Epidural analgesia is frequently used for control of labor pain. Seizure of parturient could be misdiagnosed as eclampsia. A parturient presented a generalized tonic clonic seizure during first stage of labor in two and a half hour after dural puncture and epidural blood patch. She had received an emergency cesarean section under general anesthesia and had another seizure during transfer to the intensive care unit. A brain computed tomography showed intracerebral hemorrhage and pneumocephalus. After conservative treatment, she could discharge without any sequelae in 13 days. The anesthesiologists should be aware of the possibility of intracerebral hemorrhage when they confront a seizure of parturient although there is no evidence of relation between dural puncture and intracerebral hemorrhage.
Analgesia, Epidural ; Anesthesia, General ; Blood Patch, Epidural ; Brain ; Cerebral Hemorrhage ; Cesarean Section ; Eclampsia ; Emergencies ; Female ; Intensive Care Units ; Labor Pain ; Pneumocephalus ; Pregnancy ; Punctures ; Seizures

BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.
Automation, Laboratory ; Efficiency, Organizational/*standards ; Phlebotomy/*statistics & numerical data ; Republic of Korea ; Time Factors ; Workflow

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing outpatient laparoscopy and hysteroscopy. Associated complications range in severity from mild discomfort to hospital admission for dehydration or pulmonary aspiration. This study was designed to assess the efficacy of 2 antiemetics (metoclopramide and ondansetron) with propofol as the induction agent for prophylaxis of postoperative emesis in women undergoing general anesthesia for gynecologic endoscopic surgery. METHODS: One hundred and twenty six healthy women undergoing laparoscopic and hysteroscopic surgery with general anesthesia were randomized to receive intravenous bolus of saline 2 ml, metoclopramide 10 mg, ondansetron 4 mg prior to induction of anesthesia. Anesthesia was induced with propofol 2~2.5 mg/kg, vecuronium 0.1 mg/kg and maintained with O2, N2O, enflurane, fentanyl 1~2 microgram/kg. The incidence of nausea and vomiting was assessed at recovery room and all patients were contacted 24 hours after discharge. RESULTS: The incidence of PONV showed 11.9% in control group, 11.9% in metoclopramide group and 9.5% in ondansetron group in recovery room. The incidence of PONV showed 14.3% in control group, 14.3% in metoclopramide group and 7.1% in ondansetron group in 24 hours postoperatively. There were no significant differences among the groups. CONCLUSIONS: When propofol was administered by intravenous induction agent, no antiemetic in this study was more efficacious than propofol alone in reducing PONV for women undergoing outpatient laparoscopic and hysteroscopic surgery.
Anesthesia ; Anesthesia, General ; Antiemetics ; Dehydration ; Enflurane ; Female ; Fentanyl ; Humans ; Hysteroscopy ; Incidence ; Laparoscopy* ; Metoclopramide* ; Nausea ; Ondansetron* ; Outpatients ; Postoperative Nausea and Vomiting* ; Propofol* ; Recovery Room ; Vecuronium Bromide ; Vomiting

BACKGROUND: Minimum alveolar concentration (MAC) is decreased during pregnancy, but there are no data regarding the requirements for intravenous agents. Recently only one study showed that the requirement for thiopental in pregnant women of 7-13 weeks' gestation was less than the requirement obtained in nonpregnant women. Thus we wanted to determine whether pregnant patients needed less propofol for hypnosis and anesthesia than nonpregnant patients. METHODS: One hundred nonpregnant women having gynecologic surgery and 100 pregnant women of 5-13 weeks' gestation undergoing elective abortions were recruited. They were randomly allocated 10 groups according to the doses of propofol and each group had 10 patients. During a period of 30 seconds, one of the doses of propofol 1.0, 1.25, 1.5, 1.75, 2.0, 2.25, 2.5, 2.75, 3.0 or 3.25 mg/kg was administered. Two minutes later, patients were asked to open their eyes as a test for hypnosis. Patients who did not open their eyes were given a 10 seconds, 50-Hz, 80-mA transcutaneous tetanic electrical stimulus to the ulnar nerve as a test for anesthesia. Estimates of ED50 and ED95 for hypnosis and anesthesia were obtained by logistic regression. RESULTS: In the pregnant women, the median effective doses (ED50) (95% confidence interval) for hypnosis and anesthesia were 1.25 (1.13-1.35) mg/kg and 2.71 (2.49-3.04) mg/kg, the ED95 (95% CI) were 1.51 (1.16-1.87) mg/kg and 3.04 (2.80-3.58) mg/kg respectively. Whereas in the nonpregnant women, the ED50 for hypnosis and anesthesia were 1.27 (1.39-1.90) mg/kg and 4.12 (3.50-6.01) mg/kg, the ED95 were 1.53 (1.41-1.93) mg/kg and 4.35 (3.66-7.26) mg/kg respectively. CONCLUSIONS: In early pregnant women, the doses of propofol for hypnosis and anesthesia were 1.6% and 34.2% less compared with those in nonpregnant women.
Anesthesia ; Female ; Gynecologic Surgical Procedures ; Humans ; Hypnosis ; Logistic Models ; Pregnancy* ; Pregnant Women ; Propofol* ; Thiopental ; Ulnar Nerve

BACKGROUND: Hypotension associated with epidural anesthesia for cesarean section is common and serious, despite the use of uterine displacement and volume preload. This study evaluated the role of crystalloid volume preload for prevention of hypotension during epidural anesthesia. METHODS: Forty parturients undergoing elective cesarean section were allocated randomly to receive either no preload (Group II, n=20) or preload with Ringer's lactate solution 1000 ml over 10-15 minutes (Group I, n=20) before epidural anesthesia. Hypotension was defined as a decrease of systolic blood pressure to less than 90 mmHg and to less than 80% of baseline value. Systolic blood pressure and heart rate were measured 2 minutes interval during first 20 minutes after epidural injection. Apgar score, umbilical venous, arterial and maternal arterial blood gas analysis were done. RESULTS: Significant hypotension occured in seven of the twenty parturients in no preload group (Group II) and seven of twenty parturients in Ringer's lactate preload group (Group I). There were no statistical differences in systolic blood pressure, heart rate, amount of used ephedrine, Apgar score, umbilical venous, arterial and maternal arterial blood gas analysis. CONCLUSIONS: Ringer's lactate preload (1000 ml) before epidural anesthesia in the supine tilted parturients did not decrease the incidence or severity of hypotension.
Anesthesia, Epidural* ; Anesthesia, Obstetrical ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Ephedrine ; Female ; Heart Rate ; Hypotension* ; Incidence ; Injections, Epidural ; Lactic Acid* ; Pregnancy

Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in right precordial leads (V1 to V3), without structural heart disease. However, these ECG manifestations transiently normalize in up to 40% of cases. Brugada syndrome is responsible for up to one half of all sudden cardiac deaths in young adults and they may be worsened by beta blockers. We present the anesthetic management of a patient with Brugada syndrome without the characteristic ECG pattern.
Anesthesia* ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Death, Sudden, Cardiac ; Electrocardiography* ; Heart Diseases ; Humans ; Young Adult

BACKGROUND: Aspiration of gastric contents is an ever -present risk in the use of general anesthesia, particularly in emergency and obstetric situations, and morbidity and mortality associated with this complication increases with the volume and acidity of the aspirate. Since direct inhibition of acid secretion may be a preferable method, we studied the effectiveness of ranitidine in increasing gastric pH. METHODS: Sixty patients scheduled for elective cesarean section under general anesthesia before midday were randomly divided into three groups. The control group (n=20) did not received preanesthetic ranitidine. Group I (n=20) received a slow intravenous injection of 50 mg ranitidine, one hour before surgery. Group II (n=20) received 150 mg ranitidine orally, both the night before surgery and the morning of surgery. RESULTS: Compared with the control group, the mean gastric pH increased significantly in group I and II (P<0.05). There was no significant difference of gastric pH between group I and II. CONCLUSIONS: The results of this study indicate that ranitidine is a useful agent in increasing the gastric pH in women undergoing elective cesarean section. Ranitidine administered intravenously and orally were equally effective means in increasing the gastric pH.
Anesthesia, General ; Cesarean Section* ; Emergencies ; Female ; Gastric Acid* ; Humans ; Hydrogen-Ion Concentration ; Injections, Intravenous ; Mortality ; Pregnancy ; Ranitidine*

We report a case of sudden cardiac arrest requiring external thoracic cardiac massage in a 40-year old healthy man receiving epidural anesthesia for elective vasovasostomy. The anesthetic procedure was performed in an operating room. Bradycardia and hypotension occurred 10 minutes after local anesthetic injection. Atropine 0.5 mg and ephedrine 10 mg were administered intravenously, but cardiac arrest followed with unconsciousness and apnea. Atropine 0.5 mg and epinephrine 1 mg were administered intravenously, and external cardiac massage was performed synchronously. The heart rate promptly increased, and the consciousness and spontaneous respiration of the patient were restored. Vital signs became stable in the recovery room and the patient recovered with no sequelae. We conclude that sudden bradycardia and cardiac arrest can unexpectedly develop during epidural anesthesia, and that close monitoring of the patient and adequate management are essential.
Adult ; Anesthesia, Epidural* ; Apnea ; Atropine ; Bradycardia ; Consciousness ; Death, Sudden, Cardiac ; Ephedrine ; Epinephrine ; Heart Arrest* ; Heart Massage ; Heart Rate ; Humans ; Hypotension ; Operating Rooms ; Recovery Room ; Respiration ; Unconsciousness ; Vasovasostomy ; Vital Signs

A 35 year old multipara woman was admitted for emergency repeat cesarian section. She had first cesarian section under general anesthesia 3 years ago, and appendectomy under spinal anesthesia 2 years ago. But no uneventful problem developed in two cases of anesthesia. After induction of general anesthesia with propofol and succinylcholine, the patient showed irritability and severe cough, and immediate anaphylactic reaction developed with cardiovascular collapse, bronchospasm, and erythematous skin eruption. We resuscitated the patient with epinephrine and methylprednisolone but cesarian section was performed without delay. Four minutes after the induction of anesthesia female baby was delivered and the patient was recovered without any complication.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Appendectomy ; Bronchial Spasm ; Cough ; Emergencies ; Epinephrine ; Female ; Humans ; Methylprednisolone ; Propofol ; Skin ; Succinylcholine

BACKGROUND: Obesity is a risk factor for developing hyperlipidemia and cardiovascular diseases. Various diagnostic methods and criteria of obesity have been developed. The predictive values of health risk factors(hyperlipidemia, hypertension, diabetes mellitus, and body fatness) were different for cardiovascular diseases. We reviewed the medical records to assess the relation of health risk factors to waist-hip ratio(WHR) and body mass index (BMI). METHODS: We gathered 5100 cases who have taken medical examination from March 1995 to February 1996 at Ajou University Hospital and measured BMI, WHR, body fat, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting blood sugar etc.. Except 1350 abnormal cases on current illness and laboratory study, 3750 healthy cases were analysed. First we divided the healthy cases into obese and non-obese group according to BMI 25kg/m2 in men and women. And then, the obese and non-obese group was divided into central and non-central obese type by WHR 0.8 in women and 0.9 in men. RESULTS: Except only diastolic blood pressure in male, other lab data such as body fat, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting blood sugar in male and female were significantly different between the two groups divided by WHR in BMI<25kg/m2. But in BMI)25kg/m2, men had higher(P<0.01) triglyceride at WHR>_0.9. Women had higher(P<0.05) triglyceride, systolic and diastolic blood pressure at WHR>_0.8. CONCLUSIONS: We thought that the increase of WHR was risk factor for hyperlipidemia, hypertension, diabetes mellitus in men and women when BMI was less than 25kg/m2. In obese group(BMI>_225kg/m2), increase of WHR was risk factor for hyperlipidemia in men and hyperlipidemia and hypertension in women.
Adipose Tissue* ; Blood Glucose ; Blood Pressure* ; Body Mass Index* ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Diabetes Mellitus ; Fasting ; Female ; Glucose* ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Medical Records ; Obesity ; Risk Factors ; Triglycerides ; Waist-Hip Ratio*