The funding acknowledgment in this article was omitted as published.

The objective of study was to compare biomechanical parameters between normal and arch building gait in healthy subjects. A total of 40 feet from 20 healthy adults were evaluated in this study. The participants were asked to walk on a treadmill comfortably at 2 km/hr for 30 seconds. Then, they were asked to walk after making arch building through raising arches with their feet by pulling the big toe toward the heel. Gait parameters such as geometry, center of pressure, maximum force, and maximum pressure were measured in normal and the arch building gait using a gait analysis system equipped with pressure sensor. Arch building gait demonstrated significantly (p<0.01) decreased forefoot maximum force but significantly (p=0.024) increased heel maximum force compared to normal gait. Maximum pressures of the midfoot and heel were also significantly (both p<0.01) increased. However, the maximum pressures of the forefoot were not significantly (p>0.05) different between the two conditions. Geometry, phase, and time parameters were not significantly (p>0.05) different between the two conditions, either. Although forefoot and midfoot maximum force were significantly decreased in arch building gait compared to those in normal gait, the maximum pressure of forefoot was not significantly changed, indicating decreased area of forefoot contact during arch building gait. The arch building gait moves the center of presser to the hind foot and redistributes the contact area, thus changing the distribution of maximum pressure.
Adult ; Foot ; Gait* ; Hallux ; Healthy Volunteers ; Heel ; Humans

BACKGROUND: Wake-up tests may be necessary during surgery for kypho-scoliosis to ensure that spinal function remains intact. It is difficult to predict the time when patients can respond to a verbal command. We evaluated the effectiveness of the bispectral index (BIS) and its relation to patients' levels of consciousness in wake-up tests during desflurane and sevoflurane anesthesia. METHODS: Eighteen patients each were enrolled in the desflurane and sevoflurane groups for spinal correction surgery. We measured BIS values, blood pressure, heart rate, and consciousness state and time, at the points when patients responded during the wake-up test. RESULTS: The BIS values when patients made fists upon a verbal command (T3) were 86.7 +/- 7.5 for desflurane and 90.3 +/- 5.4 for sevoflurane. Patients in the desflurane group had significantly shorter wake up delays than those in the sevoflurane group (6.9 +/- 1.8 min vs. 11.8 +/- 3.6 min). However, there was no difference between the groups in the time between the response to a verbal command and the time when a patient moved their toes in response to verbal commands. No recall of the wake-up tests occurred in either group. CONCLUSIONS: The values obtained using the BIS index could to some extent predict the time of a patient's and would be informative during desflurane and sevoflurane anesthesia. Moreover, desflurane permitted faster responses to verbal commands than sevoflurane, and allowed the wake-up test to be performed sooner.
Anesthesia ; Blood Pressure ; Consciousness ; Dietary Sucrose ; Heart Rate ; Humans ; Isoflurane ; Methyl Ethers ; Toes

PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.
Adult ; Advanced Practice Nursing/*economics ; Costs and Cost Analysis ; Humans ; Intensive Care Units ; National Health Programs ; Nurse Practitioners/*economics ; *Relative Value Scales ; Workload

BACKGROUND: Reactive oxygen species (ROS) induce lipid peroxidation and tissue damage in endothelium. We studied the influences of ketorolac and diclofenac on ROS effects using the endothelium of rabbit abdominal aorta. METHODS: Isolated rabbit aortic rings were suspended in an organ bath filled with Krebs-Henseleit (K-H) solution bubbled with 5% CO2 and 95% O2 at 37.5degrees C. After being stimulated to contract with phenylephrine (PE, 10(-6) M), changes in arterial tension were recorded following the cumulative administration of acetylcholine (ACh, 3 x 10(-8) to 10(-6) M). The percentages of ACh-induced relaxation of aortic rings before and after exposure to ROS, generated by electrolysis of K-H solution, were used as the control and experimental values, respectively. The aortic rings were pretreated with ketorolac or diclofenac at the same concentrations (10(-5) M to 3 x 10(-4) M), and the effects of these agents were compared with the effects of ROS scavengers: catalase, mannitol, sodium salicylate and deferoxamine and the catalase inhibitor, 3-amino-1,2,4-triazole (3AT). RESULTS: Both ketorolac and diclofenac maintained endothlium-dependent relaxation induced by ACh in a dose-related manner inspite of ROS attack (P < 0.05 vs. control value). The 3AT pretreated ketorolac (3 x 10(-3) M) group was decreased more significantly than un-pretreated ketorolac (P < 0.05). CONCLUSIONS: These findings suggest that ketorlac and diclofenac preserve the endothelium-dependent vasorelaxation against the attack of ROS, in a concentration-related manner. One of the endothelial protection mechanisms of ketorolac may be hydrogen peroxide scavenging.
Acetylcholine ; Amitrole ; Aorta, Abdominal ; Arterial Pressure ; Baths ; Catalase ; Contracts ; Deferoxamine ; Diclofenac ; Electrolysis ; Endothelium ; Hydrogen Peroxide ; Ketorolac ; Lipid Peroxidation ; Mannitol ; Phenylephrine ; Reactive Oxygen Species ; Relaxation ; Sodium Salicylate ; Vasodilation

