Hypothermia is defined as a core temperature of less than 35 degrees C. Hypothermia changes homeostasis of human body. It includes neurologic, cardiovascular, and metabolic abnormalities. we have anesthetized a woman patient who had intracranial hemorrhage with accidental hypothermia of 27.8 degrees C. We managed for elevation of body temperature with elevation of room temperature (30 degrees C), bladder irrigation with warm saline, application of warming pad and infusion of warming fluid during 4 hours and 20 minutes. At the end of anesthesia, her body temperature was 34.3 degrees C.
Anesthesia ; Body Temperature ; Female ; Homeostasis ; Human Body ; Humans ; Hypothermia ; Intracranial Hemorrhages* ; Urinary Bladder

A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.
Anesthesia ; Anesthesia, General ; Bronchitis* ; Child* ; Cough ; Diverticulum* ; Humans ; Hypercapnia* ; Hyperventilation ; Infant ; Male ; Metaproterenol ; Operating Rooms ; Prednisolone ; Respiratory Sounds ; Sodium Bicarbonate ; Sputum ; Suction ; Urinary Bladder*

BACKGROUND: Continuous epidural morphine infusion is a good and popular method to control postoperative pain. But intravenous morphine infusion after general anesthesia can avoid anxiety during operation and also control postoperative pain. We compared analgesia and side effects between continuous epidural infusion and continuous intravenous infusion of morphine sulfate to control of postoperative pain after cesarean section. METHODS: Forty women who received cesarean section were randomly divided into epidural and IV groups. Morphine 0.08 mg/kg was administered intravenously as an initial loading dosage for both groups. Morphine 0.08 mg/kg for epidural group or morphine 0.8 mg/kg for IV group was diluted into 96ml of normal saline. A mixture was injected into Two-day Infusor which is continuously infused 2 ml/hr. The patients received morphine solution into epidural or intravenous route with Two-day Infusor according to their allocated group. The assessments for pain score with VAS, VRS, patient's satisfaction score and side effects were made at recovery room, 0.5, 3, 12, 24, 36, 48 and 60 hours after operation. RESULTS: The VAS in IV group was significantly higher than that in epidural group at 3, 12, 24 and 36 hours after the operation (P<0.05). The VRS in IV group was significantly higher than in epidural group at recovery room and 3 hours of postoperative period (p<0.05). The frequency of pruritus, nausea, vomiting, back pain and urinary retention were less in IV group than in epidural group. The patient's satisfaction scores were similar in both groups. CONCLUSIONS: The management of postoperative pain in epidural group was more effective than the continuous intravenous morphine infusion. But the incidence of complications was more frequent in the epidural group while patient's satisfaction scores were similar in both groups. Therefore, the continuous intravenous morphine infusion can be used effectively as a postoperative pain management.
Analgesia* ; Anesthesia, General ; Anxiety ; Back Pain ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Infusions, Intravenous ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Period ; Pregnancy ; Pruritus ; Recovery Room ; Urinary Retention ; Vomiting

BACKGROUND: Monitoring of cellular function during acute reduction of oxygen delivery(DO2) remains controversial. Increases of arteriovenous difference in PCO2(AVPCO2) and in pH(AVpH) have been alleged to reflect development of tissue hypoxia in shock status associated with low cardiac output. Method: 6 anesthetized and mechanically ventilated pigs were bled via Swan-Ganz catheter by 10% of total estimated blood volume. In each pig, we measured the hemodynamic parameters, arterial and mixed venous blood gas analysis data and calculated O2-derived parameters during gradual blood loss from 10% to 50%. RESULT: As blood loss increased, DO2 declined from 521+/- 108 ml/min to 178+/- 125 ml/min but O2 extraction ratio(14+/- 4% to 47+/- 33%) increased. After 30% blood loss, O2 consumption decreased from 121 +/-48 ml/min to 79+/- 58 ml/min progressively but lactate level markedly increased from 22.0 +/-5.5 mg/dl to 52.7+/- 21.8 mg/dl. As DO2 decreased, AVPCO2 and AVpH( -11+/- 2 mmHg to - 27+/- 11 mmHg, 0.03+/- 0.02 to 0.11 0.04 respectively) rose, and these increases were especially more prominent after DO2 value at 30% blood loss than before(p<0.05). CONCLUSION: We demonstrated that the increases of AVPCO2 and AVpH can be reliable parameters of tissue hypoxia during gradual blood loss.
Anoxia* ; Blood Gas Analysis ; Blood Volume ; Cardiac Output, Low ; Catheters ; Hemodynamics ; Hemorrhage* ; Hydrogen-Ion Concentration* ; Lactic Acid ; Oxygen ; Shock ; Swine*

