Objectives: The aim of this study was to compare the compliance, efficacy, and satisfaction associated with methylphenidate and atomoxetine for treating attention-deficit/hyperactivity disorder (ADHD). Methods: The subjects were 44 patients who met the Diagnostic and Statistical Manual of Mental Disorder-5 diagnostic criteria for ADHD and were treated with methylphenidate or atomoxetine. The methylphenidate formulations included immediate release (IR), extended release (ER), and osmotic-controlled release oral delivery system (OROS). Patients and parents reported the average number of days per week the medication was taken. Efficacy was assessed using the ADHD Rating Scale. Satisfaction with medication scale (SAMS)–parent report form and SAMS–self-report form were used to evaluate parents’ and patients’ satisfaction, respectively. Results: Patients and parents were more satisfied with methylphenidate than with atomoxetine. There were no significant differences in the compliance with and efficacy of methylphenidate and atomoxetine. Compliance with methylphenidate IR and ER was markedly lower than that with OROS methylphenidate or atomoxetine. Conclusion Methylphenidate OROS formulation can be considered a suitable option given its high rates of compliance, satisfaction, and efficacy.

BACKGROUND: Major respiratory problems during spinal anesthesia occur due to several causes, particulary, high spinal block, use of sedatives or opioids, and underlying cardiopulmonary diseases. Pulse oximetry has prevented most of these problems, but has not provided rapid and accurate information of the patient's ventilation. We measured end-tidal CO2 tension via the side-stream capnometer with a small rubber cannula and investigated its effectiveness in ventilatory monitoring under spinal anesthesia. METHODS: Nineteen patients were involved in this study. We performed spinal anesthesia with 0.5% heavy marcaine 12 mg (L3-4 interspace). After fixation of spinal sensory blockade level, 0.035 mg/kg of midazolam was administered intravenously to sedate the patient. A polyvinylchloride catheter with a rubber extending nasal cannula was used for sampling of respiratory gas. PETCO2 was measured at 15 minutes after spinal anesthetic injection (before sedation), and at 5 minutes after midazolam injection (after sadation). Arterial CO2 tension was also measured during PETCO2 measurement. RESULTS: There was no correlation of spinal maximal sensory blockade level with repiratory rate, PaCO2 and PETCO2. Linear regression analysis of arterial vs. end-tidal CO2 yielded a slope of 0.92, r=0.81 and p<0.001 (before sedation), and a slope of 0.98, r=0.79 and p<0.01 (after sedation). Arterial to end-tidal differences were 4.2+/-2.8 mmHg (before sedation) and 4.3+/-3.0 (after sedation), but there was no significant difference in comparing them with each other. Conclusions : We conclude that this form of PETCO2 measurement is useful in continuous, noninvasive monitoring of ventilation in patients under spinal anesthesia.
Analgesics, Opioid ; Anesthesia, Spinal* ; Bupivacaine ; Catheters* ; Humans ; Hypnotics and Sedatives ; Linear Models ; Midazolam ; Oximetry ; Rubber ; Ventilation

BACKGROUND: Many factors affecting the spread of spinal anesthesia have been investigated. But L3-4 or L4-5 interspace was choosen which was known as the site of buffering, in their study. We investigated the effect of some of these factors on sensory blockade level by using L2-3 interspace. METHODS: Eightyfive patients, ASA physical status I - Il, were involved in our study. Sensory blockade level was checked with pinprick test at 10 minutes and 30 minutes. The effect of age, sex, height, weight, CSF pressure and pressure difference generated when full flexed and non-full flexed lateral position on sensory blockade level was studied whereas other factors such as puncture technique, dosage and concentration of drug and patients position after injection, were kept constant under the same condition. And also studied the effect of degree of flexion at injection on the sensory blockade level. RESULTS: Height and CSF pressure were correlated with sensory blockade level at 10 minutes after injection(R2=0.14, P<0.01). Only height was correlated with sensory blockade level at 30 minutes after injection(R2=0.09, P<0.0l). CONCLUSIONS: Only height was correlated with sensory blokade level at 30 minutes. So, height might be considered as the most impressive minor factor affecting the extent of sensory blockade level.
Anesthesia, Spinal* ; Humans ; Punctures

