Cronobacter sakazakii (C. sakazakii), formerly Enterobacter sakazakii, is an emerging pathogen associated with the ingestion of contaminated reconstituted formula that causes serious illnesses such as bacteremia, septicemia, necrotizing enterocolitis, meningitis and death in low-birth-weight preterm neonatal infants. The objective of this study was to develop an animal model for human neonatal C. sakazakii infections. We acquired timed-pregnant ICR mice and allowed them to give birth naturally. On postnatal day 3.5, each pup was administered orally a total dose of approximately 107 CFU C. sakazakii strain 3439. Mice were observed twice daily for morbidity and mortality. At postnatal day 10.5, the remaining pups were euthanized, and brain, liver, and cecum were excised and analyzed for the presence of C. sakazakii. C. sakazakii was isolated from cecum and other tissues in inoculated mice. In the tissues of C. sakazakii infected mice, meningitis and gliosis were detected in brain. In this study, we confirmed the neonatal ICR mice may be used a very effective animal model for human neonatal C. sakazakii infections.
Animals ; Bacteremia ; Brain ; Cecum ; Cronobacter ; Cronobacter sakazakii ; Eating ; Enterocolitis, Necrotizing ; Gliosis ; Humans ; Infant ; Liver ; Meningitis ; Mice ; Mice, Inbred ICR ; Models, Animal ; Parturition ; Sepsis ; Sprains and Strains

BACKGROUND: Because the sternomental distance (SMD) is evaluated in conscience patients and in the sitting position, this could change under general anesthesia, which is a state that the patient is unconscious and fully relaxed in the supine position. Increasing age also affects the SMD. We investigated the change in the SMD with the patients under general anesthesia and we also investigated the effect of age on the SMD. METHODS: A total of 108 patients were allocated to Group Y (20-30 yr), Group M (31-50 yr) and Group O (51-70 yr). The SMD, as measured when the patients were awake and sitting, was defined as baseline. The SMD was measured in the supine position, the shoulder-suppressed supine position, at the time of loss of consciousness (LOC), 4 min after vecuronium administration and in the sniffing position. The percent change of the SMD (%) was defined as (the baseline SMD - the measured SMD)/the baseline SMD x 100. RESULTS: Compared with the baseline, the SMD decreased significantly in the supine position, the shoulder-suppressed supine position, at the time of LOC, during neuromuscular blockade and in the sniffing position in all the groups. Group O showed a shorter SMD than did Groups Y and M for all the measurements. There was no significant difference in the percent change of the SMD between the groups. CONCLUSIONS: This study demonstrated that the SMD was significantly reduced by the supine position, the sniffing position, at the time of loss of consciousness and during neuromuscular blockade with the patient under general anesthesia and also with the increasing age of the patient.
Anesthesia, General ; Conscience ; Humans ; Neuromuscular Blockade ; Supine Position ; Unconscious (Psychology) ; Unconsciousness ; Vecuronium Bromide

BACKGROUND: Preoxygenation with tidal volume breathing for 3 min is commonly used technique. An end tidal expiratory oxygen concentration greater than 90% is considerd to be adequate for preoxygenation. The aim of this study was to check the effects of preoxygenation on elderly patients through the comparison with young patients during the 3 min tidal volume breathing technique. METHODS: Sixty patients from ASA class I or II who were scheduled for elective orthopedic general surgery were divided into an elderly (>65 yr) group and a control (25-65 yr) group. Patients were instructed in the technique of preoxygenation. Preoxygenation was accomplished with an appropriately sized face mask connected to an anesthesia machine with 100% oxygen during 3 min with patients in both groups. Expired O2, CO2 concentration and oxygen saturation were recorded simultaneously for 3 min. RESULTS: The elderly group showed significantly lower end tidal oxygen concentration than the control group from 50 sec to the end of study (180 sec) with the 3 min tidal volume breathing technique (P < 0.05). In 180 sec, the control group had over 90% (91.5%) end tidal oxygen concentration, but in the elderly group end tidal oxygen concentration could not reach 90% (86.2%). In oxygen saturation, the elderly group showed a significantly lower level until 40 sec from the start of study, and then two groups showed a similar levels of oxygen saturation until the end of study. CONCLUSIONS: End tidal oxygen concentration did not reach 90% in 180 sec in the elderly group during preoxygenation with the 3 min tidal volume breathing technique.
Aged ; Anesthesia ; Humans ; Masks ; Orthopedics ; Oxygen ; Respiration ; Tidal Volume

