BACKGROUND: Induction of anesthesia with a high dose of fentanyl and vecuronium decreases the heart rate and blood pressure. This study was designed to evaluate the effect of preinduction atropine on these hemodynamic changes in patients undergoing coronary artery bypass graft surgery (CABG). METHODS: Forty-one patients who underwent CABG were randomly divided into two groups. After insertion of a radial artery cannula and a Swan-Ganz catheter, normal saline 1 ml (control group, n = 20) or atropine 0.5 mg (atropine group, n = 21) was injected intravenously 1 min before the induction of anesthesia. Anesthesia was induced with a first dose of fentanyl (5-8 microgram/kg) and vecuronium (0.12 mg/kg) and a second dose of fentanyl (5-10 microgram/kg). The patient was then intubated. Hemodynamic variables were measured before the induction of anesthesia, 1 min after the administration of each drug during the induction of anesthesia and 5, 10, and 30 min after the intubation. RESULTS: There was no significant differences between the two groups in terms of demographic data except that the number of patients with diabetes mellitus was greater in the control group than in the atropine group. The number of patients treated for hypotension or bradycardia during the induction of anesthesia was greater in the control group than in the atropine group, but this was not statistically significant. Heart rates significantly decreased in the control group but were maintained in the atropine group without any significant tachycardia. Blood pressure significantly decreased in both groups. CONCLUSIONS: Intravenous injection of atropine before anesthetic induction in patients undergoing CABG attenuates the decrease in heart rate resulting from anesthetic induction with high dose fentanyl and vecuronium. However, it didn't prevent the decrease in blood pressure nor did it reduce the incidence of treatment for hypotension.
Anesthesia ; Atropine* ; Blood Pressure ; Bradycardia ; Catheters ; Coronary Artery Bypass* ; Coronary Vessels* ; Diabetes Mellitus ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Injections, Intravenous ; Intubation ; Radial Artery ; Tachycardia ; Transplants ; Vecuronium Bromide*

This study was designed to evaluate the possibility of esmolol to attenuate the cardiovascular reflex due to the induction of general anesthesia, tracheal intubation and/or surgical stimulations during open heart surgery. Esmolol was infused continuously to each patient by 150 ug/kg/min from 2 minutes prior to the completion of the induction of anesthesia and then by 75 ug/kg/min throughout the skin-incision. In patients undergoing coronary bypass grafts, esmolol group of 5 individuals did not show any significant change in hemodynamics in contrast to the control group of 5 individuals, which showed singificant decreases in systolic and mean arterial pressure(p<0.05). The plasma concentrations of the catecholamines in the esmolol group were not significantly different from those in control. In patients undergoing valve replacement, esmolol group did not show any significant difference in hemodynamics from control. The plasma concentrations of the catecholamines in the esmolol group were not changed by the anesthetic and surgical procedures in contrast to the control group, which showed 3 times increase (p<0.05) in norepinephrine level and 8 times increase (p<0.05) in epinephrine level. The results of these experiments demonstrate that esmolol can suppress the hemodynamic refiex and catecholamine-release due to the stimulations of anesthetic and surgical procedures under the general anesthesia by a high concentration of fentanyl, and that esmolol can be administered safely to attenuate the hazardous sympathetic reflexes.
Anesthesia ; Anesthesia, General ; Catecholamines ; Epinephrine ; Fentanyl ; Heart* ; Hemodynamics* ; Humans ; Intubation ; Norepinephrine ; Plasma ; Reflex ; Thoracic Surgery ; Transplants

BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP > 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.
Anesthesia ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Perfusion ; Phenylephrine* ; Pulmonary Artery ; Vascular Resistance ; Ventricular Dysfunction, Right

PURPOSE: This study was conducted to evaluate the process & outcome of a Health promotion program(Growing Younger & More Active) for the community resident older adults from March to December, 2001. METHOD: A quasi experimental research(one group pretest-posttest design) was used in this study. The subjects were 82 older adults(but 40 older adults 4 weeks after the program). Program had 5 sessions(10 hours) once a week. Data were collected before the program, immediately after & 4 weeks after the program and were analyzed with paired t-test. RESULT: The levels of Satisfaction, Interest & Understanding of the Program were high. Significant differences were found in health knowledge, health promoting behaviors, perceived health status and life satisfaction between before program and immediately after program as well as between before program and 4 weeks after program, but no significant differences in Health attitude. Self efficacy has significant difference only between before program and immediately after program , but no significant differences between before program and 4 weeks after the program. CONCLUSION: This results suggest that a Health promotion program for the community resident older adults developed this study is effective. So this program can be recommended as an effective nursing intervention for the health promotion of the older adults living in community.
Adult* ; Attitude to Health ; Health Promotion* ; Humans ; Nursing ; Self Efficacy

Purpose: This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR). Materials and Methods: In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared. Results: Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960). Conclusion TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.

Purpose: This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR). Materials and Methods: In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared. Results: Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960). Conclusion TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.

