BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.
Cardiopulmonary Resuscitation* ; Manikins* ; Models, Theoretical ; Positive-Pressure Respiration ; Thorax ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

No abstract available.
Emergencies* ; Emergency Service, Hospital*

BACKGROUND: Morphine for the intravenous patient controlled analgesia (IV-PCA) provides effective postoperative pain control, but it has side effects such as itching, nausea and vomiting. Meanwhile, butorphanol, a synthetic potent agonist-antagonist narcotic with low incidence of adverse side effects and minimal addiction, produce adequate analgesia for postoperative pain. The purpose of this study was to compare the suitability of butorphanol combining with or without morphine with that of morphine in terms of relieving postoperative pain and incidence of side effects. METHODS: Sixty ASA physical status I or II female patients undergoing total abdominal hysterectomy were randomly allocated into one of three groups according to type of drug used (n=20 for each group). The groups were divided to group M (morphine 100 mg), group M B (morphine 50 mg+butorphanol 10 mg) and group B (butorphanol 20 mg). Drugs for each group mixed with 90 ml of normal saline (total amount: 100 ml) for infusion. Loading dose, PCA dose, lockout interval, mode of infusion was 0.05 ml/kg, 0.02 ml/kg, 8 minute, and PCA only, respectively. In each group, visual analog scale (VAS), pain score, sedation score, degree of satisfaction, total amount of drug used, history of attempt/injetion and incidence of side effects were checked. RESULTS: There were no significant differences in analgesic effects and degree of satisfaction among three groups, but incidence of side effects (especially pruritis) were less in group M+B and B compared with group M (p<0.05). CONCLUSIONS: Butorphanol showed comparable postoperative pain relief and marked less side effects compared with morphine. Butorphanol was considered as a useful drug for postoperative pain relief using IV-PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Butorphanol* ; Female ; Humans ; Hysterectomy ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Pruritus ; Visual Analog Scale ; Vomiting

No abstract available.
Melanoma ; Nevus

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

After the report of the first case of pandemic influenza A virus H1N1 on April 2009, this infection caused more than 16 thousands deaths world-widely. Postinfectious cough is known to be one of the important causes of chronic cough. We experienced five cases of persistent cough, which developed after influenza A virus H1N1 infection. All of the cases showed bronchial hyperreactivity by methacholine inhalation challenge. We prescribed steroids, which resulted in complete symptomatic recovery within 50 days, but the bronchial hyperreactivity was not normalized. We describe these five cases in regard to clinical characteristics, methacholine challenge test, and anti-inflammatory treatment.
Bronchial Hyperreactivity ; Cough ; Influenza A virus ; Influenza, Human ; Inhalation ; Methacholine Chloride ; Pandemics ; Steroids

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results of diabetic and non-diabetic patients who had undergone decompression and postero-lateral fusion with instrumentation. OBJECTIVE: To determine whether diabetes affected the outcome of surgery and to identify the clinical features associated with a poor outcome. SUMMARY OF BACKGROUND DATA: Symptoms of peripheral angiopathy and neuropathy as long-term complications of diabetes closely mimic those of lumbar stenosis and there may be a risk of inappropriate surgical intervention in patients with both diabetes and spinal stenosis. In the presence of diabetes, a poor surgical outcome might be expected. But only a few literatures have been documented. MATERIALS AND METHODS: We reviewed 21 diabetic(mean age 58.2 years) and 21 non-diabetic patients(mean age 61.3 years) who had undergone decompression and postero-lateral fusion with instrumentation for lumbar spinal stenosis at a mean of 32 months after operation by reviewing the medical records such as clinical symptoms and results of objective examination(including electrophysiologic study). RESULTS: The preoperative symptoms were similar in the two groups except that abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. The level of decompression, co-morbidity rate, and intra-operative blood loss were similar in two groups, too. Nerve-conduction velocity was lowered in 66.7% of the diabetic and in 25% of the non-diabetic patients. Polyneuropathy, which are highly suspicious of diabetic neuropathy was detected 46.7% in only diabetic group. The long-term result was excellent or good for thirteen(61.9%) of the twenty-one diabetic patients and for nineteen(90.5%) of the twenty-one non-diabetic patients. CONCLUSIONS: Thus diabetic patients who haute spinal stenosis cannot be expected to have same clinical outcome as non-diabetic patients, which is consistent with the general belief of impression. Therefore, the selection of patient according to clinical and electrophysiologic findings would be the most important factor in determining the rate of success of surgical treatment.
Constriction, Pathologic ; Decompression ; Diabetes Mellitus* ; Diabetic Neuropathies ; Humans ; Medical Records ; Peripheral Vascular Diseases ; Polyneuropathies ; Spinal Stenosis*

