Background: Gastric juice volume and acidity are influenced by food, drugs, and patient factors such as age, sex, weight, and fasting time. But almost studies were performed without controlling of these confounding variables. This study was designed to determine the change of gastric juice volume and acidity in relation to the fasting time within a constant food intake. Methods: Fifty-seven healthy patient randomly allocated to one of two groups. Group I was instructed to ingest 200 ml of milk up to 8 hours before anesthesia and Group II was instructed to drink 200 ml of water up to 1~2 hours before anesthesia. After the endotracheal intubation the volume and acidity of gastric juice were measured. Relationships between gastric volume or acidity and fasting time were analysed using correlation analysis. The data were analyzed using Wilcoxon rank sum test, comparing Group I with Group II. Results: There is no significant relationship between gastric juice volume or acidity and the fasting time within the same food intake. Gastric juice volume and acidity of the patients who ingested milk at 8~9 hours before anesthesia were similar to that of those patients who drank water at 1~2 hours before anesthesia. Conclusion: It is necessary to individualize the fasting time of the patients and it seems that water ingestion up to 1~2 hours before anesthesia may be safe.
Anesthesia ; Confounding Factors (Epidemiology) ; Eating ; Fasting* ; Gastric Juice* ; Humans ; Intubation, Intratracheal ; Milk ; Water

No abstract available.
Blood Pressure* ; Heart Rate* ; Heart* ; Intubation* ; Lidocaine*

Between December 1994 and December 1996, 42 patients underwent arthroscopic meniscal repair in our institute. Among them, 31 patients with a follow up more than one year were reviewed. Mean age was 24.4 years(range, 18-52 years) and mean interval between onset of symptom and opera- tion was 12.3 months(range, 3 days-6 years). The associated injuries were tibial plateau fracture(6 cases), anterior cruciate ligament injury(4 cases) and posterior cruciate ligament injury(2 cases). The type of tear were longitudinal in 28 cases(90%) and combined in 3 cases(10%). Most of the meniscal tear were encountered in posterior hom(12 cases, 39%) and middle portion(11 cases, 35%). Out side to in technique was used in anterior horn tears and inside to out technique in middle or posterior hom tears. In tibial plateau fractures, arthroscopic assisted reduction was performed with autogenous bone graft. Ligament reconstructions were performed in the cases of associated cruciate ligament injury. According to Ikeuchis grading system, the result was satisfactory(excellent or good) in 23 cases(74%), fair in 6 cases(19%) and poor in 2 cases(6%). But in the cases of isolated meniscal injury, the result was satisfactory in 95%. The result of arthroscopic repair in the meniscal tears associated with other intra-articular injuries seems to be worse than that of the isolated injuries.
Animals ; Anterior Cruciate Ligament ; Follow-Up Studies ; Horns ; Humans ; Ligaments ; Posterior Cruciate Ligament ; Transplants

BACKGROUND: Crucial to the success of fiberoptic awake tracheal intubation is proper preparation of the patient; this technique will work well in most patients when they are quiet and cooperative and have a larynx nonreactive to physical stimuli. We have attempted to ascertain how well these conditions are achieved with a low-dose infusion of propofol, because of its pharmacological profile. METHODS: Thirty patients, physical status by American Society of Anesthesiologists (A. S. A.) I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive either propofol infusion 1 mg kg-1 h-1 preceded by a 1 mg kg-1 bolus (Group P) or intravenous fentanyl 1ug kg-1 and midazolam 0.05 mg kg-1 (Group F). These two groups were compared in terms of hemodynamic profile, sedation score, condition for intubation, coughing and swallowing. RESULTS: There were no statistically significant differences in mean arterial blood pressures according to time between two groups. But in Group F, heart rates were significantly increased in immediately after transtracheal injection of lidocaine, immediately before the fiberoscopy was started, 1, 2 minutes after start of fiberoscopy, compared to Group P (p<0.05). The patients in Group P were more sedated than those in Group F (p<0.05) but there were no significant differences in condition for intubation, reflex of coughing and swallowing, duration of fiberoptic intubation. CONCLUSIONS: We conclude that propofol is useful sedative agent in fiberoptic awake intubation with similar efficacy to midazolam and fentanyl but with more profound sedation and stable hemodynamic profile. These represent significant advantages for severe anxious or hypertensive patients and prolonged procedure of intubation.
Arterial Pressure ; Cough ; Deglutition ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Larynx ; Lidocaine ; Midazolam* ; Propofol* ; Reflex ; Surgery, Oral

PURPOSE: We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. PATIENTS AND METHODS: Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. RESULTS: The BIS score correlated with the sedation score (r = 0.676, P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score(r = -0.656).Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. CONCLUSIONS: BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.
Adult ; Consciousness ; Humans ; Midazolam* ; Plasma* ; Unconsciousness ; Volunteers