BACKGROUND: We studied the hemodynamic changes induced by pneumoperitoneum and a reversed Trendelenburg in elderly patients with increased cardiac risk (ASA class III; n = 30; age 70.8 +/- 4.9 years, mean +/- SD) and compared the results with elderly patients at normal risk (ASA class II; n = 30; age 69.2 +/- 4.1 years) during laparoscopic cholecystectomy. METHODS: The transesophageal Doppler monitor was performed after induction of general anesthesia (pre-incision), after onset of pneumoperitoneum (insufflation), after head-up (20degrees) and a left lateral tilt (15degrees) (reversed Trendelenburg) and after deflation and horizontal position (desufflation). Mean arterial pressure (MAP), heart rate, cardiac index (CI) and systemic vascular resistance (SVR) were measured, respectively. RESULTS: Induction of pneumoperitoneum and head-up tilt in patients with cardiac risk resulted significantly in a decrease in CI and an increase in SVR compared with patients with normal risk (P < 0.05), and that remained until deflation, but no interval changes in MAP and heart rate. The CI, MAP and heart rate decreased and SVR increased significantly in patients with cardiac risk compared with patients with normal risk before incision (P < 0.05). No complications occurred. The results indicate that pneumoperitoneum and a reversed Trendelenburg are associated with significant but relatively benign hemodynamic changes. CONCLUSIONS: Anesthesia for laparoscopic cholecystectomy in elderly patients with increased cardiac risk should be performed with an adequate hemodynamic monitoring.
Aged ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cholecystectomy, Laparoscopic ; Heart Diseases ; Heart Rate ; Hemodynamics ; Humans ; Organothiophosphorus Compounds ; Pneumoperitoneum ; Vascular Resistance

Irregular or unexpected antibodies are alloantibodies against serum or red blood cells after previous exposure to transfusion. When encountered in critical condition, however, risk of ongoing complication is not entirely predictable. Rapid transfusion of safe blood is thus, crucial not to compromise further procedure. A 78-year-old ASA IV man presented with Hunt-Hess grade IV subarachnoid hemorrhage with huge temporal bleeds. While in operating room, his blood pressure dropped when the dura was opened. Meanwhile, routine screening of blood typing repeatedly denoted Rh+O with irregular antibodies. Soon, compatible cross-matched blood was infused with 37 degrees C normal saline 200 ml at a rate of 4-5 ml/kg/hr. There was no laboratory evidence of hemolytic transfusion reaction. Postoperatively, BUN and creatinine increased slightly, but urination and respiration were unremarkable.
Aged ; Antibodies ; Blood Group Incompatibility ; Blood Grouping and Crossmatching ; Blood Pressure ; Creatinine ; Emergencies ; Erythrocytes ; Humans ; Isoantibodies ; Mass Screening ; Operating Rooms ; Respiration ; Subarachnoid Hemorrhage ; Urination

