Atrial fibrillation is one of the most common arrhythmias in everyday life, and it is responsible for substantial mortality and morbidity in the general population.When atrial fibrillation is first noticed and it persists for a long time, it will be more difficulty to control and it will recur more often.A 58-year old female patient was scheduled for surgery due to the increased size of an intracranial arteriovenous malformation.During the preparation of anesthesia, we noticed the presence of atrial fibrillation.After about 2 hours of sedation and consultation, we decide to proceed with the surgery. With the induction of anesthesia by using thiopental sodium, we observed the rapid conversion of atrial fibrillation to sinus tachycardia.During the maintenance of anesthesia, the patient showed normal sinus rhythm and the surgery was completed without complications.
Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Female ; Humans ; Thiopental

BACKGROUND: Existing laryngoscopes are designed to be handled by the left hand, whereas most healthcare professionals are right-handed. However, controlling the laryngoscope device requires considerable strength and refinement to control the blade. We examined the usefulness of a right-handed laryngoscope to validate its clinical applicability. METHODS: One hundred sixty-four patients for general anesthesia were involved. Laryngoscopy was performed twice for each patient, once using a conventional left-handed Macintosh No. 3 laryngoscope and once using a right-handed one, by 25 right-handed and 18 left-handed laryngoscopists. The perpendicular distance from the tip of the maxillary incisor to the flange of each blade was measured when the maximum visibility of the glottis was obtained. We compared the distances, chances of directly contacting the tooth, laryngoscopic views and subjective feeling of difficulty in handling device between the two laryngoscopes. RESULTS: For the right-handed laryngoscopists, distance varied significantly between the two laryngoscopes (5.0 ± 3.5 and 5.7 ± 3.7 mm [mean ± standard deviation] for the conventional and right-handed laryngoscopes, respectively [P < 0.001]). The right-handed laryngoscope was associated with a decreased chance of directly contacting the teeth (P = 0.001). Additionally, the right-handed laryngoscope provided a better view than the conventional one (P = 0.005). Conversely, most of the left-handed laryngoscopists felt that the procedure using a conventional laryngoscope was easier than with a right-handed one. CONCLUSIONS: When a right-handed laryngoscopist uses a right-handed laryngoscope, a better laryngoscopic view and a reduced chance of blade contact with the teeth can be achieved.
Anesthesia, General ; Delivery of Health Care ; Glottis ; Hand* ; Humans ; Incisor ; Laryngoscopes ; Laryngoscopy* ; Tooth

BACKGROUND: Prolonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT. METHODS: Perioperative data of adult patients undergoing LDLT were reviewed. "Early" extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis. RESULTS: Of 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of < or = 7.0 units and last serum lactate of < or = 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865). CONCLUSIONS: Intraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT.
Adult ; Airway Extubation* ; Ascites ; Blood Transfusion ; Erythrocytes ; Hepatic Encephalopathy ; Humans ; Incidence ; Intensive Care Units ; Lactic Acid ; Liver Diseases ; Liver Transplantation* ; Living Donors ; Logistic Models ; Lung Diseases ; Multivariate Analysis ; Operating Rooms ; Operative Time ; Reoperation ; Respiration, Artificial ; ROC Curve ; Thrombosis

No abstract available.
Butyrylcholinesterase* ; Humans

BACKGROUND: School age is a time when students form habits of healthy behavior that affect their lifetime health. However, most previous studies were conducted on hand washing and brushing teeth and no studies included bathing in personal hygiene. We aim to improve knowledge and performance about hand washing, brushing teeth, and bathing in school age children. The study was based on the health belief model and ways to establish proper personal hygiene habits. METHODS: A non-equivalent control group, pretest-posttest design was used in this study. The educational content included hand hygiene, oral hygiene and bath hygiene. After the pre and post evaluation of the control group, the experimental group received the education and pre and post evaluation over five weeks. Then, the education program was provided to the control group. This study was conducted over ten weeks from April to June 2017. RESULTS: Knowledge on personal hygiene habits (F=8.41, P=0.006) and performance of personal hygiene habits (F=29.09, P < 0.001) were higher in the experimental group compared to the control group after controlling the covariates. CONCLUSIONS: The results of this study show obvious difference between the experimental group and control group on knowledge and performance for personal hygiene habits. This result demonstrated that the program based on the health belief model was effective. It is necessary to develop other effective programs including hand washing, brushing teeth, and bathing to help students develop good personal hygiene habits.
Baths ; Child ; Education ; Hand Disinfection ; Hand Hygiene ; Humans ; Hygiene ; Oral Hygiene ; Tooth