No abstract available.
Anesthesia* ; Head* ; Neck*

BACKGROUND: Mixed venous oxygen saturation (SO2) monitoring turned out to be invaluable in following up systemic cardiovascular status. But balloon-tipped flow-directed thermodilution catheter (Swan-Ganz catheter) insertion carries additional inherent risks other than those of central venous catheterization, and it costs much more expense than simple venous catheter. There has been a lot of papers which argue that central venous catheterization may substitute for the Swan-Ganz catheterization. In addition, it may be very difficult or impossible to insert the Swan-Ganz catheter in pediatric patients. This study was performed to determine whether Swan-Ganz catheterization might be replaced by the central venous catheterization in regards to SO2. METHODS: In 17 pediatric open heart surgery (OHS) patients, from the central venous catheter, the tip of which had been located in the center of right atrium (RA) and pulmonary artery, blood samples were drawn for gas analysis simultaneously, which was done immediately after emergence from cardiopulmonary bypass. RESULTS: There were no significant differences between RA blood and mixed venous blood gas analyses except oxygen saturation. The oxygen saturations of both were linearly correlated with each other. The relation was SO2=17 0.8 SRAO2 (R=0.77, p<0.05) CONCLUSIONS: It may be concluded that RA blood may be used for blood gas analysis in place of mixed venous blood immediately after pediatric open heart surgery.
Blood Gas Analysis ; Cardiopulmonary Bypass* ; Catheterization, Central Venous ; Catheterization, Swan-Ganz ; Catheters ; Central Venous Catheters ; Heart Atria ; Heart* ; Humans ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*

BACKGROUND: Nasotracheal intubation is commonly and safely used in the anesthetic management of patients undergoing head and neck surgeries. There are some kinds of reports about complications associated with nasotracheal intubation which are related to long intubation period in the intensive care unit. But there are few reports about complications after nasotracheal intubation in surgery patients. A prospective study was carried out to evaluate the incidence and outcome of complications of nasotracheal intubation in oral and maxillofacial surgery patients in the Seoul National University Dental Hospital. METHODS: We studied 317 nasally intubated patients over 8 months. Endotracheal tubes softened by soaking in hot normal saline were used. After general anesthesia, we followed the hospital course of patients from the view point of the incidence and outcome of complications associated with nasotracheal intubation. RESULTS: The overall complication rate was 27.1%. Nasal bleeding and benign nasal obstruction were the most frequent events, accounting for a mean of 15.5% and 9.8%, respectively. Other low incidence complication was ulceration of the nose. None of the complications were fatal or resulted in serious sequelae. There was a slight relationship between complications and age or intubation period. CONCLUSIONS: These results suggest that short term use of nasotracheal intubation may be as safe as orotracheal intubation. Complications may be associated with elderly patients and long intubation duration over than 24 hours in surgery patients.
Aged ; Anesthesia, General ; Epistaxis ; Head ; Humans ; Incidence ; Intensive Care Units ; Intubation* ; Nasal Obstruction ; Neck ; Nose ; Prospective Studies* ; Seoul ; Surgery, Oral* ; Ulcer

Although the endotracheal intubation using laryngoscope can usually be performed under general anesthesia, it may be very difficult in situations such as head and neck trauma, hemorrage, or deformity. Recently we performed antegrade fiberoptic nasotracheal intubation with a guide wire. A 15-month aged female child with mandibular fracture was scheduled for open reduction and internal fixation under general anesthesia. She was anticipated difficult intubation due to displacement of the fracture site. After induction of anesthesia, we passed an adult fiberoptic bronchoscope (O.D. 3.8 mm, LF-2, Olympus optical co, Japan) to vocal cord via right nostril. Then a guidewire was inserted through the suction port of bronchoscope, and bronchoscope was removed in a state of guidewire in situ. We slid the endotracheal tube over guidewire according to Seldinger's technique. We think that nasotracheal intubation using an adult fiberoptic bronchoscope and a guidewire is good for children under 2 years old who are expected the difficult intubation.
Adult ; Anesthesia ; Anesthesia, General ; Bronchoscopes* ; Child ; Child, Preschool ; Congenital Abnormalities ; Female ; Head ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes ; Mandibular Fractures* ; Neck ; Suction ; Vocal Cords

BACKGROUND: Propofol is a relatively new intravenous anesthetic agent, and the cerebral blood flow (CBF) response to changes in PaCO2 during propofol anesthesia has not been extensively studied. The purpose of this study was to investigate the effects of propofol anesthesia on the CBF response to changes in PaCO2 in dogs. METHODS: In six dogs, after surgical preparation for posterior sagittal sinus outflow method, loading dose of propofol 5~6 mg/kg was injected and then anesthesia was maintained with a propofol infusion of 20 mg . kg-1 . hr-1 during study. Ventilation was controlled to hypocapnia(PaCO2 20~35 mmHg), normocapnia(PaCO2 35~45 mmHg) and hypercapnia(PaCO2 45~60 mmHg) by adjustment of minute ventilation. Posterior sagittal sinus blood flow was measured by metered syringe and then CBF was calculated. Cerebral metabolic rate for oxygen(CMRO2) was calculated with arterial and sagittal sinus blood analysis. RESULTS: CBF at normocapnia (PaCO2 41+/-5 mmHg) was 28.7+/-11.6 ml . 100 g-1 . min-1 which increased to 46.5+/-14.4 ml . 100 g-1 . min-1 and decreased to 22.1+/-8.9 ml . 100 g-1 . min-1 on increasing PaCO2 (63+/-18 mmHg) and decreasing PaCO2 (33+/-3 mmHg), respectively. The slope of CBF versus PaCO2 was 1.29 ml . 100 g-1 . min-1 . mmHg. Blood pressure, herat rate, PaO2, CMRO2 were not changed between groups. CONCLUSIONS: CBF response to changes in PaCO2 during propofol anesthesia is maintained and the slope of the CBF-CO2 response is similar to that found during anesthesia with other intravenous agents such as thiopental, midazolam, etomidate, opioids.
Analgesics, Opioid ; Anesthesia* ; Anesthetics ; Animals ; Blood Pressure ; Carbon Dioxide* ; Carbon* ; Dogs* ; Etomidate ; Midazolam ; Propofol* ; Syringes ; Thiopental ; Ventilation