The ankle joint plays important biomechanical role in erect position or ambulation. The ankle injury includes bony structures with articular surface, ligaments and soft tissue injury. So the goal of treatment is anatomical reduction of ankle mortise. Fifty two patients of ankle fractures which were admitted and treated in Seoul Adventist Hospital from January, 1980 to December, 1984, were analysed in the clinical and radiological aspect. The results obtained from this study were as follows; l. Of the 52 cases, male was 39 cases(75.0%) and female was 13 cases(25.0%). The average age of the patients was 33 years with range from 18 years to 75 years. 2. The most common cause of injury was traffic accidident. Nexts were fall down, sports injury, slip down and industrial injury in orders. 3. The most common type of the ankle fractures, according to the classification of Lauge-Hansen, was supination-external rotation type(40.4%). 4. 36 cases(69.2%) were treated with open reduction and internal fixation and 16 cases(30.8%) were treated with closed reduction. Poor outcome seemed closely related to the severity of the injury and degree of fracture displacement. 5. Accurate reduction and rigid internal fixation of the lateral malleolus without shortening was important factor. Classification of Lauge-Hansen was useful in the diagnosis and treatment of the ankle fractures.
Ankle Fractures ; Ankle Injuries ; Ankle Joint ; Ankle ; Athletic Injuries ; Classification ; Clinical Study ; Diagnosis ; Female ; Humans ; Ligaments ; Male ; Seoul ; Soft Tissue Injuries ; Walking

Stimulation of ulnar nerve and. measurement of adductor pollicis response have been used for many years in clinical practice and research, but different muscles respond differently to relaxants, both in terms of onset and duration of blockade. The onset time of neuromuscular blockade at the vocal cords and at the orbicularis oculi muscle(OO) was similar, and was shorter than at the adductor pollicis muscle(AP). The purpose of this study was to examine which will be the best stimulus among double burst stimulation(DBS), train of four(TOF) and single twitch stimulation(STS) on OO or AP for an indicator of the optimal tiime for tracheal intubation. Two hundreds and thirty six healthy patients were randomly allocated to six groups in which DBS(n=34), TOF(n=36) and STS(n=37) group in OO group, and DBS(n=43), TOF(n=43) and STS(n=43) group in AP grouy. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained with 1% enfluraae until intubation. Neuromuscular block was induced by intravenous vecuronium 0.1 mg/kg and applied facial nerve or ulnar nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher & Paykel Co.) continuously. The complete relaxation time of OO group was closely observed with authors naked eyes, but the time of AP group were measured by tactile response of thumb. Tracheal intubation was tried immediately by the author after complete disappearance of the muscle contraction. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cord opening, coughing reflex and response to laryngoscopy attempts. The results were as follows: 1) The intubation time of OO group was 195.97+/-12.82 sec. in DBS group, 182+/-8.46 sec. in TOF group and 167.73+/-6.24sec. in STS group, respectively and there were no significance among groups. 2) The intubation time of AP group was 290.56+/-12.1sec. in DBS group, 276.79+/-10.32sec. in TOF group and 230.16+/-9.88sec, in STS group, respectively and there were no significance among groups. But the intubation time of AP group was significantly prolonged more than that of OO group. as much as 95 sec. of DBS group, 94 sec. of TOF group and 63 sec. of STS group, respectively(p<0.05). 3) There were no significance of vocal cords opening and response to laryngoscopy attempts in three groups, but DBS group(6%) was statistically less cough reflex than TOF(37%) and STS group(33%) in OO group(p<0.05). There were no significance of the intubation responses among three groups in AP group. 4) Coughing reflex ratio(positive cough cases/total cases X 100) of OO group(36%) was significantly more than that of AP group(12%) in TOF group, and coughing reflex ratio of OO group (32%) was significantly more than that of AP group(12%) in STS group, but there were no significance of coughing reflex ratio between OO and AP group in DBS group. With the above results the authors concluded that DBS on facial nerve observed orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation, and facial nerve stimuli was more sensitive than ulnar nerve stimuli due to reduce 95 sec. of intubation time. The optimal intubation time was about 196 sec. after vecuronium(0.1 mg/kg).
Anesthesia ; Cough ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle Contraction ; Muscle, Skeletal ; Muscles ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Thumb ; Ulnar Nerve* ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.
Atropine ; Muscle Relaxation* ; Neostigmine* ; Pancuronium ; Rabbits* ; Relaxation