Kimura's disease is an uncommon, chronic inflammatory disorder of unknown etiology that is seen in an endemic form in the Orient. It usually presents as a mass in the subcutaneous tissue of the head and neck region or the major salivary glands, and is often associated with a regional lymphadenopathy. The patients have peripheral blood eosinophilia and elevated IgE levels but are otherwise usually healthy. We encountered the case of a 33-year-old man who had a soft tissue mass in his left distal arm which was diagnosed as being Kimura's disease.
Adult ; Arm* ; Eosinophilia ; Head ; Humans ; Immunoglobulin E ; Lymphatic Diseases ; Neck ; Salivary Glands ; Subcutaneous Tissue

The subarachnoidal or epidural opioid reveals excellent analgesic effect for postoperative pain and intractable cancer pain, but its side effects such as nausea, vomiting, voiding difficulty, pruritus and respiratory failure limit its use. There were many studies for decreasing frequency and severity of side effects and reinforcing the analgesic effect of opioid by administrating other drugs. Clonidine is one of such drugs which is able to be administered epidurally with opioids for that purpose. We studied the changes of cardiovascular response, analgesic and sedative effect according to the dose of epidural clonidine. The analgesic effect of epidural clonidine was investigated in 30 patients who underwent anal surgery with epidural anesthesia using 15 ml of 1.5~2 % lidocaine.The time of maximal intensity of pain after disapperance of injected lidocaine was checked. Thirty patients were divided into three groups randomly. In group 1 (n=10), the dose of epidural clonidine was 50 ug; Group 2 (n=10) was 150 ug; Group 3 (n=10) was 450 ug. Changes in the arterial pressure, pulse rate, sedation state and SpO2 were observed before and during 60 minutes after epidural clonidine administration. And the analgesic effect was assessed by measuring VAS pain score. Blood pressures and pulse rates decreased according to increase of dosage of clonidine. Group 1 showed the analgesic effect of 34%, group 2 showed 77% and group 3 showed 81% at 60 minutes after administration. Sedation effect was seen in group 2 and 3 but SpO2 was not decreased significantly. We thought that the respiratory depression of epidural clonidine was not so significant to limit the use for the postoperative pain control. We conclude that it is better to administer clonidine with opioids epidurally than clonidine slone to get better analgesic effect and less sedative effect, because the analgesic effect of epidural clonidine increases according to increase of dosage but the sedative effect increases also.
Analgesics, Opioid ; Anesthesia, Epidural ; Arterial Pressure ; Clonidine* ; Heart Rate ; Humans ; Hypnotics and Sedatives* ; Lidocaine ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Vomiting

BACKGROUND: Theoretical advantages in maintaining an effective blood concentration of the analgesic medication using basal infusions with or without standard intermittent PCA dosing regimens is controversial. The purpose of this study was to compare the effectiveness and incidence of side effects among three modes which include PCA only(group 1), PCA+ basal infusion(group 2), and basal infusion only(group 3). METHODS: Sixty ASA physical status 1 or 2 female patients who scheduled elective cesarean section were randomly allocated into one of three modes. Loading/PCA/basal infusion dose and lockout interval was 0.05 mg/kg, 0.02 mg/kg, 0.015 mg/kg/hr, and Smin, respectively. In each group, visual analog scale(VAS), pain score, sedation score, degree of satisfaction, total amount of morphine used, history of attempt or injection and incidence of side effects were checked. RESULTS: Group 2 did not show any improvement of VAS, and group 3 showed significantly higher VAS from 2 hours after initiation of morphine infusion compared to group 1(P<0.05). Degree of satisfaction was lower in group 3 compared to group 1 and 2(P<0.05). Total amount of morphine was increased in group 2(P<0.05) and reduced significantly in group 3 compared to group 1(P<0.01). There was no evidence of respiratory depression. Incidence of nausea and pruritus did not show any difference among groups. CONCLUSIONS: Addition of basal infusion did not show any improvement of postoperative pain control compared to conventional PCA method.
Analgesia ; Cesarean Section* ; Female ; Humans ; Incidence ; Morphine ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Pregnancy ; Pruritus ; Respiratory Insufficiency