BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Dopamine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Jugular Veins ; Saphenous Vein ; Vascular Resistance ; Veins*

BACKGROUND: Diabetic cardiovascular autonomic neuropathy (CAN) causes perioperative cardiovascular instability. A rapid increase in the desflurane concentration induces tachycardia and hypertension (HTN). This study examined the effects of the cardiovascular response to desflurane on patients with diabetic CAN. METHODS: Forty diabetes mellitus (DM) patients with CAN were divided two groups: one with HTN (DM+HTN group, n = 17) and one without HTN (DM group, n = 23). The control group (n = 20) was composed of healthy patients without DM or HTN. In each group, the concentration of desflurane inspired was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The target was to produce an end-tidal concentration of desflurane of 10.0 vol%, which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were measured. RESULTS: The HR, MAP and CI increased significantly in all three groups when compared with the baseline (P<0.05). Additionally, the HR and MAP showed did not differ among the three groups at any of sampling times. However, the CI of the DM group and the DM+HTN group differed when compared with the control group at 90 and 120 seconds after intubation (P<0.05). CONCLUSIONS: In diabetic patients with CAN, the hemodynamic responses to a rapid increase in desflurane concentration are similar to those in non-diabetic patients before endotracheal intubation. However, after endotracheal intubation, increments in CI are blunted in diabetic patients with CAN.
Arterial Pressure ; Diabetes Mellitus ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Nebulizers and Vaporizers ; Tachycardia ; Thiopental

BACKGROUND: Although one lung ventilation (OLV) is frequently used for facilitating thoracic surgical procedures, arterial hypoxemia can occur while using one lung anesthesia. Continuous positive airway pressure (CPAP) in 5 or 10 cmH2O to the non-ventilating lung is commonly recommended to prevent hypoxemia. We evaluated the effects of incremental CPAP to the non-ventilating lung on arterial oxygenation and pulmonary shunt without obstruction of the surgical field during OLV. METHODS: Twenty patients that were scheduled for one lung anesthesia were included in this study. Systemic and pulmonary hemodynamic data and blood gas analysis was recorded every fifteen minutes according to the patient's positions and CPAP levels. CPAP was applied from 0 cmH2O by 3 cmH2O increments until a surgeon notifies that the surgical field was obstructed by the expanded lung. Following that, pulmonary shunt fraction (QS/QT) was calculated. RESULTS: There were no significant differences of QS/QT between supine and lateral positions with two lung ventilation (TLV). OLV significantly decreased arterial oxygen partial pressure (PaO2) and increased QS/QT compared to TLV. PaO2 and QS/QT significantly improved at 6 and 9 cmH2O of CPAP compared to 0 cmH2O. However, there were no significant differences of PaO2 and QS/QT between 6 and 9 cmH2O CPAP. In 18 patients (90%), surgical fields were obstructed at 9 cmH2O CPAP. CONCLUSIONS: This study suggests that 6 cmH2O CPAP effectively improved arterial oxygenation without interference of the surgical field during OLV when CPAP was applied from 0 cmH2O in 3 cmH2O increments.
Anesthesia ; Anoxia ; Blood Gas Analysis ; Continuous Positive Airway Pressure ; Hemodynamics ; Humans ; Lung ; One-Lung Ventilation ; Oxygen ; Partial Pressure ; Thoracic Surgical Procedures ; Ventilation

BACKGROUND: The nasopharyngeal temperature probe should be placed in the upper nasopharynx to reflect accurate core temperature. However, there have been no studies conducted to predict parameters for the optimal depth of the nasopharyngeal temperature probe. The purpose of this study was to examine the correlation between the optimal depth to the upper nasopharynx and the distance from the philtrum to the tragus and height. METHODS: Two hundred patients (100 females and 100 males) were enrolled in the study. The distance from the philtrum to the tragus along the facial curvature was measured, and the optimal depth from the nostril to the upper nasopharynx was evaluated using nasendoscopy. The relationships between the optimal depth to the upper nasopharynx and the distance from the philtrum to the tragus and height were examined. RESULTS: The distances from the philtrum to the tragus were 14.4 +/- 0.5 cm in females and 15.1 +/- 0.6 cm in males (P < 0.01). The depths from the nostril to the upper nasopharynx were 9.4 +/- 0.6 cm in females and 10.0 +/- 0.5 cm in males (P < 0.01). The correlation coefficients between the depth from the nostril to the upper nasopharynx and the distance to the tragus from the philtrum were 0.43 in females and 0.41 in males (P < 0.01). However, there were very weak correlations and no correlations between height and the depth from the nostril to the upper nasopharynx in females and males, respectively. CONCLUSIONS: The depth from the nostril to the upper nasopharynx is correlated weakly with the distance from the philtrum to the tragus. Although the distance from the philtrum to the tragus is not a good predicting parameter for the optimal depth of nasopharyngeal temperature probe placement, subtraction of 5 cm from the distance is helpful to estimate the optimal depth of the nasopharyngeal temperature probe.
Anesthesia ; Female ; Humans ; Lip* ; Male ; Nasopharynx

