Transvaginal cervical cerclage for the prevention of pregnancy loss in patients with cervical incompetence is well accepted. However, there is a small subject of patients with incompetence of cervix, congenital or surgical shortening of the cervix, previously failed transvaginal cerclage and deep cervical damage or tears in the fornices. We experienced a case of the transabdominal cervical cerclage. 'Ihe patient had a past history of deep cervical laceration due to vaginal delivery. Therefore, we present here a surgical technique of transabdominal cerdage and report it with brief review of literatures.
Cerclage, Cervical ; Cervix Uteri* ; Female ; Humans ; Lacerations ; Pregnancy

In order to investigate the factors influencing QOL and life satisfaction of the physically disabled, the author interviewed, by using structuralized questionnaire, 440 individuals among the physically disabled who were participated in Health Examination from April to July, 1997. The questionnaire consisted of the general characteristics(sex, age, marital status, family number, etc), the Reintegration to Normal Living Index(RNLI) to assess QOL, and the single item of five-likert scale to evaluate life satisfaction. The means of RNLI were 16.2+/-4.8 in total score, 12.2+/-3.4 in daily functioning and 4.0+/-2.1 in perception of self. The respondents were less reintegrated toward social activities and relationships than impairments or disabilities. While the satisfied group was 47.3%, the dissatisfied group was 52.7%. As the results of multiple regression and logistic regression analysis, the significant predictors of QOL were age, education, job, grade of disability and subjective health status. The life satisfaction were related to economic status, job and subjective health status. To improve QOL and life satisfaction of the physically disabled, it is important that we improve their basic socioeconomic status by getting a job through rehabilitation education and induce them to have positive self-assessment by extending the opportunity of social participation.
Daegu* ; Surveys and Questionnaires ; Disabled Persons* ; Education ; Humans ; Logistic Models ; Marital Status ; Surveys and Questionnaires ; Rehabilitation ; Self-Assessment ; Social Class ; Social Participation

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Twin pregnancy and cesarean delivery are well-known risk factors for PPH. However, few studies have investigated PPH risk factors in mothers who have undergone cesarean delivery for twin pregnancies. Therefore, this study investigated the risk factors associated with severe PPH after cesarean delivery for twin pregnancies. Methods: We searched and reviewed the Korean Health Insurance Review and Assessment Service’s claims data from July 2008 to June 2021 using the code corresponding to cesarean delivery for twin pregnancy. Severe PPH was defined as hemorrhage requiring red blood cell (RBC) transfusion during the peripartum period. The risk factors associated with severe PPH were identified among the procedure and diagnosis code variables and analyzed using univariate and multivariate logistic regressions. Results: We analyzed 31,074 cesarean deliveries for twin pregnancies, and 4,892 patients who underwent cesarean deliveries for twin pregnancies and received RBC transfusions for severe PPH were included. According to the multivariate analysis, placental disorders (odds ratio, 4.50; 95% confidence interval, 4.09– 4.95; P < 0.001), general anesthesia (2.33, 2.18–2.49; P < 0.001), preeclampsia (2.20, 1.99–2.43; P < 0.001), hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome (2.12, 1.22–3.68; P = 0.008), induction failure (1.37, 1.07–1.76; P = 0.014), and hypertension (1.31, 1.18–1.44; P < 0.001) predicted severe PPH. Conclusions: Placental disorders, hypertensive disorders such as preeclampsia and HELLP syndrome, and induction failure increased the risk of severe PPH after cesarean delivery for twin pregnancy

BACKGROUND: Somatosensory evoked potentials (SSEPs) have been frequently used to monitor cerebral ischemia during cerebral aneurysm surgery. The relation of SSEP changes and postoperative neurologic deficits due to ischemia have been studied many times but the relation according to the location of temporary clips have not yet been evaluated. METHODS: We studied 81 patients undergoing cerebral aneurysm surgery. Median nerve SSEP was used for temporary clipping of internal carotid artery (ICA) or middle cerebral artery (MCA) and posterior tibial nerve SSEP for temporary clipping of anterior cerebral artery (ACA). SSEPs were recorded after induction of anesthesia and dural opening (control value), during temporary clipping, and after relieving temporary clips. A change in cortical amplitude of more than 50%, as compared with control was considered as `significant'. The presence of significant SSEP changes and neurologic deficits according to the location of temporary clips were analyzed using 2 test. RESULTS: Significant changes in M-SSEP were recognized in 7 of 31 patients of MCA clipping. 2 patients showed neurologic deficits in these 7 patients. Significant changes in M-SSEP were recognized in 7 of 26 patients of ICA clipping, but there was no neurologic deficit. Significant changes in P-SSEP were recognized in 4 of 24 patients of both ACAs clipping. Only 1 patient showed neurologic deficit, but SSEP change of this patient was insignificant. Temporary clip time was significantly prolonged if there were neurologic deficits. CONCLUSION: SSEPs may be able to be used to detect significant cerebral ischemia due to temporary clipping. Especially, M-SSEP was useful to detect cerebral ischemia due to MCA temporary clipping.
Anesthesia ; Anterior Cerebral Artery ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Arteries* ; Evoked Potentials, Somatosensory* ; Humans ; Intracranial Aneurysm ; Ischemia ; Median Nerve ; Middle Cerebral Artery ; Neurologic Manifestations ; Tibial Nerve

