BACKGROUND: Postoperative nausea and vomiting are common postoperative complaints. The purpose of this study was to assess the effect of preoperative midazolam on vomiting after appendectomy. METHODS: Sixty patients, aged 10 64 yr, undergoing emergency appendectomy were randomly allocated to receive midazolam 30, 50, 75 microgram/kg or placebo after induction of anesthesia. Anesthesia consisted of 67% nitrous oxide, 33% oxygen and propofol infusion 6 10 mg/kg/h. Postoperative vomiting was checked by the recovery room nurse at 1 h after operation and we examined the incidence of postoperative vomiting at 24 h after operation. RESULTS: Midazolam reduced the overall incidence of vomiting, especially in the midazolam 50 and 75 microgram/kg groups, completely abolishing vomiting (P< 0.05). However, in the midazolam 75 microgram/kg group, there was a delay in eye opening time (P< 0.05). CONCLUSIONS: Preoperative injections of midazolam 30 or 50 microgram/kg were useful to prevent postoperative vomiting in patients undergoing appendectomy without delayed recovery.
Anesthesia ; Antiemetics* ; Appendectomy* ; Emergencies ; Humans ; Incidence ; Midazolam* ; Nitrous Oxide ; Oxygen ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Vomiting

BACKGROUND: Epidural administration of morphine is a common method for postoperative analgesia in the lower abdominal surgery, but many complications can be produced. Since the pfannenstial incision lies within L1 dermatome, bilateral ilioinguinal and iliohypogastric nerve blocks(IINB) should provide analgesia after surgery through that incision. METHODS: Forty patients undergoing cesarean delivery or total abdominal hysterectomy(TAH) through a pfannenstiel incision were randomly assigned to one of two groups: epidural morphine group(n=20) received 3 mg of morphine epidurally after surgery with epidural anesthesia; IINB group(n=20) performed IINB with 0.5% bupivacaine, 10 ml to each side after surgery with general anesthesia. Visual analogue scale(VAS) scores at resting and moving state, and complications were checked at 0, 2, 4, 8, 12, 24 hours after surgery. RESULTS: Postoperative VAS scores did not show significant differences between the two groups at rest after 0, 2, 4, 8, 12, 24 hours and at moving state after 0, 2, 4 hours, but IINB group had less pain with movement than epidural morphine group at 8, 12, 24 hours after surgery(p<0.05). The incidence of pruritus was rare in IINB group(P<.05), but incidences of other complications were not significantly different between the two groups. CONCLUSIONS: IINB is effective for analgesia after surgery through a pfannenstiel incision because of a lower incidence of complications and less postoperative pain with movement than epidural morphine, and can be performed to patients who have contraindications and difficulty for epidural analgesia.
Analgesia* ; Analgesia, Epidural ; Analgesics ; Anesthesia, Epidural ; Anesthesia, General ; Bupivacaine ; Humans ; Incidence ; Morphine ; Nerve Block* ; Pain, Postoperative ; Pruritus

Cerebral vasospasm is one of most serious complication after subarachnoid hemorrhage due to aneurysmal rupture and a very important cause affecting to prognosis. The most reliable diagnostic assessment of cerebral vasospasm is angiography, but this is limited to perform because of complications such as neurological deficits or death, especially to repeat studdy. It seems likely that assessment of evoked elective, a much simpler and safer than the repeated study of angiography, will be of use in following the condition of patients with clinical vasospasm following SAH. In order to study relationship between clinical vasospasm and electrical activity, we traced SSEP from upper extremity by median nerve stimulation and lower extremity by posterior tibial stimulation which manifest the neurophysiologic function of cerebral ischemia. MN(Me-dian n.) and PTN(Posterior tibial n.)were performed simultaneously. Over 2 years period (1986 through 1988), 41 patients were performed SSEP and evaluated the relationship between SSEP and clinical or angiographic vasospasm in patients of SAH.
Aneurysm ; Angiography ; Brain Ischemia ; Humans ; Lower Extremity ; Median Nerve ; Prognosis ; Rupture ; Subarachnoid Hemorrhage ; Upper Extremity ; Vasospasm, Intracranial