Of a total of 11690 operative cases, 2111 patients who received a transfusion during operation were analyzed statistically at the Department of Anesthesiology, Chung-Nam University Hospital from January 1985 to December 1987 according to department, sex, preoperative hemoglobin, blood type, operation time and blood component therapy. The results as follows: 1) The percentage of transfused patients among all operative cases was 18.05 percent. 2) Of all the transfused patients, 477 cases(22.95%) were general surgery cases. 3) Of all the transfused patients, 1187 cases(56.2%) were male. 4) The mean value of hemoglobin measured preoperatively was 10~15g/dl (72.19%). 5) The most frequent cases of transfusion were done in operations requiring 2~3 hours. 6) Blood component therapy was preformed 11 percent in 1985, 26.73 percent in 1986, and 80.72 percent in 1987. The number of cases receiving blood component therapy has tended to increase year by year.
Anesthesiology ; Blood Transfusion* ; Humans ; Male

The in vivo effects of ethrane and single intravenous injection of hydrocortisone 250 mg on T-cell subsets (T3, T4 and T8), s-cortisol, s-Na+ and K+, polymorphonuclear leukocytes, lymphocytes and HSR (T-helpers to T-suppressors ratio) has been studied. Six healthy volunteers and 16 patients was selected and observed. Sixteen patients has been done surgery under ethrane anesthesia, and single dose of hydrocortisone 250 mg was injected intravenously to eight patients among them. The result is as follows; 1) Serum cortisol level was increased after surgery under ethrane anesthesia and was decreased bellow control value at 24 hours after injection of hydrocortisone 250 mg. 2) After surgery under ethrane anesthesia, PMN's counts and monocyte counts in peripheral blood were increased, but absolute number of lymphocytes and T-cell subsets were decreased. 3) After surgery under ethrane anesthesia with hydrocortisone 250 mg, there was the most elevation of PMN's counts and the most redution of absolute number of T-cell subsets at 5 hours and was somewhat tended to return to control values, but remained changed at 24 hours, and monocyte counts was unchanged. 4) Adding hydrocortisone 250 mg compared with ethrane anesthesia alone, the increasing rate of PMN's counts and the decreasing rate of lymphocytes and absolute number of T-cell subsets were higher at 5 hours, and were lower at 24 hours. 5) Relative percentage of T-cell subsete and HSR were unchanged after surgery under ethrane anesthesia alone and adding hydrocortisone 250 mg.
Anesthesia* ; Enflurane* ; Healthy Volunteers ; Humans ; Hydrocortisone* ; Injections, Intravenous* ; Lymphocytes ; Monocytes ; Neutrophils ; T-Lymphocyte Subsets* ; T-Lymphocytes*

This patient who was a 42-year-old female had suffered from bearing down sensation and pain on anal region due to metastatic rectal cancer. She was done intrathecal block with 15% phenol in glycerine. The result was exellent to bearing down sensation and pain on anal area. Because lower back pain, pain on lower extremity and generalized painful sensation was not improved, we has done pharmacologic assistance. Urination difficulty became slightly aggrevated but was improved at post-block day 4th. This pain clinic report that intrathecal block with 15% phenol in glycerine was effective to treatment of cancer pain without major complications.
Adult ; Female ; Glycerol* ; Humans ; Low Back Pain ; Lower Extremity ; Pain Clinics ; Phenol* ; Rectal Neoplasms* ; Sensation ; Urination

Resistance to heparin therapy during cadiopulmonary bypass(CPB) is infrequent but can result in potentially life-threatening event. The precise etiology of the heparin resistance remains unknown. Clearly, the most predictive risk factor is a history of previous heparin exposure. Assessment of the clinical heparin effect, by determination of the activated clotting time(ACT), identifies those patients with heparin resistance. The potential risk of suboptimal anticoagulation is circumvented by the administration of additional heparin. High dose aprotinin suppress the activation of intrinsic coagulation pathway through surface activators inhibition, as documented by increases in the ACTs during CPB. Such effect of aprotinin on ACT, which can allow heparin-resistant patients to overestimate heparinization. We report a case of pump failure due to inappropriate heparinization in heparin-resistant patient.
Aprotinin ; Cardiopulmonary Bypass ; Heart ; Heparin* ; Humans ; Risk Factors

