High frequency ventilation has been used experimentally and clinically in a variety of situations. This report describes two cases in which high frequency jet ventilation was used to provide adequate ventilation during thoracic surgery. A solenoid valve controlled ventilator at rates of 100 breaths/min. with a double lumen tube provided adequate gas exchange for these patients with an open chest. The minimal lung movement during high frequency jet ventilation was found to provide excellent operating conditions without undue cardiovascular embarrassment. This case report demonstrates the use of high frequency jet ventilation in two adults undergoing operation ofr pulmonary lobectomy and biopay with segmental resection.
Adult ; High-Frequency Jet Ventilation ; High-Frequency Ventilation ; Humans ; Lung ; Thoracic Surgery* ; Thorax ; Ventilation* ; Ventilators, Mechanical

In 10 anesthetized and paralyzed rabbits, cardiovascular variabled(blood pressure, pulse rate), rectal temperature and arterial blood gase tension were investigated during high frequency oscillatory ventilation(about 17hz). During high frequency oscillation(HFO) blood pressure, rectal temprerature and blood gas tension remained stable and were not different from the control values( intermittent positive pressure ventilation IPPV). The PaO2/FIO2 ratio remained unchanged during the experiment in spite of changing airway pressure. We observed that HFO provided adequate ventilation and oxygenation without altering cardiovascular dynamics. High frequency oscillatory ventilation appears to be a promising new way of achieving gas exchange with minimal risk of barotrauma to the lung.
Barotrauma ; Blood Pressure ; Intermittent Positive-Pressure Ventilation ; Lung ; Oxygen ; Rabbits ; Ventilation*

The dose-response of intravenous thiopental (2.5%) for induction of general anesthesia in cesarean section (C/S) patients and in patients with end stage renal disease(ESRD) was studied at seven doses of 2.0, 3.0, 3.5, 4.0, 4.5, 5.0 and 6.0 mg/kg body weight. Thiopental was injected as an IV bolus into a preexisting IV catheter. Patients were divided into four groups(ESRD-CONTROL, C/S-CONTROL, C/S, and ESRD). Each patient was examined at 60 seconds after injection of thiopental. Presence or absence of verbal command response, lid reflex and trapexius reflex were observed. For each reflex, dose-response curves were analysed using the log probit model to determine ED 50, Ed95 and parallelism. The value of ED50 for verbal command response was lowest in the ESRD patient group (2.2mg/kg) and was similar in the remaining groups(2.5, 2.6mg/kg). The ED50 values for lid and trapezius reflex were lowest in the C/S group(2.9and 4.0mg/kg respectively) and the others had similar values (3.5~3.7mg/kg and 4.7~5.3mg/kg respectively). The ED95 values for trapezius reflex in all patients were distributed between a range of 6.5~9.1mg/kg and this suggests that the usual dose (3~6 mg/kg) is not sufficient to prevent the stress response of tracheal intubation. Also, the results indicate that the dose of thiopental for induction should be reduced because of the increasing sensitivity of the central nervous system with the cesarean section group and the free drug fraction of thiopental in patients with end stage renal disease. Therefore, if a patient with full term pregnancy or renal failure is to be induced with a single injection of thiopental, it is recommended to reduce the rate of injection.
Anesthesia, General* ; Body Weight ; Catheters ; Central Nervous System ; Cesarean Section* ; Female ; Humans ; Intubation ; Kidney Failure, Chronic* ; Pregnancy ; Reflex ; Renal Insufficiency ; Superficial Back Muscles ; Thiopental*

This experimental study was done to understand the functional difference and variables thought to be important in determing CO2 elimination and arterial oxygenation during HFJV and system J (System J means that an expiratory valve is attached to the expiratory port of the double lumen tube). In an experimental lung model, a plastic tube, simulating the traches, was intubated with a double-lumen tracheal tube. Ventilation was performed with a solenoid valve controlled high frequency ventilator. Changing the inspiratory time and driving pressure during HFJV and system J can linearly alter the tidal volume and airway pressure. There was a significant difference in airway pressure between the two modes of high frequency ventilation at I:E ratios of 1:2 adn 1:3. With air entrainment, HFJV provided more peak flow than system J and less FIO2 with and increasing driving pressures. Some functional charateristics of two high frequency ventilatory system using double-lumes tubes in a lung model are shown in this study.
High-Frequency Ventilation ; Lung* ; Oxygen ; Plastics ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

