BACKGROUND: Elderly patients often have postoperative psychiatric disorders compared with young patients. METHODS: This study was undertaken to compare the effects of general or regional anesthesia on postoperative psychiatric disorders in 31 elderly patients with elective orthopedic and urological surgery. Mini Mental States Examinations(MMSE) was done to find out postoperative delirium at preoperative, postoperative 6hours, 1st, 3rd, and 7th days. RESULTS: Mean changes in MMSE score after general anesthesia were significantly decreased compared with preoperative score and with in regional anesthesia at postoperative 6 hours and 1st day. Postoperative MMSE scores were decreased below 17 points in 17 patients among 22 patients in general anesthesia and 3 patients among 26 patients in regional anesthesia. Hospital admission duration were significantly prolonged in general anesthesia compare with regional anesthesia. CONCLUSIONS: The incidence of postoperative delirium is more common after general aneshtesia than after regional anesthesia. Therefore regional anesthesia is recommeded in elderly patients to decrease postoperative delirium.
Aged* ; Anesthesia, Conduction* ; Anesthesia, General* ; Delirium* ; Humans ; Incidence ; Orthopedics

BACKGROUND: An ominous sign is the oliguria frequently observed during an anesthesia. In order to elucidate the causes of oliguria during early stages of anesthesia, we observed renin, aldosterone, antidiuretic hormone (ADH), creatinine clearance (Ccr), fractional excretion of sodium (FeNa) and free water clearance (CH2O) before and 1 hour after anesthesia. METHODS: Twenty-four patients (ASA physical status I II) 20 to 60 years of age scheduled for elective surgery of low risk were anesthetized with N2O/O2/enflurane. According to the urine volume, we divided the patients into two groups (oliguria group and control group). The criteria for the oliguria group was urine volume less than 0.25 ml/kg during the first 30 minutes. Eleven patients were allocated to the oliguria group. Blood samples for sodium, creatinine, osmolality, renin, aldosterone, ADH and urine samples for sodium, creatinine and osmolality were collected before anesthesia and 1 hour after anesthesia. Ccr, FeNa and CH2O were calculated with equations. RESULTS: Before anesthesia, urine sodium (mEq/L), creatinine (mg/dl) and osmolality (mOsm/kgH2O) were significantly higher in the oliguria group than in the control group (153.4+/-15.8 vs 107.2+/-14.9, 75.5+/-10.9 vs 48.2+/-8.7, 543.7+/-27.5 vs 380.1+/-49.1, P< 0.05). Before anesthesia, ADH (pg/ml) was significantly higher in the oliguria group than in the control group (9.4+/- 3.6 vs 1.9+/-0.5, P< 0.05). One hour after anesthesia, urine sodium, creatinine and osmolality were significantly higher in the oliguria group than in the control group (170.1+/-14.6 vs 46.7+/-6.5, 71.1+/-6.9 vs 15.0+/-2.5, 557.5+/-27.5 vs 176.9+/-17.9, P< 0.05). CH2O (ml/hr) was significantly lower in the oliguria group than in the control group (-46.4+/-7.5 vs 112.5+/-23.9, P< 0.05). CONCLUSIONS: Our results suggest that the main cause of oliguria is dehydration during the early stages of anesthesia, so before anesthesia, appropriate hydration with free water is necessary to avoid oliguria.
Aldosterone ; Anesthesia* ; Creatinine ; Dehydration ; Humans ; Oliguria* ; Osmolar Concentration ; Renin ; Sodium ; Water

PURPOSE: Developing a curriculum(DACUM) is a method of analyzing job focused competency, which is obtained from the data of an expert belonging to a certain career. In this study the DACUM method was used to analyze the jobs of operating room nurses. METHOD: Through the DACUM workshop which was arranged by two DACUM facillitators, a definition of the role of operating room nurses was developed and then duties and tasks of operating room nurses' were identified. For the workshop, a DACUM committee with 10 operating room nurses was organized. Finally, the duties and tasks which were identified were validated by 422 nurses for importance, difficulty, and frequency. RESULTS: Thirteen duties and 105 tasks were identified on the DACUM chart, where importance, difficulty, and frequency of tasks were represented by alphabet letters A, B, and C as higher degree of importance. The determinant coefficient(DC) showed that the most important duty was assisting with operations(DC=6.61), and the least, managing operating materials(DC=4.22). For tasks, the most important ones were assisting in orthostatic surgery(DC=7.60), and assisting in thoracic surgery(DC=7.38), and the least important making gauze ball(DC=2.39), and saving of operation site((DC=3.27). CONCLUSION: The results suggest a need to develop an education program using the DACUM chart as a basis for the development and as a clinical career ladder and for curriculum of operating room nursing.
Career Mobility ; Curriculum ; Job Description ; Operating Room Nursing ; Operating Rooms

