BACKGROUND: To estimate real time concentration of drugs during TIVA is theoretical, but it is not easy and inefficient. To maintain designed target concentration with continuous infusion using methods that account for the multicompartmental pharmacokinetic profile of fentanyl, isoconcentration nomogram is one of the methods. We evaluated the clinical usefulness of the isoconcentration nomogram using two different expected concentration of fentanyl. METHODS: Thirty ASA class I or II adult patients scheduled for spine fusion were randomly allocated into two groups according to 1.5 or 3 ng/ml of expected fentanyl concentration. Using isoconcentration nomogram, fentanyl concentration was adjusted and the propofol concentration was fixed to 3.5 g/ml according to Prys-Roberts method. Vital signs were titrated using variable flow rate of propofol. Fentanyl and propofol were discontinued 15 min before the end of operation. And, IV-PCA using fentanyl were applicated for postoperative pain control. The dosage of propofol and fentanyl, recovery time of consciousness and orientation were checked. Also, first buttoning time and 24hr fentanyl dosage in IV-PCA were checked. RESULTS: Average flow rate of propofol used were 7.5 1.2 mg/kg/hr in group 1, 5.7 1.1 mg/kg/hr in group 2 which was significantly lower than group 1 (p<0.05). Spontaneous eye opening and recovery of orientation was delayed 1.8 times in group 2. First buttoning time and 24hr fentanyl requirement for postoperative pain control using IV-PCA was delayed by 2 and decreased 60% in group 2, respectively. CONCLUSIONS: Isoconcentration nomogram was useful tool to control the expected concentration of fentanyl during TIVA and postoperative pain control using fentanyl IV-PCA.
Adult ; Anesthesia, Intravenous* ; Anesthetics ; Consciousness ; Fentanyl* ; Humans ; Nomograms* ; Pain, Postoperative ; Propofol ; Spine ; Vital Signs

No abstract available.
Carcinoma, Squamous Cell* ; Prognosis*

No abstract available.
Chorion* ; Chorionic Villi*

PURPOSE: Nonsteroidal anti-inflammatory drugs inhibit the synthesis of prostaglandin(PG) through inhibition of the enzyme, cyclooxygenase. Some of the arachidonic acid metabolites may influence the spread of electrocortical activity, and delay the pentylenetetrazol(PTZ)-induced seizures. The purpose of the present study was to evaluate systematically the effect of pretreatment with PG synthetase inhibitors on PTZ-induced seizures. METHODS: To evaluate the effects of pretreatment with PG synthetase inhibitors on seizures produced by 30mg/kg, 60mg/kg PTZ, free-moving Sprague-Dawley rats weighing 250-300gm with chronically-implanted supracortical electrodes were used. Electrocorticogram was recorded for 1hr prior to pretreatment administration of either saline (control) or PG synthetase inhibitor and 1hr after administration of PTZ. RESULTS: 1) A 30mg/kg dose of PTZ produced bursts of high voltage activity after a latency of 616+/-72sec. Although the animals showed spontaneous movements throughout the test period, they were motionless or myoclonus. The number of high voltage bursts during the first hr of the test period was 368+/-31.2) A 30mg/kg of PTZ produced high voltage bursts after a latency of 1118+/-35sec which was significantly greater for the ibuprofen-pretreated groups receiving 90mg/kg when compared to the saline-pretreated group. In addition, the number of high voltage bursts(173+/-17) which occurred during the first hr of the test period was significantly smaller than that recorded from the saline-pretreated group. 3) After pretreatment with a 450mg/kg dose of paracetamol, a 30mg/kg of PTZ produced bursts of electrocortical activity with onset latencies of 665+/-112sec which were not significantly different than those recorded from the saline-pretreated group. The number of high voltage bursts during the first hr of the test period was 141+/-30 which was significantly smaller than that recorded from the saline-pretreated group. 4) A 50mg/kg dose of mefenamic acid pretreatment caused 30mg/kg PTZ-induced high voltage bursts after latency of 227+/-47sec which was significantly shorter than that recorded from the saline-pretreated group. The number of high voltage bursts during the first hr of the test period was 522+/-42 which was significantly greater than that recorded from the saline-pretreated group.5) A 60mg/kg dose of PTZ produced bursts of high voltage activity after a latency of 79+/-14sec. An electrocortical seizure with concurrent convulsions appeared subsequently by 129+/-30sec. 6) A 60mg/kg of PTZ produced high voltage bursts after a latency of 217+/-38sec which was significantly greater for the ibuprofen-pretreated groups receiving 90mg/kg when compared to the saline-pretreated group. An electrocortical seizure with concurrent convulsions appeared subsequently by 287+/-30sec.7) After pretreatment with paracetamol(450mg/kg), a 60mg/kg of PTZ produced bursts of electrocortical activity with onset latencies of 143+/-36sec which were significantly different than those recorded from the saline-pretreated group. There was no convulsive or no electrocortical seizure.8) A 50mg/kg mefenamic acid pretreatment caused 60mg/kg PTZ-induced high voltage bursts after latency of 35+/-5sec which was significantly shorter than that recorded from the saline-pretreated group. An electrocortical seizure appeared subsequently by 58+/-10sec which was significantly different than that recorded from the saline-pretreated group. CONCLUSION: It is possible that the delay and/or block of convulsions induced by the higher doses of PTZ was the result of PG synthesis inhibition. However, the PG synthetase inhibitors had a more differential effect on general PTZ-induced excitation of the CNS evidenced by changes in electrocortical activity. The mechanism underlying this action could be either through inhibition of the activity of cyclooxygenase in tissues which play a role in the manifestation of seizure activity or through an action not related to their common action on cyclooxygenase.
Acetaminophen ; Animals ; Arachidonic Acid ; Electrodes ; Ibuprofen ; Ligases ; Mefenamic Acid ; Myoclonus ; Pentylenetetrazole ; Prostaglandin-Endoperoxide Synthases* ; Rats, Sprague-Dawley ; Seizures*