BACKGROUND: For many drugs, dosing scalars such as ideal body weight (IBW) and lean body mass are recommended over the use of total body weight (TBW) during weight-based dose calculations. Doses based on TBW are frequently used, and this may cause under- or over-dosing. Because dexmedetomidine (DEX) overdosing could increase the incidence of side effects, and spinal anesthesia may increase sensitivity to a sedative agent, determining an appropriate dose is critical. METHODS: Eighty patients were randomly divided into 2 groups, the IBW and TBW groups. Patients received a loading dose of DEX 1 µg/kg IBW or TBW for 10 min, followed by a continuous infusion at 0.5 µg/kg/h IBW or TBW after the induction of spinal anesthesia. The patients' vital signs, bispectral index (BIS), peripheral capillary oxygen saturation, time to reach a BIS of 80, airway obstruction score, and coughing were monitored and recorded at 0, 10, 30, and 50 min after the start of the loading dose injection. RESULTS: The changes in BIS, airway obstruction score, the incidence of side effects, and time to reach a BIS of 80 did not show statistically significant differences between the two groups. However, airway obstruction and/or coughing occurred in both groups, and the average BIS in both groups was lower than the target BIS of 60-80 at 30 and 50 min. CONCLUSIONS: A loading dose of DEX 1 µg/kg for 10 min, and a maintenance dose of DEX 0.5 µg/kg/h of either IBW or TBW, may induce excessive sedation, airway obstruction, and/or coughing under spinal anesthesia.
Airway Obstruction* ; Anesthesia, Spinal* ; Body Weight ; Capillaries ; Consciousness Monitors ; Cough ; Dexmedetomidine* ; Humans ; Ideal Body Weight ; Incidence ; Oxygen ; Vital Signs

Among exocrine pancreatic tumors, adenosquamous carcinoma is a rare, aggressive subtype with a poor prognosis and a high potential for metastases compared with its more conventional glandular counterpart, adenocarcinoma of the pancreas. We herein describe the imaging findings of pancreatic adenosquamous cell carcinoma with solitary liver metastasis showing different imaging features and also review the previous literature to recognize characteristic imaging features of pancreatic adenosquamous cell carcinoma.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Liver* ; Neoplasm Metastasis* ; Pancreas ; Prognosis

PURPOSE: The purpose of the study was to develop and evaluate the effect of a metabolic syndrome prevention program using mobile application for university students. METHODS: A pretest-posttest design with content analysis as a triangulation method was used. The participants were 49 university students. Data were analyzed using descriptive statistics, chi2-test, t-test and Fisher's exact test with the SPSS WIN 18.0 program. RESULTS: The application consisted of six main menus as follows: 'basic education', 'nutrition education', 'exercise education', 'meal diary', 'exercise checkup', and 'tips'. The experimental group had higher recognition about metabolic syndrome prevention than the control group (F=7.919, p=.007). Understanding of metabolic syndrome among participants was mostly related to chronic diseases such as obesity, hypertension and diabetes in relation to the importance of eating habits and exercising. CONCLUSION: The results indicate that metabolic syndrome prevention education using mobile application is necessary and would be useful for university students.
Chronic Disease ; Eating ; Education ; Humans ; Hypertension ; Mobile Applications* ; Obesity