The purpose of this study is to evaluate the use of high frequency percutaneous transtracheal ventilation and high frequency jet insufflation for laryngomicrosurgery performed under general anesthesia. Twenty patients were anesthetized with intermittent intravenous anesthetics and paralyzed with either d-tubercurarine or pancuronium. For the operations for 8 of them (group 1) ventilation was supplied through a 16 G Angiocatch introduced into the trachea through the cricothyroid membrane. For the operations for 12 remaining patients(group 2) ventilation was supplied through a 5 mm endotracheal catheter. A respiratory rate of 100 breaths/minute was used at an FiO2 1.0 using a solenoid valve-actuated ventilator. The inspiratory-expiratory ratio was 1:2. The driving pressure of oxygen was 10-45 psi. In neither group was there any significant change in the value of the pH, of PaCO2, or of PaO2. Cardiovascular parameters such as blood pressure and heart rate were slightly increased. Data obtained from these observations indicate that these techniques and devices when used properly, should provide adequate ventilation and improve the visibility of the operative field.
Adolescent ; Adult ; Aged ; Anesthesia, General* ; Child ; Child, Preschool ; Human ; Laryngeal Diseases/surgery* ; Microsurgery* ; Middle Age ; Respiration, Artificial

OBJECTIVE: To assess the association between alcohol drinking and hip fracture in the elderly people in Korea. BACKGROUND: Hip fracture is known as one of the major health problems because of its high incidence and serious consequences in the elderly people. The association between alcohol consumption and hip fractures has not been directly evaluated yet in Korea. So we conducted a nested case-control study to investigate the relationship between alcohol consumption and hip fracture in the Korean elderly people. DESIGN: Nested case-control study from the Korea Elderly Pharmacoepidemiology Cohort (KEPEC), in Pusan, Korea. METHODS: Seventy incident cases have been selected since 1993, and 280 controls have been matched with the cases by age and gender among the KEPEC. Average alcohol intake was calculated by multiplying frequency and amount of drinking and unit capacity of each alcohol type. Odds ratios of alcohol intake on the hip fracture and their confidence intervals were computed by using multiple logistic regression with Windows version SAS 6.12. RESULTS: The elderly people's drinking rate is lower than the young people in Korea. In univariate analysis, crude odds ratio was 0.26 in male and adjusted odds ratio after contolling for age, smoking status, medication history, physical activity and body mass index was 0.36 in male. So current drinking reduces the risk of hip fracture. Adjusted odds ratio after controlling for age, smoking status, medication history, physical activity and body mass index odds ratio was 0.24 in female with moderate drinking. CONCLUSION: We found that alcohol consumption reduces the risk of hip fracture in the elderly Korean. However, we could not explain the plausible mechanism with our data yet. So, we suggest the further study for elucidating the possible mechanism of the finding including the possible association between nutritional status, alcohol drinking and bone marrow density in the elderly.
Aged* ; Alcohol Drinking ; Body Mass Index ; Bone Marrow ; Busan ; Case-Control Studies* ; Cohort Studies ; Drinking ; Female ; Hip Fractures ; Hip* ; Humans ; Incidence ; Korea* ; Logistic Models ; Male ; Motor Activity ; Nutritional Status ; Odds Ratio ; Pharmacoepidemiology ; Smoke ; Smoking

