BACKGROUND: Clonidine, an alpha 2adrenergic agonist, has nonopiate antinociceptive properties which might be an alternative for postoperative analgesia free of undesirable effects from opioid. The aim of this study was to evaluate the postoperative analgesic effects of intravenous (IV) infusion of clonidine. METHODS: Seventy two healthy patients who undergoing cesarean section or gynecological surgery under general anesthesia were randomly divided into three groups as follows; the patients of group l received fentanyl (100 g bolus + 0.5ug/kg/hr) alone, the patients of group II received clonidine (100ug bolus + 10ug/kg/hr) and same dose of fentanyl, and the patients of group III received clonidine (200 g bolus + 20ug/kg/hr) and same dose of fentanyl. Pain score using a visual analogue scale (VAS), sedation score and any side effects were evaluated at 1, 6, 24 and 48 hours after starting the infusion. RESULT: Patients in group II and group III were more pain relieved during 48 hours and more sedated compared to group I at 1 hr, but there were no significant difference of side effects. CONCLUSION: Continuous IV infusion of clonidine potentiates postoperative analgesia induced by fentanyl.
Analgesia* ; Anesthesia, General ; Cesarean Section ; Clonidine* ; Female ; Fentanyl* ; Gynecologic Surgical Procedures ; Humans ; Infusions, Intravenous* ; Pain, Postoperative ; Pregnancy

Background: Reporting rate of notifiable communicable diseases has been assumed to be low in Korea. To encourage timely reporting of notifiable communicable diseases and to improve the reporting process by the Infection Control Unit, a disease code-based electronic surveillance and in-house electronic reporting system was developed and implemented in February 2003. We evaluated the reporting rates of notifiable communicable diseases before and after the implementation of the electronic reporting- system. METHODS: The electronic reporting system, which was integrated to the computerized physician order entry system, was designed to monitor KCD-4 codes at the time of every order entry. Whenever the system recognized the predetermined codes of notifiable communicable diseases, it generated an alert box to recommend reporting: and then a physician could fill up an electronic report form, which was collected and faxed to the local public health authority by the Infection Control Unit. Reporting rate of notifiable communicable diseases in 2002, when the conventional paper-based reporting system was used, was assumed comparing the number of cases reported actually and that of cases identified to be reported by reviewing the medical records and electronic database. RESULTS: From March to July 2003, 181 cases with tuberculosis and 14 with other communicable diseases were reported whereas 106 and 9 cases were reported respectively for the same 5-month period in 2002. Reporting rate using the conventional reporting system in 2002 was assumed to be 61% and 39% respectively. Conclusions: Using a disease code-based electronic reporting system, reporting of notifiable communicable diseases could be improved compared with conventional paper-based reporting system.
Communicable Diseases* ; Disease Notification ; Infection Control ; Korea ; Medical Informatics Applications ; Medical Order Entry Systems ; Medical Records ; Public Health ; Tuberculosis

PURPOSE: This study aimed to investigate the job stress level of call center workers and figure out its relation with cognitive emotion regulation strategies as a cognitive coping strategy. METHODS: Data collection was conducted on 985 call center workers, working for K companies in Korea. ANOVA, t-test, Scheffe's test and multiple regression have been conducted for the data analysis using SAS 9.0 software. RESULTS: The total job stress score of subjects ranges Q25~49 (the lower 50%) whereas the score of job demand and job control ranges Q50~74 (the upper 50%), and its sectional job stress level is high. Since job stress is the major factor affecting cognitive emotion regulation strategies, it is shown that when the job stress score gets higher, the score of positive cognitive emotion regulation strategies gets decreased but the score of negative cognitive emotion regulation strategies, increased. CONCLUSION: Based on the results of this study, it is necessary to develop and apply an effective stress easing method for call center workers which reduces negative cognitive emotion regulation strategies and increases positive ones.
Data Collection ; Korea

Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.
Abdominal Pain ; Adult ; Aged ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Drainage ; Fever ; Humans ; Peritonitis ; Rupture

