For the purpose of preparing the fundamental data on air pollution in underground shopping center and also contributing to the health improvement of resident, the authors measured the level of SO2, NO2, TSP, CO, CO2 and also some related factors as air temperature, air movement, relative humidity and mean radiation temperature at inside and outside of underground shopping center in Pusan from January to February and from July to August 1994. The results were as follows: 1. The mean concentration of CO within the underground shopping center was 3.1+/-1.3ppm in winter and 2.1+/-0.9 ppm in summer. There was a negative correlation (p<0.01) between inner CO concentration and temperature in summer and no correlation between inner CO concentration and outer CO concentration in underground shopping center 2. The mean concentration of C02 within the underground shopping center was 876+/-353 ppm in winter and 757+/-125 ppm in summer. There was a negative correlation (P<0.01) between inner CO2 concentration and air movement in summer and positive correlation (p<0.05) between inner CO2 oncentration and outer CO2 concentration in underground shopping center. 3. The mean concentration SO2 within a underground shopping center was 0.036+/-0.019ppm in winter and 0.040+/-0.013ppm in summer. There was a positive correlation(p<0.01) between inner SO2 concentration and positive correlation between inner SO2 concentration and outer SO2 concentration in summer and winter in Underground shopping center. 4. The mean concentration of NO2 within a underground shopping center was 0.052+/-0.038ppm in winter and 0.042+/-0.016ppm in summer. There was a no correlation between inner NO2 concentration and thermal factors in summer and winter and low correlation between inner NO2 concentration in underground shopping center. 5. The mean concentration of TSP within a underground shopping center was 430+/-214 microgram/m3 in winter, 366+/-73 microgram/m3 in summer, and very in excess of the atmospheric environmental quality standards of Korea(150 microgram/m3). There was low correlation between inner TSP concentration and temperature in summer and high correlation between inner TSP concentration and outer TSP concentration in underground shopping center.
Air Movements ; Air Pollution* ; Busan* ; Humidity

There is a direct relationship between the plasma concentration of the drugs and the magnitude of neuromuscular blockade in non-depolarizing neuromuscular blocking agents. But the classical pharmacokinetic data of succinylcholine have not been obtained because of the lack of an appropriate assay to detect plasma concentration hydrolyzed rapidly by pseudocholinesterase. The purposes of this study was to determine neuromuscular response from the release of minute interval of toumiquet occlusion after intravenous bolus adminstration of succinylcholine at one arm following blood flow occlusion at contralateral arm with pneumatic toumiquet. The twitch height of neuromuscular responses after adminisration of succinylcholine was completely depressed in the group(control) without occlusion, but 5.40+/-3.63% on 1 minute, 30.11+/-9.72% on 2 minutes, 85.00+/-4.19% on 4 minutes and 97.75+/-0.59% on 5 minutes after blood flow occlusion respectively. The onset time of maximum depression in each group was not significant different. At 5 minutes after succinylcholine given systemically, the twitch height was 8.35%, while it was 97.75% from tourniquet release on 5 minutes after blood flow occlusion. It is concluded that succinylcholine should be also related to plasma concentration in magnitude of neuromuscular block, and receptor binding(dissociation constant) more than plasma concentration in offset of neuromuscular blockade.
Arm ; Depression ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Plasma ; Pseudocholinesterase ; Succinylcholine* ; Tourniquets

