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BACKGROUND: A light plane of general anesthesia is chosen for fetal safety during a cesarean section. Therefore an experience of wakefulness and pain perception is not infrequent and can be distressful to patients. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study was designed to assess the adequacy of general anesthesia and to evaluate the usefulness of the BIS in monitoring the awareness during a cesarean section. METHODS: Twenty one parturients undergoing general anesthesia for an elective caesarean section were examined. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then followed with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min. Before administration of succinylcholine, a tourniquet was applied to the free arm and inflated to 250 mmHg. Responsiveness to verbal commands using the Tunstall isolated forearm technique was detected and the BIS was monitored throughout the study period. RESULTS: The incidence of responsiveness to verbal commands were 33% at the time of skin incision and fetal delivery respectively. BIS values of response to commands were significantly higher than that of no respose at both time points (p < 0.05). Fisher's exact test suggested that the BIS value less than 75 was related to unresponsiveness to verbal commands at time of skin incision (p < 0.05) and the BIS less than 85 at fetal delivery (p < 0.05). CONCLSIONS: These results suggest that adequate anesthesia is not provided with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min at the time of skin incision and fetal delivery. In addition BIS could be a predictor of awareness during cesarean section under general anesthesia.
Anesthesia ; Anesthesia, General* ; Arm ; Cesarean Section* ; Consciousness Monitors* ; Enflurane ; Female ; Forearm ; Humans ; Incidence ; Pain Perception ; Pregnancy ; Skin ; Succinylcholine ; Thiopental ; Tourniquets ; Wakefulness

We experienced a case of vitamin B12 unresponsive methlymalonic acidemia in a 4 day old female, who had poor feeding, dehydration with metabolic acidosis, and hyperammonernia and died at 7 days of age. Diagnosis was made by gas chromatography and mass spectrometry, and this case is probably a methylmalonyl CoA mutase apoenzyme deficiency type.
Acidosis ; Apoenzymes ; Chromatography, Gas ; Dehydration ; Diagnosis ; Female ; Humans ; Mass Spectrometry ; Methylmalonyl-CoA Mutase ; Vitamin B 12

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam in patients receiving intravenous patient-controlled analgesia (PCA) using morphine after total abdominal hysterectomy. METHODS: Group C (n = 27) received bolus of morphine 5 mg and PCA of morphine 1 mg/ml. Group M1 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.2 mg/ml mixed with morphine 1 mg/ml. Group M2 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.4 mg/ml mixed with morphine 1 mg/ml. The PCA delivery system was programmed to deliver 1 ml of the test solution per demand with a 10 min lockout interval and no background infusion. The incidence of PONV, metoclopramide and ketorolac usage, morphine and midazolam consumption, pain, sedation, and other side effects were assessed at 1, 4, 8, 16, 24, 36 and 48 h after the operation. RESULTS: The incidences of PONV were 19 (70%) in Group C, 14 (52%) in Group M1 and 10 (37%) in Group M2. The incidence of PONV in Group M2 was significantly lower than that in Group C (P < 0.05). Patients in Group M2 experienced more sedation than those in Group C (P < 0.05). No severe sedation was observed in all groups. CONCLUSIONS: Combination of midazolam 0.4 mg per morphine 1 mg in PCA had more effective antiemetic efficacy than control without significant adverse effects.
Analgesia, Patient-Controlled* ; Antiemetics* ; Humans ; Hysterectomy* ; Incidence ; Ketorolac ; Metoclopramide ; Midazolam* ; Morphine ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam after middle ear surgery. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 90 healthy patients were scheduled for middle ear surgery (tympanomastoidectomy and tympanoplasty). Patients were randomly divided into two groups; Midazolam 0.075 mg/kg (n = 45) or normal saline (n = 45) was administered after induction of anesthesia. The incidence of PONV, metoclopramide and ketorolac usage, pain, sedation, and other side effects were assessed at 6, 24 h after the operation. RESULTS: The incidences of PONV were 15 (33%) in midazolam group and 27 (60%) in placebo group during 24 h postoperatively. The incidence of PONV in midazolam group was significantly lower than that in placebo group (P < 0.05). There were no significant differences between groups in adverse events. CONCLUSIONS: Midazolam 0.075 mg/kg was effective for preventing PONV after middle ear surgery without significant adverse effects.
Anesthesia ; Antiemetics ; Ear, Middle* ; Humans ; Incidence ; Ketorolac ; Metoclopramide ; Midazolam* ; Nausea* ; Postoperative Nausea and Vomiting ; Prospective Studies ; Vomiting*