Maternal alcohol abuse is thought to be the common cause of mental retardation. Especially, continuous alcohol consumption during critical period of brain development induce fetal alcohol effects. In this study, the authors investigated the effects of maternal alcohol drinking on the postnatal changes of BDNF contents and patterns of BDNF-containing neuron in neonatal rat brain, and, the influence of maternal thyroxine treatment on the brain of pups of alcohol abused mother. Pregnant rats were divided into three groups. Alcohol-fed group (n=4) received 35 calories of liquid alcohol diet daily from gestation day 6; control pair-fed group (n=4) was fed a liquid diet in dextrin replaced alcohol isocalorically; alcohol+T4 group (n=4) received 35 calories liquid alcohol diet and exogenous thyroxine (5 microgram/kg/day) subcutaneously. The amount of BDNF was significantly higher in the alcohol+T4 group as compared to the alcohol group at P7, P14 and P21, especially, alcohol+T4-exposed pups showed a significant increase of BDNF at P7. The decrease in BDNF was found in alcohol group compared to control pair-fed group at all ages. In alcohol+T4 group, BDNF-containing Purkinje cells exhibited mature pattern and monolayer arrangement at P14. Alcohol+T4 group showed mature pattern and numerical increase of BDNF-containing cells in cerebral cortex, hypothalamus and hippocampus at P7. The BDNF immunoreactivity of hippocampus continued to show prominent configuration in alcohol+T4 group at P28. These results indicate that the increase of the BDNF-containing neurons and BDNF amount in pups of thyroxinesupplemented alcohol-exposed dams as compared to control pair-fed and alcohol-exposed pups at P7, presumably suggest the early postnatal growth stimulatory effect of the exogenously supplemented thyroxine. Therefore, the increase of BDNF synthesis caused by maternal administration of exogenous thyroxine may ameliorate fetal alcohol effects, one of the ill effects as a result of the dysthyroid state following maternal alcohol abuse.
Alcohol Drinking ; Alcoholism ; Animals ; Brain* ; Brain-Derived Neurotrophic Factor ; Cerebral Cortex ; Critical Period (Psychology) ; Diet ; Hippocampus ; Humans ; Hypothalamus ; Immunohistochemistry ; Intellectual Disability ; Mothers* ; Neurons* ; Pregnancy ; Purkinje Cells ; Rats ; Thyroxine*

Anesthesiologists face a special challenge in managing Jehovahs witness patients, who have deep religious convictions against accepting blood transfusion. Therefore, clear understandings of the philosophy of Jehovah's witness regarding blood transfusion and of the medicolegal aspects of their care are essential. Beginning of anesthesia, we explained about the blood conserving anesthetic management such as autotransfusion and hemodilution. After induction of anesthesia, we have conducted autologous predonation and acute normovolemic hemodilution. And aprotinin was administered to reduce perioperative blood loss. During cardio-pulmonary bypass, body temperature was at 28degrees C, hematocrit was around 20%, using bloodless priming solution and mean arterial blood pressure was in the range of 60 to 70 mmHg. Hematocrit was increased up to 32% at the first day after operation. We had successful experience of anesthesia in Jehovahs witness patient undergoing emergency mitral valve replacement without homologus blood transfusion. (Korean J Anesthesiol 1995; 29: 296~299)
Anesthesia ; Aprotinin ; Arterial Pressure ; Blood Transfusion ; Blood Transfusion, Autologous ; Body Temperature ; Emergencies* ; Heart* ; Hematocrit ; Hemodilution ; Humans ; Mitral Valve ; Philosophy ; Thoracic Surgery*

Vulvodynia is the term used to describe unexplained vulvar pain, sexual dysfunction, and the resultant psychological disability. In vulvar vestibulitis, surgery is carried out on patients who have failed conservative therapy. Surgical procedures which is removal of all sensitive vestibular tissue are most effective in patients with pure vestibulitis, but effective surgery is not known in patient with dysesthetic vulvodynia. We experienced one case of vulvar denervation operation in patients with intractable dysesthetic vulvodynia, which have failed conservative therapy. So we report one case with a brief review of literature.
Denervation* ; Humans ; Vulvar Vestibulitis ; Vulvodynia*

BACKGROUND/OBJECTIVES: This research was conducted to compare lecture-and experience-based methods of nutritional education as well as provide fundamental data for developing an effective nutritional education program in elementary schools. SUBJECTS/METHODS: A total of 110 students in three elementary schools in Jeollanam-do were recruited and randomly distributed in lecture-and experience-based groups. The effects of education on students' dietary knowledge, dietary behaviors, and dietary habits were analyzed using a pre/post-test. RESULTS: Lecture-and experience-based methods did not significantly alter total scores for dietary knowledge in any group, although lecture-based method led to improvement for some detailed questions. In the experience-based group, subjects showed significant alteration of dietary behaviors, whereas lecture-based method showed alteration of dietary habits. CONCLUSIONS: These outcomes suggest that lecture-and experience-based methods led to differential improvement of students' dietary habits, behaviors, and knowledge. To obtain better nutritional education results, both lectures and experiential activities need to be considered.
Education* ; Food Habits ; Humans ; Jeollanam-do ; Learning* ; Lectures