Postoperative residual neuromuscular blockade or residual paralysis in the postanesthesia care unit is associated with postoperative complications such as muscle weakness, difficulty in breathing, airway obstruction, and hypoxemia. Residual paralysis can be defined by inadequate neuromuscular recovery as measured by objective neuromuscular monitoring. The train-of-four ratio threshold less than or equal to 0.9 is considered to indicate inadequate neuromuscular recovery. Careful management of residual paralysis may decrease the occurrence of adverse events associated with residual neuromuscular blockade. In this review, the clinical implications of residual neuromuscular blockade are summarized.
Airway Obstruction ; Anoxia ; Muscle Weakness ; Neuromuscular Blockade* ; Neuromuscular Monitoring ; Paralysis ; Postoperative Complications ; Respiration

BACKGROUND: The purpose of this study was to evaluate the efficacy of intravenous clonidine-fentanyl to prevent postepidural shivering in patients undergoing an elective orthopedic surgery. METHODS: Forty ASA class 1 or 2 patients who received epidural anesthesia for an orthopedic surgery were allocated randomly to two groups. 10 min before epidural anesthesia group 1 received intravenous clonidine 2.0ng/kg and group 2 received clonidine 1.0ng/kg and fentanyl 1.0ng/kg shivering was determined objectively by observing involuntary muscle activity. Mean arterial pressure, heart rate and sedation score were measured at 5 minute intervals during the first 30 minutes following epidural anesthesia. RESULTS: There were no significant differences between the two groups in the occurrence of shivering, hemodynamic changes and sedation score. CONCLUSIONS: Intravenous clonidine 2.0ng/kg and the combination of clonidine 1.0ng/kg and fentanyl 1.0ng/kg were not significantly different in occurrence of postepidural shivering. Therefore, a combination of small doses of intravenous clonidine and fentanyl may be safe and useful to reduce postepidural shivering.
Anesthesia, Epidural ; Arterial Pressure ; Clonidine ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Muscle, Smooth ; Orthopedics ; Shivering*

BACKGROUND: Intraarticular opioids and local anesthetics may provide effective analgesia following knee arthroscopic surgery. However, there are conflicting results about the analgesic effects of a combination of morphine, bupivacaine and clonidine injected intraarticularly following knee arthroscopic surgery. The goal of this study was to determine whether clonidine added to an intraarticular morphine- bupivacaine combination provide an analgesic benefit. METHODS: Thirty patients scheduled for knee arthroscopic surgery under epidural anesthesia were selected and divided to two groups randomly. The patients in Group 1 received a combination of morphine 3 mg 0.25% bupivacaine 30 ml and patients in Group 2 received a combination of clonidine 3microgram/kg and morphine 3 mg in 30 ml of 0.25% bupivacaine intraarticularly following knee arthroscopic surgery. Postoperative pain was assessed using the visual analogue scale (VAS) and changes of arterial blood pressure, heart rate, requirement of additional analgesics, adverse effects and sedation scale were observed at 1, 2, 4, 8 and 24 hours after intraarticular injection. RESULTS: The VAS observed at 4, 8 and 24 hours after intraarticular injection were significantly lower in group 2 than group 1. Blood pressure and heart rate were not significantly changed between group 1 and group 2. The incidence of side effects, injection of additional analgesics and sedation were similar between the groups. There were no significant differences in hemodynamic changes, analgesic requirements, sedation scale or the increase of side effects between group 1 and group 2. CONCLUSIONS: The results suggest that the combination of intraarticular morphine 3 mg in 30 ml 0.25% bupivacaine plus clonidine provides significantly better analgesia than morphine 3 mg in 30 ml 0.25% bupivacaine alone following knee arthroscopy.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia, Epidural ; Anesthetics, Local ; Arterial Pressure ; Arthroscopy* ; Blood Pressure ; Bupivacaine ; Clonidine ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Injections, Intra-Articular ; Knee* ; Morphine ; Pain, Postoperative