BACKGROUND: According to the report that KCNK activity in transfected COS-7 and HEK-293 cells was modulated by volatile anesthetics and activation of KCNK channels by neuroprotectants, the importance of KCNK2 were emphasized. In this study, we studied the effect of halothane and isoflurane on KCNK2 in the KCNK2 transfected HEK-293 cells. METHODS: Multiple patch clamp experiments with halothane and isoflurane were conducted to characterize KCNK2 in the KCNK2 transfected HEK-293 cells. KCNK2 cDNA were transiently transfected with FuGENE6 transfection reagents and whole cell recordings were made using predesigned pulse protocol. RESULTS: KCNK2 transfected HEK cells exhibited rapid rising, a time-independent, non-inactivating, outward-rectifying currents and had no threshold for activation by voltage. Multiple patch clamp experiments showed the presence of outward-rectifying K+ selective channels with a conductance of 1.31 +/- 0.59 nS (n = 16) at positive potentials. Recordings of halothane 448microM (-2 MAC) increased outward currents from control by 218% in standard saline perfusate (n = 4, P<0.05, paired t-test) and that of isoflurane 822microM (-3 MAC) increased outward currents by 172% in standard saline perfusate (n = 12, P<0.05, paired t-test). Channel activity enhanced during the duration of the exposure to volatile anesthetics returned to the baseline quickly upon wash. CONCLUSIONS: Considering the activation of KCNK2 by neuroprotectants such as riluzole and PUFA, we might think of the possibility of halothane and isoflurane as neuroprotectants because these anesthetics activated background K+ channels in KCNK2 transfected HEK-293 cells.
Anesthetics ; DNA, Complementary ; Halothane* ; Indicators and Reagents ; Isoflurane* ; Neuroprotective Agents ; Riluzole ; Transfection

Somatosensory evoked potential(SSEP) has been recorded during 31 operations for intracranial aneurysm. We had monitored the SSEP in each stage of aneurysm surgery(preoperative, anesthetic induction, dura opening, temporary vascular occlusion, aneurysm neck clipping and 30 minute after aneurysm neck clipping). Temporary occlusion of intracranial arteries have performed in 21 cases. In cortical amplitude of more than 50% as compared with induction was considered to be "significant" SSEP change. Eleven out of 21 cases of temporary vascular occlusion showed significant decrease of amplitude. Three out of 4 cases with flat wave had new neurologic deficits postoperatively. We studied the relationship between SSEP changes and postoperative neurologic deficit and concluded as follows: 1) The monitoring of amplitude of SSEP may help control the duration and number of application in temporary clipping during aneurysm surgery. 2) Decreased in amplitude with temporary clipping, especially flat wave, is a strong suggestion of the postoperative neurologic deficit. These results indicate that monitoring of SSEP during aneurysm surgery would be helpful to reduce the incidence of postoperative neurologic deficits.
Aneurysm* ; Arteries ; Incidence ; Intracranial Aneurysm ; Neck ; Neurologic Manifestations

Bronchial foreign body aspirations are uncommon in adults and usually have various underlying conditions, otherwise accidentally occurred in dental procedure, medical, surgical procedure. The most commonly aspirated objects were food materials, with peanuts leading the list. When bronchial foreign body was aspirated, no definite respiratory symptoms or foreign body is may not seen, then diagnosis is delayed. Therefore late complications was developed. The tendency to use fiberoptic bronchoscope for removal of foreign bodies in adults is increased. We report a rare case of bronchial pneumonia due to occult aspiration of a twig before 1 year with a review of the literatures.
Adult ; Arachis ; Aspirations (Psychology) ; Bronchopneumonia ; Bronchoscopes ; Diagnosis ; Foreign Bodies ; Humans ; Pneumonia*

BACKGROUND: The effects of the levering laryngoscope (McCoy laryngoscope) on the laryngoscopic view classified by the Cormack and Lehane were investigated in this study. METHODS: The laryngoscopic view with the levering laryngoscope blade in neutral and best position were recorded respectively and analysed statistically. RESULTS: 109 laryngoscopic views were grade 1 or 2 and 12 were grade 3 or 4 in the neutral position with the McCoy blade. Only three patients were grade 3 or 4 in its best position and the others grade 1 or 2. The reduction in the incidence of difficult laryngoscopic view (grade 3 or 4) using the levering laryngoscope in its best position was statistically significant (p<0.01). CONCLUSIONS: Levering laryngoscope improves laryngoscopic view and also reduces the incidence of difficult intubation. So, we suggest that it is an useful instrument for the anesthesiologists in the difficult tracheal intubation.
Humans ; Incidence ; Intubation ; Laryngoscopes*