BACKGROUND: This study was designed to determine the optimal dose of remifentanil single bolus for the prevention of cardiovascular disturbance due to both a rapid increase in desflurane concentration and stimulation by intubation. METHODS: One hundred three adult patients were enrolled in this prospective, double-blind, randomized study. Before anesthesia induction, all patients received normal saline (control) or one of the following 3 doses of remifentanil: 1.0 microg/kg of remifentanil (remifentanil 1.0), 1.5 microg/kg of remifentanil (remifentanil 1.5), and 2.0 microg/kg of remifentanil (remifentanil 2.0). After induction with propofol and rocuronium, 1.3 minimal alveolar concentration of desflurane with oxygen was administered via a face mask. Heart rate (HR) and mean blood pressure (MBP) were recorded before remifentanil administration, and 1, 2, and 3 min after inhalation of desflurane, as well as 0, 1, 2, and 3 min after intubation. The proportions of patients with hemodynamics that maintained within +/- 25% of preinduction values (MBP and HR proportion) were calculated. RESULTS: MBP and HR were lower in the 3 remifentanil groups than in the control group throughout the study period. The MBP proportion was higher in remifentanil 1.0 group than in control group. The HR proportion was higher in the 3 remifentanil groups than in control group. CONCLUSIONS: A single bolus injection of remifentanil (1.0-2.0 microg/kg) may be effective in alleviating adverse hemodynamic changes induced by both desflurane inhalation and tracheal intubation. Especially, administration of remifentanil 1.0 microg/kg maintained more stable blood pressure compared to the control group throughout the study period.
Adult ; Anesthesia* ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Inhalation ; Intubation ; Masks ; Oxygen ; Propofol ; Prospective Studies ; Tachycardia

BACKGROUND: Postoperative nausea and vomiting (PONV) commonly occur after general anesthesia, especially in women. In this study, we evaluated the antiemetic efficacy of propofol administered at the end of surgery in highly susceptible patients undergoing a laparoscopy-assisted vaginal hysterectomy. METHODS: A total of 107 women undergoing a laparoscopy-assisted vaginal hysterectomy under general anesthesia were enrolled for this prospective, double-blind, randomized study. Fifteen minutes before the end of surgery, all patients received 50 microg fentanyl and 1 of following 3 doses; 0.5 mg/kg of propofol (propofol 0.5 group), 1 mg/kg of propofol (propofol 1.0 group), and normal saline (control group). All patients received intravenous patient-controlled analgesia (PCA). Emergence time, a visual analog scale for pain and nausea, duration of postanesthesia care unit (PACU) stay, and frequency of antiemetic use were recorded at 0-2, 2-24, and 24-48 hours postoperatively. RESULTS: The incidence of nausea significantly lower in the propofol 0.5 and propofol 1.0 groups than in the control group (12.1 vs 14.7 vs 40%). During the first postoperative 2 hours, antiemetics were less frequently administered in the propofol 0.5 and propofol 1.0 groups than in the control group (3.0 vs 5.9 vs 22.5%). Emergence time was slightly longer in the propofol 0.5 and propofol 1.0 groups than in the control group, but there was no significant difference in PACU stay time was observed between the 3 groups. CONCLUSIONS: The results of this study suggest that low-dose propofol administration at the end of surgery may effectively reduce the incidence of PONV within 2 hours postoperatively in highly susceptible women undergoing a laparoscopiy-assisted vaginal hysterectomy and receiving opioid-based PCA.
Analgesia, Patient-Controlled ; Anesthesia, General ; Antiemetics* ; Female ; Fentanyl ; Humans ; Hysterectomy, Vaginal* ; Incidence ; Laparoscopy ; Nausea ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Propofol* ; Prospective Studies ; Visual Analog Scale

BACKGROUND: The old age population, including the very old aged (> or = 85 years), is rapidly increasing, and femur neck fracture from accidents is commonly seen in the elderly. Use of bone cement during bipolar hemiarthroplasty can cause bone cement implantation syndrome. METHODS: This study was prospectively conducted on the elderly who were scheduled to undergo elective cemented bipolar hemiarthroplasty under spinal anesthesia. Patients were divided into 2 groups: the old age (65-84 years) and very old age groups (> or = 85 years). Hemodynamic parameters were recorded at the following time points: the start of the operation, femoral reaming, cement insertion, every 2 minutes after cement insertion for 10 minutes, femoral joint reduction, and the end of operation. When hypotension occurred, ephedrine was given. RESULTS: Sixty-five patients in the old age group and 32 patients in the very old age group were enrolled. Mean ages were 78.9 and 89.4 years, respectively, in the old age and very old age groups. The very old age group showed constantly decreased levels of cardiac index and stroke volume from cementing until the end of the operation compared to the old age group. To maintain hemodynamic stability after cement insertion, the requirement of ephedrine was higher in the very old age group than in the old age group (13.52 +/- 7.76 vs 8.65 +/- 6.38 mg, P = 0.001). CONCLUSIONS: Bone cement implantation during bipolar hemiarthroplasty may cause more prominent hemodynamic changes in very elderly patients. Careful hemodynamic monitoring and management are warranted in very elderly patients undergoing cemented bipolar hemiarthroplasty.
Aged ; Anesthesia, Spinal* ; Bone Cements ; Ephedrine ; Femoral Neck Fractures ; Hemiarthroplasty* ; Hemodynamics* ; Humans ; Hypotension ; Joints ; Prospective Studies ; Stroke Volume