BACKGROUND: The present study was done to elucidate the effects of acute normovolemic hemodilution (ANH) on intrapulmonary shunt (Qs/Qt) and systemic oxygen delivery balance during one lung ventilation (OLV). METHODS: To induce one lung ventilation, an atelectasis of the right lung was produced in anesthetized mongrel dogs. In 6 dogs with OLV, ANH was produced by sequential hemodilution with hydroxyethyl starch. ANH was divided into 3 stages (ANH0: no hemodilition, ANH1: first hemodilution, ANH2: second hemodilution). Qs/Qt was measured by using blood gas analysis. Various hemodynamic parameters, oxygen delivery, and consumption were measured or calculated indirectly. RESULTS: After hemodilution, hemoglobin levels at each stage were 9.9 +/- 1.3 g/dl (ANH0), 7.0 +/- 1.0 g/dl (ANH1), and 5.2 +/- 0.7 g/dl (ANH2). The Qs/Qt of ANH2 stage increased from 25.0 11.4% of ANH0 to 35.4 9.2% (P < 0.05). Cardiac output of ANH2 increased from 2.4 +/- 0.8 ml/min of ANH0 to 3.2 +/- 0.8 ml/min (P < 0.05). Pulmonary and systemic vascular resistance measurements in ANH2 were lower than those of ANH0 (P < 0.05). The changes in pH and carbon dioxide tension and mixed venous oxygen tension by ANH were not significant in comparison with ANH0 (P > 0.05). Global oxygen delivery was markedly decreased by hemodilution in OLV (P < 0.05), whereas global oxygen consumption was maintained. CONCLUSIONS: We conclude that global oxygen delivery balance is preserved by ANH in this study. However, extreme ANH has a deleterious effect on pulmonary gas exchange, possibly through the attenuation of hypoxic pulmonary vasoconstriction during one-lung ventilation. On the basis of this study, increased cardiac output generated by ANH might be the cause of inhibition or blunting of hypoxic pulmonary vasoconstriction.
Animals ; Blood Gas Analysis ; Carbon Dioxide ; Cardiac Output ; Dogs* ; Hemodilution* ; Hemodynamics ; Hydrogen-Ion Concentration ; Lung ; One-Lung Ventilation* ; Oxygen Consumption ; Oxygen* ; Pulmonary Atelectasis ; Pulmonary Gas Exchange ; Starch ; Vascular Resistance ; Vasoconstriction

BACKGROUND: The effect of epidural local anesthetics on the spinal anesthesia is not well known during the combined spinal epidural anesthesia (CSE). But, Blumgart and his colleagues suggested that epidural volume load affect spinal sensory blockade level. This study was designed to investigate the effect of extradural injection of normal saline on the level of the subarachnoid block according to the time of the extradural saline injection. METHODS: Sixty patients undergoing lower abdominal and lower extremity operation were involved in our study. After performing subarachnoid block with 12 mg of hyperbaric tetracaine, divided into as follows: Group 1 (n=20), received only spinal anesthesia; Group 2 (n=20), received 15 ml of epidural saline immediately after spinal anesthetic administration; Group 3 (n=20), received 15 ml of epidural saline at 15 minutes after spinal anesthetic administration. Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes. Blood pressure, heart rate and incidence of complications such as hypotension, bradycardia, nausea and high spinal block were also measured. RESULTS: The maximal sensory blockade level of Group 2 was higher than those of Group 1 and Group 3 (p<0.05). However, there was no difference between Group 1 and Group 3 as comparing to the maximal sensory blockade level. Changes of blood pressure and heart rate and incidence of complications were not different comparing with each other groups (p>0.05). CONCLUSIONS: From the results obtained, epidural volume load at the 15 minutes after spinal anesthetic administration did not affect the sensory blockade level of spinal anesthesia during CSE.
Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics, Local ; Blood Pressure ; Bradycardia ; Heart Rate ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Lower Extremity ; Nausea ; Tetracaine

Unidirectional valve (UDV) malfunction causes rebreathing of expired gas during anesthesia. However, the resultant hypercarbia without hypoxemia by UDV malfunction is not easily detected. We experienced a case of severe hypercarbia which caused by sticking expiratory valve at 45 minutes after the induction of anesthesia, in spite of checking UDV function preoperatively. In this case, expiratory UDV malfunction was diagnosed with the change of capnographic waveform. And so, we recommend monitoring of capnographic waveform during every anesthesia, in addition to preoperative UDV checking.
Anesthesia ; Anoxia

BACKGROUND: Temporary occlusion of hepatic blood inflow and vascular exclusion are effective for reduction of intraoperative bleeding which is a major problem during hepatic resection. But it might be suggested that they resulted in hemodynamic, electrolyte and blood gas changes. This study was designed for investigating those changes during liver resection using portal triad clamping and/or right, left or both hepatic vein clamping. METHODS: Forty one patients, diagnosed as hepatoma and intrahepatic duct stone, were involved in this study. Duration of liver ischemia was 48.7+/-14.8 min. Hemodynamic variables, electrolytes and arterial blood gas were measured before portal triad clamping and at 10, 30 min after clamping, and 10, 30, and 120 min after declamping, and were compared with each other. Bicarbonate was given when its value was below 20 mEq/L. RESULTS: In the changes of hemodynamics, diastolic blood pressure was decreased significantly at 10 and 30 min after declamping compared with before clamping. In the changes of ABG and electrolytes, pH, bicarbonate and chloride ion were changed significantly at 10 min after clamping compared with before clamping. pH at 10 min after declamping was decreased more associated with increasing anion gap without change of the bicarbonate and increased PaCO2. CONCLUSION: From these results, hemodynamic changes are not remarkable but metabolic acidosis is occurred from 10 minutes after portal triad clamping and more acidotic change was developed at 10 min after declamping, immediate treatment of metabolic acidosis is needed.
Acid-Base Equilibrium ; Acidosis ; Blood Pressure ; Carcinoma, Hepatocellular ; Constriction ; Electrolytes ; Hemodynamics ; Hemorrhage ; Hepatic Veins ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Liver

