BACKGROUND: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. METHODS: We started continuous infusion of midazolam at a rate of 0.5~1.0 ug/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. RESULTS: The mean loading dose, infusion rate and total dose of midazolam were 4.1+/-0.9 mg, 1.2+/-0.4 ug/kg/minute and 251.9+/-84.0 mg. The mean duration of infusion was 59.0+/-37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. CONCLUSIONS: Continuous infusion of midazolam at a rate of 1.2+/-0.4 ug/kg/minute after 4.1+/-0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.
Benzodiazepines ; Blood Pressure ; Central Venous Pressure ; Gases ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Intensive Care Units* ; Critical Care* ; Kidney ; Liver ; Midazolam* ; Solubility ; Ventilation

BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone* ; Anesthesia ; Arterial Pressure ; Central Venous Pressure ; Dobutamine* ; Ethics Committees, Research ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Sternotomy ; Vascular Resistance ; Ventilation

BACKGROUND: Low values of lung compliance have been reported in patients with increased pulmonary blood flow due to intracardiac left to right(L-R) shunt. The compliance had returned to within normal limits 4 to 6 weeks after surgical correction of the shunt. We investigated whether lung compliance was improved immediately after surgical correction of the shunt. METHODS: Fifty four pediatric patients who were undergoing repair of intracardiac L-R shunt were evaluated. Lung compliance, arterial oxygen tension(PaO2) and arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) were measured after induction of anesthesia and at the completion of surgery. Left atrial pressure(LAP) was monitored. Lung compliance and end-tidal carbon dioxide tension were measured by monitoring system built in Cato anesthetic ventilator system. RESULTS: Lung compliance was significantly lower after surgery(6.57+/-6.46 ml/mbar) than after induction of anesthesia(7.71+/-7.18 ml/mbar). After surgery, PaO2 was significantly decreased and Pa-ETCO2 significantly increased than after induction of anesthesia. The decrease in lung compliance after surgery significantly correlated with a decrease in PaO2(r=0.43) and an increase in Pa-ETCO2 (r=0.47) but not correlated with LAP. CONCLUSIONS: Although surgical correction of intracardiac L-R shunt reduces pulmonary blood flow, the lung compliance decreases in immediate postoperative period. Therefore a deterioration of postoperative lung compliance may need judicious management for pulmonary and hemodynamic instability.
Anesthesia ; Carbon Dioxide ; Compliance ; Hemodynamics ; Humans ; Lung Compliance* ; Lung* ; Oxygen ; Postoperative Period ; Ventilators, Mechanical

PURPOSE: The importance of team dynamics with regard to clinical performance is being emphasized to improve patient safety and the quality of health care. The aim of this study was to examine the correlation and differences in team dynamics and team clinical performance in a web-based simulation (WS) and high-fidelity simulation (HS) in the medical students. METHODS: The simulations were held for 15 teams of fourth year medical students (n=52). They were given two clinical cases, dyspnea (case 1) and chest pain (case 2) by WS and then HS. The scores on the team dynamics and the team's clinical performance were analyzed by paired t-test and multiple regression using SPSS version 21.0 (IBM Corp.). RESULTS: The teamwork scores on case 2 (22.67+/-6.58) were higher than for case 1 in the HS (20.47+/-7.22). Team clinical performance scores were the same the WS and HS. Team clinical performances were significantly associated with team dynamics in both cases by HS. Teamwork scores of team dynamics were each explanation on case 1 (74.9%), case 2 (63.4%) in the HS. CONCLUSION: The team dynamics and clinical performance can improve if undergraduate medical students have more opportunities. They should be trained in these endeavors to become future doctors for which scenario-based simulations could be valuable.
Chest Pain ; Dyspnea ; Humans ; Patient Safety ; Quality of Health Care ; Students, Medical*

General anesthesia for the removal of a large mediastinal mass has been associated with life-threatening airway obstruction. We present a case of general anesthesia for a patient with superior posterior mediastinal mass and critical airway compression who was allowed to maintain spontaneous ventilation throughout general anesthesia for a thoracotomy. The patient was a 5-year-old boy complaining of productive cough and intermittent fever for 3 weeks. His chest radiograph and magnetic resonance imaging(MRI) film demonstrated a critically narrowed and deviated trachea at the level of the thoracic inlet to the proximal portion of the right bronchus. We can secure the airway by spontaneous ventilation without muscle relaxation and allowing the patient to breathe spontaneously and insertion of endotracheal tube distal to the narrowed portion of trachea.
Airway Obstruction ; Anesthesia, General ; Bays ; Bronchi ; Child, Preschool ; Cough ; Fever ; Humans ; Male ; Muscle Relaxation ; Radiography, Thoracic ; Thoracotomy ; Trachea ; Ventilation

