Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

BACKGROUND: Endobroncheal intubation or extubation may occur accidentally when the patient's neck is flexed or extended even in the appropriate endotracheal intubation. The purpose of this study is to examine the effect of fixation or unfixation of the endotracheal tube at the teeth level on the displacement of its distal end when the patient's neck is extended or flexed. METHODS: This study was conducted in 37 patients who underwent endotracheal general anesthesia. The patients with the evidence of pathology in head, neck and chest were excluded from the study. Individual patient's displacement in endotracheal tube tip compared unfixed cases with fixed cases when the change of neck position. The moved distance was measured by fiberoptic bronchoscope. The data were statistically analyzed by Student's paired t-test. RESULTS: The endotracheal tube moved away from the carina when the patient's neck was extended, while it moved toward the carina when flexed in all cases. When the patient's neck was extended the average distance displaced 1.2 0.7 cm in fixed cases and 1.1 0.9 cm in unfixed cases. when the neck was flexed, they were 1.2 0.5 cm and 1.0 0.8 cm respectively. There were not statistically significant between the fixed and the unfixed cases. CONCLUSIONS: It is concluded that the displacement of the endotracheal tube is not related to its fixation or unfixation at the teeth level and therefore, unfixation does not provide any benefits in terms of the displacement of the distal end of the tube in adult trachea.
Adult ; Anesthesia, General ; Bronchoscopes ; Head ; Humans ; Intubation ; Intubation, Intratracheal ; Neck* ; Pathology ; Thorax ; Tooth ; Trachea

No abstract available.
Humans ; Organophosphate Poisoning* ; Respiratory Insufficiency*

OBJECTIVES: Since 2000, the National Health Service (NHS) in the United Kingdom (UK) has challenged for a large-scale reforms. This study aims to review those reforms to reflect in the dental care system in Korea. METHODS: Reports and papers that were published from 2000 to 2015 and were related to the NHS dental care system and reforms were searched. Among them, official reports from the government or organization were prioritized. RESULTS: In 2002, the “NHS Dentistry: Options for Change” report suggested rebuilding the structure to meet the standard of care, improving the remuneration system, and modernizing the workforce. Eight years later, the government proposed the “NHS Dental Contract: Proposals for Pilots” to improve accessibility to oral health and dental care. The pilot was based on three elements: registration, capitation, and quality. In 2015, the Department of Health announced the “Dental Contract Reform: Prototypes.” These prototypes include the clinical pathway, measurement and remuneration by quality of care, and a weighted capitation and quality model reimbursement system. CONCLUSIONS: The changes to the UK dental care system has implications. First, national coverage should be extended to improve accessibility to dental care. Second, the dental care system is necessary to reform focused on patient-centered and prevention. Third, registration and remuneration by quality of care needs to be introduced. Fourth, change should start from the basic steps, such as forming consensus or preparing manuals, to strengthening personnel and conducting a pilot study. Most of all, the new system will center on clinical leadership.
Consensus ; Critical Pathways ; Delivery of Health Care* ; Dental Care ; Dentistry ; Great Britain ; Health Care Reform* ; Health Manpower ; History of Dentistry ; Korea ; Leadership ; Legislation, Dental ; National Health Programs ; Oral Health ; Pilot Projects ; Remuneration ; Standard of Care

We describe a 73-year-old Parkinson's disease patient with bilateral pleural effusion after receiving a prescription of L-dopa and amantadine. Although, the mechanism is unknown, the occurrence of bilateral pleural effusion following the administration of amantadine and improvement after the cessation of amantadine suggests a possible relationship between amantadine and pleural effusion.
Aged ; Amantadine* ; Humans ; Levodopa ; Parkinson Disease ; Pleural Effusion* ; Prescriptions

BACKGROUND: Postoperative nausea and vomiting (PONV) after thyroidectomy in women is especially frequent. Ramosetron and dexamethasone prevent cancer chemotherapy-related nausea and vomiting- and PONV. METHODS: Ninety three women undergoing thyroidectomy under general anesthesia with sevoflurane and remifentanil were allocated to one of three groups: Control (n = 30), ramosetron (Group R, n = 30), ramosetron with dexamethasone (Group RD, n = 33). Doses of ramosetron (0.1 mg) oral tablet by oral route and intravenous dexamethasone (5 mg) were used. The incidence and severity of PONV, and postoperative blood glucose level in each group were studied. RESULTS: The incidence of PONV in the control and R and RD groups were 43%, 20%, and 18% respectively. The incidence and severity of PONV were similar in the R and the RD groups. Blood glucose levels postoperatively were higher in RD group compared with control and R groups. CONCLUSIONS: Oral ramosetron reduced the incidence of postoperative nausea. The combination of ramosetron and dexamethasone increased postoperative blood glucose levels significantly without additional effect on PONV.
Anesthesia, General ; Antiemetics ; Benzimidazoles ; Blood Glucose ; Dexamethasone ; Female ; Glucose ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Piperidines ; Postoperative Nausea and Vomiting ; Thyroidectomy

