that of TEM-1. Seventeen strains produced SHV-12, six strains produced SHV-2a, three strains produced TEM-52 and SHV-12, three strains produced TEM-52 and SHV-2a, and one strain produced SHV-2a and SHV-12. One out of twenty-seven strains of cefoxitin-resistant E. coli was confirmed to have CMY-1 beta-lactamase by PCR and nucleotide sequence analysis. CONCLUSIONS: TEM-52 was the most prevalent in E. coli isolates. The most common SHV-types of ESBL in Korea are SHV-12 and SHV-2a in E. coli isolates. In Korea, widespread use of oxyimino-cephalosporins in the hospitals has dramatically increased the prevalence of ESBL-producers in E. coli. Therefore, more prudent use of antibiotics is necessary to reduce the spread of these resistant organisms.
Agar ; Amino Acids ; Anti-Bacterial Agents ; Aztreonam ; Base Sequence ; beta-Lactamases* ; beta-Lactams ; Carbapenems ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Cephamycins ; Chungcheongnam-do ; Escherichia coli* ; Escherichia* ; Humans ; Isoelectric Focusing ; Korea ; Monobactams ; Polymerase Chain Reaction ; Prevalence

BACKGROUND: The aim of this study was to estimate the effective concentration of subacromial ropivacaine for the control of postoperative pain after arthroscopic shoulder surgery. METHODS: In a prospective, randomized double-blind trial, 60 patients were divided equally into 3 groups; Groups I, II, and III. At the end of surgery, a bolus dose (0.75% ropivacaine 150 mg, depomedrol 40 mg) was injected via the trocar and a continuous subacromial infusion catheter was inserted into all patients. The drugs were administered for 48 hours after surgery. Group I was given 0.11% ropivacaine in 96 ml of normal saline, which consisted of 0.75% ropivacaine (15 ml), and fentanyl (10 microgram/kg). Group II received 0.15% ropivacaine in 96 ml saline consisting of 0.75% ropivacaine (20 ml) and fentanyl, (10 microgram/kg). Group III received 0.23% ropivacaine in saline consisting of 0.75% ropivacaine (30 ml) and fentanyl (10 microgram/kg). The rate of continuous infusion was, 2 ml/hr. The VAS for pain at rest and the range of motion (ROM) exercise, the amounts of supplemental analgesics and side effects were assessed postoperative 3, 9, 24 and 48 hours. RESULTS: There was no significant difference in the VAS for pain at rest and ROM exercise as well as in the amounts of supplemental analgesics between the three groups. CONCLUSIONS: 0.11% ropivacaine with 10 microgram/kg fentanyl provides effective postoperative analgesia at rest and during ROM exercise after arthroscopic shoulder surgery.
Analgesia* ; Analgesics ; Catheters ; Fentanyl ; Humans ; Pain, Postoperative ; Prospective Studies ; Range of Motion, Articular ; Shoulder* ; Surgical Instruments