Esmolol is a cardioselective beta-blocker with a very rapid onset of action and a short half-life. Labetalol is a combined alpha- and beta-adrenoceptor blocking agent. It is a nonselective antagonist at beta-adrenoceptors and a competitive antagonist of postsynaptic alpha 1-adrenoceptors. A 51 year old female patient was transferred to the operating room for performing spinal fusion under general anesthesia. She had no operation and medication history. The initial heart rate was 150 beats/min. Despite administering several bolus injections of esmolol, the heart rate was not decreased to under 130 beats/min. But the heart rate was decreased to 100 beats/min after the administration of labetalol 5 mg and this rate was maintained without an additional injection. The vital signs were stable until the operation was finished and the patient recovered uneventfully in the recovery room. The postoperative laboratory findings revealed that she had hyperthyroidism. We report here on an anesthetic experience of effective labetalol treatment for esmolol-resistant tachycardia in a patient who was under general anesthesia.
Anesthesia, General ; Female ; Half-Life ; Heart Rate ; Humans ; Hyperthyroidism ; Labetalol ; Operating Rooms ; Propanolamines ; Recovery Room ; Spinal Fusion ; Tachycardia ; Vital Signs

BACKGROUND: The hemodynamic and metabolic effects of tourniquet application undergoing knee surgery with general anesthesia in elderly patients with hypertension have been rarely reported. We evaluated the hemodynamic and metabolic effects in elderly patients compared with young adults. METHODS: Thirty elderly patients (elderly hypertension group, 71.8 +/- 3.9 years) with chronic hypertension undergoing total knee replacement and 30 young adults (normal group, 33.1 +/- 5.1 years) undergoing knee surgery were studied. Mean arterial pressure (MAP), heart rate, cardiac index (CI) by esophageal doppler method, and systemic vascular resistance index (SVRI) were measured before, during, and after tourniquet application. pH, PaO2, PaCO2, Hb and lactate blood concentrations were also measured. RESULTS: MAP increased 25% and 16% in elderly hypertension and normal groups during inflation, respectively (P < 0.05) and returned to basal values after deflation. CI increased to 30% higher than basal values in both groups after deflation (P < 0.05). SVRI decreased 31% and 19% in elderly hypertension and normal groups after deflation, respectively (P < 0.05). After deflation, PaCO2 and lactate increased (P < 0.05). CONCLUSIONS: Elderly patients with hypertension have the significant hemodynamic changes during and after tourniquet application than before, however, there are no differences compared to normal group. These elderly patients should be needed the active hemodynamic monitoring due to the lower compensatory ability.
Aged* ; Anesthesia, General ; Arterial Pressure ; Arthroplasty, Replacement, Knee ; Heart Rate ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension* ; Inflation, Economic ; Knee* ; Lactic Acid ; Tourniquets* ; Vascular Resistance ; Young Adult

BACKGROUND: Steroids are normally used in neurosurgery, especially when treating brain edema and reducing the intracranial pressure. Methylprednisolone is known to increase the blood glucose concentration. However, the effect of a single methylprednisolone injection on the blood glucose concentration is unknown. Therefore, this study measured and compared the blood glucose concentration in a methylprednisolone group with that in a placebo group at the same interval. METHODS: Thirty-three adult patients were enrolled in this study. The patients were scheduled to undergoing an elective craniotomy with the procedure lasting 4 hours or longer. The candidates were divided in two groups. One group was the methylprednisolone group (patients receiving methylprednisolone 125 mg, n = 18), and the other group was the placebo group (n = 15). The exclusion criteria were a clinical diagnosis of diabetes mellitus, an impaired glucose tolerance and had received steroid previously. Before injecting 125 mg of either methylprednisolone or the placebo, the blood glucose concentration was checked by glucose analyzer. After the injection, blood glucose concentration was checked every 30 minutes for more than 4 hours. RESULTS: The blood glucose concentration increased significantly over time compared with the baseline concentration in both groups. The glucose concentration increased significantly in the methylprednisolone group than in the placebo group (P < 0.05). The magnitude of this difference was greater in those who received methylprednisolone (54 mg/dl increase over 4 hours) than in the placebo group (11 mg/dl increase over 4 hours). CONCLUSIONS: In this study, compared with placebo controls, an injection of methylprednisolone (125 mg) produced a significant increase in the blood glucose concentration over a 4 hours period. Therefore, we recommend that the blood glucose level be monitored carefully in cases of brain surgery and/or when steroids are used.
Adult ; Blood Glucose* ; Brain Edema ; Brain* ; Craniotomy ; Diabetes Mellitus ; Diagnosis ; Glucose ; Humans ; Intracranial Pressure ; Methylprednisolone ; Neurosurgery ; Steroids