BACKGROUND: The start-up behavior of syringe and syringe pump is known to be one of the causes of inaccurate intravenous infusion. This study evaluated the method of priming the infusion system (PRIMING), and its impact on the target-controlled infusion (TCI) of two remifentanil diluents. METHODS: PRIMING was performed using an evacuation of 2.0 ml to the atmosphere prior to TCI. Forty-eight TCI, using 50 microg/ml (Remi50) or 20 microg/ml (Remi20) of diluents, were performed targeting 4.0 ng/ml of effect-site concentration (Ceff), with PRIMING or not. The gravimetrical measurements of the delivered infusates reproduced actual Ceff. The bolus amount and time to reach 95% target were compared. RESULTS: Without PRIMING, Remi50 infused less bolus (43 +/- 23 %) than Remi20 (19 +/- 9 %) (P = 0.003), and showed more delayed increase of Ceff (11.2 +/- 4.0 min) than Remi20 (7.4 +/- 0.4 min) (P = 0.028). However, PRIMING significantly decreased the deficit of the bolus (2 +/- 1%), as well as the delay of the increase of Ceff in Remi50 (1.2 +/- 0.2 min) (both P < 0.001). In addition, with PRIMING, the start-up bolus showed minimal difference to the nominal bolus (1 and 2%), and Ceff were increased to 4.0 +/- 0.1 ng/ml at the expected time of peak effect, irrespective of the diluents. CONCLUSIONS: Proper operation of the syringe pump used in the priming of the syringe may be helpful in reduction of the inaccuracy of TCI, particularly during the early phase of infusion, or the infusion of a more concentrated diluent.
Atmosphere ; Infusions, Intravenous ; Piperidines ; Syringes

No abstract available.
Humans

BACKGROUND: Target-controlled infusion (TCI) of propofol and remifentanil can provide satisfactory intubating conditions without a neuromuscular blocking agent. We compared the effect-site concentration of remifentanil required for intubation with the lightwand and the Macintosh laryngoscope during propofol TCI without a neuromuscular blocking agent in adult patients. METHODS: Forty-nine patients were randomly assigned to the lightwand group (n = 25) or the direct laryngoscope group (n = 24). Anesthesia was induced by propofol TCI with an effect-site concentration of 5.4 microg/ml. Two minutes after start of propofol TCI, remifentanil was administered at the predetermined effect-site concentration. The effect-site concentration of remifentanil was determined using Dixon's up-and-down method (0.5 ng/ml as a step size). The first patient in each group was tested at 4.5 ng/ml of remifentanil. Tracheal intubation was performed 2 min after the start of remifentanil TCI. Acceptable intubation was defined as an excellent or good intubating conditions. RESULTS: Using a modified Dixon's up and down method, the EC50 +/- SD of remifentanil in the lightwand and laryngoscope groups was 4.75 +/- 0.71 ng/ml and 5.08 +/- 0.52 ng/ml, respectively; there was no statistically significant difference between the groups (P = 0.373). CONCLUSIONS: The effect-site concentration of remifentanil for acceptable intubation with the lightwand and Macintosh laryngoscope in 50% of adults did not differ during propofol TCI without a neuromuscular blocking agent.
Adult ; Anesthesia ; Humans ; Intubation ; Laryngoscopes ; Laryngoscopy ; Neuromuscular Blockade ; Piperidines ; Propofol

