BACKGROUND: Patients infected with Staphylococcus aureus related to the use of propofol have been reported. The purpose of this study was to assess and compare the growth of S. aureus in propofol, thiopental, midazolam and ketamine. METHODS: These intravenous anesthetics were inoculated with S. aureus and they were plated onto blood agar at 0, 3, 6, 21, 24 and 27 hrs. The number of colony forming units (CFU) on the plate was counted after 24 hours of incubation. RESULTS: Samples from ketamine and midazolam showed no CFU at the 3 hr and thereafter. The 21hr, thiopental exhibited no CFU. The inoculated propofol emulsion showed a significant increase in number of CFU at the 21, 24 and 27hr compared with the zero time (P<0.05). CONCLUSIONS: This study shown that propofol was the only anesthetic that provided a medium for the growth of S. aureus. Therefore when handling propofol, meticulous sterile technique is advised.
Agar ; Anesthetics ; Anesthetics, Intravenous* ; Humans ; Ketamine ; Midazolam ; Propofol ; Staphylococcus aureus* ; Staphylococcus* ; Stem Cells ; Thiopental

Since the first report by Drury and Szent-Gyorgyi in 1929, the inhibitory influences of adenosine on the heart have repeatedly been described by many investigators. A lot of investigations on the working mechanisms of adenosine have been focused mainly on the effects on the coronary blood flow. However, the cellular mechanisms underlyiag the inhibitory action of adenosine on the SA node are not well understood yet. Furthe-rmore, the physiological role of adenosine in the regulation of the heart beat remains still to be explored. Thus, this study was undertaken to examine the behavior of the rabbit SA node ander the influence of adenosine, and the interactions between adenosine and aminophylline on the SA node, and then to compare these results with those of acetylcholine. At the same dosage range, adenosine suppressed the sinus rate and atrial contractility even in the reserpinized preparation. The spontaneous firing rate of the SA node at 35degrees C (mean+/-SEM, n=16) was 154+/-3.3 beats/min. The parameters of action potential were: maximum diastolic potential(MDP), -73+/-1,7 mV; overshoot(OS), 9+/-1.4 mV; slope of pacemaker potential(SPP), 94+/-3.0 mV/sec. Adenosine suppressed the firing rate of the SA node in a dose-dependent manner. This inhibitory effect appeared at the concentration of 10(-4)M and was potentiated in parallel with the increase in adenosine concentration. Changes in the action potential by adenosine were dose-dependent as show by the increase of MDP and the decrease of SPP until 10(-4)M. Above this concentration, however, the amplitude of the action potential decreased markedly due to the simultaneous decrease of both MDP and OS. Dipyridamole, which is known to block the adenosine transport aross the cell membrane, definately potentiated the action of adenosine. The effects of adenosine on the SA node were inhibited by aminophylline. However, the similar effects of acetylcholine to those of adenosine were not reversed by aminophylline. These results suggest that adenosine suppressed the pacemaker activity by acting dire-ctly on the membrane of the SA node, and the effects of adenosine on SA node are sele-ctively inhibited by aminophylline.
Acetylcholine ; Action Potentials ; Adenosine ; Aminophylline ; Cell Membrane ; Dipyridamole ; Fires ; Heart ; Humans ; Membranes ; Research Personnel

BACKGROUND: A tourniquet is commonly used to achieve a bloodless field in surgery of the extremities. However, the anesthesiologist is concerned about the adverse effects of hypertension which occur during general anesthesia. In this study, we assessed the effects of lidocaine infiltration in the tourniquet site on blood pressure and heart rate during tourniquet inflation under general anesthesia. METHODS: Forty patients of ASA class I or II, scheduled for knee surgery, were randomly divided into two groups. In group 1 underwent general anesthesia and in group 2 also underwent general anesthesia and combined with 1% lidocaine infiltration in the tourniquet site. The changes of systolic and diastolic blood pressure and heart rate were measured before and after toumiquet inflation, after skin incision and 30 min after inflation. RESULTS: Comparing group 1 with group 2, there were significant increases after tourniquet inflation to 30 min after inflation in systolic and diastolic blood pressure in group 1 (p<0.05). However, there were no significant changes in heart rates in either group. CONCLUSIONS: The above results demonstrate that patients who received lidocaine infiltration in the tourniquet site showed less increase in blood pressure during tourniquet inflation.
Anesthesia, General ; Anesthetics ; Blood Pressure* ; Extremities ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Inflation, Economic ; Knee ; Lidocaine* ; Skin ; Tourniquets*

