Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but -may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels (3.97+/-0.22-4.48+/-0.36 mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels (7.50+/-0.66-11.83+/-0.59 mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and incresed pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was assciated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVM). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered. reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level (7.64+/-0.79-13.79+/-0.82 mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After CaCl2 administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, UP was rather incresed than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.
Anesthetics ; Anesthetics, Local ; Animals ; Arterial Pressure ; Autonomic Nervous System ; Cardiovascular System* ; Central Nervous System ; Central Venous Pressure ; Cough ; Diazepam* ; Dogs* ; Heart Rate ; Hemodynamics ; Intubation ; Laryngoscopy ; Lidocaine* ; Nerve Block ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Reflex ; Stroke ; Vascular Resistance

BACKGROUND: The large hemodynamic response induced by laryngoscopy and endotracheal intubation may cause serious cerebral complications. This study was performed to evaluate the effects of intralaryngotracheal 10% lidocaine spray on hemodynamic responses to endotracheal intubation for patients with a cerebral aneurysm. METHODS: Sixty patients with a cerebral aneurysm were randomly divided into three groups by lidocaine administration methods before endotracheal intubation: Group 1 (Control, 2% lidocaine 1.5 mg/kg, intravenous injection); Group 2 (10% lidocaine 1 mg/kg, intralaryngotracheal spray); Group 3 (10% lidocaine 1.5 mg/kg, intralaryngotracheal spray). Anesthesia was induced intravenously with midazolam (0.02 mg/kg) and thiopental sodium (2 - 3 mg/kg), and then maintained with 50% nitrous oxide in oxygen and 1.0 vol% isoflurane. Blood pressure and heart rate were measured preinduction, before laryngoscopy, immediately after epiglottis elevation, immediately after intubation and 3 minutes after intubation. Data were compared and analyzed within and between groups. RESULTS: Immediately after intubation, the increase in blood pressure and heart rate were blunted significantly in the groups 2 and 3 compared to the intravenous lidocaine injection group (P < 0.01). However, there were no significant hemodynamic changes between groups 2 and 3. CONCLUSIONS: The elevation of blood pressure and heart rate after endotracheal intubation can be prevented by intralaryngotracheal spray of 1 mg/kg of 10% lidocaine 3 minutes before endotracheal intubation.
Anesthesia ; Blood Pressure* ; Epiglottis ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intracranial Aneurysm* ; Intubation ; Intubation, Intratracheal* ; Isoflurane ; Laryngoscopy ; Lidocaine* ; Midazolam ; Nitrous Oxide ; Oxygen ; Thiopental

BACKGROUND: Epinephrine is commonly used to reduce bleeding by constriction of nasal vessels in endoscopic sinus surgery. However, when it absorbs to other organs systemically, tachycardia and hypertension may occur and result in more bleeding. This study is performed to evaluate the dose response effects of remifentanil infusion to suppress these adverse responses without delaying emergence. METHODS: Sixty healthy patients who scheduled for endoscopic sinus surgery were randomly allocated into three groups by the dose of remifentanil infusion. For induction and maintenance of anesthesia, 0.05, 0.15, 0.25microgram/kg/min of remifentanil and 3.5microgram/ml of intravenous propofol by TCI were infused to each group. Systolic and diastolic blood pressure, heart rate and bispectral index were measured for 15 minutes at the 1 minute intervals after nasal packing of epinephrine. RESULTS: Systolic and diastolic blood pressure in R0.15 and R0.25 group were significantly lower compared to R0.05 group during 9 to 12 minutes after epinephrine packing, but heart rate and bispectral index were not significantly different among the groups. The frequency of hypotension and bradycardia were significantly higher in R0.25 than R0.05 and R0.15. CONCLUSIONS: Continuous infusion of 3.5microgram/ml of propofol with 0.15microgram/kg/min of remifentanil attenuate hypertension and tachycardia induced by epinephrine with little side effects.
Anesthesia ; Blood Pressure ; Bradycardia ; Constriction ; Epinephrine* ; Heart Rate ; Hemodynamics* ; Hemorrhage ; Humans ; Hypertension ; Hypotension ; Propofol ; Tachycardia

