BACKGROUND: This study was undertaken to evaluate the analgesic effect of a self administered surgical wound infusion of local anesthetic alone compared to combination of local anesthetic and morphine or ketorolac. METHOD: Forty eight patients undergoing minor surgery were randomly classified into four groups: Group 1 (saline, n = 10), Group 2 (bupivacaine only, n = 11), Group 3 (bupivacaine with morphine, n = 14), and Group 4 (bupivacaine with ketorolac, n = 13). A two-hole 19 G epidural catheter was tunneled subcutaneously into the surgical wound and was connected to 100 ml elastometric balloon pump filled with either 0.5% bupivacaine only, 0.5% bupivacaine and morphine 40 mg, or 0.5% bupivacaine and ketorolac 80 mg. We assessed the postoperative visual analogue scale (VAS) pain scores at postoperative 0.5, 1, 2, 6, 12, 24, 36, and 48 hours, and the side effects, sedation score and total amount of infused bupivacaine were recorded. RESULTS: VAS pain score were significantly decreased until 36 hours in groups 2, 3, and 4 compared to group 1, and significantly lower at 1, 2, 12, and 24 hrs in groups 3, 4 than in group 2 (P < 0.05). The total requirement of infused bupivacaine in groups 3, 4 is significantly decreased compared to that of group 2. Side effects like nausea, vomiting, urinary retension, pruiritis, respiratory difficulty, sedation, and dizziness did not occur in the four groups but seroma did in one case. CONCLUSION: Patient-controlled surgical wound infusion of bupivacaine reduced postoperative pain after minor surgery without any side effects. The combination of bupivacaine with morphine or ketorolac gave rise to a significant additive effect to local analgesia.
Analgesia ; Analgesia, Patient-Controlled* ; Bupivacaine ; Catheters ; Dizziness ; Humans ; Ketorolac ; Morphine ; Nausea ; Pain, Postoperative ; Seroma ; Surgical Procedures, Minor ; Vomiting ; Wounds and Injuries*

Sulfuric acid can cause local or systemic effects after exposure by inhalation, ingestion, or topical application. Direct ingestion is the main exposure route for fatal sulfuric acid injury. Fatal accidents involving the inhalation of toxic sulfuric acid vapors are rare. Inhalation of sulfuric acid fumes causes severe irritation or corrosive damage to the upper respiratory tract. Consequently, severe congestion, edema, and inflammation of the mucous membranes of the upper respiratory passages hinder the entry of air into the lungs, possibly leading to fatalities in victims. A 35-year-old man died at his home after complaining of a severe sore throat. One day earlier, he had worked in a sulfuric acid tank in a copper-smelting plant while wearing an ordinary gas mask that offered no protection against sulfurous acid vapors. Upon autopsy, the larynx and epiglottis showed pronounced edema, congestion, and inflammation that histologically mimicked an acute bacterial suppurative inflammation, accompanied by severe pulmonary edema. A field analysis of the air inside the sulfuric acid tank revealed SO4(2-) positivity and a 40% sulfuric acid concentration.
Adult ; Autopsy ; Eating ; Edema ; Epiglottis ; Estrogens, Conjugated (USP) ; Humans ; Inflammation ; Inhalation* ; Larynx ; Lung ; Mucous Membrane ; Pharyngitis ; Plants ; Pulmonary Edema ; Respiratory Protective Devices ; Respiratory System ; Sulfur* ; Sulfuric Acids

No abstract available.
Gangwon-do* ; Rehabilitation*

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.
Angioplasty, Balloon, Coronary/*adverse effects/*instrumentation ; *Aorta, Thoracic/radiography ; Cardiac Catheterization/*adverse effects/*instrumentation ; Coronary Angiography ; Device Removal/*instrumentation ; Foreign Bodies/etiology/radiography/*therapy ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; *Stents ; Treatment Outcome

BACKGROUND: We evaluated the potentiating effect of anesthetics to vecuronium, and recovery profiles, and cost according to the consumption amounts, and usefulness of newly developed anesthetic agents for ambulatory anesthesia. METHODS: Seventy-five patients undergoing a major gynecological surgery were randomly divided into three groups. Group 1 received isoflurane, group 2 received sevoflurane, and group 3 received desflurane. Clinical duration, recovery index, recovery time in each group, and consumption of volatile anesthetics by weighing the vaporizes were measured. RESULTS: Emergence from anesthesia was more rapid in the group 2 and 3, and there was no significant difference in potentiating effect of anesthetics to a neuromuscular blocker among the three groups. Costs according to the comsumption amount were significantly higher in the group 2 and 3. CONCLUSIONS: Sevoflurane and desflurane clinically represent a more efficient alternative to isoflurane in ambulatory anesthesia because of their rapid emergence without side effects.
Anesthesia* ; Anesthetics ; Female ; Gynecologic Surgical Procedures ; Humans ; Isoflurane* ; Muscle Relaxation* ; Neuromuscular Blockade ; Vecuronium Bromide