To compare the features of stroke associated with nonvalvular and valvular atrial fibri!lation, we carried out a retrospective study on cerebral infarcts in 27 patients with nonvalvular atrial fibrillation (AF) and in 33 patients with valvular AF.Iwe analyzed the clinical courses, the underlying heart diseases, and the features of echocardiography and brain cornputed tomograpy, Thefollowing results were obtained; 1) Most strokes in nonvalvular AF occurred after 7th decade and the age of stroke onset in nonvalvular group was younger than that of nonvalvular group(p<.05).; 2) Echocardiographic studiesshowed that the left atriurn of the heart in the nonvalvular AF group was srnaller in size than the valvular group and that the left atrial thrombi were not detectable on conventional echoardiograrn in the nonvalvular irouP.: 3) Both groups showed sirnilar distribution in the sites, number, and nature of the brain lesions.; 4) Stroke recurred with sirnilar frequency in both groups and rnost of them occurred during the first year of the initial stroke.
Atrial Fibrillation* ; Brain ; Cerebral Infarction* ; Echocardiography ; Heart ; Heart Diseases ; Humans ; Retrospective Studies ; Stroke

STATEMENT OF PROBLEM: It is not clear how to make a stable bonding between zirconia ceramic and resin cement. And the study about surface treatment of zirconia ceramic or bonding resin cement are not enough. PURPOSE: To measure and compare the shear bond strength of some resin cements on zirconia ceramic after different surface treatments. MATERIAL AND METHOD: 48 ceramic discs were made of 3 ceramic materials, zirconia ceramics Zi-Ceram), heat-pressed ceramics (IPS Empress 2) and slip cast alumina ceramics (In-Ceram). According to the surface treatments of ceramic specimens and resin cements, specimens were classified into 6 groups and each group was composed of 8 specimens. For the surface treatment of Zi-Ceram group (test group), sandblasting and diamond bur preparation were applied and Superbond C&B and Panavia F were bonded respectively. For IPS Empress 2 group (control group), Variolink II was bonded after sandblasting, acid etching, silanization and for In-Ceram ALUMINA group (control group), Panavia F was bonded after sandblasting. After storing specimens in distilled water for 24 hours, the shear bond strength was measured by the universal testing machine. RESULTS AND CONCLUSION: 1. Zi-Ceram group with Superbond C&B cement showed higher bond strength than with Panavia F cement regardless to the surface treatments (p<0.05). 2. In Zi-Ceram group with Superbond C&B cement, sandblasting treatment group (12.1MPa) showed higher bond strength than diamond bur treatment group (7.7MPa) (p<0.05). In Zi-Ceram group with Panavia F cement, there were no significant differences in the bond strength according to the surface treatments (p>0.05). 3. Zi-Ceram group with sandblasting and Superbond C&B cement (12.1MPa) showed the highest bond strength. The bond strength of this group was not significantly different from In-Ceram ALUMINA group (10.4MPa) (p>0.05) and lower than IPS Empress 2 group (15.9MPa) (p<0.05).
Aluminum Oxide ; Ceramics* ; Dental Instruments ; Resin Cements* ; Water

Among 152 premature infants admitted to Nursery of Chung Nam National University Hospital between Jan, 1975 & December 1977. We selected 44 premature babies who were clinically normal, 30 to 37 weeks aged gestationally, 1000 to 2200 gm weighed at birth and admitted within 24hrs after birth & observed mainly on the change of their body weight & intake from birth to 20 days of age to obtain the normal values of physical growth calory and water requirements in neonatal period of premature infants. We also stuied on relation of the gestation age to body weight & feeding method, degree of initial weight loss, duration of regain to birth weight & duration from birth to 2200 gm of body weight by various age & body weight. The results were as follows: 1. Distributions of birth weight by gestational age were similar to that of Lubchenco's in 33 to 35 weeks group but higher in 30 to 32 weeks one and lower in 36 to 37 weeks group. 2. During the first week after birth, 69% of all cases were nursed by gavage & 6% being by mixed feeding. Gavage feeding was given to 89% of cases in 30 to 32 weeks group, 77% in 33 to 35 weeks one and 44% in over 36 weeks group. 3. Inital weight loss was less than 4% in 30%, 5 to 9% in 45% and over 10% in 25% of all cases. 4. Body weight was regained to birth weight within 5 days in 7% 5 to 10 days in 43%, 10 to 15days in 23% and over 15days in 27% of all cases and appeared to be rapidly returned to birth weight in order ^ heavier group. 5. Daily body weight was increased average 15 gm for the first 20days after birth, decreased 3.7 to 19.5 gm, lost 3.7 to 19.5 gm till 4 days, gained 11.0 to 28.5 gm after 5 days, elevated 14gm from the day regained to 10days and 24gm from 11 days to 20 days of age. 6. Daily amonunt of calory intake was shown average 142.5 cal. For the first 20days, 40.5 to 66cal till 4 days and 103 to 145cal after 5 days of age. 7. Daily amount of water intake was seen same tendency as calory intake, 191.5cc for the first 20 days, 73.5 to 120.5cc until 4 days and 145.5 to 193.5cc after 5days of age.
Infant ; Male ; Female ; Infant, Newborn ; Humans