Subclavian venous catheterization is common technique for a variety of purposes, but this procedure is associated with complications that include damage to the lung, pleura, thoracic duct, nerve and subclavian artery. We recently encountered a case of the tracheal puncture and endotracheal cuff perforation during the subclavian catheterization in a 67-year-old female who was scheduled for tracheal reconstruction. Tidal volume was escaping from around the endotracheal tube during the subclavian catheterization, however, repeated inflation of the cuff failed to maintain the necessary cuff pressure to seal the trachea. After the operation, by using the fiberoptic bronchoscope and injecting dye into the cuff, we confirmed the site of tracheal puncture and endotracheal cuff perforation which caused by the introducer needle of the central venous kit. We suggest that tracheal puncture and endotracheal cuff perforation be added to the list of complication of subclavian catheterization. This complication should be suspected whenever the cuff pressure cannot be maintained during or after an subclavian catheterization.
Aged ; Bronchoscopes ; Catheterization* ; Catheters* ; Female ; Humans ; Inflation, Economic ; Lung ; Methods ; Needles ; Pleura ; Punctures* ; Subclavian Artery ; Subclavian Vein* ; Thoracic Duct ; Tidal Volume ; Trachea ; United Nations

We experienced a case of inadvertent partial removal of vdegrees Cal polyp which was expelled through the tube after awake endotracheal intubation with stylet under direct laryngoscopy. The patient was a 73-years-old female suffering from dyspnea on exertion for 5 days and diagnosed bilateral vdegrees Cal polyps which were nearly obstructed vdegrees Cal cords. Awake endotracheal intubation was planned for her operation after preoperative conference with surgeons because she did not want tracheostomy. After topical anesthesia with 4% liddegrees Caine spray on oropharynx and injected midazolam intravenously, endotracheal tube with stylet under direct laryngoscopy was inserted with ease. But immediately after removal of the stylet, coughing was developed and a part of polyp was expelled through the tube. So, it might be suggested that tracheal reflex should be preserved when the patient refused tracheostomy and injury of lesion was worried by any kinds of awake intubation techniques.
Anesthesia ; Cough ; Dyspnea ; Female ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Midazolam ; Oropharynx ; Polyps* ; Reflex ; Tracheostomy

BACKGROUND: As the clinical application of non-invasive shunt estimation to operation under one-lung ventilation has not been reported, this study was carried out to evaluate the validity and accuracy of the non-invasive shunt estimations in one-lung ventilation with hemodilution. METHODS: Following general anesthesia with enflurane 0.5 1 vol.% and 100% oxygen in ten Mongrel dogs (B.W. around 16 kg), tracheostomy and insertion of left-side endobronchial tube and one-lung ventilation were performed. Acute normovolemic hemodilution was produced by sequential hemodilution with hydroxyethyl starch. The intrapulmonary shunt (QS/QT) was calculated by the classic shunt equation, by the oxygen contents-based estimated shunt equation, and by oxygen tension-based estimations such as alveolar to arterial oxygen difference (P(A-a)O2), respiratory index (RI, P(A-a)O2/PaO2), arterial oxygen tension to alveolar oxygen ratio (PaO2/PAO2), and PaO2 to FiO2 ratio. To assess the quantitative accuracy of the estimated shunt, the data were divided arbitrarily into two groups on the basis of the mean arteriovenous oxygen content difference (C(a-v)O2) being 3.6 ml/dl or greater (group 1) and less than 3.6 ml/dl (group 2). Relationships to QS/QT were analyzed by simple linear regression. RESULTS: In 104 measurements, the correlation between QS/QT and non-invasive shunt were poor (r = 0.66 - 0.76). However, in group 1 (n = 45), the correlation between QS/QT and the estimated shunt were very good (r = 0.93) and good for P(A-a)O2 (r = 0.83), RI (r = 0.87), PaO2/PAO2 (r = - 0.84), and PaO2/FiO2 (r = - 0.85). In group 2 (n = 58), the correlation between QS/QT and non-invasive shunt were worse than in group 1. Group 2 had lower hematocrit (20.6% vs 26.7 %, P < 0.001), higher cardiac output, and lower pulmonary and systemic vascular resistance than group 1 (P < 0.05). The difference between the estimated shunt and the classic shunt in group 1 remained constant when the classic shunt was increased further. However, the difference in group 2 was enhanced by the increment of the classic shunt. CONCLUSIONS: We conclude that even if the non-invasive shunt estimation might be affected by hemoglobin and cardiac output, it is a viable method in mild hemodiluted patients with good cardiovascular reserve.
Anesthesia, General ; Animals ; Cardiac Output ; Dogs* ; Enflurane ; Hematocrit ; Hemodilution ; Humans ; Linear Models ; One-Lung Ventilation ; Oxygen ; Starch ; Tracheostomy ; Vascular Resistance