OBJECTIVE: GnRH-agonist (GnRH-Ag) used in controlled ovarian hyperstimulation (COH) for IVF-ET has been known to affect directly on apoptosis of human ovarian cells, but its mechanism is not clearly understood. Therefore, the purpose of the present study was to investigate whether caspase-3 and -9 activation and poly-(ADP-ribose)-polymerase (PARP) cleavage are involved in the mechanism(s) by which GnRH-Ag induces apoptosis in human granulosa-luteal cells. METHODS: Human granulosa-luteal cells collected from IVF-ET patients were cultured and treated with 10(-6) M GnRH-Ag or saline as a control. To access apoptosis in the cells, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end-labeling (TUNEL) assay and DNA fragmentation analysis were preformed 24 h after the treatment. Activity of caspase-3 and -9 in the cells was examined by using a fluorogenic substrate. Caspase-3 and -9 activation and poly (ADP-ribose) polymerase (PARP) cleavage were analyzed by Western blotting. RESULTS: DNA fragmentation in the cells increased in the higher concentration over 10(-6) M GnRH-Ag. In the result of TUNEL assay, the rate of apoptotic cells in GnRH-Ag treatment increased significantly compared with that of saline treatment (p<0.05). The activity of caspase-3 and -9 investigated by using a fluorogenic substrate increased only in the apoptotic cells. In Western blot analysis, the cells treated with GnRH-Ag revealed an increase in active forms of caspase-3 and -9 compared with those of the saline treatment. In addition, cleavage of PARP also increased in the cells treated with GnRH-Ag. CONCLUSION: These results suggest that activation of caspase-3 and -9 and cleavage of PARP might be involved in apoptosis of human granulosa-luteal cells induced by GnRH-Ag.
Apoptosis* ; Blotting, Western ; Caspase 3* ; DNA Fragmentation ; DNA Nucleotidylexotransferase ; Female ; Fluorescent Dyes ; Humans* ; In Situ Nick-End Labeling ; Luteal Cells*

PURPOSE: Concurrent chemoradiation (CRT) with 3-weekly doses of cisplatin is a standard treatment for loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). However, treatment with 3-weekly doses of cisplatin is often associated with several adverse events. Therefore, we conducted this retrospective analysis to determine the efficacy and tolerance of CRT with a low weekly dose of cisplatin in stage IV HNSCC patients. MATERIALS AND METHODS: Medical records of patients who were diagnosed with stage IV HNSCC and received concurrent CRT were analyzed. All patients were treated weekly with cisplatin at 20-30 mg/m2 until radiotherapy was completed. RESULTS: A total of 35 patients were reviewed. Median follow up was 10.7 months (range, 1.7 to 90.5 months), the median radiation dose was 7,040 cGy, and the median dose of cisplatin received was 157 mg/m2. Eleven patients received docetaxel combination chemotherapy. Overall, 25 patients (71.4%) achieved complete response (CR), eight (22.9%) showed partial response. The median overall survival was 42.7 months, the 3-year survival rate was 51.2% and the 3 year disease-free survival rate was 72.8%. Overall survival was improved in patients who achieved CR relative to others (59.7 months vs. 13.4 months; p=0.008). There were significant differences in survival between patients who received docetaxel combination and cisplatin alone (51.8 months vs. 7.9 months; p=0.009). Grade 3-4 adverse events included stomatitis (82.9%), dermatitis (22.9%), infection (11.4%), dysphagia (8.6%), and neutropenia (5.7%). CONCLUSION: CRT with low dose weekly cisplatin is likely effective and tolerable, even in patients with locally advanced-stage IV HNSCC.
Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Cisplatin* ; Deglutition Disorders ; Dermatitis ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Head and Neck Neoplasms ; Head* ; Humans ; Medical Records ; Neck* ; Neutropenia ; Radiotherapy ; Retrospective Studies ; Stomatitis ; Survival Rate