BACKGROUND: This study was performed to determine the effect of a endotracheal intubation & induction of anesthesia using propofol 2.0 mg/kg or 2.5 mg/kg and fentanyl 2 g/kg without succinylcholine chloride. Also we have compared this method with technique using succinylcholine 1.5 mg/kg and thiopental sodium 5 mg/kg. METHODS: They were divided into 3 groups as follows: group 1, succinylcholine 1~1.5 mg/kg and thiopental sodium 5 mg/kg; group 2, propofol 2 mg/kg and fentanyl 2 microgram/kg; group 3, propofol 2.5 mg/kg and fentanyl 2 microgram/kg. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP), and heart rate (HR) were measured before induction, after induction, after tracheal intubation immediately, at 1, 2, 3, and 5min. after tracheal intubation in all patients. The incidence of adverse effects and the quality of condition for intubation were measured in all patients. RESULTS: There were significant increases in SAP, DAP, HR after intubation in group 1 but significant decreases in SAP, DAP after induction and at 5min. after intubation in group 2 and group 3. The incidence of adverse effects, and the quality of condition for intubation were no significant difference between group 1 and group 3. CONCLUSIONS: From the above result, use of propofol 2.5 mg/kg and fentanyl 2microgram/kg provided a satisfactory alternative to succinylcholine and thiopental sodium for rapid sequence induction of anesthesia.
Anesthesia ; Arterial Pressure ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Propofol ; Sodium* ; Succinylcholine ; Thiopental

OBJECTIVE: To examine the effects of coculture with human oviductal cells regarding the development of 1-cell stage ICR mouse embryos and to investigate the effects of duration and start time of coculture. MATERIALS AND METHODS: ICR mice were superovulated with PMSG/hCG and 1-cell stage mouse embryos were recruited. 1-cell mouse embryos were cocultured on human oviductal cells in a CO2 incubator(coculture group) and were cultured on 0.4 % BSA+HTF media(control group)(Experiment 1). 1-cell mouse embryos were cocultured on human oviductal cells for 36, 44, 52, 60 hours after hCG IP respectively, and then were transferred to 0.4 % BSA+HTF media(Experiment 2). In comparison, 1-cell mouse embryos were cultured by using 0.4 % BSA+HTF media, and then were transferred to human oviductal cell coculture system using the same schedule(Experiment 3). Afterward, they were examined regarding the development to 2-cell, 4~8 cell stage mouse embryos, morulas and blastocysts. RESULTS: In experiment 1, the developmental rates to 2-cell embryos of coculture group and control group were 97.3 % and 98.7 %, respectively. After 2-cell embryos, coculture group showed significantly higher developmental rate than control group (p<0.05). In experiment 2, the developmental rates after 2-cell embryos showed the significant differences. The groups with coculture effects removed before post-hCG 60 hours showed significantly lower developmental rates (p<0.05). In experiment 3, the developmental rates after 2-cell embryos were higher when the coculture started at an earlier stage. Furthermore, the groups which were cocultured from post-hCG 52 hours exhibited significant lower developmental rate than the groups which were cocultured continuously (p<0.05). CONCLUSION: The coculture with human oviductal cell could improve the development of the embryos in vitro and might mimic the natural physiological condition better than media environment. The degree of improvement was more pronounced when the coculture started at an earlier stage and the duration of coculture was longer. More importantly, the changes of culture condition at post-hCG 52 hours in which secondary mitosis occurs, have significant detrimental effects on growth and development of mouse embryos.
Animals ; Blastocyst ; Coculture Techniques* ; Embryonic Structures* ; Growth and Development ; Humans* ; Mice ; Mice, Inbred ICR* ; Mitosis ; Morula ; Oviducts*