BACKGROUND: Intravenous administration of rocuronium induces intense pain in most patients (60-100%). This could be harmful during anesthesia induction because of the unintended reflex movement of an unconscious patient in response to the pain. Previous studies have reported that remifentanil effectively reduces rocuronium-induced pain and withdrawal movements. This study was designed to evaluate the EC50 and EC95 of remifentanil to prevent withdrawal movements in children. METHODS: We enrolled a total of 171 pediatric patients scheduled for general anesthesia in this study. Remifentanil was administrated by target-controlled infusion. Effect-site target concentrations ranged from 0.5 to 3.0 ng/ml. At each concentration, experiments were repeated in 10-20 patients. Propofol 2 mg/kg and rocuronium 0.9 mg/kg were administrated after equilibration of plasma and effect-site target remifentanil concentration. The withdrawal movements were graded on a 4-point scale. The EC50 and EC95 of remifentanil to prevent rocuronium-induced withdrawal movements were determined by using a logistic regression model. RESULTS: The logistic regression model showed that the probability of preventing rocuronium-induced withdrawal movement was as follows: exp (-3.49 + 2.07 x remifentanil concentration) / (1 + exp [-3.49 + 2.07 x remifentanil concentration]). EC50 and EC95 were 1.69 ng/ml (95% confidence intervals [CIs], 1.42-1.87) and 3.11 ng/ml (95% CIs, 2.79-3.72), respectively. CONCLUSIONS: Administration of remifentanil at an effect-site target concentration of 3.1 ng/ml could effectively prevent rocuronium-induced withdrawal movements.
Administration, Intravenous ; Anesthesia ; Anesthesia, General ; Child* ; Humans ; Logistic Models ; Pediatrics ; Plasma ; Propofol ; Reflex

BACKGROUND: This study compared the preventive effects of ramosetron and ondansetron on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing abdominal hysterectomy. METHODS: In a prospective, randomized, double-blinded study, a total of 120 highly susceptible women (nonsmokers, those receiving opioid-based IV patient-controlled analgesia [PCA]) undergoing abdominal hysterectomy were included in the study. Patients were divided into 2 groups and each group received either 0.3 mg of ramosetron or 4 mg of ondansetron, IV. All patients received fentanyl-based IV PCA during the 48 h postoperative periods. The incidences of PONV and side effects of 5-HT3 antagonists (headache and dizziness) were assessed at 3 intervals (<2 h, 2-24 h and 24-48 h) postoperatively. RESULTS: Patients in the ramosetron group showed a significantly higher ratio of complete response and lower incidence of nausea during the 24-48 h interval after surgery compared with those the ondansetron group. CONCLUSIONS: Ramosetron (0.3 mg) is more effective in preventing delayed PONV in highly susceptible women undergoing abdominal hysterectomy compared with ondansetron (4 mg).
Analgesia, Patient-Controlled ; Antiemetics ; Benzimidazoles ; Female ; Humans ; Hysterectomy ; Incidence ; Nausea ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Postoperative Period ; Prospective Studies ; Serotonin 5-HT3 Receptor Antagonists

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common perioperative complication. The definitive causes of POCD have not been identified, but depth of anesthesia or sedation has been reported to influence POCD. The purpose of the present study was to assess the possible effect of the level of sedation on POCD at 1 week after surgery under spinal anesthesia in elderly patients. METHODS: We included 48 patients aged over 60 years, who were scheduled for elective knee and hip joint surgery under spinal anesthesia. Those patients were randomly allocated to one of the 2 groups: deep sedation group and light sedation group. The depth of sedation was monitored by entropy and observer's assessment of alertness/sedation (OAA/S) score. Cognitive function was assessed by 5 neurocognitive tests before and at 1 week after surgery. A postoperative deficit was defined as a postoperative decrement to preoperative score greater than 1 standard deviation on any test. A patient whose postoperative performance deteriorated by 1 or more standard deviations on 2 or more tests was classified as having experienced POCD. RESULTS: POCD occurred in 7 patients (28%) in the deep sedation group and in 4 patients (17.4%) in the light sedation group. The incidence of the POCD was not significantly different between the 2 groups. CONCLUSIONS: We were unable to detect a significant association between the depth of sedation and the presence of POCD at 1 week after surgery under spinal anesthesia.
Aged* ; Anesthesia ; Anesthesia, Spinal* ; Deep Sedation ; Entropy ; Hip Joint ; Humans ; Incidence ; Knee ; Propofol*