BACKGROUND: Ideal condition of endotracheal intubation after administration of non-depolarizing muscle relaxants like vecuronium is the time when the diaphragm and upper airway muscles are completely relaxed. But these muscles are difficult to determine the degree of relaxation. Neuromuscular response of these muscles are similar to that of orbicularis oculi (OO), but adductor pollicis (AP) is different. However, it is sometimes difficult to monitor OO response. The purpose of this study was to monitor the upper airway muscle relaxation using AP other than OO. METHODS: Fourty-four adult patients of ASA class 1 schaduled for elective surgery under general anesthesia were examined. Anesthesia was induced with fentanyl 2 mcg/kg, and 2 minutes later followed by thiopental sodium 5 mg/kg. After supramaximal stimulation for control twitch height, vecuronium 0.1 mg/kg was intravenously injected and applied continuous train-of-four (TOF) facial nerve stimuli. The TOF response of OO was closely observed with examiner's naked eyes. When complete relaxation of OO achieved, TOF ratio of AP and the time after vecuronium injection were recorded. Thereafter, tracheal intubation was performed and the intubating condition scores was recorded. Ulnar nerve stimuli were continuously applied until complete relaxation of AP was achieved. The time of complete relaxation of AP after vecuronium injection was also recorded. RESULTS: The onset time of complete relaxation was significantly faster in OO (181.3+/- 47.4 secs) as compared with that of AP (265.0+/-67.8 secs). The average TOF ratio of AP was 47.3+/-17.2% and the condition of intubation performed after complete relaxation of OO was satisfied. CONCLUSION: The optimal time for endotracheal intubation was about 3 min after vecuronium 0.1 mg/kg injection, when TOF ratio of AP was about 50%.
Adult ; Anesthesia ; Anesthesia, General ; Diaphragm ; Facial Nerve ; Fentanyl ; Humans ; Intubation ; Intubation, Intratracheal* ; Muscle Relaxation ; Muscles ; Neuromuscular Nondepolarizing Agents ; Relaxation ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

Recently, since muscle relxants has been used routinely, it is very important to understand the state of muscle relaxation during and after anethesia for safe anesthesia. But it is difficult that all patients have the opportunity to be helped by the auto-recording neuromuscular monitor, because of high in price. Therefore, many anesthesiologists have been using the simple tactile neuromuscular monitor for the evaluation of muscle relaxation, but there are many difference to evaluate for the reponse of muscle contraction by tactile or visual sensation. This study was designed to investigate the method of recording on the response of nerve stimulation from simple tactile neuromuscular monitor. The pressure generated from moving of thumb connected with finger ring lock syringe by ulnar nerve stimulation was transmitted to the invasive blood pressure monitor through the arterial pressure transducer. As a result, this method could record the response of single twitch stimulation, train-of-four stimulation, tetanic stimulation, post-tetanic count and double-burst stimulation displaying in the invasive blood pressure monitor, and was exellent in recording compared with auto-record- ing neuromuscular monitor.
Anesthesia ; Arterial Pressure ; Blood Pressure Monitors ; Fingers ; Humans ; Muscle Contraction ; Muscle Relaxation ; Sensation ; Syringes ; Thumb ; Transducers ; Ulnar Nerve

BACKGROUND: Lidocaine has been used widely to prevent propofol injection pain. Various methods of administration exist, such as lidocaine premixed with propofol or lidocaine pretreatment using a tourniquet, but it is unclear which method of lidocaine administration is more effective for the prevention of injection pain of propofol LCT/MCT. The purpose of this study was to compare pretreatment of lidocaine with a tourniquet and a premixed injection of lidocaine to prevent injection pain of propofol-LCT/MCT. METHODS: Patients were randomly allocated into the pretreatment group (n = 117) or the premixed group (n = 117). The pretreatment group was pretreated with 2 ml of lidocaine 2%, held with a tourniquet, before propofol-LCT/MCT injection. The premixed group was injected with a premixed solution of propofol-LCT/MCT and 2 ml of lidocaine 2%. To evaluate the incidence and severity of pain, spontaneous verbal expressions of pain, movement of hand, frowning, and moaning were recorded, and the patients were asked to recall their pain with the visual analogue score (VAS) 30 minutes after awakening from anesthesia. RESULTS: Overall, injection pain occurred in 13.7% of the pretreatment group and 15.4% of the premixed group, without any statistical difference (P = 0.71). There was no difference in spontaneous verbal expressions of pain, movement of hand, frowning, and moaning between the two groups. The pain intensity (VAS) also showed no difference between the two groups (P = 0.49). CONCLUSIONS: Pretreatment of lidocaine with a tourniquet showed no more benefit to prevent injection pain of propofol LCT/MCT compared to a premixed injection with lidocaine.
Anesthesia ; Emulsions ; Hand ; Humans ; Incidence ; Lidocaine* ; Methods ; Propofol ; Tourniquets*

