Midazolam, a water soluble benzodiazepine, was compared with diazepam as a sedation for spinal anesthesia. Forthy healthy patients were allocated at random to receive midazolam 0.1mg/kg or diazepam 0.2mg/kg at 15 min after tetracaine inction for spinal anesthesia and increments of half of the initial dose every 2 min to induce sleep. Mean dose of midazolam 8.5 mg and diazepam 17.1 mg were injected for sedation throughout surgery. There was no difference concerning sedation level during surgery and speed of recovery. With the same degree of sedation, midazolam produced a higher frequency of anterograde amnesia(70% vs. 30%). Uenous tolerance was better for midazolam. Neither drug caused obstruction of airway nor significant cardiovascular change. Higher degree of amnesia and venous tolerance with midazolam may be advantages of sedation for spinal anesthesia.
Amnesia ; Anesthesia, Spinal* ; Benzodiazepines ; Diazepam* ; Humans ; Hypnotics and Sedatives* ; Midazolam* ; Tetracaine

No abstract available.
Anemia, Iron-Deficiency* ; Humans ; Infant* ; Iron*

Since Dongboo City Hospital cares patients with medicaid and poor socio-economic status in large percentage, we analized all the newborns delivered at the hospital from 1984 to 1992 by their birth weights, gender, gestational age and their Medical Care System. We found our babies?mean birth weight was lower than National standard mean birth weight of 1975 and 1985 (published by KPA) and also lower than other reported studies. But the fact than mean birth weight has been increasing since 1990 is encouraging.
Birth Weight* ; Gestational Age ; Hospitals, Urban* ; Humans ; Infant, Newborn ; Medicaid ; Parturition*

BACKGROUND: Ropivacaine closely resembles bupivacaine with propyl group substitutes for butyl group at the same position. Ropivacaine is presented as 100% S-isomer with important implication of safety and less cardiotoxic than bupivacaine. Because of this, ropivacaine is used as an epidural anesthesia. However this study was performed to evaluate clinical effects of ropivacaine for spinal anesthesia. METHODS: Thirty patients (ASA I-II) scheduled for elective lower extremity operation were randomly selected and received spinal anesthesia with 3 ml of 0.75% isobaric ropivacaine. The patients were placed in the lateral position and dura puncture was performed at the L3-4 interspace using the median or paramedian approach with a 25 G Quincke spinal needle. After spinal anesthesia, sensory block was assessed using the pin-prick test every 2 min., motor block was assessed using a four-point scale, and circulatory variables were monitored every 5 min. RESULTS: The mean sensory block level was T 8.6 and the maximum sensory block level was T4. Time needed for extremity motor block was 10.8 min. and 25 of 30 patients reached Bromage scale 3. Duration of motor and sensory block were 260.6 min. and 422.3 min. Hemodynamic changes (arterial pressure and pulse) were stable during anesthesia and complications were rare. CONCLUSIONS: We concluded that 0.75% isobaric ropivacaine was suitable for spinal anesthesia with good lower extremity sensory and motor block, and it was long-lasting without any specific complications.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Spinal* ; Bupivacaine ; Extremities ; Hemodynamics ; Humans ; Lower Extremity* ; Needles ; Punctures

