The purpose of this study was to evaluate the effectiveness of gargling solution with 0.05% NaF and 10% Xylitol in orthodontic patients with fixed appliance. The sample consisted of 30 adolescent patients who were classified into an experimental group and a control group, 15 patients each. Experimental group was used experimental gargling solution and the control group was used with placebo solution. The change of S. mutans in saliva was observed by Cariescreen(R) SM kit at pre and post 2, 4, 6, 8 weeks. The results were as follows. 1. There were significant reduction in the number of S. mutans in saliva between pre and post 2 weeks(p<0.01), 4 weeks(p<0.05), 6 weeks(p<0001), and 8 weeks(p<0001) in experimental group. And significant reduction also were observed in the number of Ss mutans in saliva between post 2 weeks, 6 weeks(p<0.05), and 8 weeks(p<0.05), but no significant reduction were showed in control group. 2. There were significant correlation in the number of S. mutans between each measurement time(pre and post 2, 4, 6, 8 weeks) in control group. 3. There weee no correlation between pre and post 2 weeks, but significant correlation were observed between 2, 4, 6, 8 weeks in experimental group.
Adolescent ; Humans ; Saliva* ; Streptococcus mutans* ; Streptococcus* ; Xylitol

No abstract available.
Tongue Neoplasms* ; Tongue*

BACKGROUND: We performed this study to determine the changes of hemodynamic parameters following major surgical events such like incision for trochar insertion, institution and deflation of pneumoperitoneum during a laparoscopic cholecystectomy. METHODS: Ten-female patients ASA physical status 1 during a laparoscopic cholecystectomy were enrolled into this study. Anesthesia was performed with propofol, alfentanil and vecuronium. Pneumoperitoneum was instituted by CO2 gas with intraperitonial pressure under 12 mmHg. Hemodynamic parameters before skin incision (BI), after skin incision (AI), 2, 5, 10, 15 and 20 min after the institution of pneumoperitoneum (P + 2, P + 5, P + 10, P + 15 and P + 20), 2 and 5 min after deflation (D + 2 and D + 5) were measured by the use of a thoracic electrical bioimpedance technique (TEB). RESULTS: Trochar insertion did not significantly change the hemodynamic parameters. Heart rate, total fluid content and left cardiac work index were not significantly changed through this study. Mean BP (MBP), pre-ejection period (PEP) and systemic vascular resistance index (SVRI) were significantly increased, and acceleration time index (ACI), cardiac index (CI), stroke index (SI) and velocity index (VI) were significantly more decreased after institution of pneumoperitonium than those of BI and AI. However, all parameters in P + 20, D + 2 and D + 5 were not significantly different from those of BI and AI. CONCLUSIONS: MBP, PEP, SVRI, ACI, CI, SI and VI measured by TEB were significantly changed by the institution of pneumoperitonium during a laparscopic cholecystectomy, but they all recovered to the values before the institution of pneumoperitonium within 20 min.
Acceleration ; Alfentanil ; Anesthesia ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Hemodynamics* ; Humans ; Laparoscopy ; Pneumoperitoneum ; Propofol ; Skin ; Stroke ; Vascular Resistance ; Vecuronium Bromide