The syndrome of ectopic production of ACTH by non-pituitary neoplasm occur with various types of tu#rnors. Pheochromocytoma is a rare, but one of the important causes of this syndrome. Recently we experienced a 36-year-old male patient with ACTH-producing pheochromocytoma. After left adrenalectomy, serum ACTH level retumed to the normal range. The patient became normotensive without antihypertensive agents and hyperglycemia resolved and insulin therapy was discontinued. Secretion of ACTH was confirmed by immunohistochemical stain.
ACTH Syndrome, Ectopic* ; Adrenalectomy ; Adrenocorticotropic Hormone ; Adult ; Antihypertensive Agents ; Humans ; Hyperglycemia ; Insulin ; Male ; Pheochromocytoma* ; Reference Values

BACKGOUND: Postoperative complications in the geriatric patients undergoing radical neck dissection are generally considered to be more severe than young patients. The incidence of carotid sinus hypersensitivity in elderly patients is also considered to be higher than the young. The comparison between old (above 65 years) and young (below 65 years) aged groups about intraoperative carotid sinus hypersensitivity and postoperative complication is necessary for safe anesthesia. METHODS: Sixty five adult patients, of either sex, regardless of age, given radical neck dissection from January 1990 to January 1998, were investigated for the incidence of intraoperative carotid sinus hypersensitivity and postoperative hypertension by way of retrospective chart review. The authors also examined the postoperative complications such as high fever, pulmonary, cardiac and renal complications, cerebrovascular diseases and neurologic injuries. RESULTS: The incidence of intraoperative carotid sinus hypersensitivity were 28% in elderly patients (n=25), 10% in young patients (n=40) but there was no statistical significance. The incidence of postoperative hypertension were 79.1% in patients with hypertension history, 34.1% in patients without hypertension history and there was statistical significance between the two groups (P=0.001). The incidence of postoperative pulmonary complication were 44% in elderly patients, 20% in young patients, and there was also statistical significance between the two groups (P=0.038). There was no statistical significance in the incidence of postoperative high fever above 38.5degrees C between the two groups (p=0.059). CONCLUSION: After the radical neck dissection, the geriatric patients had a greater incidence of postoperative pulmonary complications than young patients and the most relating factor to postoperative hypertension was previous history of hypertension. Therefore optimal preoperative preparations for the hypertensive patients and the prevention and immediate treatment of the postoperative pulmonary complications in geriatric patients are very important during the radical neck dissection.
Adult ; Aged ; Anesthesia ; Blood Pressure ; Carotid Sinus* ; Fever ; Humans ; Hypersensitivity* ; Hypertension ; Incidence ; Neck Dissection* ; Postoperative Complications* ; Retrospective Studies*

PURPOSE: This study was to suggest the direction to the exercise intervention development for the stroke survivors. METHOD: 12 domestic and 54 foreign research papers about the exercise intervention for the stroke patients published during 1998~2007 were analyzed. RESULT: Among the papers, quasi-experimental design(75.8%) and multidisciplinary approach(60.6%) were the most frequent ones. The mean age of the respondents was 63.3 and the intervention was supplied for 7.14 weeks. The frequency of exercise was 3.87 per week and the exercise time was 1.88 hours. And physical research variables - such as ambulation, muscle strength, activities of daily living and balance - were more than psychosocial variables. This study suggested that the exercise intervention for the stroke survivors need to include aerobic exercise, muscle strengthening exercise, flexible exercise, body coordination, balance exercise. In addition we confirmed that the exercise intervention was revealed as an effective physiological parameters; such as maximum oxygen uptake quantity, blood pressure. CONCLUSION: We suggest that the further researchs are needed which include the intensity of exercise into the quantity of the exercise. Also researchers need to extend the motion intervention time for an effective sociopsychological variable and to try the meta analysis for the effective exercise intervention for the stroke survivors.
Activities of Daily Living ; Blood Pressure ; Surveys and Questionnaires ; Exercise ; Humans ; Muscle Strength ; Oxygen ; Stroke* ; Survivors* ; Walking