The occurrence of injuries and death caused by traffic accidents have been increasing during last few decades in Korea, which resulted in enormous personal, social and economic loss in terms of death, disability, labour days and medical costs incurred for treatment. Generally, it is well known and even became an hot sociopolitical issue that the duration of hospital stay for traffic accident patients are much longer than that of other patients with the similar condition. The objective of the study is to find out epidemiologic characreristics and management pattern of traffic accident patients in a general hospital of medium-sized, industrialized town. This study was carried out on 177 cases injured by motor vehicle accidents, who were admitted and treated in a general hospital from Feb. 1, 1997 to Sept. 30, 1997. The results obtained are as followings: The most of the patients(44%) were 20-30 years old age group although the occurrence of injuries was more frequent among older ages, 50's for male and 60's for female being 2.1 times more frequent among male. The traffic accidents occurred most frequently(14.1%) in the morning(06:00-08:00) and afternoon(14:00-16:00), and on Saturdays(20.3%); the (14.1% traffic accidents were frequent during weekends for passengers whereas it was more frequent during weekdays for pedestrian. Old and child pedestrians were most vulnerable subjects to traffic accidents. The most common site injured was head(19.9%) and the injury types were fracture of lower extremity(9.3%), skull fracture(8.6%) and rib fracture(8.6%) for both sexes; rib fractures/thoracic spine fractures(12.0%) for female and tibia/ fibula fractures(11.6%) for male. Mean days of hospital stay presumptively judged by the doctor who examined, made diagnosis and admitted the patient was 43.8 days compare to 38.4 days of actual mean days of hospitalixation. On the other hand, the optimal mean days of hospital stay for the patients determined by two doctors independently was estimated to be 26.6 days. Thus the difference between actual days of hospitalization and optimal days of hospitalization was 11.7 days, which can be regarded as excess hospitalization days. It consists 30.5% of actual hospitalization days, an enormous waste of resources. The only factor associated with this excess hospitalization was payment responsibility for the hospital cost; when the hospitalization expenses are to be paid by the person inflicted the injury there were always excess days of hospitalization regardless of insurance status.
Accidents, Traffic* ; Child ; Diagnosis ; Epidemiology ; Female ; Fibula ; Hand ; Hospital Costs ; Hospitalization* ; Hospitals, General ; Humans ; Insurance Coverage ; Korea ; Length of Stay ; Male ; Motor Vehicles ; Ribs ; Skull ; Spine

BACKGROUND: Midazolam, a water soluble benzodiazepine, is a good sedative, hypnotic, anxiolytic, and anticonvulsant drug. During stressful condition such as an operation, sympathetic tone increases and cardiovascular variables are unstable. This study evaluated the effects of midazolam for cardiovascular stability in elderly patients during anxiety and stress conditions. Method: Thirty patients (aged 61-93 yrs and in ASA 1, 2, and 3), who were scheduled for lower extremity surgery and showed elevated blood pressure before anesthesia, were divided into two groups. Group 1 (n = 15) has taken antihypertensive medication and group 2 (n = 15) had no hypertension history. Blood pressure and pulse of all patients were checked at 8 AM on operation day, arrival in operation room, 5, 10, 15 min. before anesthesia and every 5 min after anesthesia. Patients were given intravenous midazolam 0.01 mg/kg every 5 min until blood pressure lowered to 140/90 mmHg or spontaneous eye closing. RESULTS: The midazolam doses were 1.7 mg in group 1, 1.2 mg in group 2, and the total dose of midazolam for elderly patient was 1.5 mg (0.03 mg/kg). The sedation level was between the Ramsey scale 3-4. Age is a major determinant in deciding the dose of the drug. Blood pressure at arrival in the operation room was significantly elevated, but, 15 min after the midazolam injection, blood pressure was decreased to blood pressure level at 8 AM of the operation day. Conclusion: The total dose of midazolam for the elderly is nearly 1/3-1/4 of the recommened dose for healthy young adults. Small doses of midazolam in elderly patients were good for anxiolysis and cardiovascular stability.
Aged* ; Anesthesia ; Anxiety* ; Benzodiazepines ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension ; Lower Extremity ; Midazolam* ; Young Adult