BACKGROUND: Mechanical ventilation is frequently used in the intensive care unit. Sedation is usually required to tolerate the presence of a tracheal tube and other unpleasant stimulus during mechanical ventilation. The ideal regimen for sedation has not yet been determined. This study was designed to compare the characteristics of safety and effectiveness of propofol to those of midazolam for sedation in patients undergoing mechanical ventilation in surgical intensive care unit. METHODS: 44 mechanically ventilated patients were randomized to receive either propofol (loading dose 20~40 mg, followed by 10~50 microgram/kg/min) or midazolam (loading dose 1~2 mg, followed by 0.2~0.8 microgram/kg/min). Infusion rates were titrated to 3~5 points of Ramsay scale. All patients also received morphine 0.5 microgram/kg/24 h without any muscle relaxants. Hemo-dynamic changes (SBP, DBP, HR), ventilatory parameters and recovery time were evaluated. Hepatic and renal functions were measured before start of infusion and after discontinuation of both drugs. RESULTS: The mean initial loading and maintenance dose were 0.35 mg/kg and 1.5 mg/kg/hr for the propofol, 29.2 microgram/kg and 29.1 microgram/kg/h for midazolam group, respectively. There was no difference between the two groups regarding the sedation score evaluated by Ramsay scale. Patients receiving propofol recovered more rapidly than those receiving midazolam (40.5+/-20.1 min vs. 88.2+/-29.5 min respectively; P<.05). No one in either group showed marked hemodynamic(>30% of pre-injection value) or hepatic or renal function changes. CONCLUSIONS: Propofol is a sedative agent with shorter awakening time than midazolam but with the same safety and clinical effectiveness for the continuous sedation of mechanically ventilated patients.
Humans ; Critical Care ; Intensive Care Units ; Midazolam* ; Morphine ; Propofol* ; Respiration, Artificial

BACKGROUND: Mechanical ventilation is frequently used in the intensive care unit. Sedation is usually required to tolerate the presence of a tracheal tube and other unpleasant stimulus during mechanical ventilation. The ideal regimen for sedation has not yet been determined. This study was designed to compare the characteristics of safety and effectiveness of propofol to those of midazolam for sedation in patients undergoing mechanical ventilation in surgical intensive care unit. METHODS: 44 mechanically ventilated patients were randomized to receive either propofol (loading dose 20~40 mg, followed by 10~50 microgram/kg/min) or midazolam (loading dose 1~2 mg, followed by 0.2~0.8 microgram/kg/min). Infusion rates were titrated to 3~5 points of Ramsay scale. All patients also received morphine 0.5 microgram/kg/24 h without any muscle relaxants. Hemo-dynamic changes (SBP, DBP, HR), ventilatory parameters and recovery time were evaluated. Hepatic and renal functions were measured before start of infusion and after discontinuation of both drugs. RESULTS: The mean initial loading and maintenance dose were 0.35 mg/kg and 1.5 mg/kg/hr for the propofol, 29.2 microgram/kg and 29.1 microgram/kg/h for midazolam group, respectively. There was no difference between the two groups regarding the sedation score evaluated by Ramsay scale. Patients receiving propofol recovered more rapidly than those receiving midazolam (40.5+/-20.1 min vs. 88.2+/-29.5 min respectively; P<.05). No one in either group showed marked hemodynamic(>30% of pre-injection value) or hepatic or renal function changes. CONCLUSIONS: Propofol is a sedative agent with shorter awakening time than midazolam but with the same safety and clinical effectiveness for the continuous sedation of mechanically ventilated patients.
Humans ; Critical Care ; Intensive Care Units ; Midazolam* ; Morphine ; Propofol* ; Respiration, Artificial

We describe a patient with infective endocarditis (IE) complicated by mycotic cerebral aneurysms (MCAs). Transarterial embolization of a larger MCA was attempted but failed. Aneurysmal clipping through craniotomy was followed by mitral valvuloplasty. During mitral valvuloplasty for IE, the low values of cerebral oxygen saturation after aneurysmal clipping were improved by continuous nimodipine infusion. We also review anesthetic management of patients with IE complicated by MCAs.
Aneurysm ; Craniotomy ; Endocarditis ; Humans ; Intracranial Aneurysm ; Nimodipine ; Oxygen

