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

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

In 9 patients who were expected to have the dental orthognatic surgery under the general anesthesia, Na Nitroprusside was administered to induce and maintain the hypotension. The following results were obtained during operation 1) Mean arterial pressure was 58mrnHg during controlled hypotension. 2) There were no significant changes in heart rates and central venous pressure during operation. 3) There were no significant changes in arterial pH and arterial contents of oxygen and carbon dioxide during operation. 4) Hemoglobin concentration and hematocrit were significantly decreased 90 minutes after administration of Na Nitroprusside and 30 minutes after discontinuing intravenous infusion of Na Nitroprusside. 5) There were no significant changes in the blood concentration of K, Na, and Cl. 6) The average amount of blood loss during operation was estimoted by 380 cc.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Carbon Dioxide ; Central Venous Pressure ; Heart Rate ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Hypotension, Controlled ; Infusions, Intravenous ; Nitroprusside ; Oxygen

In 2D surgical paients wihose general anesthsia was maintained with one to one ratio of oxygen and nirtous oxide and 1 vo19 of halothane, 1 mg/kg of lidocaine was administered to the 10 patients in each group intravenously to evaluate the effects of lidocaine on cardiovascular changes. In these clinical study, heart rate (HR), mean arterial pressure (MAP), stroke volume (SV) and cardiac output (CO) were measured iri one minute interval after intravenous administration of lidocaine and these values were compared with the control. The following results were obtained: 1) There are no significant changes of the heart rate. 2) The mean arerial pressure was significantly decreased one minute after that, there was no significant change. 3) There were no signifieant changes in the stroke volume. 4) The cardiac outit was significantly decreased in all patients after the administration of lidocaine and there were also the significant decrease of the cardiac output three and four minutes in patients with 1.0 mg/kg of lidocaine and four and five minutes in patients with 1.5 mg/kg of lidocaine after the administration of lidocaine.
Administration, Intravenous ; Anesthesia* ; Arterial Pressure ; Cardiac Output ; Halothane* ; Heart Rate ; Humans ; Lidocaine* ; Oxygen ; Stroke Volume

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: 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

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