Recently many studies have shown the usefulness of computed tomogram in diagnosing abdominal mass when clinical and conventional radiologic examinations fail to reveal the nature of abdominal mass or the cause of abdominal distension. To evaluate the usefulness of CT in diagnosing neuroblastoma, we retrospectively analyzed computed tomographic findings of 16 neuroblastoma patients, who pathologically proved in Yeungnam University Hospital from 1986 to 1995. The age range of the patients studied were from 8months to 18years. The most frequent sith of origin was adrenal gland and the next was retroperitioneum. The presenting symptoms were palpable mass, abdominal distension, and abdominal pain.- The viewpoints of this analysis were tumoral calcifications, midline cross, shape, margin, internal structure, contrast enhancement patterns, major vessel involvement, and lymph node involvement. ':haracteristic CT findings were 'as follows: Fine dense curvillinear calcification within the tumor(56%), midline cross(50%), lobulation(75%), well-circumscribed margin(56%), cystic degeneration(56%), heterogeneous contrast enhancement(690/o), encasement of major vessels such as aorta, IVC and celiac trunk(50%), and paraaortic lymphadenopathy(87%). We conclude that these CT findings were very common and could be helpful in diagnosting and differentiation neuroblastoma in infant and children.
Adrenal Glands ; Aorta ; Child ; Diagnosis ; Humans ; Infant ; Lymph Nodes ; Neuroblastoma* ; Retrospective Studies

A 49 year-old male was scheduled for a cholecystectomy, thereafter a 37 year-old female scheduled for removal of a epidural hematoma in the same operating room. Both of them had no specific medical problems and past medical histories for anesthesia. For those reasons, anesthesia was induced with thiopental sodium and succinylcholine with endotracheal intubation. After induction, vital signs including body temperatures were stable. But moisture dew in the unidirectional valves and corrugated tubes, and color changes of soda lime were discovered. At that time, severe hypercarbia was recognized by arterial blood gas analysis in both cases. In both cases, there were no malfunctions in unidirectional valves, expiratory valves, corrugation tubes, soda lime, ventilators and there connection parts in the anesthetic machines. Also there were no abnormalities of blood pressures, electrocardiograms, pulse oxymeters, temperatures and the pulse in the patient monitoring systems except capnography. At first, we thought that medical signs revealed malignant hyperthermias. But vital signs, air way pressures and functions of all kinds of anesthetic machine components including ventilators were normal. After discontinuing N2O gas deliveries in the operation room, hypercarbias disappeared. Thus, anesthetic gas delivery systems via central piping systems were checked and it was discovered that CO2 gas was in the N2O gas tank instead of N2O.
Adult ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Capnography ; Carbon Dioxide* ; Carbon* ; Cholecystectomy ; Electrocardiography ; Female ; Hematoma ; Humans ; Intubation, Intratracheal ; Male ; Malignant Hyperthermia ; Middle Aged ; Monitoring, Physiologic ; Nitrous Oxide* ; Operating Rooms ; Succinylcholine ; Thiopental ; Ventilators, Mechanical ; Vital Signs

No abstract available.
Chlorambucil* ; Nephrotic Syndrome*

BACKGROUND: This study was performed to evaluate lumbar epidural depth using two methods, and to identify the correlation between epidural depth and body mass index (BMI). METHODS: The anatomy of the lumbar epidural space was evaluated using MRI images in 124 patients (93 male and 31 female patients). Epidural depth was measured from the skin to the center of the posterior epidural space at the L3-4 and L4-5 level using two methods (in a parallel line to the lumbar spinous process [EP-I] and in a vertical line to the long axis of the spine [EP-II]). RESULTS: The mean +/- SD of epidural depth by EP-I was 4.82 +/- 1.16 cm at L3-4 and 5.08 +/- 1.08 cm at L4-5, and depth by EP-II was 4.18 +/- 0.97 cm at L3-4 and 4.78 +/- 1.02 cm at L4-5. The epidural depths were 3.71 to 4.37 cm (L3-4) and 4.36 to 4.65 cm (L4-5) in normal weight patients, 4.29 to 4.86 cm (L3-4) and 4.79 to 5.06 cm (L4-5) in overweight patients, and 5.16 to 5.87 cm (L3-4) and 5.79 to 6.16 cm (L4-5) in obese patients. CONCLUSIONS: Epidural depth showed a close correlation with BMI, but not with sex.
Axis, Cervical Vertebra ; Body Mass Index ; Epidural Space ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Overweight ; Skin ; Spine