An unusual case of homicide of a 21-year-old man who was smothered with a hot steam towel by his mother and a pastoress in the name of exorcism. Homicidal smothering in adults is rare, but does occur when the victims are not capable of defending themselves in situations such as chronic illness, old age, drug intoxication or when restrained by other people. In this case, distinct facial scalding was a clue to smothering with a hot steam towel.
Adult ; Chronic Disease ; Homicide ; Humans ; Mothers ; Steam

BACKGROUND: Midazolam is often used as an anxiolytic premedication before surgery. Although the sedative, anxiolytic, and amnestic properties of midazolam may be desirable before the induction of general anesthesia, respiratory function is impaired frequently by larger doses of midazolam. Therefore, we evaluated the adequate doses of midazolam premedication on anxiolytic and sedation without its serious side effects. METHODS: Eighty ASA I or II adult patients scheduled for elective minor surgery were randomly allocated to four groups according to premedication doses of midazolam. They were group 1: midazolam 0.05 mg/kg IM for lean body mass (LBM); group 2: midazolam 0.075 mg/kg IM for LBM; group 3: midazolam 0.1 mg/kg IM for LBM.; group 4: midazolam 0.125 mg/kg IM for LBM. Blood pressure, heart rate, bispectral index (BIS), oxygen saturation (SpO2), anxiety visual analogue scale (VAS), and observer's assessment of alertness and sedation (OAA/S) scores were measured before and at 30 minutes after midazolam premedication. The frequency of apnea, defined as a cessation of spontaneous respiration for more than 10 seconds, was recorded. Induction time and dose requirements in propofol-induced general anesthesia were recorded at the loss of opening their eyes on verbal command and eyelid reflex after starting the propofol infusion. Following intubation, blood pressure and heart rate were measured. RESULTS: The bispectral index and anxiety VAS was significantly decreaced in group 3 and group 4. However, oxygen saturation were significantly lower in group 4 compared with group 3. CONCLUSIONS: We concluded that group 3 (midazolam 0.1 mg/kg IM for LBM) is the proper premedication dosage for anxiolytic and sedation in Koreans without respiratory side effects.
Adult ; Anesthesia, General ; Anxiety ; Apnea ; Blood Pressure ; Eyelids ; Heart Rate ; Humans ; Intubation ; Midazolam* ; Oxygen ; Premedication* ; Propofol ; Reflex ; Respiration ; Surgical Procedures, Minor

BACKGROUND: It used to induce hypercarbia that carbon dioxide insufflated into the peritoneum in laparoscopic surgery. It might stimulate sympathetic nervous system, and decrease splanchnic circulation, hepatic function, and metabolism of anesthetics. The purpose of the present study was to examine the influence of hypercarbia on concentrations of propofol at the time of eye opening and recovery of orientation after propofol target controlled infusion (TCI) during a laparoscopic cholecystectomy. METHODS: Fifty patients were divided randomly into a laparoscopic group (group 1, n = 25) and an exploratory group (group 2, n = 25). A propofol infusion was started at a propofol target concentration of 6microgram/ml, and anesthesia was maintained at 4microgram/ml by using a Diprifusor (TM) turing the operation, intraabdominal pressure was maintained automatically at 12 14 mmHg by a CO2 insufflator and controlled ventilation settings were adjusted about 50 mmHg of PaCO2 after peritoneal insufflation. This ventilatory setting was not changed throughout the operation. We evaluated the estimated plasma concentrations of propofol at the time of eye opening and recovery of orientation in each group using user interface of a Diprifusor (TM). RESULTS: In the laparoscopic group, PaCO2, and PetCO2 increased significantly at 5, 15, 30 minutes after carbon dioxide insufflation, but there was no significant difference in concentrations of propofol at eye opening and orientation after propofol TCI between the two groups. CONCLUSIONS: Hypercarbia induced by insufflation of carbon dioxide into peritoneum didn't give rise to an influence on awakening concentrations after propofol TCI during a laparoscopic cholecystectomy.
Anesthesia ; Anesthetics* ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Humans ; Insufflation ; Laparoscopy ; Metabolism ; Peritoneum ; Plasma ; Propofol* ; Splanchnic Circulation ; Sympathetic Nervous System ; Ventilation

OBJECTIVE: The aim of this study was to analyze the status of split tablet prescription in South Korea. METHODS: We conducted this analysis using 2016 National Patient Sample data from the Health Insurance Review and Assessment Service. We computed split tablet prescription rates by sex and age and determined which medicine and medical specialties had the highest split tablet prescribing rates. RESULTS: The proportion of prescriptions that included split tablets was 15.6% (n=6,687,35). The proportion of prescriptions that included split tablets was higher for females (56.7%) than for males (43.3%), while that of prescriptions including split tablets versus total prescriptions for each sex was higher for males (16.4%) than for females (14.9%) (p<0.001). In the age group under 19 years, the proportion of prescriptions including split tablets (53.7%) was more than half of the total. The highest tablet splitting rate was found to be 89.9% for formoterol fumarate (40 µg), and pseudoephedrine hydrochloride (60 mg) had the highest number of prescriptions. Pediatrics (65.6%) was the medical field with the highest rate of split tablet prescription. CONCLUSION Split tablets were most prescribed to pediatric patients. To minimize the use of split tablets, it is necessary to develop lower dose tablets and establish a policy that promotes prescription of these lower-dose tablets.