BACKGROUND: The purpose of this study was to investigate the effect of potassium, bicuculline (BIC) and 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) on epileptiform activity induced by pilocarpine in the rat visual cortex slices. METHODS: In the rat visual cortex slices, we observed the change of pilocarpine-induced epileptiform discharges using extracellular recordings during perfusion of artificial cerebro-spinal fluid (ACSF) with various potassium concentrations ([K+], 2.5, 5, 7.5 and 10 mM) and ACSF with 10 micrometer BIC and 20 micrometer CNQX under 7.5 mM [K+]. RESULTS: Spontaneous interictal epileptiform activity induced by pilocarpine was observed in 5 mM or higher [K+] and ictal discharge was only detected in 7.5 mM [K+]. Increase of [K+] from 2.5 to 7.5 mM not only resulted in the increase of frequency and amplitude of epileptiform activity but also favored the transformation of pilocarpine-induced interictal activity into ictal activity in the rat visual cortex. However, in 10 mM [K+], the ictal discharge was unprovoked and interictal activity was provoked with decreased frequency and amplitude. The spontaneous ictal discharge was blocked but interictal activity was maintained with increased frequency and amplitude by BIC. Interictal and ictal activities were completely blocked by CNQX. CONCLUSIONS: These results suggested that the extracellular potassium concentration, GABA system, and non-NMDA mechanism seemed to be involved in the development and maintenance of pilocarpine-induced epileptiform activity in the rat visual cortex.
6-Cyano-7-nitroquinoxaline-2,3-dione* ; Animals ; Bicuculline* ; gamma-Aminobutyric Acid ; Perfusion ; Pilocarpine* ; Potassium* ; Rats* ; Visual Cortex*

We experienced a case of adenocarcinoma arising in sacrococcygeal teratoma. The patient was a 52-year-old woman. She was admitted due to one month of sacral pain. She had a sacral mass since birth. On physical examination, anal fistula was present at the perianal area and pus drainage was noted. MR image showed multiple variable-sized cysts with inhomogeneous density. Resected specimen, mesuring 12.5 7.0 cm in diameter, showed multiple variable-sized cystic lesions admixed with grayish solid portion. The cysts contained mucoid material. The microscopic examination showed mature teratoma composed of cysts lined by pseudostratified ciliated columnar epithelium, intestinal mucosa, mature cartilage, bone, and fat tissue. A moderately differentiated adenocarcinoma developed from the cystic area in the mass.
Adenocarcinoma* ; Adult ; Cartilage ; Drainage ; Female ; Humans ; Intestinal Mucosa ; Middle Aged ; Mucous Membrane ; Parturition ; Physical Examination ; Rectal Fistula ; Suppuration ; Teratoma*