OBJECTIVE: To evaluate the changes of bladder management methods after the discharge from hospital, and to identify the problems associated with their method changes of bladder management after the discharge. METHOD: The subjects of this study were 128 spinal cord injury patients with a neurogenic bladder dysfunction who were admitted to the hospital and received the neurogenic bladder management and training. We reviewed the medical records of these patients for the management methods of neurogenic bladder and interviewed the patients whether they are still using the same methods after the discharge. RESULTS: The number of patients who were doing the intermittent catheterization at the time of discharge from hospital was markedly reduced after the discharge and most of the patients in this group have switched to the external collecting device method, using Cred, Valsalva or tapping method. The reasons of this change were that the intermittent catheterization method was not only difficulty and complicated but also restricted their social activities. CONCLUSION: We concluded that a long term close follow up and continuous encouragement are very important in the management of neurogenic bladder patients who are discharged with the intermittent catheterization method.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Medical Records ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic*

Celosia cristata , belongs to Amaranthaceae family, has been utilized in many traditional medicinal systems to treat hemostasis, eye and mouth inflammation, and gynecological diseases. The various physiological investigations on C. cristata have documented its antibacterial, antioxidant, antifungal, and antihepatotoxic properties. During the research program aimed at isolating bioactive constituents from the medicinal plants, the aerial parts of C. cristata were extracted using 80% EtOH, then sequentially partitioned with n-hexane, CH 2 Cl 2 , and EtOAc. The CH 2 Cl 2 -soluble fraction demonstrated inhibitory effects on nitric oxide production in LPS-induced RAW 264.7 cells, with an IC50 value of 24.7 μg/mL. The CH 2 Cl 2 -soluble fraction was subjected to a series of chromatographic techniques, such as Sephadex LH-20 column chromatography, MPLC, and preparative HPLC. As a result, seven known norisoprenoids (1–7) were isolated, and the structures were determined through the analysis of spectroscopic data, especially 1D NMR, 2D NMR, and HR-ESI-MS. Dehydrovomifoliol (2), 3-hydroxy-4,7-megastigmadien-9-one (6), and 9-hydroxy-4,7-megastigmadien-3-one (7) exhibited inhibitory effects on LPS-induced nitric oxide production in RAW 264.7 macrophages with IC50 values of 17.7–24.4 μM.

BACKGROUND: Appropriate placement of aortic and venous cannulas is important to ensure effective systemic perfusion. The malposition of the aortic cannula may promote preferential flow down the aorta or induce flow to aortic arch vessels causing pressure gradient between mean radial arterial pressure (RAP) and femoral arterial pressure (FAP). In this study we compared mean radial to femoral artery pressure gradient before and immediately after aortic cannulation and during cardiopulmonary bypass (CPB). METHODS: Ninety two pediatric patients undergoing open heart surgery were examined. After induction of anesthesia RAP and FAP were measured. The pressure gradient was measured before and after aortic cannulation, 15, 30 and 60 minutes after aortic cross clamping (ACC). When the pressure gradient of more than 10 mmHg developed, the surgeon was recommended to manipulate position of the aortic cannula. If the pressure gradient returned to pre-CPB level after manipulation, the pressure gradient was considered to develop due to aortic cannula. The age, presence of cyanosis, adjustment of shape of aortic cannula tip before cannulation and side of radial artery cannulation as factors developing pressure gradient were examined. RESULTS: Fifteen patients (16.3%) developed pressure gradient due to position of aortic cannula. Two patients (2.2%) developed immediately after aortic cannulation and fourteen patients (15.2%) during CPB. There was no statistically significant factor developing pressure gradient except non-cyanotic disease. CONCLUSIONS: The pediatric patient could develop pressure gradient due to malposition of aortic cannula frequently during CPB. Therefore, the simultaneous monitoring of RAP and FAP may be beneficial for managing CPB in pediatric cardiac surgery.
Anesthesia ; Aorta ; Aorta, Thoracic ; Arterial Pressure ; Cardiopulmonary Bypass ; Catheterization ; Catheters* ; Constriction ; Cyanosis ; Femoral Artery* ; Humans ; Perfusion ; Radial Artery ; Thoracic Surgery*

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We found an error of funding acknowledgment in this article.