No abstract available.
Diarrhea* ; Korea*

Anesthetic drugs by themselves were without effect on neummuscular function, but when the margin of safety in transmission was reduced, because of the admimstration of a musde relaxant, then a synergistic effect on relaxation might be observed. The purpose of this study was to examine whether the twitch recovery after vecuronium bromide (vecuronium) was influenced by thiopental sodium (thiopental), ketamine and lidocaine. Eighty healthy adult patients were randomly allocated to four groups according to the drugs, control group, normal saline 5 ml, study group ; 2.5% thiopental 5 mg/kg, ketamine 2 mg/kg and 1% lidocaine 1 mg/kg. Neuromuscular bloek was induced by intravenous vecuronium 0.1 mg/kg and applied ulnar nerve stimuli of every 10 seconds single twitch using Myotest Mk II(R). The adduction force of the resultant thumb twitch was measured by the acceleration of a small piezo-electric ceramic wafer with electrodes of Mini-accelograph(8) and recorded by Datascope 2200I(8). When the twitch height was near 15 mm, the drug was injected and recorded the twitch height for 10 min. and checked mean arterial pressure and heart rate after injection. The results were as follows ; 1) There were no significant changes of mean arterial pressure after drug injection. 2) Heart rate was significantly increased in thiopental group (77.7+/-8.3 beats/min. 93.7+/-9.1 beats/min.) and lidocaine group (85.6+/-15.9 beats/min. - 88.4+/-16.4 beats/min.), but no change in control and ketamine group. 3) In the linear regression analysis between the twitch length and the time, control group was Y=16.0+/-1.0X, r2=0.33, thiopental group was Y=14.9+/-1.1X, r2%.39, ketamine gmup was Y=14.8+0.9X, r2=0.24 and lidocaine group was Y=15.1+0.8X, r2=0.30. Lidocaine group was only significantly decreased than control group. With the above results the authors concluded that the twitch recovery after vecuronium was significantly deaeased by lidocaine, but no cbanges by thiopental and ketamine. We should more find the drug interaction with vecuronium in the man.
Acceleration ; Adult ; Anesthetics ; Arterial Pressure ; Ceramics ; Drug Interactions ; Electrodes ; Heart Rate ; Humans ; Ketamine ; Lidocaine* ; Linear Models ; Relaxation ; Thiopental* ; Thumb ; Ulnar Nerve ; Vecuronium Bromide*

No abstract available.
Larynx* ; Pharmacology ; Succinylcholine* ; Vecuronium Bromide*

The incidence of W-P-W syndrome is often noted in patients without other evidence of heart diseases. However, most of them wlll have supraventricular arrhythmias, characterized by paroxismal tachyarrhythmias. W-P-W- syndrome may be complicated by severe hypotension, syncope, congestive heart failure, atrial and/or ventrioular fibrillation and even sudden death, We experienced a case of W-P-W syndrome Immediately after induction of general anes-thesia on a patient with preoperatively normal ECG patterne and no evidence of otder heart disease.
Anesthesia, General* ; Arrhythmias, Cardiac ; Death, Sudden ; Electrocardiography ; Heart Diseases ; Heart Failure ; Humans ; Hypotension ; Incidence ; Syncope ; Tachycardia

Despite the fact that the anticholinesterases, mainly neostigmine, has been used for many years to antagonize a nondepolarizing neuromuscular blockade, until recently nothing was known about their pharmacokinetics and dynamics in anesthetized patients. This deficiency was largely due to lack of a suitable analytic technique to measure the concentration of these drugs in body fluids, most importantly serum. Recently it was developed a method by which the serum concentrations of neostigmine, pyridostigmine, edrophonium and their metabolities can be measured. Recently,k pyridostigmine and edrophonium have gained popularity to use for reversing a nondepolarizing muscle relaxants. We have studied newly introduced vecuronium effects and its reversal with pyridostigmine. The results were as follows: 1) Spontaneous recovery index by vecuronium 0.1mg/kg was 620.8 sec. 2) Recovery index by the pyridostigmine 160ug/kg reversal was significantly shortened as 134.0sec in vecuronium 0.1mg/kg block. 3) Tetanic stimulation (100Hz, 5sec) was sustained after 75% recovery of twitch height by pyridostigmine 160ug/kg reversal.
Body Fluids ; Cholinesterase Inhibitors ; Edrophonium ; Humans ; Neostigmine ; Neuromuscular Blockade* ; Pharmacokinetics ; Pyridostigmine Bromide* ; Rabbits* ; Vecuronium Bromide*

BACKGROUND: Propofol(2,6 diisopropylphenol) is a potent hypnotic currently formulated as an oil-in-water emulsion. Although previous studies reported decreases in arterial pressures and heart rate, no detailed studies of hemodynamic effects of propofol administration alone are available in Korea. This study is to determine the hemodynamic changes induced by doses of propofol. METHODS: Sixty patients(ASA physical status 1 or 2) were divided randomly into three groups as follows: group I, pmpofol 1.5 mg/kg; group 2, propofol 2.0 mg/kg; group 3, propofol 2.5 mg/kg. Heart rate and mean arterial pressure were measured by Datascope 2200I, and cardiac index(CI) and systemic vascular resistance index(SVRI) were obtained by doppler cardiac output monitor(Datascope Accucom 2) at the suprasternal notch before and after induction of propofol. RESULTS: Statistically significant decreases in mean arterial pressure were observed since 2 min after induction. CI was decreased from 2.94+/-0.51 to 2.35+/-0.57 L/min/m(2) at 6 min after induction of propofol 2.5 mg/kg, and no differences among groups. CI was also decreased in group 1 and 2 but without any significance. SVRI was decreased in all groups but there were no significance, and no differences among groups. CONCLUSIONS: The data suggest that the usual doses of propofol do not significantly cause hemodynamic changes, and a decrease in mean arterial pressure is a result of decreased CI and reduced SVRI.
Anesthetics ; Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Korea ; Propofol* ; Vascular Resistance

Asthma is a common medical syndrome which significantly increases the morbidity and mortality of surgical and anesthetic procedures. The anesthesiologist should be closely involved in the preoperative assessment and Prep-aration of these patients for, surgery and anesthesia and should be continually aware of the possibility of bronchospasm. The safe clinical management of this challenging population group demands not only expertise in carefully planning an anesthetic technique best suited to an individual patient and his specific disease process. We reported a case of bronchospasm after injection of neostigmine intravenously in 34-rear old female patient during endotracheal general inhalation anesthesia, together with brief of review of literature.
Anesthesia ; Anesthesia, Inhalation ; Asthma ; Bronchial Spasm* ; Female ; Humans ; Mortality ; Neostigmine* ; Population Groups