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketamine pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n=30), lidocaine group (n=30) and ketamine group (n=30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% ketamine) via 18G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ketamine group compared with the saline group at the induction of anesthesia (p<0.05) and there was no significant difference between the lidocaine group and the ketamine group. We had similar results in the recovery room and one patient from the saline group and the ketamine group had no recall regarding injection pain. CONCLUSION: Intravenous ketamine pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Arm ; Female ; Humans ; Incidence ; Injections, Intravenous ; Ketamine* ; Lidocaine* ; Propofol* ; Recovery Room ; Tourniquets

BACKGROUND: Postoperative nausea and vomiting (PONV) are very common side effects of laparoscopic procedures. The aim of this study was to compare the effectiveness of dexamethasone with that of ondansetron in prevention of PONV after laparoscopic cholecystectomy. METHODS: Seventy-five ASA class 1, 2 patients planned for laparoscopic cholecystectomy were assigned to receive intravenously either dexamethasone 5 mg (dexamethasone group, n = 25), ondansetron 4 mg (ondansetron group, n = 25), or normal saline 2 ml (control group, n = 25) just after induction of general anesthesia. During the maintenance, end-tidal carbon dioxide tension was controlled to maintain 35-40 mmHg and intraabdominal pressure was controlled to maintain 12 mmHg. Patient's nausea and vomiting were observed in the recovery room just after operation and 6 h, 12 h and 24 h after operation. RESULTS: Incidences of PONV were significantly lower in dexamethasone group and ondansetron group than control group. However there was no significant difference between the two antiemetic groups. CONCLUSIONS: Both of dexamethasone and ondansetron were effective for the prevention of PONV after laparoscopic cholecystectomy.
Anesthesia, General ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Dexamethasone* ; Humans ; Incidence ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting* ; Recovery Room ; Vomiting

BACKGROUND: Although a laparoscopic cholecystectomy results in less pain than an open cholecystectomy, it is not a pain-free procedure. A controversy exists over the effectiveness and clinical value of intraperitoneal local anesthetics for treating pain after a laparoscopic cholecystectomy. We investigated the effects of intraperitoneal lidocaine on pain after a laparoscopic cholecystectomy. METHODS: Forty patients were randomly assigned to receive 200 ml saline containing 200 mg lidocaine or the same volume of saline instilled under the right hemidiaphragm and cholecystectomy site at the end of surgery. Intensity of abdominal and shoulder pain were assessed 0, 1, 6, 12, 24 and 48 hours after surgery and recorded on a visual analog scale (VAS) and verbal rating scale (VRS). RESULTS: The abdominal pain scores (VAS and VRS) were significantly lower in the lidocaine group than the control group at 0 - 24 hours after surgery (P < 0.05). The shoulder pain scores and incidence were significantly lower in the lidocaine group than the control group at 6 - 12 hours after surgery. In the lidocaine group, the incidence of epigastric and right flank pain were significantly lower than the control group. CONCLUSIONS: Intraperitoneal instillation of lidocaine significantly reduces shoulder and abdominal pain for 24 hours after a laparoscopic cholecystectomy.
Abdominal Pain ; Anesthetics, Local ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Flank Pain ; Humans ; Incidence ; Lidocaine* ; Pain, Postoperative ; Shoulder Pain* ; Shoulder* ; Visual Analog Scale