Pseudothrombocytopenia caused by platelet clumping is an in vitro phenomenon that occurs in ethylene-diamine-tetra-acetic acid (EDTA) anticoagulated blood at room temperature. Pseudothrombocytopenia may lead to erroneous diagnosis, unnecessary and costly additional laboratory examinations, and inappropriate medical or surgical therapy. We experienced 75-year old female pseudothrombocytopenia patient scheduled for orthopedic surgery, who showed abnormal thrombocytopenia (35,000/mm3) in preoperative routine platelet count using EDTA anticoagulant, but showed normal platelet count in sodium citrate anticoagulant.
Aged ; Blood Platelets ; Citric Acid ; Diagnosis ; Edetic Acid ; Female ; Humans ; Orthopedics ; Platelet Count ; Sodium ; Thrombocytopenia

PURPOSE: This study investigated the need for information and social support in parents of children with epilepsy. METHODS: A total of 119 parents of children with epilepsy were recruited and asked to fill out questionnaires. RESULTS: Of 119 parents, two-third reported that they received full and sufficient information about their child's disease and its management but one-third felt the information was insufficient and incomplete. Most parents (62.2%) felt at loss when their child had a seizure, either at home or at school. They wanted information on the causes of seizures, adequate steps deal with seizure and steps they should take to become adequate and supportive parents for their children. However, most parents were reluctant to disclose the disease or to receive support from outsiders. CONCLUSION: Regardless of the fact that most parents received sufficient information about the management of epilepsy, they felt at a loss when their child had a seizure attack. Therefore nurses should give specific instruction on seizure management and assess the needs of parents on a regular basis.
Child* ; Epilepsy* ; Humans ; Needs Assessment* ; Parents* ; Surveys and Questionnaires ; Seizures

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*

INTRODUCTION: Several methods, including loss of eye lash (eyelash) reflex and loss of verbal contact, have heen used as criteria for estimating the optimal hypnosis for anesthesia induction. However, these methods are too objective. We examined the hypnotic dose response of etomidate, using a bispectral index as a more subjective criterion for anesthesia induction. METHODS: Fourty-Five ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to induction dose of etomidate. They were Group 1: 0.1 mg/kg ; Group 2: 0.15 mg/kg; Group 3: 0.2 mg/kg (n = 15 for each group), respectively. Etomidate diluted as 10 ml in a syringe injected through an 18G forearm intravenous catheter, using a syringe pump at the rate of 20 ml/min. Observer's Assessment of Alertness/sedation (OAA/S) scale of 1 was considered optimal for hypnosis. Bispectral index, OAA/S scale, and vital signs were checked every minute until spontaneous eye opening after end of drug infusion. Also, the correlation coefficient between BIS and OAA/S scale was checked for evaluating the bispectral index; this was a useful tool for estimating the degree of hypnosis. RESULTS: BIS and OAA/S showed their lowest scores around 60 sec. after the etomidate injection, which was very different from time to peak effect known to be the 2 min. The correlation coefficient (r) between BIS and OAA/S was 0.84 on average, suggesting the BIS as an good subjective indicator of optimal hypnosis for anesthesia induction. Vital signs were stable in all groups. Hypnotic ED50 and ED95 were 0.12 and 0.19 mg/kg, respectively. CONCLUSIONS: Bispectral index can be a useful tool for estimating the optimal hypnosis for anesthesia induction. Hypnotic ED50 of etomidate was 0.12 mg/kg.
Adult ; Anesthesia* ; Catheters ; Etomidate* ; Forearm ; Humans ; Hypnosis ; Orthopedics ; Reflex ; Syringes ; Vital Signs