BACKGROUND: Most morphometric studies of the airway have relied on plain radiographs or CT scan with their attendant limitations. We evaluated the length from vocal cord to carina and diameter of the trachea in adults who had no abnormality of the airway using three-dimensional chest CT scan and compared with demographic data. METHODS: We performed a multiplane reconstruction of the airway using axial, sagittal, and coronal slices (aged 18-87, 100 men, 100 women). We measured that the lengths from vocal cord to carina and the diameters (AP, anteroposterior; TR, transverse) of 50 mm above carina of the trachea. RESULTS: The lengths from vocal cord to carina was 130.2 +/- 11.4 mm in men and 119.5 +/- 10.5 mm in women. The AP and TR diameters of the trachea at 50 mm above carina were men; 18.0 +/- 2.4 mm, 17.2 +/- 2.6 mm, women; 14.4 +/- 2.0 mm, 14.4 +/- 1.9 mm, respectively. The correlation between airway length and age and height was statically significant in men and women but less clinically significant. The correlation between diameter of trachea and height was only statically significant in men but less clinically significant. CONCLUSIONS: This study suggests that these measured data are helpful for the endotracheal intubation and endotracheal tube placement in airway management.
Adult ; Airway Management ; Female ; Humans ; Intubation, Intratracheal ; Male ; Thorax ; Trachea ; Vocal Cords

BACKGROUND: The purpose of this study was to compare temperatures measured at three different sites where a nasopharyngeal temperature probe is commonly placed. METHODS: Eighty elective abdominal surgical patients were enrolled. After anesthesia induction, four temperature probes were placed at the nasal cavity, upper portion of the nasopharynx, oropharynx, and the esophagus. The placement of the nasopharyngeal temperature probes was evaluated using a flexible nasendoscope, and the depth from the nares was measured. The four temperatures were simultaneously recorded at 10-minute intervals for 60 minutes. RESULTS: The average depths of the probes that were placed in the nasal cavity, upper nasopharynx, and the oropharynx were respectively 5.7 ± 0.9 cm, 9.9 ± 0.7 cm, and 13.6 ± 1.7 cm from the nares. In the baseline temperatures, the temperature differences were significantly greater in the nasal cavity 0.32 (95% CI; 0.27-0.37)℃ than in the nasopharynx 0.02 (0.01-0.04)℃, and oropharynx 0.02 (−0.01 to 0.05)℃ compared with the esophagus (P < 0.001). These differences were maintained for 60 minutes. Twenty patients showed a 0.5℃ or greater temperature difference between the nasal cavity and the esophagus, but no patient showed such a difference at the nasopharynx and oropharynx. CONCLUSIONS: During general anesthesia, the temperatures measured at the upper nasopharynx and the oropharynx, but not the nasal cavity, reflected the core temperature. Therefore, the authors recommend that a probe should be placed at the nasopharynx (≈ 10 cm) or oropharynx (≈ 14 cm) with mucosal attachment for accurate core temperature measurement.
Anesthesia ; Anesthesia, General ; Body Temperature ; Esophagus ; Humans ; Nasal Cavity ; Nasopharynx ; Oropharynx ; Thermometers

No abstract available.
Humans ; Lung*

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.
Adult ; Analgesia, Patient-Controlled ; Humans ; Insurance ; Korea ; Patient Satisfaction ; Postoperative Complications

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.
Adult ; Analgesia, Patient-Controlled ; Humans ; Insurance ; Korea ; Patient Satisfaction ; Postoperative Complications

BACKGROUND: The proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement. METHODS: Fifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively. RESULTS: There were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 +/- 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 +/- 6.7 (P < 0.001) and 26.7 +/- 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 +/- 8.8 (P < 0.001) and 29.9 +/- 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure. CONCLUSIONS: The position change from supine to prone without head movement can cause a change in ETT cuff pressure.
Head Movements ; Head* ; Humans ; Neck ; Prone Position ; Spine