BACKGROUND: We experienced unintentional hyperventilation during mechanical ventilation in pediatric general anesthesia. It is very difficult to decide respiratory rate or tidal volume with a patient's condition for adequate ventilation while respiratory gas monitoring is unavailable in many cases. Therefore, we studied to find a proper respiratory rate (RR) with a fixed tidal volume during mechanical ventilation in general anesthesia. METHODS: We studied 70 children weighing 10-30 kg during general anesthesia. An endotracheal tube was selected according to 3.5+age (yrs)/4. After intubation with midazolam, thiopental sodium and succinylcholine, mechanical ventilation was applied: tidal volume 8-10 ml/kg, peak inspiratory pressure 15-20 mmHg, RR 20 (infant), 18 (under 3 yrs), 16 (under 5 yrs), 14 (above 5 yrs) breaths/min. We adjusted the RR for a PetCO2 30 33 mmHg and arterial blood gas analysis was done 30 minutes each change. We calculated the RR for a PaCO2 of 36 mmHg according to the equation: RR (applied) = estimated RR estimated PaCO2/ideal PaCO2. In addition, the linear regression was analyzed between the age and RR. RESULTS: The estimated regression for RR using Pearson's correlation coefficient was as follows: RR = 19.25-0.07Xage (month). CONCLUSIONS: The equation (RR = 19.25-0.07Xage [month]) could be an index for safe ventilatory management without severe hyper- or hypo-carbia in the pediatric general anesthesia.
Anesthesia, General* ; Blood Gas Analysis ; Child ; Humans ; Hyperventilation ; Intubation ; Linear Models ; Midazolam ; Respiration, Artificial* ; Respiratory Rate* ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilation

PURPOSE: The purpose of this study was to suggest agenda priorities for nursing service R&D (Research and Development) related policies development. METHODS: Two steps in developing the agendas and priorities were performed in this descriptive study. First, nursing service R&D agendas were extracted through needs assessment of nursing researchers and practitioners. Then, the priority of agendas was set by Analytic Hierarchy Process by ten experts who were representatives of nursing and other healthcare professionals. RESULTS: Six core areas and forty-six nursing service R&D agendas were developed. The priority of agendas was different according to the evaluation criteria depending on weight value of nursing services. CONCLUSION: In order to select and promote nursing service R&D projects within national healthcare policy, nursing service R&D policy should be proposed with consideration to the importance of the criteria in reflecting characteristics of nursing care. By strengthening R&D capabilities for quality improvement and sensitive awareness of national directions for healthcare R&D policies, nursing service R&D can be appropriately promoted.
Delivery of Health Care ; Needs Assessment ; Nursing ; Nursing Care ; Nursing Research ; Nursing Services* ; Quality Improvement

PURPOSE: Testosterone deficiency has recently captured attention as a possible risk factor for metabolic syndrome. This study was conducted to investigate a correlation of the serum testosterone level with insulin resistance(IR) and metabolic syndrome(MS). MATERIALS AND METHODS: The metabolic risk factors, the blood pressure, the waist circumference and the fasting serum levels of glucose, triglyceride and high density lipoprotein cholesterol were measured for a total of 215 patients(mean age; 61.04+/-0.54 years) with erectile dysfunction(ED) or/and symptomatic benign prostatic hyperplasia(BPH). The serum total testosterone and insulin were measured at the same time, and the free testosterone, bioavailable testosterone and IR were calculated. RESULTS: The prevalence of MS and the number of associated MS risk factors were significantly higher in the insulin resistance group(IRG) than in the insulin sensitive group(ISG). The serum testosterone level significantly decreased with more risk factors. The IRG showed a significantly lower level of serum testosterone than the patients with ED and the total patients. CONCLUSIONS: The negative correlation of a decrease in the serum testosterone level with IR and MS suggests that late onset hypogonadism might be a risk factor of MS.
Blood Pressure ; Cholesterol ; Cholesterol, HDL ; Erectile Dysfunction ; Fasting ; Glucose ; Humans ; Hypogonadism ; Insulin ; Insulin Resistance ; Lipoproteins ; Male ; Prevalence ; Prostatic Hyperplasia ; Risk Factors ; Testosterone ; Waist Circumference