Controlled hypotension has been used to facilitate the surgical procedure and to reduce blood loss. This study was performed to compare the change of the cardiovascular systerm and intracranial pressure following the controlled hypotension induced by isoflurane, sodium nitroprusside, and labetalol in 28 cats. The results were as follows. 1) Heart rate was decreased with the isoflurane-induced hypotension, increased with the sodium nitroprusside-mduced hypotension. Both were not significant, but labetalol-induced hypotension increased heart rate significantly(P< 0.05). 2) Intracranial pressure was increased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.05), but there was significantly small per cent ehange in labetalol-induced hypotension than sodium nitroprusside-induced hypotension(P< 0.05). 3) Cerebral perfusion pressure was decreased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.01), but there was significantly small per cent change in labetalol-induced hypotension than isoflurane or sodium nitroprusside-induced hypotension(P < 0.01, P< 0.001).
Animals ; Cats* ; Heart Rate ; Hypotension* ; Hypotension, Controlled ; Intracranial Pressure ; Isoflurane* ; Labetalol ; Nitroprusside* ; Perfusion ; Sodium*

Controlled hypotension has been used to facilitate the surgical procedure and to reduce blood loss. This study was performed to compare the change of the cardiovascular systerm and intracranial pressure following the controlled hypotension induced by isoflurane, sodium nitroprusside, and labetalol in 28 cats. The results were as follows. 1) Heart rate was decreased with the isoflurane-induced hypotension, increased with the sodium nitroprusside-mduced hypotension. Both were not significant, but labetalol-induced hypotension increased heart rate significantly(P< 0.05). 2) Intracranial pressure was increased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.05), but there was significantly small per cent ehange in labetalol-induced hypotension than sodium nitroprusside-induced hypotension(P< 0.05). 3) Cerebral perfusion pressure was decreased with isoflurane, sodium nitroprusside, and labetalol-induced hypotension significantly(P< 0.01), but there was significantly small per cent change in labetalol-induced hypotension than isoflurane or sodium nitroprusside-induced hypotension(P < 0.01, P< 0.001).
Animals ; Cats* ; Heart Rate ; Hypotension* ; Hypotension, Controlled ; Intracranial Pressure ; Isoflurane* ; Labetalol ; Nitroprusside* ; Perfusion ; Sodium*

We found an error in this article. The author's name should be corrected as following: from "Younsuk Koh" to "Younsuck Koh".

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.
Adult* ; Critical Care ; Critical Illness ; Electronic Mail ; Hospitals, Teaching ; Humans ; Insurance, Health ; Intensive Care Units ; Jurisprudence ; Korea ; Motivation ; National Health Programs ; Personnel Staffing and Scheduling ; Surveys and Questionnaires ; Tertiary Care Centers

BACKGROUND: Earlier studies have reported conflicting results regarding long-term behavioral consequences after anesthesia during the fetal period. Previous studies also suggest several factors that may explain such conflicting data. Thus, we examined the influence of age and sex on long-term behavioral consequences after multiple sevoflurane exposures during the fetal period. METHODS: C57BL/6J pregnant mice received oxygen with or without sevoflurane for 2 hours at gestational day (GD) 14-16. Offspring mice were subjected to behavioral assays for general activity (open field test), learning, and memory (fear chamber test) at postnatal day 30–35. RESULTS: Multiple sevoflurane exposures at GD 14–16 caused significant changes during the fear chamber test in young female offspring mice. Such changes did not occur in young male offspring mice. However, general activity was not affected in both male and female mice. CONCLUSIONS: Multiple sevoflurane exposures in the second trimester of pregnancy affects learning and memory only in young female mice. Further studies focusing on diverse cognitive functions in an age-, sex-dependent manner may provide valuable insights regarding anesthesia-induced neurotoxicity.
Anesthesia ; Animals ; Cognition ; Female* ; Fetus ; Humans ; Learning ; Male ; Memory* ; Mice* ; Oxygen ; Pregnancy Trimester, Second ; Pregnancy*