BACKGROUND: At present, epidural steroid injection is one of the most frequently used methods in the treatment for low back pain.. But this method is nonspecific and results in a widespread of injected agent around the target point. Therefore we thought direct injection to the nerve root is more specific and effective. METHODS: The authors evaluated the effects of lumbar paravertebral steroid injection in 39 patients with low back pain and radicular pain, retrospectively. We used triamcinolone 40mg(1ml) and 0.25% bupivacaine 3ml as injection agents and used pain relief scale(PRS) score for assessment of the effect. RESULTS: One week after injection, the patients of PRS score less than 5 were 65% in spinal stenosis and 85% in herniated intervertebral disc(HIVD). The patients of effective response more than 4 weeks after injection were 48% in spinal stenosis and 68% in HIVD, more than 12 weeks were 22% and 38%, respectively. The patients of PRS score less than 5 were 45% at the time of follow-up study. CONCLUSIONS: We think paravertebral steroid injection is effective in patients with low back pain and radicular pain. Therefore, this technique could be alternative method to epidural steroid injection.
Bupivacaine ; Follow-Up Studies ; Humans ; Low Back Pain* ; Retrospective Studies ; Spinal Nerve Roots* ; Spinal Nerves* ; Spinal Stenosis* ; Triamcinolone

BACKGROUND: Preemptive analgesia may prevent nociceptive input generated during surgery from sensitizing central neurons and, therefore, may reduce postoperative pain. The purpose of this study is to examine the effect of epidural fentanyl between preincisional (preemptive) and postincisional groups on postoperative morphine requirements. METHODS: Sixty patients (ASA physical status 1 or 2) scheduled for elective total abdominal hysterectomy under general anesthesia were allocated randomly to one of two groups and prospectively studied in a double-blind manner. Group 1 received epidural fentanyl(2 g/kg in 15 ml normal saline) before surgical incision followed by epidural normal saline (15 ml) 15 minutes after skin incision. Group 2 received epidural normal saline(15 ml) before surgical incision followed by epidural fentanyl(2 g/kg in 15 ml normal saline) 15 minutes after skin incision. No additional analgesics were used before or during the operation. Postoperative visual analogue pain scores, PCA morphine requirements and side effects were assessed. RESULTS: Postoperative PCA morphine requirements in preincisional group were significantly less (p<0.05) than those in postincisional group between 6 and 24 hours postoperatively. VAPS was also significantly less (p<0.05) in preemptive group than in postincisional group 12 hours after surgery. CONCLUSIONS: Preemptive analgesia with epidural fentanyl is more effective in reducing the postoperative morphine requirements and VAPS than analgesia with postincisional epidural fentanyl in patients with total abdominal hysterectomy.
Analgesia ; Analgesics ; Anesthesia, General ; Fentanyl* ; Humans ; Hysterectomy ; Morphine ; Neurons ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Prospective Studies ; Skin

BACKGROUND: Pulse oximetry has been recommended as a standard of care for ICU, CCU, Post Anesthetic Care Unit as well as general anesthesia. The device provides valuable data regarding blood oxygenation. But there are some limitations and inaccuracies of pulse oximetry. The purpose of the present study is to assess the knowledge of pulse oximetry in the doctors and nurses who frequently use pulse oximeter in their practice. METHODS: We investigated 29 doctors(resident) and 41 nurses who answered a structured questionnaire about pulse oximetry. Questions were given about the knowledge of equipment, factors affecting readings, normal values in various patients, values in hypothetical clinical situations, education experience and source of information about pulse oximetry. RESULTS: Only 20% of doctors understood how a pulse oximeter worked and about 60% of doctors and 80% of nurses were confused about factors influencing readings. About 30% of doctors and 12% of nurses had received formal training about the pulse oximetry. Sources of information about pulse oximetry were operating manual, senior, books and journal. CONCLUSION: Our survey revealed that most of resident doctors and nurses using pulse oximeter were untrained, lacked knowledge of the basic principles and factors influencing saturation values in pulse oximetry. Therefore the systematic training program is important for doctors and nurses to use of pulse oximeter.(Korean J Anesthesiol 1996; 31: 791~796)
Anesthesia, General ; Education ; Humans ; Oximetry* ; Oxygen ; Reading ; Reference Values ; Standard of Care

BACKGROUND: Pulse oximetry has been recommended as a standard of care for ICU, CCU, Post Anesthetic Care Unit as well as general anesthesia. The device provides valuable data regarding blood oxygenation. But there are some limitations and inaccuracies of pulse oximetry. The purpose of the present study is to assess the knowledge of pulse oximetry in the doctors and nurses who frequently use pulse oximeter in their practice. METHODS: We investigated 29 doctors(resident) and 41 nurses who answered a structured questionnaire about pulse oximetry. Questions were given about the knowledge of equipment, factors affecting readings, normal values in various patients, values in hypothetical clinical situations, education experience and source of information about pulse oximetry. RESULTS: Only 20% of doctors understood how a pulse oximeter worked and about 60% of doctors and 80% of nurses were confused about factors influencing readings. About 30% of doctors and 12% of nurses had received formal training about the pulse oximetry. Sources of information about pulse oximetry were operating manual, senior, books and journal. CONCLUSION: Our survey revealed that most of resident doctors and nurses using pulse oximeter were untrained, lacked knowledge of the basic principles and factors influencing saturation values in pulse oximetry. Therefore the systematic training program is important for doctors and nurses to use of pulse oximeter.(Korean J Anesthesiol 1996; 31: 791~796)
Anesthesia, General ; Education ; Humans ; Oximetry* ; Oxygen ; Reading ; Reference Values ; Standard of Care