BACKGROUND: Combined spinal epidural (CSE) anesthesia has become the technique of anesthesia for cesarean section. We attempted to find the most suitable spinal and epidural local anesthetic doses providing high quality analgesia and minimal side effects during CSE anesthesia. METHODS: Thirty nine parturients were divided into 3 groups by dose of local anesthetics. The dose of 0.5% hyperbaric bupivacaine for spinal anesthesia were 6mg (group 1), 4 mg (group 2) and 2 mg (group 3) and 2% lidocaine for epidural anesthesia were 100 mg (group 1), 200 mg (group 2) and 300 mg (group 3). RESULTS: The number of request of analgesics during operation were 2 in group 1, 1 in group 2 and 3 in group 3. Group 3 had higher incidence of hypotension than other groups. The time to T4 level block were faster in group 1 and 2 than group 3. CONCLUSIONS: The CSE technique using 0.5% hyperbaric bupivacaine 4mg for subarachnoid and 2% lidocaine 200mg for epidural is most suitable for rapid onset, sufficient analgesia and few side effects in this study.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Anesthetics, Local* ; Bupivacaine ; Cesarean Section* ; Female ; Hypotension ; Incidence ; Lidocaine ; Pregnancy

BACKGROUND: Hypoxemia during one lung ventilation (OLV) for thoracotomy in patients in the lateral position remains a clinical problem. And thoracic epidural anesthesia (TEA) during one lung ventilation recently has been combined with general anesthesia in our clinical practice for thoracic surgery. Then the effects of TEA combined with general anesthesia on PaO2 remains controversial. The aim of this study to investigate whether thoracic epidural anesthesia (TEA) affect PaO2 and pulmonary shunt during one lung anesthesia. METHODS: Fifteen patients undergoing lobectomy with one lung ventilation were examined. Each group was injected normal saline (control group, n = 7) or 1% lidocaine (TEA group, n = 8) 8 ml through thoracic epidural catheter after induction. We compared pulmonary shunt fraction (Qs/Qt) after OLV 30, 60 minutes and after two lung ventilation (TLV). RESULTS: We found the significant increases of intrapulmonary shunt fraction (%) in the TEA group compared to control group at each event, OLV30, 60 and TLV. And significant increase of intrapulmonary shunt was found after one lung ventilation in the both groups. CONCLUSIONS: These results suggest that TEA may influence hypoxic pulmonary vasoconstriction (HPV) by blockade of sympathetic activity during OLV.
Anesthesia* ; Anesthesia, Epidural* ; Anesthesia, General ; Anoxia ; Catheters ; Humans ; Lidocaine ; Lung* ; One-Lung Ventilation ; Tea ; Thoracic Surgery ; Thoracotomy ; Vasoconstriction ; Ventilation

No abstract available.
Humans ; T-Lymphocytes*

PURPOSE: The purpose of this study was to analyze the importance, difficulty, and frequency of work (duties and tasks) done by nurses' in Outpatient Departments (OPD). METHOD: Data were collected using structured questionnaires, which included 11 duties and 92 tasks making up the OPD nurse's job. Questionnaires were completed by 286 nurses. Each duty and task was analyzed for importance, difficulty, and frequency (range 1-3). RESULTS: The mean score for importance was 2.58+/-0.29, for difficulty, 2.11+/-0.31, and for frequency, 2.18+/-0.31. OPD nurses recognized'patient education and consultation' as important and difficult. However, in practice OPD nurses reported the most frequent task as'support for medical services'. There was a significant difference in importance and difficulty of duties according to OPD nurses' university degree (F=3.693, p= .026; F=4.089, p= .018) and hospital size (F=4.274, p= .006; F=3.154, p= .025). However there were no differences in importance, difficulty, or frequency according to clinical experience in OPD. CONCLUSION: The findings indicate that OPD nurses must be able to do important and difficult duties and tasks, especially patient education and consultation. To have time for these uniquely nursing tasks, OPD nurses need to delegate'preparation for medical service', and'management of facility and environment' to nonmedical health-care workers.
Health Facility Size ; Humans ; Job Description ; Outpatients ; Patient Education as Topic ; Surveys and Questionnaires