BACKGROUND: Intraoperative acid-base imbalance frequently occurs during liver transplantation (LT). The purpose of this study was to compare the acid-base changes between cadaveric whole LT and a LT from a living relative using a strong ion approach. METHODS: Twenty-four patients undergoing LT were allocated to a group receiving a LT from a brain dead donor (BD group, n = 12) or a LT from a living, related donor (LD group, n = 12) according to the surgical technique required. Acid-base parameters such as PaCO2, pH, base excess, and serum concentrations of bicarbonate, albumin, lactate, phosphate, and other electrolytes were measured at 30 min after skin incision (T1), 30 min after reperfusion (T2), and 1 h after the arrival at the intensive care unit (T3). The apparent strong ion difference (SIDa), the effective strong ion difference (SIDe), and the strong ion gap (SIG) were calculated using the Stewart equation. RESULTS: There were no significant differences in pH, PaCO2, base excess, SIDa, and SIG between the two groups throughout the entire period of investigation. pH was decreased from T1 to T2, and increased significantly from T2 to T3 in both groups. The serum concentration of lactate was significantly increased from T1 to T2 and T3 in both groups without any intergroup differences. The strong ion gap was significantly increased from T1 to T2 only in the BD group. CONCLUSIONS: During LT from both cadaveric and living related donors, there is a biphasic acid-base change that is characterized by an initial metabolic acidosis and then a metabolic alkalosis, with no significant intergroup differences in acid-base variables.
Acid-Base Equilibrium ; Acid-Base Imbalance ; Acidosis ; Alkalosis ; Brain Death ; Cadaver ; Electrolytes ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Lactic Acid ; Liver ; Liver Transplantation ; Reperfusion ; Skin ; Tissue Donors

BACKGROUND: The addition of remifentanil during the propofol induced anesthesia facilitates the insertion of laryngeal mask airway (LMA) with minimal adverse hemodynamic disturbances. This study predicted the optimal effect-site concentration of remifentanil for LMA insertion with propofol target-controlled infusion (TCI). METHODS: In 25 adults patients, aged 18-60 years, anesthesia was induced with propofol TCI at the effect-site concentration of 4microgram/ml. Two minutes later, the predetermined effect-site concentration of remifentanil was started. The remifentanil concentration was determined using modified Dixon's up-and-down method (0.5 ng/ml as a step size). The first patient was tested at 2.0 ng/ml remifentanil. The insertion of LMA was attempted 3 min after remifentanil TCI began. The response of the patients to the insertion of LMA was classified as either 'movement' or 'no movement'. RESULTS: The remifentanil concentration at which there was a 50% probability of successful LMA insertion (EC50) was 3.18 +/- 0.53 ng/ml. From probit analysis, the EC50 of remifentanil was 3.10 ng/ml (95% confidence limits, 2.55-4.11 ng/ml), and the EC95 was 4.31 ng/ml (95% confidence limits, 3.64-11.11 ng/ml). CONCLUSIONS: The predicted effect-site concentration of remifentanil for facilitating LMA insertion was 3.18 ng/ml in 50% of adults during propofol TCI at an effect-site concentration of 4microgram/ml without premedication.
Adult ; Anesthesia ; Hemodynamics ; Humans ; Laryngeal Masks* ; Premedication ; Propofol*

BACKGROUND: Lidocaine is a useful intravenous and topical adjunct to facilitate tracheal intubation. We evaluated the effect of tracheal lidocaine on tracheal intubating conditions without neuromuscular blocking agent and hemodynamics during anesthesia induction with propofol and remifentanil target-controlled infusion (TCI). METHODS: Fifty patients, aged 18-60 years, scheduled for closed reduction of fractured nasal bone were randomly assigned to the control group (n = 25) or lidocaine group (n = 25). Anesthesia was induced with propofol-remifentanil TCI with the effect-site concentration of 5 microg/ml and 5 ng/ml. Four minutes after the start of propofol-remifentanil TCI, 4% lidocaine or saline 3 ml was instilled to larynx and trachea, and intubation was performed 1 min later. Acceptable intubation was defined as excellent or good intubating conditions. Hemodynamic data, induction and recovery profiles were recorded. RESULTS: Intubating condition was clinically acceptable in 13 out of 25 (52%) patients in the control group and in 22 out of 25 (88%) in the lidocaine group, and there was a significant difference between the two groups in regard to acceptable intubating conditions (P = 0.005). Mean arterial pressure change over time was significantly different between the two groups. There were no significant differences in the heart rate between the two groups. CONCLUSIONS: This study demonstrated that laryngotracheal administration of 4% lidocaine could increase the percentage of acceptable conditions for tracheal intubation during propofol and remifentanil anesthesia without neuromuscular blockade.
Anesthesia* ; Anesthesia, Intravenous ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Larynx ; Lidocaine* ; Nasal Bone ; Neuromuscular Blockade* ; Piperidines ; Propofol ; Trachea