BACKGROUND: Because of wide individual variations in response to sedative and the level of sedation desired by different patients, inadequate sedation is frequent during surgery. Patient-controlled sedation is a logical extension of patient-controlled analgesia to find and maintain their own steady-state of sedation by self-administration of sedatives during surgery. The purpose of this study was to evaluate the feasibility of patient-controlled sedation compared with anesthesiologist-controlled sedation during surgical spinal anesthesia. METHODS: Unpremedicated forty adult patients who received spinal anesthesia for lower extremity surgery were randomly allocated into two groups (n=20 for each group). After selection of target state of sedation according to sedation scale, patient-controlled sedation (PCS) group self-administered 0.5 mg (1 ml) intravenous midazolam in increments using a Walkmed PCA infusor and anesthesiologist- controlled sedation (ACS) group administered by the anesthesiologist as the same manner to achieve previously selected sedation state. Sedation score, vital signs, SpO2 were checked 5, 10, 20, 30, 40min after start of drug injection. RESULTS: The sedation scores patient desired were 4.4 +/- 0.8 in PCS group and 4.3 +/- 0.7 in ACS group. These scores were achieved 20min after start of injection in PCS group and 40 min in ACS grou p (p<0.05). Degree of satisfaction was higher in PCS group compared with ACS group (1.5 +/- 0.6 vs 2.1 +/- 0.8, p<0.05). No complications were detected in two groups. CONCLUSIONS: PCS using midazolam was better than ACS in terms of early achievement of sedation state patient desired and degree of satisfaction.
Adult ; Analgesia, Patient-Controlled ; Anesthesia, Spinal ; Humans ; Hypnotics and Sedatives ; Infusion Pumps ; Logic ; Lower Extremity ; Midazolam* ; Passive Cutaneous Anaphylaxis ; Vital Signs

We evaluated the clinical and radiologic results of 48 cases (31 patients) who had rheumatoid arthritis of the knee joint and were managed with cementless total knee arthroplasty between November 1988 and December 1994. The mean follow-up period was 3.7 years (range, 2 to 7 years). The knee score of the Hospital for Special Surgery improved from an average of 44 points (range, 5 to 77 points) preoperatively to 83 points (range, 50 to 97 points) at the time of the most recent followup examination. In knee score, 85.4% of cases had excellent or good grade (over 75 points). The range of motion improved from an average of 77 degrees to an average of 103 degrees postoperatively. In tibiofemoral angle, 95.8% of cases were between valgus I degree and 10 degrees. The implants were inserted in an optimal position. Continuous radiolucency was not visible beneath any implant and loosening was not found. In one case, heterotopic ossification was removed to improve the range of motion. There was one case of patellar fracture during operation. Even in relatively poor bone quality in rheumatoid arthritis of the knee, the cementless total knee arthroplasty revealed good clinical and radiologic results.
Arthritis, Rheumatoid* ; Arthroplasty* ; Follow-Up Studies ; Knee Joint ; Knee* ; Ossification, Heterotopic ; Range of Motion, Articular

No abstract available.
Scleroderma, Localized

Spontaneous intracranial hypotension (SIH) is an uncommon disease which present as a spontaneously occurring postural headache. Diagnosis is supported by a low CSF pressure by lumbar puncture, diffuse dural enhancement on gadolinium-enhanced brain MRI, or by a CSF leakage site on a radioisotope cisternography or by computed tomographic myelography. Usually SIH treatment is conservative but often requires caffeine, steroids, continuous epidural saline infusion and an epidural blood patch. The most important complication of SIH is bilateral subdural hematoma (SDH), because it may require urgent neurosurgical intervention. We experienced two-cases of SIH with SDH treated with an epidural blood patch, but subdural hematoma increased after radioisotope cisternography, so burr hole drainage was performed with another epidural blood patch.
Blood Patch, Epidural ; Brain ; Caffeine ; Diagnosis ; Drainage ; Headache ; Hematoma, Subdural* ; Intracranial Hypotension* ; Magnetic Resonance Imaging ; Myelography ; Spinal Puncture ; Steroids

Background: Although competency-based education (CBE) is becoming a popular form of medical education, it has not been used to train residents. Recently, the Korean Society of Anesthesiologists completed a pilot implementation and evaluation of a CBE program.This study aims to outline the experience. Methods: The chief training faculty from each hospital took a one-hour online course about CBE. Emails on the seven core competencies and their evaluation were sent ahead of a pilot core competency evaluation (CCE) to residents and faculty. The pilot CCE took place in late 2021, followed by a survey. Results: A total of 68 out of 84 hospitals participated in the pilot CCE. The survey response rate was 55.9% (38/68) for chief training faculty, 10.2% (91/888) for training faculty, and 30.2% (206/683) for residents. More than half of the training faculty thought that CCE was necessary for the education of residents. Residents’ and training faculty’s responses about CCE were generally positive, although their understanding of CCE criteria was low. More than 80% of the hospitals had a defibrillator and cardiopulmonary resuscitation manikin while the rarest piece of equipment was an ultrasound vessel model. Only defibrillators were used in more than half of the hospitals. Thoughts about CCE were related to various factors, such as length of employment, location of hospitals, and the number of residents per grade. Conclusions This study’s results may be helpful in improving resident education quality to meet the expectations of both teaching faculty and residents while establishing CBE.

Although colorectal cancer emerged as a major public health concern, its incidence as well as mortality are decreasing during recent years in Korea. Most important contributor for these reduction in disease burden is colorectal cancer screening. Besides screening, primary prevention through risk factor modification could reduce 10% to 54% of colorectal cancer incidence. These factors include limiting alcohol, processed and red meat consumption, and cigarette smoking, maintaining optimal weight, and engaging physical activities.
Colorectal Neoplasms ; Epidemiology ; Incidence ; Korea ; Mass Screening ; Mortality ; Motor Activity ; Primary Prevention ; Public Health ; Red Meat ; Risk Factors ; Smoking

Although colorectal cancer emerged as a major public health concern, its incidence as well as mortality are decreasing during recent years in Korea. Most important contributor for these reduction in disease burden is colorectal cancer screening. Besides screening, primary prevention through risk factor modification could reduce 10% to 54% of colorectal cancer incidence. These factors include limiting alcohol, processed and red meat consumption, and cigarette smoking, maintaining optimal weight, and engaging physical activities.

Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.
Bronchi ; Bronchoscopy ; Diagnosis ; Dyspnea ; Granulation Tissue ; Humans ; Lung Injury ; Pulmonary Atelectasis* ; Rupture* ; Thorax

No abstract available.
Hospitals, Community* ; Humans