BACKGROUND: School age is a time when students form habits of healthy behavior that affect their lifetime health. However, most previous studies were conducted on hand washing and brushing teeth and no studies included bathing in personal hygiene. We aim to improve knowledge and performance about hand washing, brushing teeth, and bathing in school age children. The study was based on the health belief model and ways to establish proper personal hygiene habits. METHODS: A non-equivalent control group, pretest-posttest design was used in this study. The educational content included hand hygiene, oral hygiene and bath hygiene. After the pre and post evaluation of the control group, the experimental group received the education and pre and post evaluation over five weeks. Then, the education program was provided to the control group. This study was conducted over ten weeks from April to June 2017. RESULTS: Knowledge on personal hygiene habits (F=8.41, P=0.006) and performance of personal hygiene habits (F=29.09, P < 0.001) were higher in the experimental group compared to the control group after controlling the covariates. CONCLUSIONS The results of this study show obvious difference between the experimental group and control group on knowledge and performance for personal hygiene habits. This result demonstrated that the program based on the health belief model was effective. It is necessary to develop other effective programs including hand washing, brushing teeth, and bathing to help students develop good personal hygiene habits.

BACKGROUND: Acute liver failure (ALF) is a rapidly progressing and fatal disease for which liver transplantation (LT) is the only treatment. Posttransplant mechanical ventilation tends to be more prolonged in patients with ALF than in other LT patients. The present study examined the clinical effects of prolonged posttransplant mechanical ventilation (PMV), and identified risk factors for PMV following LT for ALF. METHODS: We reviewed data of patients undergoing LT for ALF between January 2005 and June 2011. After grouping patients according to administration of PMV (> or = 24 h), donor and recipient perioperative variables were compared between the groups with and without PMV. Potentially significant factors (P < 0.1) from the univariate intergroup comparison were entered into a multivariate logistic regression to establish a predictive model for PMV. RESULTS: Twenty-four (25.3%) of 95 patients with ALF who received PMV had a higher mortality rate (29.2% vs 11.3%, P = 0.038) and longer intensive care unit stay (12.9 +/- 10.4 vs 7.1 +/- 2.7 days, P = 0.012) than patients without PMV. The intergroup comparisons revealed worse preoperative hepatic conditions, more supportive therapy, and more intraoperative fluctuations in vital signs and less urine output in the with- compared with the without-PMV group. The multivariate analysis revealed that preoperative hepatic encephalopathy (> or = grade III), intraoperative blood pressure fluctuation, and oliguria (< 0.5 ml/kg/h) were independent risk factors for PMV. CONCLUSIONS: PMV was associated with deleterious outcomes. Besides care for known risk factors including hepatic encephalopathy, meticulous attention to managing intraoperative hemodynamic circulatory status is required to avoid PMV and improve the posttransplant prognosis in ALF patients.
Blood Pressure ; Hemodynamics ; Hepatic Encephalopathy ; Humans ; Intensive Care Units ; Liver ; Liver Failure, Acute ; Liver Transplantation ; Logistic Models ; Multivariate Analysis ; Oliguria ; Prognosis ; Respiration, Artificial ; Risk Factors ; Tissue Donors ; Vital Signs

BACKGROUND: Laryngoscopy and tracheal intubation are known to have profound cardiovascular effects. The Callander modification of Macintosh blade is associated with greater field of laryngoscopic view and decreased risk of dental contact. The purpose of this study was to compare the hemodynamic responses to laryngoscopy and tracheal intubation according to the degree of difficult airway, and to evaluate the usefulness of Callander modification of Macintosh blade for attenuating the hemodynamic responses. METHODS: One hundred, forty-eight patients scheduled for elective surgery were divided into Easy group and Difficult group by Wilson's risk sum score. Laryngoscopy was performed using either an ordinary Macintosh No. 3 blade or the modified Macintosh blade. The modification consisted of reducing the height of the flange by partial removal, as described by Callander et al. Hemodynamic variables (systolic, diastolic, mean blood pressure, heart rate and rate pressure product) were noted before induction (baseline) and immediately after intubation. RESULTS: The hemodynamic changes after tracheal intubation in Difficult group were significantly greater than those in Easy group (P < 0.05). When using the modified blade, systolic, diastolic and mean blood pressure after tracheal intubation were lower than those using the conventional blade regardless of Wilson's risk sum score, but no statistical significances could be found. CONCLUSIONS: The hemodynamic changes after tracheal intubation increased as the degree of airway difficulty increased. Laryngoscopy with the Callander's modified blade did not reduce the degree of hemodynamic stimulation compared with the conventional Macintosh blade.
Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Laryngoscopy