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*

Purpose: Nursing students are susceptible to medication safety incidents in the neonatal intensive care unit (NICU) related to a lack of communication experience. The purpose of the present study was to investigate the impact of a NICU medication safety simulation (NMSS) focusing on communication clarity, patient hand-off confidence, and patient safety competency in senior-year nursing students. Methods: The study utilized a nonequivalent control group pretest-posttest design. In total, 60 nursing students were assigned to two groups. The experimental group participated in the NMSS, which included three medication error scenarios. Pairs of students completed the scenarios together in 10 to 20 minutes. Data were analyzed using the chi-squared test, independent t test, and ANCOVA. Results: The experimental group showed significant improvements in communication clarity (p=.015), and patient safety competency (p<.001) compared to the control group. Using the pretest values as covariates, patient hand-off confidence scores significantly increased (p=.027). Conclusion Implementing the NMSS focusing on communication in the pediatric nursing curriculum helped students to communicate clearly and concisely about medication errors, and its use is recommended to promote patient safety competency in the NICU.

No abstract available.
Piperidines

BACKGROUND: In general, pregnancy is considered a hypercoagulable state, and an increased incidence of thromboembolic phenomena have been reported in pregnant women. A thrombelastography (TEG) measures whole blood coagulation and fibrinolysis, and has been used to manage coagulation defects in patients. The purpose of this study was to establish the physiologic changes in the coagulation and fibrinolytic systems in a normal term pregnancy using a TEG. METHODS: A TEG was performed in 31 nonpregnant women and 31 healthy pregnant women using native whole blood. The TEG variables included reaction time (R), clot formation time (K), maximum amplitude (MA), alpha angle, TEG coagulation index and percentage of reduction in MA at 30 minutes (LY30) and 60 minutes (LY60). Other laboratory tests such as hemoglobin (Hgb), hematocrit (Hct), platelet count (PC) and routine coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT) and bleeding time (BT) were measured in all women. RESULTS: The R and K were significantly decreased in pregnant women compared with nonpregnant women (P < 0.05). The MA, alpha angle, LY30 and LY60 were significantly increased in pregnant women compared with nonpregnant women (P < 0.05). The TEG coagulation index was significantly greater in pregnant women compared with nonpregnant women (P < 0.05). CONCLUSIONS: In this study, the TEG showed that term pregnant women were in a hypercoagulable state and had increased fibrinolysis.
Bleeding Time ; Blood Coagulation ; Female ; Fibrinolysis ; Hematocrit ; Humans ; Incidence ; Partial Thromboplastin Time ; Platelet Count ; Pregnancy ; Pregnant Women* ; Prothrombin Time ; Reaction Time ; Thrombelastography*

The original article contained an error in Figure and Figure legend.

BACKGROUND: Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks. METHODS: A total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications. RESULTS: The success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups. CONCLUSIONS: The new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique.
Adult ; Anesthesia, Caudal ; Fluoroscopy ; Humans ; Incidence ; Injections, Epidural ; Injections, Spinal ; Ligaments ; Low Back Pain ; Needles* ; Prospective Studies ; Punctures ; Radiculopathy ; Ultrasonography

Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.
Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Critical Illness ; Fluoroscopy ; Humans ; Intensive Care Units ; Operating Rooms

BACKGROUND: Laryngoscopy and tracheal intubation often cause hemodynamic changes such as hypertension and tachycardia. This study was carried out to determine the optimal dose of sufentanil for attenuating the hemodynamic changes that occur during the induction of anesthesia with propofol. METHODS: The authors examined 100 ASA class 1-2 patients, who were scheduled for elective surgery anddivided randomly into 4 groups. Anesthesia was induced with propofol (5.0microg/kg target controlled infusion). Three minutes later, rocuronium 1.2 mg/kg was administered. Group 1 (CON group) received no sufentanil, and groups 2, 3 and 4 (SO3, SO5, SO7 groups) received 0.3, 0.5, 0.7 microg/kg, sufentanil, respectively. The hemodynamic changes and BIS were measured at preinduction, 1 and 3 minutes after propofol infusion, and 1 and 3 minutes after sufentanil infusion, intubation, and post-intubation period for 10 minutes. RESULTS: In the SO3, SO5, SO7 groups, the systolic and diastolic and mean arterial pressure did notincrease compared with that at preinduction. However, in the SO7 group, the systolic and diastolic and mean arterial pressure decreased significantly 1 minute after intubation. In the SO3 group, the heart rate increased significantly after intubation compared with preinduction. On the other hand, the heart rate did not increase after intubation in the SO5 and SO7 groups. CONCLUSIONS: When anesthesia is induced with propofol TCI (5.0 microg/ml, the authors suggest that the recommended dosage of sufentanil for attenuating the hemodynamic changes accompanying a laryngoscopy and tracheal intubation be approximately 0.5microg/kg.
Anesthesia ; Arterial Pressure ; Hand ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Propofol ; Sufentanil* ; Tachycardia

Pulse oximetry is a noninvasive, continuous monitoring of arterial oxygenation and provides rapid detection of perioperative hypoxemia. However, many factors give a factitious reading of hemoglobin desaturation, some of these are vital dyes. Many authors report intravenous administration of vital dyes gave a transient factitious reading of hemoglobin desaturation, but few report peritumoral injection of vital dyes giving a spurious reading of hemoglobin desaturation. 1% Isosulfan blue dye has often been used for evaluation of the sentinel lymph node in breast cancer surgery. We report a case of spurious reading of a hemoglobin desaturation on a pulse oximetry following a peritumoral injection of 1% isosulfan blue dye in a patient with breast cancer.
Administration, Intravenous ; Anoxia ; Breast Neoplasms* ; Breast* ; Coloring Agents ; Humans ; Lymph Nodes ; Oximetry* ; Oxygen

BACKGROUND: From our clinical experiences, there are some problems with a paratracheal stellate ganglion block at the 6th cervical level e.g. small changes in blood flow to the upper extremities and more difficulty in differentiating sympathetically-maintained pain from neuropathic pain. This study compared the effectiveness of the classic injection technique and the modified injection technique in paratracheal stellate ganglion block at the 6th cervical level. METHODS: Forty patients were randomly divided into 2 groups. In Group I, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the classic injection technique. In Group II, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the modified injection technique by applying strong pressure to the cephalad portion of the needle entry point. The skin temperature of the first finger was measured before and after the stellate ganglion block, and the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis were examined. RESULTS: The increase in skin temperature of the first finger after the procedure was 0.26 +/- 0.22 degrees C in Group I and 0.84 +/- 0.63 degrees C in Group II, which was statistically significant (P < 0.05). There were no significant differences in the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis between the two groups. CONCLUSIONS: The modified injection technique is more effective in the sympathetic block on the upper extremities than the classic injection technique.
Fingers ; Hoarseness ; Humans ; Mepivacaine ; Needles ; Neuralgia ; Paralysis ; Sensation ; Skin Temperature ; Stellate Ganglion* ; Upper Extremity*