BACKGROUND: Sympathetic nervous hyperactivity presents in response to surgical stress has been implicated as an important component of postoperative ileus. Because desflurane induces sympathetic activation, the effects of desflurane and sevoflurane on the recovery of bowel function were compared. METHODS: Forty patients undergoing a laparoscopic appendectomy were randomly assigned to receive either sevoflurane (Group S, n = 20) or desflurane (Group D, n = 20). The anesthetic, operative, and postoperative pain managements were standardized. The CRP (C-reactive protein), total leukocyte count, and ratio of the neutrophil to leukocyte counts were measured preoperatively and 12 hours postoperatively. The mean arterial blood pressure (MABP), heart rate, and end-tidal anesthetic concentration were measured at 10-min intervals during the surgery. The degree of postoperative pain, 11-graded surgical difficulty score, time to the first passage of flatus and first oral intake of clear fluid, as well as the postoperative hospital stay were also evaluated. RESULTS: Finally, 16 and 17 subjects in Groups S and D were included the analyses. There were no significant differences in the MABP, heart rate, and end-tidal anesthetic concentration between the two groups. The clinical and laboratory parameters related to the severities of inflammation and surgical trauma were similar in both groups. There were no significant differences in the times to the first passage of flatus and first oral intake of clear fluid and the postoperative hospital stay between the two groups. CONCLUSIONS: Although desflurane induces sympathetic activation, unlike sevoflurane, it does not delay the return of bowel function following a laparoscopic appendectomy.
Anesthesia* ; Appendectomy ; Arterial Pressure ; Flatulence ; Heart Rate ; Humans ; Ileus ; Inflammation ; Length of Stay ; Leukocyte Count ; Neutrophils ; Pain, Postoperative ; Sympathetic Nervous System

Renal failure frequently accompanies advanced hepatic failure. Even if adequate renal function is not considered as a prerequisite for transplant candidacy, impaired renal function prior to liver transplantation has been regarded as an independent risk factor of graft dysfunction and mortality. Liver transplantation in such a patient also presents a number of challenges to the anesthesiologists. Optimal fluid therapy, prompt and aggressive correction of electrolytes and metabolic disturbances, careful selection of anesthetic techniques and agents, and close monitoring of cardio-respiratory function help reduce the graft failure and perioperative mortality. In such cases, continuous renal replacement therapy (CRRT) is used with increasing frequency during or after the surgery. So, anesthesiologists need to understand the basic principles, potential applications, and anesthetic implications of several CRRT options. We therefore present the anesthetic experience in a patient with hepatic failure combined with primary renal failure, successfully managed during or after liver transplantation.
Anesthesia* ; Electrolytes ; Fluid Therapy ; Humans ; Liver Failure* ; Liver Transplantation* ; Liver* ; Mortality ; Renal Insufficiency* ; Renal Replacement Therapy ; Risk Factors ; Transplants

We experienced an extremely rare complication during performance of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair for a 57-year-old healthy man. About 50 minutes after CO2 insufflation, the patient developed tachycardia, hypoxemia, hypercapnia and an increased airway pressure. Right pneumothorax with subcutaneous emphysema was recognized on the emergency chest X-ray and this was successfully treated by chest tube insertion. Anesthesiologists should be aware of the possible occurrence of pneumothorax during laparoscopic TEP hernia repair.
Anoxia ; Chest Tubes ; Emergencies ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Hypercapnia ; Insufflation ; Laparoscopy ; Middle Aged ; Pneumothorax ; Pyrazines ; Subcutaneous Emphysema ; Tachycardia ; Thorax

Loeys-Dietz Syndrome (LDS) is a recently described autosomal dominant aortic aneurysm syndrome with widespread systemic involvement. It is characterized by the triad of 1) arterial tortuosity and aneurysms, 2) hypertelorism, and 3) bifid uvula or cleft palate. A 12-year-old boy with LDS was scheduled to undergo correction of aortic valve regurgitation due to aortic annuloectasia. We report our clinical experiences of a case of LDS patient with brief review of related literatures and relevant anesthetic problems.
Aneurysm ; Aortic Aneurysm ; Aortic Valve ; Arteries ; Child ; Cleft Palate ; Humans ; Hypertelorism ; Joint Instability ; Loeys-Dietz Syndrome ; Skin Diseases, Genetic ; Uvula ; Vascular Malformations