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: In this study, the optimal effect-site concentration of remifentanil for blunting hemodynamic responses to endotracheal intubation during total intravenous anesthesia using propofol were evaluated. METHODS: 137 ASA class I and II patients, aged 18-60 years, were randomly allocated to one of six groups according to the effect-site concentration of remifentanil. Remifentanil was then infused at a target effect-site concentration of 0, 1, 2, 3, 4 or 6 ng/ml in groups R0, R1, R2, R3, R4 and R6, respectively. Anesthesia was induced with propofol infusion at a target effect-site concentration of 4microgram/ml endotracheal intubation was performed 5 minutes after remifentanil administration. Blood pressure (BP), heart rate (HR) and cardiac index (CI) were recorded at the baseline and then every 30 seconds until 3 minutes after intubation. RESULTS: BP and HR in groups R0, R1 and R2 increased significantly after intubation when compared with the baseline values. The CI in group R0 also increased significantly after intubation when compared with the baseline values. Incidences of hypertension and hypotension were 50% and 5% in R0, 32% and 14% in R1, 18% and 32% in R2, 10% and 48% in R3, 8% and 54% in R4, and 0% and 81% in R6. There were also 2 cases in which the mean blood pressure was less than 50 mmHg in group R6. CONCLUSIONS: We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to endotracheal intubation are 3 or 4 ng/ml during total intravenous anesthesia using propofol at an effect-site concentration of 4microgram/ml.
Aged ; Anesthesia ; Anesthesia, Intravenous ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal ; Piperidines ; Propofol

Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction. In this article, two cases of retrobulbar hematoma after surgical repair of blow-out fracture are reported. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate decompression after definite diagnosis. We present our clinical experience with regard to the treatment process and method for prevention of retrobulbar hematoma using a scalp vein set tube and a negative pressure drainage system.
Decompression ; Drainage ; Facial Bones ; Hematoma ; Humans ; Orbit ; Orbital Fractures ; Retrobulbar Hemorrhage ; Scalp ; Veins ; Vision, Ocular

No abstract available.
Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus*