The neuromuscular blocking effsct of mivscurium 0.15mg/kg and atracurium 0.5mg/kg were compared in 17 adult patients (ASA class I and II) during N2O propofol-fentanyl anesthesia. Neuromuscular transmission was monitored by recording the compound electromyogram of the hypothenar muscles resulting from supramaximal train of four stimulation applied to the ulnar nerve. Neuromuscular block was recovered spontaneously in all cases. Onset time of over 95% block was not different significantly between mivacurium and atraeurium (201+/-37.6vs 176.6+/-28.5sec, p>0.05, mean SD). Duration from injection of mivacurium to 25% recovery of control twitch height was significantly shorter than that of atracurium (13.0+/-2.2vs 38.8+/-4.9min, p<0.05). The recovery index was also significantly shorter for mivacurium than for atracurium (6.9+/-1.1vs 14.5+/-53.0min, p<0.05). In conclusion, we have confirmed that duration and recovery of action of mivacurium were shorter than those of atracurium, but onset times of both agents were not different.
Adult* ; Anesthesia* ; Atracurium* ; Humans ; Muscles ; Neuromuscular Blockade* ; Ulnar Nerve

This investigation was carried out in healthy twenty-four pregnant women undergoing elective Caesarean section and twelve nonpregnant women of the same age group, The premedication was performed with glycopyrroiate 0.2 mg and hydroxyzine l mg/kg IM respectively in the nonpregnant women, and glycopyrrolate 0.2 mg IM only in the pregnant women. Anesthesia was induced with IV pentothal sodium(4-5 mg/kg), vecuronium(0.08 mg/ kg) and ketamine(0.2 mg/kg) in the nonpregnant(Group I, N =12) or pregnant women(Group II, N=12), and pentothal sodium(4-Smg/kg), vecuronium(reducing dose of 20% from 0.08mg/kg) and ketamine(0.2 mg/kg) in the pregnant women(Group III, N=12). Anesthesia was maintained with 1-2% enflurane, 50% N2O, and O2. The ulnar nerve was stimulated supramaximally at the wrist with train-of-four stimuli every 20 sec. with ABM(Datex Co.) and the electromyographic response of the adductor pollicis muscle was measured. The onset of 50% block of first twitch height(T1) was faster in the group II(1.33+/-0.3min) than in the group I(1.9+/-0.6 min) and group III(1.6+/-0.3 min)(p<0.05). Also, the onset of 95% block of T 1 was faster in the group II(2.5+/-0.5 min) and III(1.6+/-0.3 min) than in the group I(3.8+/-0.9min)(p<0,05). The time of recovery of Tl to 10%, 25% and 50% of control were longer in the group II(34.9+/-5.3, 43.1+/-7.2 and 53.3+/-9.1 min respectively) and III(22.3+/-3.2, 29.5+/-4.5, 38.8+/-8.3 min respectively) than in the group I(21.1+/-4.8, 25.6+/-4.8 and 32.6+/-6.3 min respectively)(p<0.05). The conditions of intubation at 50% block of Tl were adequate in the group I and II but poor in the group III(p<0.05). Apgar score at 1 and 5 minutes after delivery were not significantly different between group II and III. Conclusively, administration of vecuronium dose on body weight basis in the pregnant women resulted in a more rapid onset and prolonged recovery of neuromuscular block than in the nonpregnant women without any adverse effects. Moreover, the conditions of intubation was poor when the dose of vecuronium was reduced by 20% in the pregnant women, Therefore, it is inadequate to reduce the dose of vecuronium concerning about relative overdose in the pregnant women undergoing Caesarean section.
Anesthesia ; Apgar Score ; Body Weight ; Cesarean Section ; Enflurane ; Female ; Glycopyrrolate ; Humans ; Hydroxyzine ; Intubation ; Neuromuscular Blockade* ; Pregnancy ; Pregnant Women ; Premedication ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Wrist

PURPOSE: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.
Analgesics ; Appendectomy ; Appendicitis ; Cosmetics ; Hand ; Hospital Costs ; Humans ; Korea ; Length of Stay ; National Health Programs ; Pain, Postoperative

PURPOSE: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.
Analgesics ; Appendectomy ; Appendicitis ; Cosmetics ; Hand ; Hospital Costs ; Humans ; Korea ; Length of Stay ; National Health Programs ; Pain, Postoperative

PURPOSE: The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality. METHODS: The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses. RESULTS: Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9). CONCLUSION: Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.
Colon ; Colon, Sigmoid ; Colorectal Neoplasms ; Diverticulitis ; Humans ; Multivariate Analysis ; Peritonitis ; Retrospective Studies ; Shock

PURPOSE: Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis. METHODS: We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications. RESULTS: In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 +/- 11.9 vs. 69.7 +/- 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 +/- 2.9 vs. 22.6 +/- 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001). CONCLUSION: In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Body Mass Index ; Diverticulitis ; Humans ; Incidence ; Leukocytosis ; Nausea ; Peas ; Vomiting

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.