BACKGROUND: Buprenorphine is more potent and has less side effects than morphine. Therefore it can be used instead of morphine in cancer or postoperative pain contol. The aim of this study was to find an effective low dose of buprenorphine in epidural administration for pain control after obstetric-gynecologic surgery. METHODS: Epidural catheters were placed at L2-3 or L3-4 epidural space in all groups. Sixty nine patients were randomized to three epidural infusion group M, B1 and B2. Each group was 23. Group M: 3 mg morphine with 0.5% bupivacaine 10 ml as bolus, morphine 7 mg in 0.125% bupivacaine 100 ml in infusor; group B1: 0.068 mg buprenorphine with 0.5% bupivacaine 10 ml as bolus, buprenorphine 0.17 mg in 0.125% bupivacaine 100 ml in infusor; group B2: 0.11 mg buprenorphine with 0.5% bupivacaine 10ml as bolus, buprenorphine 0.24 mg in 0.125% bupivacaine 100 ml in infusor. Pain score, side effects and frequency of adjuvant analgesics were recorded at postoperative 1, 2, 6, 12, 24 and 48 hours. RESULTS: There was statistically significant difference of pain score at postoperative 1, 2 and 12 hrs in group B1 (p<0.05). Frequency of adjuvant analgesic was significantly increased in group B1. But there was no significant difference between group M and B2 in pain score. CONCLUSIONS: Our results suggest that buprenorphine 0.11 mg as bolus and 0.24 mg for 2 days are the optimal dose in continuous epidural administration for postoperative pain contol.
Analgesics ; Bupivacaine ; Buprenorphine* ; Catheters ; Epidural Space ; Humans ; Infusion Pumps ; Morphine ; Pain, Postoperative*

BACKGROUND: Dexmedetomidine extends the duration of nerve block when administered perineurally together with local anesthetics by central and/or peripheral action. In this study, we compared the duration of nerve block between dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in infraclavicular brachial plexus block. METHODS: Thirty patients, scheduled for upper limb surgery were assigned randomly to 3 groups of 10 patients each. We performed brachial plexus block using a nerve stimulator. In the control group (group C), patients received 40 ml of 1% mepivacaine. In group E, patients received 40 ml of 1% mepivacaine containing 200 microg of epinephrine as an adjuvant. In group D, patients received 40 ml of 1% mepivacaine containing 1 microg/kg of dexmedetomidine as an adjuvant. Sensory block duration, motor block duration, time to sense pain, and onset time were assessed. We also monitored blood pressure, heart rate, oxygen saturation and bispectral index. RESULTS: In group D and group E, sensory block duration, motor block duration and time to sense first pain were prolonged significantly compared to group C. However, there was no significant difference between group D and group E. CONCLUSIONS: Perineural 1 microg/kg of dexmedetomidine similarly prolonged nerve block duration compared to 200 microg of epinephrine, but slowed heart rate. Thus, dexmedetomidine is expected to be a good alternative as an adjuvant to local anesthesia in patients who are cautioned against epinephrine.
Anesthesia, Local ; Anesthetics, Local ; Blood Pressure ; Brachial Plexus* ; Dexmedetomidine* ; Epinephrine* ; Heart Rate ; Humans ; Mepivacaine* ; Nerve Block ; Oxygen ; Upper Extremity

The aim of this study was to investigate prevalence and risk factors associated with spasticity at 3 months after a first-ever stroke in Korean patients. This cohort study included consecutive patients with first-ever stroke who were admitted to 9 participated hospitals in different areas of Korea. The Modified Ashworth Scale (MAS), which defines spasticity as MAS > 1 in any of the examined joints was used to assess patients 3 months after stroke occurrence. The prevalence of spasticity was 7.3% (339 of 4,658 patients), 3 months after stroke onset. Spasticity was more frequent in upper extremity (6.7%) than lower extremity (4.3%). Severity of spasticity was as follows: 63.1%: MAS I, 23.3%: MAS I+, 9.4%: MAS II, 2.6%: MAS III, and 1.4%: MAS IV. Stroke type (hemorrhagic) (p < 0.05) were identified as correlated risk factors. Patients with spasticity scored higher with National Institute of Health Stroke Scale (NIHSS) and lower with modified Rankin Scale (mRS) than non-spastic patients (p < 0.001). This study showed 7.3% prevalence of spasticity in Korean first-ever stroke patients at 3 months, and identified those who carried higher risks of developing spasticity who would particularly benefit from preventive or therapeutic strategies. It would contribute to assessing spasticity in patients with first-ever stroke in Korea.
Cohort Studies* ; Humans ; Joints ; Korea* ; Lower Extremity ; Muscle Spasticity* ; Prevalence* ; Rehabilitation* ; Risk Factors ; Stroke* ; Upper Extremity