PURPOSE: This study is to investigate the effect of nurse's competency empowerment and boss' job competency recognition on work performance. METHODS: 216 nurses participated for data collection which was conducted from September 1, 2011 to September 10, 2011. The collected data were analyzed with SPSS/WIN 16.0 and with frequency test, ANOVA, Scheffe test and Multiple regression. RESULTS: Firstly, the work performance in accordance with subject's general characteristics was found to be significant in the 50s, graduate school or higher education, Roman Catholic, charge nurse and 21-years or older. Secondly, the correlation among nurse's competency empowerment, boss' competency recognition and work performance was found to be positively related (r=.501~.639, p<.001). Thirdly, competency empowerment was found to be the most effective factor for work performance, followed by boss' competency recognition and career year, and these factors accounted for 63.5%. CONCLUSION: As the results show that the work performance is highly affected by the nurse's competency empowerment, boss' competency recognition level and career level in clinical environment, effective education programs are required to provide an appropriate experience to both entry-level and experienced nurses, as well as to enhance boss' competency empowerment at the same time.
Catholicism ; Data Collection ; Humans ; Nursing, Supervisory ; Power (Psychology)

We experience a 1 day old female patient with congenital esophageal atresia and tracheoeso-phageal fistula combined with a subglottic laryngeal stenosis which was 2 mm in diamete. At the time of surgery, an attempt was made to intubate, but it was impossible to pass a tube beyond the vocal cord which was mormal in size and shape. Thus a gastrostomy was performed only under mask with pure oxygen and local anesthesia. The child died one day later due to respiratory failure. Congenital subglottic laryngeal stenosis combined with esophageal atresia and tracheoeso-phageal fistula is very rare, but it is a very critical anomaly to anesthesia and resuscitation. Therefore, in the case of esophageal atresia and tracheoesophageal fistula with signs of respiratory obstruction, the possible presence of subglottic laryngeal stenosis should be considered and accurately assessed.
Anesthesia* ; Anesthesia, Local ; Child ; Esophageal Atresia* ; Female ; Fistula ; Gastrostomy ; Humans ; Laryngostenosis* ; Masks ; Oxygen ; Respiratory Insufficiency ; Resuscitation ; Tracheoesophageal Fistula* ; Vocal Cords

The accurate control of the concentration of anesthetic gas is most important for ideal induction, maintenance and recovery in general inhalation anesthesia. So vaporizers for the control of the concentration of anesthetic gas were investigated for many years, and the Fluotec series for halothane was also designed. When using the Fluotec Mark lll, which is known to be one of the most accurate halothane vaporizer, it will be clinicaly significant to confirm the relationships of the actual concentration of halothane output and the dial setting in the change of carrier gas flow rate, so studied as follows. At Soon Chun Hyang University Hospital, general inhalation anesthesia was used on three groups of 20 patients each. Halothane was delivered respectively at a dial setting concentration of 1% to group l, 2% to group ll and 3% to group lll. The halothane concentration was measured with the Engstom EMMA gas analyser in 50% oxygen(O2) and nitrous oixde(N2O) gas mixture, as the carrier gas flow was changed from 2l to 4l, to 6l per minute. The results were as follows: 1) The actual inhaled concentration of halothane increased in proportion ot the increase of carrier gas flow rate in all three groups. 2) At a dial setting concentration of 1 percent the delivered actual concentration of halothane approximated the dial setting, on the other hand, at a dial setting concentration of 2 percent and 3 percent the delivered actual concentreation of halothane was less that the dial setting.
Anesthesia, Inhalation ; Halothane* ; Hand ; Hospitals, General ; Humans ; Nebulizers and Vaporizers*

