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

Topical phenylephrine, an agent used to facilitate nasotracheal intubation and prevent nasal mucosal bleeding, can cause severe hypertension in some patients, secondary to its stimulation of alpha-adrenergic receptors. Moreover, a high incidence of pulmonary edema is found in patients whose phenylephrine administration is followed by treatment with beta-blocking agents. We report a case of acute pulmonary edema in a pediatric patient who developed severe hypertension after the inadvertent administration of a large dose of topical nasal phenylephrine, followed by beta-adrenergic antagonists (esmolol).
Administration, Intranasal ; Adolescent ; *Anesthesia, General ; Dentigerous Cyst/surgery ; Humans ; Male ; Phenylephrine/*adverse effects ; Pulmonary Edema/*chemically induced/radiography ; Radiography, Thoracic

No abstract available.
Exotropia*

BACKGROUND: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. METHODS: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). RESULTS: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 +/- 3956.9 vs 32,284.8 +/- 1209.4 won) were significantly lower in the TEA group than in the GA group. CONCLUSIONS: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Blood Pressure ; Breast* ; Bupivacaine ; Enflurane ; Heart Rate ; Humans ; Injections, Epidural ; Lidocaine ; Nitrous Oxide ; Oxygen ; Pain, Postoperative ; Sodium ; Tea