Dermatomyositis is an idiopathic inflammatory myopathy characterized by skin changes and muscle weakness. Depending on the involvement of various muscles, dermatomyositis can cause aspiration pneumonia, ventilatory impairment, and heart failure. Several reports have documented normal or prolonged neuromuscular blockade following administration of different non-depolarizing neuromuscular blockers in patients with dermatomyositis. We observed delayed onset of blockade and prolonged recovery following administration of 0.6 mg/kg rocuronium in a patient with dermatomyositis. However, when the train-of-four ratio reached 0.3, the patient was administered pyridostigmine and glycopyrrolate, which led to normal response to reversal of rocuronium. The patient was extubated without respiratory complications. The outcomes of this case indicate that response to the usual dosage of muscle relaxants in patients with dermatomyositis might be different from that in patients without this condition. Anesthesiologists should pay attention to preoperative cardiorespiratory evaluation and intraoperative neuromuscular monitoring.
Anesthesia, General ; Dermatomyositis ; Glycopyrrolate ; Heart Failure ; Humans ; Muscle Weakness ; Muscles ; Myositis ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Pneumonia, Aspiration ; Pyridostigmine Bromide ; Skin

No abstract available.
Pulmonary Embolism*

PURPOSE: Blood glucose control in diabetic mothers during pregnancy is very important because it can affect fetal and neonatal outcomes. We therefore investigated the clinical outcomes of infants of diabetic mothers in relation to the maternal HbA1c level. METHODS: The subjects were diabetic mothers and their newborns who were admitted in Wonkwang University Hospital from July 2007 to June 2012. We retrospectively reviewed the medical records of 73 neonates, out of the 128 born to diabetic mothers and investigated neonatal and maternal characteristics based on the differences in maternal HbA1c levels. 55 neonates was excluded because maternal HbA1c was not measured. RESULTS: The mean time for testing the maternal HbA1c was 30+/-5.0 weeks, and the mean level was 6.7+/-1.4%. The mean birth weight in neonates was 3,094+/-831.6 g and was higher in the group with > or =7% HbA1c than in the group with < or =6.4% HbA1c (3,370+/-950.8 g vs. 2,855+/-661.97 g, P=0.0113). When assessing neonatal morbidity, the rates of hypoglycemia (56.0% vs. 28.6%, P=0.0381), large baby (36.0% vs. 4.8%, P=0.0015) and congenital heart disease (CHD) (28% vs. 0%, P=0.0055) were higher in the group with > or =7% HbA1c than in those with < or =6.4% HbA1c. Serum blood sugar level was significantly lower in the group with > or =7% HbA1c than those with < or =6.4% HbA1c (26.5+/-10.5 vs. 35.9+/-8.3 mg/dL, P=0.0196). When considering the rate of large babies (> or =4,000g), there were no differences in birth weights between both groups. CONCLUSION: If the maternal HbA1c level during pregnancy is above 7% with glucose control failure, infants born to diabetic mothers are susceptible to hypoglycemia, large baby syndrome and CHD.
Birth Weight ; Blood Glucose ; Glucose ; Heart Defects, Congenital ; Humans ; Hypoglycemia ; Infant* ; Infant, Newborn ; Medical Records ; Mothers* ; Pregnancy ; Retrospective Studies

Background: We used machine learning and population-based data for analyzing the determinants of sarcopenia in adult women and developing its decision support systems for various subgroups. Methods: All data was acquired from the Korea National Health and Nutrition Examination Survey, and women 18 years and older were included in this research. The variables were selected based on female characteristics and the ability to be acquired in a survey format, and were ranked by importance using Random Forest. From this ranking, four main variables were selected, age, menopause age, menarche age and number of pregnancy. A decision supporting system was constructed based on a tree randomly selected from Random Forest. Results: We defined sarcopenia as -2SD below the appendicular skeletal mass (ASM) index reference of 0.5136, and 89.87% (n = 8,610) were found non-sarcopenic and 10.13% (n = 971) were found sarcopenic. The subjects were divided into 6 groups based on menopausal status and BMI. The obese postmenopausal women had the highest number of sarcopenia, whereas the non-obese premenopausal women had the least number of sarcopenic subjects. In non-obese premenopausal women, which was considered to be at the lowest risk for sarcopenia, the most determining variable was the menarche age, followed by age and number of pregnancies. In obese and postmenopausal women, which was considered to be at the highest risk for sarcopenia, the most influential factor was the menopausal age, followed by age and menarche age. Conclusions We identified the major determinants of sarcopenia using machine learning and population-based data. This study demonstrated the strengths of the random forest as an effective decision support system for each stratified subgroup to find its own optimal cut-off points for the major variables of sarcopenia.