To evaluate the effect of Morphine during spinal anesthesia with alpha-adrenergic agonist, we used 0.18 mg of epinephrine, 90 ug of clonidine and 0.3 mg of morphine with 12 mg of T-cain respectively and compared hemodynamic and analgesic effects of each drug. Eighty patients were divided into four groups as follows; Group I (n=20); T-cain with clonidine, Group II (n=20); T-cain with epinephrine, Group III (n=20); T-cain with clonidine and morphine, and Group IV (n=20); T-cain with epinephrine and morphine. The results were as follows; 1) The onset time of analgesia and the time reached to the highest level of sensory loss were most rapid in the epinephrine and morphine group. 2) The duration of analgesia was significantly prolonged in the group of epinephrine and morphine than the group of epinephrine and clonidine. 3) It was more likely complicated in the morphine groups than others but there was no significance. 4) Although the heart rate was gradually decreased over 60 min. after anesthesia, there was no significance between the groups. 5) Systolic and diastolic blood pressure were decreased mainly over 30~45 min. after anesthesia, but there was no significance. In conclusion, epinephrine can be sustituted for clonidine because analgesic duration was not significantly changed, and the duration of analgesia was prolonged by morphine.
Adrenergic alpha-Agonists ; Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Clonidine* ; Epinephrine* ; Heart Rate ; Hemodynamics ; Humans ; Morphine*

To evaluate the efficacy of transdermal scopolamine patch in reducing nausea and vomiting associated with general anesthesia, we studied 60 healthy women undergoing major gynecologic surgery. The patients were divided into 2 groups. Each group was composed of 30 patients. Group I; not applied a transdermal scopolamine patch. Group II: applied one transdermal scopolamine patch on the skin behind her ear at the night before surgery. Anesthesia was induced by thiopental sodium(5 mg/kg) and succinylcholine(1.5 mg/kg) and maintained with fentanyl(3-6 ug/kg), enflurane(0.5-1.5 vol%) and nitrous oxide(50 vo1%) in oxygen. A comparison with Group I and Group II indicated that the transdermal scopolamine patch reduced the incidence of postoperative nausea or vomiting associated with general anesthesia significantly(Group I; 36.67%, Group II; 13.33%, p<0.05).
Anesthesia ; Anesthesia, General* ; Antiemetics ; Ear ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Nausea* ; Oxygen ; Postoperative Nausea and Vomiting ; Scopolamine Hydrobromide* ; Skin ; Thiopental ; Vomiting*

The fallowing study was performed in 100 patients undergoing gynecologic lower abdominal surgery. Analgesic efficacy, changes in arterial blood pressure and heart rate, and incidence of side effect were observed after epidural injection of the drugs. The patients were devided into two groups (N=50). Group I was given a bolus dose of 1 mg morphine in 10 ml of 0.25% bupivacaine followed by continuous epidural infusion of morphine 0.05 mg/ml in 0.15% bupivacaine at 2 ml/hr. Group II was given a bolus dose of 100 ug fentanyl in 10 ml of 0.25% bupivacaine followed by continuous epidural infusion of fentanyl 5 ug/ml in 0.15% bupivacaine at 2 ml/hr. The results were as follows. 1) The pain score (visual analogue pain scale) measured at postoperation 1 hr was significantly decreased in Group II (1.51+/-1.0) compared to group I (2.20+/-1.1). Percentage of patients needed supplemental analgesics within postoperation 20 min was significantly lower in Group II (4%) than Group I (16%). 2) The cardiovascular changes for 2 hrs after epidutal injection were not occurred significant in both groups. 3) The incidence of nausea or vomiting was significantly lower in Group II (8%) than Group I (28%). Pruritus occurred also significantly less often in Group lI (6%) than group I (30%). Urinary retention and respiratory depression were not observed.
Analgesia, Epidural ; Analgesics ; Arterial Pressure ; Bupivacaine ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Injections, Epidural ; Morphine ; Nausea ; Pain, Postoperative* ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

OBJECTIVE: To understand the difference of defecation physiology between postpartum and postoperative women. METHODS: Between July 1998 to April 1999, we performed defecogram and pudendal nerve motor latency to 31 women, who were 8 postoperative women, 9 post cesarean-section state women, and 14 normal vaginal delivery-state women. RESULTS: According to the defecogram results, only squeezing angles of the anorectal angle were significantly increased(96.0 vs 72.3, 74.9 degree) in normal vaginal delivery-state women compared to post cesarean-section state and postoperative women, but rest and evacuation angles were not. And to pudendal nerve latency, there were no statistically significant difference. CONCLUSION: We concluded that the pudendal plexus was damaged during labor, therefore its ability to control puborectalis muscle was damaged. So, the anorectal angles of squeezing of postpartum women were significantly increased, compared to those of post cesarean section women or postoperative women.
Cesarean Section ; Defecation* ; Female ; Humans ; Physiology* ; Postpartum Period* ; Pregnancy ; Pudendal Nerve*

These are natural inhibitors of coagulation, and deficiencies of any of these factors is referred to as thrombophilia. The identified main causes of thrombophilia are deficiencies of antithrombin III, protein C, or protein S, resistance to actived protein C associated with Factor V Leiden mutation, and inherited hyperhomocystinemia. Inherited and acquired thrombophilias may also contribute to pathophysiological processes involved in recurrent pregnancy loss, fetal death, intrauterine growth restriction, placental abruption, placental infarction, and pre-eclampsia. Various therapeutic protocols with low-molecular-weight heparin (LMWH) were used. because it is associated with a low incidence of osteoporosis and thrombocytopenia. We experienced the two cases of successful deliveries by Cesarean section following a successful pregnancy maintenance in thrombophilia. we administered LMWH to prevent thromboembolism. one patient was the primi-gravidarum, with inherited thrombophilia, who has the familial history of pulmonary embolism and deep vein thrombosis. the other was the multi-gravidarum, with acquired thrombophilia, who has the past medical history of pulmonary embolism.
Abruptio Placentae ; Antithrombin III ; Cesarean Section ; Factor V ; Female ; Fetal Death ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Infarction ; Osteoporosis ; Pre-Eclampsia ; Pregnancy Maintenance ; Pregnancy* ; Protein C ; Protein S ; Pulmonary Embolism ; Thrombocytopenia ; Thromboembolism ; Thrombophilia* ; Venous Thrombosis

OBJECTIVE: Our purpose was to determine whether abnormal triple marker in the second trimester may be associated with adverse pregnancy outcomes. METHODS: Between November 1996 and April 1998, we evaluated 1,158 pregnant women undergoing second trimester triple marker screening tests who delivered at our hospital. The pregnancy outcomes of 48 women with false positive screens were compared with 1,158 screen negative controls. The pregnancy outcomes were obtained from hospital delivery records. RESULTS: Women with abnormal triple marker showed increased risks for low birth weight(p<0.01). But there was no significant differences between study and control groups with respect to preterm labor, pregnancy induced hypertension, oligohydroamnios, premature rupture of membrane, placenta previa, abruptio placenta, fetal death in utero. CONCLUSION: Abnormal triple marker in the second trimester was associated with low birth weight.
Female ; Fetal Death ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Low Birth Weight ; Infant, Newborn ; Mass Screening* ; Membranes ; Obstetric Labor, Premature ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnancy, High-Risk* ; Pregnant Women ; Rupture