No abstract available.
Blood Pressure* ; Heart Rate* ; Heart* ; Intubation* ; Lidocaine*

PURPOSE: We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. PATIENTS AND METHODS: Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. RESULTS: The BIS score correlated with the sedation score (r = 0.676, P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score(r = -0.656).Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. CONCLUSIONS: BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.
Adult ; Consciousness ; Humans ; Midazolam* ; Plasma* ; Unconsciousness ; Volunteers

The purpose of this randomized, prospective study was to compare the intubation time, hemodynamic effect and complication rates of orotracheal intubation performed by direct laryngoscopic or lighted stylet (lightwand) methods in the controlled settings of the operating room. After approval of clinical investigation committee and informed consent from patients, healthy ASA class 1 and 2 elective surgical patients were studied. On arrival to operating room, EKG, radial arterial cannulation to monitor blood pressure continously and neuromuscular monitoring device were applied to patients. Anesthesia was induced with fentanyl 3 ug/kg, thiopental 4 mg/kg and vecuronium 0.15 mg/kg to facilliate relaxation. Ventilation was controlled for 5 min by facemask with oxygen-isoflurane (1.2 vol%) or enflurane(1.7 vol%) before intubation. The patients were intubated randomly using either direct curved laryngoscope (DL, 37 patients) or lightwand (LW, 36 patients). The time to intubation (TTI) was recorded. The mean arterial pressure(MAP) and heart rate(HR) were recoreded every 30 sec after intubation for 5 min. The changes of MAP and HR after intubation were compared with pre-intubation value. After extubation, complications such as mucosal trauma and postoperative sore throat were recorded. The data were analyzed using either unpaired t-test or Chi-square analysis, where appropriate. There were no failed intuhation in either groups. There was no significant differences between the groups with respect to sex, age, weight, height, existence of nasogastric tube. The TTI was similar between groups(14.5+/-8.1 sec for LW, 16.8+/-9.5 sec for DL). There was no differences in incidence of trauma(19.4% for LW, 16.2% for DL) between groups. There were no statistically significant difference in the maximal increase in MAP(44% for LW, 55% for DL at 30 sec) and HR(25.6% for LW, 24.1% for DL at 30 sec) and during 5 min following intubation. In canclusion, even though the hemadynamic effect after intubation was not influenced by using LW, the results of this study indicate that the use of the LW is as useful, effective and safe method as using DL for oro-endotracheal intubation. Further study may prove that using the LW to be an effective alternative technique of intubation in patients with difficult airway.
Anesthesia ; Blood Pressure ; Catheterization ; Electrocardiography ; Fentanyl ; Heart ; Hemodynamics* ; Humans ; Incidence ; Informed Consent ; Intubation* ; Laryngoscopes ; Neuromuscular Monitoring ; Operating Rooms ; Pharyngitis ; Prospective Studies ; Relaxation ; Thiopental ; Vecuronium Bromide ; Ventilation

Atelectasis or collapse of lung is a common complication following surgery. Atelectsis also occurs during anesthesia but profound pulmonary collapse is uncommon. We experienced acute lung collapse of entire left lung and right upper lobe after endotracheal suction following endotracheal intubation. Mucoid secretions and blood clots were aspirated through the bronchoscopy. The possible cause of lung collapse is described.
Anesthesia ; Bronchoscopy ; Intubation, Intratracheal* ; Lung* ; Pulmonary Atelectasis* ; Suction

In cervical spine disease patients, the authors performed awake intubation with a flexible fiberscope under local anesthetic preparation to avoid insult to the cervical spine during intubation, and had patients self pronate for positioning to prevent possible complications durings the turning from cart to operating table. We performed this method in 25patients(age15-68 years,19male female6). For oral anesthesia we used 15-20cc of 4% lidocaine in a divided dose. We injected 2 cc of 2% lidocaine for each superior laryngeal nerve block and injected 4-6 cc of 2 to 4% lidocaine through the cricothyroid membrane for transtracheal nerve block with a 22-gauge intravenous catheter. It took 5-10 minutes in 23 patients and over 10 minutes in 2 patients for local anesthetic preparation. It took less than 1 minute in 15 patients, 1-4 minutes in 6 patients and more than 4 minutes in 4 patients for fiberoptic awake intubation. We observed vocal cord movement in 6 patients and blood clot in the trachea in 7 patients. Seventeen patients did pronate without help, 5 patients needed some help and 3 patients needed full support. Among the 3 patients who needed full support, 2 patients were in a halo traction state and one was in deep sedation. Ten patients complained of pain or discomfort during intubation. This complaint may be related which the time taken for intubation and inadequate local anesthesia. There were no complications related to positioning. We concluded that fiberoptic awake intubation and self pronation for positioning is a safe and useful method for anesthetic mnagement in cervical spine disease patients.
Anesthesia ; Anesthesia, Local ; Catheters ; Deep Sedation ; Humans ; Intubation* ; Laryngeal Nerves ; Lidocaine ; Membranes ; Nerve Block ; Operating Tables ; Pronation* ; Spine* ; Trachea ; Traction ; Vocal Cords