Sodium nitroprusside is reported to inhibite platelet aggregation. We studied the effects of sodium nitroprusside on platelet aggregation function were in 30 adult patients undergoing spine surgery with enflurane anesthesia. Platelet-rich plasma from patients receiving sodium nitroprusside was studied for aggregation in response to adenosine diphosphate, epinephrine and collagen. Maximum aggregation rate and maximum aggregation time were evaluated serially from the samples collected at post-induction (pre-sodium nitroprusside infusion), 30 min and 90 min after sodium niroprusside infusion. The mean maximum aggregation rate of adenosone diphosphate, epinepherine and collagen at post-induction decreased significantly 30 min and 90 min after sodium nitroprusside infusion (P 0.05),but maximum aggregation time showed no significant changes. The correlation between total sodium nitroprusside dose delivered and maximum aggregation rate of adenosine diphosphate, epinepherine and collagen were r=-0.54 (P<0.05), r=-0.706 (P<0.05) and r=-0.794 (P<0.05). In summary, in situation in which sodium nitroprusside is administered during deliberate hypotensive anesthesia, the anesthesiologist must be aware of the potential for the inhibition of platelet aggregation.
Adenosine Diphosphate ; Adult ; Anesthesia* ; Blood Platelets* ; Collagen ; Enflurane ; Epinephrine ; Humans ; Nitroprusside* ; Platelet Aggregation* ; Platelet-Rich Plasma ; Sodium* ; Spine

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of metoclopramide pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n = 30), lidocaine group (n = 30) and metoclopramide groups (n = 30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% metoclopramide) via 18 G angiocatheter inserted in the antecabital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assesement of pain was made at the induction of anesthesia and in the recovery room and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the metoclopramide group compared with the saline group at the induction of anesthesia (P < 0.05) and there was no significant difference between the lidocaine group and metoclopramide group. We had similar results in the recovery room and one patient from the saline group and the metoclopramide group had no recall regarding injection pain. CONCLUSIONS: Intravenous metoclopramide pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Anesthetics ; Arm ; Equidae ; Female ; Humans ; Incidence ; Injections, Intravenous ; Lidocaine* ; Metoclopramide* ; Propofol* ; Recovery Room ; Tourniquets

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ondansetron pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n = 30), lidocaine group (n = 30) and ondansetron groups (n = 30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, ondansetron) via 18 G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ondansetron group compared with the saline group at the induction of anesthesia (P < 0.05) and there was no significant difference between the lidocaine group and ondansetron group. We had similar results in the recovery room and one patient from the saline group and two patients from the ondansetron group had no recall regarding injection pain. CONCLUSIONS: Intravenous ondansetron pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Arm ; Female ; Humans ; Incidence ; Injections, Intravenous ; Lidocaine* ; Ondansetron* ; Propofol* ; Recovery Room ; Tourniquets

The purpose of this study is to identify the effects of the supportive nursing care for arthritis patients enrolled in a rheumatoid clinic. To achieve this purpose, this study adopted a quasi-experimental, pre- and post-test research design, categorized subjects into experimental and control groups. Outpatient clinic nurse alloted the subjects by experimental and control groups and nurse researcher meets the experimental subject with in-depth, direct personal interview and advices via telephone for 8 weeks. During this pre and after the treatment period, the level of pain, uncertainty, self-efficacy, family support, and perception for health were measured. Analyses for the measured results for pre- and post-test showed that the supportive program conducted during this study decreased the level of uncertainty and increased the perception of family support in experimental group. So, the supportive healing interpersonal communication service proved to be effective and this result justifies the argument that the role of the nursing professionals at out-patient clinic should be extended for the more qualified care for the patient.
Ambulatory Care Facilities ; Arthritis* ; Follow-Up Studies* ; Humans ; Nursing Care* ; Nursing* ; Outpatients ; Research Design ; Telephone ; Uncertainty