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) is a common problem in otolaryngology and comprises a spectrum of airway disorders that ranges from simple snoring to obstructive sleep apnea. SDB can exhibit problems of behavioral regulation such as inattention, hyperactivity and impulsivity. We aim to assess the effect of adenotonsillectomy on inattention and hyperactivity before and after adenotonsillectomy in children with SDB. SUBJECTS AND METHOD: We selected 19 pediatric patients with SDB, whose tonsils are of grade III or greater and the adenoid-nasopharyngeal ratio was 70% or more. The degree of inattentiveness and hyperactivity was evaluated by ADHD diagnostic system (ADS), trail making test, Wisconsin card sorting test (WCST) and SNAP-IV rating scale. RESULTS: There was significant improvement after adenotonsillectomy in the score of auditory ADS, trail making test, WCST, SNAP-IV rating scale. However, no improvement in postoperative visual ADS was observed. CONCLUSION: Adenotonsillectomy could be recommended to improve inattentiveness and hyperactivity in children with SDB.
Adenoidectomy ; Attention Deficit Disorder with Hyperactivity ; Child* ; Humans ; Impulsive Behavior ; Otolaryngology ; Palatine Tonsil ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive ; Snoring ; Tonsillectomy ; Trail Making Test ; Wisconsin

The pharmacokinetics of intravenously adminstrered lidocaine were studied in 5 normal patients withno renal disease and 4 patients with end-stage renal failue during anesthesia. In both group of patinets, the half life, the volume of distribution and clearance were not significantly different. However, valuses were altered in comparison with those of subjuc without anesthesia. This alteration of parameters is thought to be the effect of reduced hepatic blood flow due to potent anestheics grugs. Our understanding of lidocaine pharmacokinetics in patients with chronic renal failure during anesthesia suggests that these patients can safely receive a normal loading and maintenanece dose with close monitoring for signs of lidocaine toxicity. even though the total plasma concentration may be within the therapeutic range.
Anesthesia* ; Half-Life ; Humans ; Kidney Failure, Chronic ; Lidocaine ; Pharmacokinetics ; Plasma

Spinal Anesthesia employing 0.5% plain bupivacaine was administered to 40 patients scheduled for lower limb or perineum sThe plasma concentrations and pharmacokinetic parameters of lidocaine were studied in 4 patients under general anesthesia(halothane, or enflurane-N20-O2) following the introduction of an 1% lidocaine endotracheal spray(1.5mg/kg) through an epidural catheter. Poak plasma lidocaine levels were reached in 5 to 15 minutes and were within the nontoxic range. The pharmacokinetics of lidocaine in these patients can be described by a two-compartment model with a rapid alpha distribution(T 1/2 alpha 8.66+/-2.24 min.), and an extensive apparent volume of idstribution(1.32+/-0.46 1/kg) similar to that observed in normal subjects. The half-life of absorption was 3.65+/-1.21 minutes. However, the elimination half-life(T 1/2 beta 173.25+/-32.41 min.) was prolonged and the total plasma clearance( 6.15+/-3.25 ml/min/kg) was decreased. This potent inhalation anesthetic agent may reduce the hepatic blood flow and would be expected to reduce the plasma clearance of lidocaine by reducing the delivery of plasma lidocaine. This study suggests that tracheal administration of lidocaine will produce effective plasma lidocaine levels in many clinical situations as will intravenous administration.
Absorption ; Administration, Intravenous ; Anesthesia, General* ; Anesthesia, Spinal ; Bupivacaine ; Catheters ; Half-Life ; Humans ; Inhalation ; Lidocaine* ; Lower Extremity ; Perineum ; Pharmacokinetics* ; Plasma

OBJECTIVE: To evaluate the utility of Cognitive Perceptual Assessment for Driving (CPAD) through the on-road test in predicting the actual road driving skills in brain injured patients. METHOD: 25 brain injured patients with actual driving experience before the occurrence of diseases participated in the handicapped driving adaptation training program of our hospital as the subjects of the study, and one round of CPAD and on-road test were performed. CPAD evaluations and on-road tests for all patients were evaluated by the same therapist. RESULTS: 11 patients passed the CPAD and all of them passed the on-road test. 3 patients failed from CPAD and they turned out to be failed at the on-road test. The mean CPAD score of the on-road test passed group was 53.6 which was significantly different from the mean 43.6 CPAD score acquired by the on-road test failed group by showing a significant difference between two groups (p<0.05). Among the 11 patients who received the borderline CPAD score, 9 patients passed the on-road test. CONCLUSION: CPAD is considered to be useful in predicting the actual road driving skills of brain injured patients who previously had driving experiences before the occurrence of the diseases.
Brain ; Disabled Persons ; Humans