Malignant tumors of the eyelid pose a serious threat because of their proximity to the globe, brain & paranasal sinuses. Three types of carcinomas account for the vast majority of the malignant eyelid tumors: basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma. In these malignancies, basal cell carcinoma is the most common. However, sebaceous gland carcinoma has a high recurrence rate and a moderately high 5-year mortality rate because of late diagnosis and incomplete surgical removal. This tumor may be clinically misdiagnosed frequently as a chronic unilateral conjunctivitis, chalazion, basal cell carcinoma, or squamous cell carcinoma in initial biopsy. Suspicious lid lesions should be managed with incisional biopsy initially. If they are positive for sebaceous gland carcinoma, wide excision and frozen section monitoring of surgical margin is the treatment of choice. The final diagnosis should be confirmed by special stain for lipid. We experienced 12 cases of malignant eyelid tumors including 3 cases of sebaceous gland carcinoma. In cases of sebaceous gland carcinoma, wide surgical excision with frozen section monitoring was performed and followed by eyelid reconstruction with intact eyelid tissue remained and adjuvant radiotheraphy. Guidelines for management are discussed.
Biopsy ; Brain ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Chalazion ; Conjunctivitis ; Delayed Diagnosis ; Diagnosis ; Eyelids* ; Frozen Sections ; Mortality ; Paranasal Sinuses ; Recurrence ; Sebaceous Glands

Nalbuphine, a mixed agonist-antagonist type opioid, can precipitate abstinence syndrome in opioid-dependent patients especially in large doses. We can prevent this syndrome by avoiding the injection of agonist-antagonist type opioid to the patient who already has used opioid for a long time, and the method of relatively small dose increments in its use. We experienced a case of opioid withdrawal symptom in chronically morphine-administered patient via epidural catheter after using intramuscular nalbuphine for analgesia. The symptom was promptly relieved by intravascular morphine injection without any problems.
Analgesia ; Catheters ; Humans ; Morphine ; Nalbuphine* ; Substance Withdrawal Syndrome*

This study demonstrated that xenogenic human marrow mesenchymal stem cells (hMSCs) could elicit the regeneration of the sensory nerve after axotomy in the adult rats'infraorbital nerves without immunosuppression. For this, we evaluated the behavioral testing for functional recovery of the nerve and histological findings at weeks 3 and 5 compared to controls. Xenogenic hMSCs did not evoke any significant inflammatory or immunologic reaction after systemic and local administrations. HMSCs-treated rats exhibited significant improvement on sensory recovery tested with von Frey monofilaments. At 5 postoperative weeks, in the hMSCs treated nerve, expression of myelin basic protein (MBP), neurofilament (NF) at the site of axotomy was higher than control. And mRNA expression of neurotropin receptor Trk precursor (TrkPre), nerve growth factor receptor (NGFR) and neuropeptide (NPY) in trigeminal ganglion were also higher. The number of myelinated nerve at distal stump and cells in trigeminal ganglion were higher in hMSC treated rats. So it was supposed that transplanted MSCs contributed to reducing post-traumatic degeneration and production of neurotrophic factors. Immunofluorescence labeling showed small portion of hMSCs(<10%) expressed a phenotypic marker of Schwann cell (S-100). Xenogenic or allogenic mesenchymal stem cells might have immune privileged characteristics and useful tool for cell based nerve repair.
Adult ; Animals ; Axotomy ; Bone Marrow* ; Fluorescent Antibody Technique ; Humans* ; Immunosuppression ; Mesenchymal Stromal Cells* ; Myelin Basic Protein ; Myelin Sheath ; Nerve Growth Factor ; Nerve Growth Factors ; Nerve Regeneration ; Neuropeptides ; Rats* ; Regeneration* ; RNA, Messenger ; Trigeminal Ganglion

Small cell carcinoma is most frequently described as occurring in the bronchial tree. Extrapulmonary small cell carcinoma is a very rare disease and it has been reported in the esophagus, stomach, small intestine, pancreas, uterus, salivary gland and prostate. Primary esophageal small cell carcinoma with gastric metastasis and without regional lymph node involvement is very rare. We have experienced a case of primary esophageal small cell carcinoma with gastric metastasis and without regional lymph node involvement. The patient was treated with chemotherapy and this patient is alive at 40 months after the treatment.
Carcinoma, Small Cell ; Esophagus ; Humans ; Intestine, Small ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Prostate ; Rare Diseases ; Salivary Glands ; Stomach ; Uterus

BACKGROUND: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. METHODS: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. RESULTS: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8+/-7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4+/-3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7+/-4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). CONCLUSION: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.
Anoxia ; Compliance ; Dyspnea ; Heart ; Humans ; Insurance ; Insurance Coverage ; Korea ; Lung ; Lung Neoplasms ; Male ; Medical Records ; National Health Programs ; Oxygen ; Partial Pressure ; Prescriptions ; Pulmonary Disease, Chronic Obstructive ; Respiratory Insufficiency ; Stress, Psychological ; Telephone