To compare the rate of uptake and elimination of volatile anesthetics, we administered 2% Halothane, 2% Enflurane and 2% Isoflurane respectively for one hour to 90 healthy adult patients through a semicolsed circuit with controlled ventilation to maintain normocapnea for determining the rates of uptake, and the volatile anesthetics and nitrous oxide were discontinued to determine the rates of elimination for 30 minutes. The expired(Fe=Fa) and inspired(F1) vapor concentrations of volatile anethetics were measured using an infrared analyser and F(A)/ F(1) ratios were used to determine rates of uptake, and F(A)/F(AO)(Where F(AO) is the last end-tidal concentration during uptake) ratios were used to determine rates of elimination. And to evaluate the effects of gas flow pattern on the rate of uptake and elimination, the patients were divided into three groups: Control group inhaled three volatile anesthetics respectively with 3 liter of oxygen per minute, study group 1 inhaled three volatile anesthetics respectively with 6 liter of oxygen per minute and study group 2 inhaled three volatile anesthet- ics respectively with 1 liter of oxygen and 2 liter of nitrous oxide. The results obtained were as follows: l) To compare the rate of uptake(F(A)/F(1)) of the anesthetics, the pulmonary uptake was most rapid with isoflurane followed by enflurane and halothane in accord with their respective solubilities in blood 2) With increased fresh gas flow, the rates of uptake of anesthetics more rapidly augmented, especially significantly in halothane and enflurane 3) With gas mixture of 70% N2O, the rate of uptake of anesthetics more rapidly augmented, especially significantly in isoflurane and enflurane 4) To compare the rate of elimination of anesthetics, isoflurane and enflurane eliminated more rapidly than halothane but there are no difference in that of isoflurane with enflurane in control group. But there are no difference significantly between that of halothane, enflurane and isoflurane in study group 1 and 2. 5) With increased gas flow rate, the rate of elimination decreased more rapidly in halothane, enflurane and isoflurane significantly. 6) By the elimination of anesthetics with N2O simultaneously from the lung, the rate of elimination decreased more rapidly in halothane and isoflurane significantly. In conclusion, we have shown that we can obtained more rapid induction and recovery of inhalation anesthetics with lower solubility of anesthetics. In addition, with increased fresh gas flow and use of gas mixture af nitrous oxide, induction and recovery of anesthetics will be more rapidly.
Adult ; Anesthetics* ; Anesthetics, Inhalation ; Enflurane ; Halothane ; Humans ; Isoflurane ; Lung ; Nitrous Oxide ; Oxygen ; Solubility ; Ventilation

BACKGROUND: The aim of the present study is to evaluate the effect of propofol on the incidence of postoperative nausea and vomiting (PONV) during the first 24 hours after minor orthopedic surgery using general anesthesia. METHODS: We studied 66 healthy female patients (aged 20-67 years old). The patients were randomly divided into the two groups: (i) Group P (n=33): Anesthesia was induced with propofol and fentanyl, and maintained with continuous infusion of propofol. (ii) Group E (n=33): Anesthesia was induced with thiopental and fentanyl, and maintained with enflurane. We compared the incidence and severity of PONV at 6 and 24 hours after the operation between the two groups. RESULTS: The incidence and severity of PONV in Group P was significantly lower than in Group E during the first 6 hours after the operation (p<0.05). However, after 6 hours, there was no significant differences between the two groups. CONCLUSION: In the early postoperative period, the use of propofol prevents PONV.
Anesthesia ; Anesthesia, General ; Enflurane ; Female ; Fentanyl ; Humans ; Incidence* ; Orthopedics* ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Propofol* ; Thiopental

Until recently edrophonium has not been used in clinical anesthesis because of its short duration of action and poor anticholinesterase activity. However there has been a renewed interest in the use of edrophonium for the reversal of the new intermediate acting relaxants, vecuronium and atracurium, which have a fast spontaneous recovery rate. Edrophonim in sufficient dosages may produce a fast onset of antagonism of non-depolarizing neuromuscular blockade with minimal muscarinic side effects. The porpose of this study was therefore to compare the efficiency of edrophonium and neostigmine in reversal of a profound neuromuscular blockad following continuous infusion of vecuronium (0.06 mg/kg/hr). Recovery of T1 and T4 twitch height, change of heart rate and mean arterial pressure were obsered after antagonism with control mixture group (n=10): neostigmine 0.04mg/kg and atropin 0.02 mg/kg, and experimental mixture group (n=9): edrophoninm 0.5mg/kg and atropine 0.007 mg/kg were evaluated respectively at the 10% spontaneous recovery of T1 twitch height. Recovery of T1 was more faster in the edrophonium group than in the neostigmine group but it was significant until 5 minutes after antagonism (p<0.05) and recovery of T4 was also significantly faster in the edrophonium group until 5 minutes after antagonism but thereafter, conversly faster in the neostigmine group than in the edrophonium(p<0.05). Changes of heart rate with +/-5% after edrophonium administration were observed. We conclude that edrophonium provides a more rapid antagonism within 5 minutes after antagonizing vecuronium infusion, and small change in heart rate, but no other any advantage in using edrophomine instead of neostigmine for reversal after 5 minutes.
Arterial Pressure ; Atracurium ; Atropine ; Edrophonium* ; Heart Rate ; Neostigmine* ; Neuromuscular Blockade ; Vecuronium Bromide*