BACKGROUND: Combining adjunctive medications with patient-controlled analgesia (PCA) has been used to minimize opioid related side-effects. The aim of this study was to evaluate whether postoperative infusion of a sub-sedative dose of dexmedetomidine can reduce opioid consumption and opioid related side-effects. METHODS: We selected 60 patients from 18 to 60 years old with an American Society of Anesthesiologists physical status of 1–2 who were scheduled for elective surgery. The types of surgery were limited to thoracoscopic wedge resection of the lung and pulmonary wedge resection under a mini-thoracotomy. Patients received PCA with sufentanil upon arrival in the recovery room, along with a separate continuous infusion of dexmedetomidine that was not mixed in the PCA but started at the same time. Patients were randomly allocated to two groups: dexmedetomidine 0.15 μg/kg/h was administered to patients in group D and normal saline was administered to patients in group C. The visual analogue scale (VAS) pain score, blood pressure, pulse rate, and respiratory rate were measured at each assessment. PCA related side-effects were evaluated. RESULTS: The VAS pain score was significantly lower in the dexmedetomidine group. Patients in the dexmedetomidine group required significantly less PCA at postoperative 1–4, 4–8, and 8–24 h time intervals. The incidence of nausea was significantly less in the dexmedetomidine group, and levels of sedation and hemodynamic variables except for blood pressure at postoperative 8 h were similar between the groups. CONCLUSIONS: In conclusion, a postoperatively administered sub-sedative dose of dexmedetomidine reduces PCA sufentanil consumption and decreases nausea.
Analgesia, Patient-Controlled* ; Blood Pressure ; Dexmedetomidine* ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Lung ; Nausea ; Passive Cutaneous Anaphylaxis ; Recovery Room ; Respiratory Rate ; Sufentanil*

No abstract available.
Humans ; Thrombocytosis

OBJECTIVES: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. METHODS: Bupivacaine (0.5%) 9 mg with fentanyl 10 microg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. RESULTS: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed. CONCLUSION: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Heart Rate ; Hypotension ; Incidence ; Injections, Spinal ; Pregnancy ; Subarachnoid Space

BACKGROUND: Spinal anesthesia for cesarean section is widely used technique for rapid induction, high success rate and excellent intraoperative and postoperative analgesia. Potentiating the effect of intrathecal local anesthetics by addition of opioid for cesarean section is well known. In this study, we compared the clinical effects when different doses of fentanyl were combined with intrathecal hyperbaric bupivacaine. METHODS: Ninety six healthy term parturients were randomly divided into four groups: Group C (control), : Group F10 (fentanyl 10 microg), : Group F15 (fentanyl 15 microg), F: Group F20 (fentanyl 20 microg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS: There were no significant differences between four groups in maximal level and recovery rate of sensory and motor block. Quality of intraopertive analgesia and muscle relaxation was increasing by increasing dosage of intrathecal opioids. Duration of effective analgesia was significantly prolonged in Group F15 and F20 than Group C and F10, but there were no differences between Group F15 and F20. And the frequencies of side effects such as hypotension, max sedation level were increasing by increasing dosage of intrathecal opioids. The Apgar scores were normal, and there were no differences between the four groups. CONCLUSIONS: The addition of fentanyl 15 microg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia without significant adverse effects.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Cesarean Section ; Female ; Fentanyl ; Humans ; Hypotension ; Muscle Relaxation ; Pregnancy

BACKGROUND: Although upper gastrointestinal (UGI) endoscopy is highly sensitive for the detection of esophago-gastroduodenal lesions, pain and discomfort during the procedure cause examinees to experience stress and anxiety. Moreover, there have been only a few studies on relief of pain and discomfort during UGI endoscopy through preparatory interventions. Therefore, the aim of this study was to investigate the relationship between a preparatory education program and the discomfort and retching experienced by examinees during endoscopy. METHODS: A total of 306 examinees who visited a health promotion center and underwent non-sedated endoscopy from May 13 to July 3, 2009 were included in this study. After they were assigned to experimental (n = 154) and control groups (n = 152), their discomfort and retching were measured with a visual analogue scale. The preparatory education program consisted of cognitive intervention, behavioral intervention and information. RESULTS: The preparatory education program relieved discomfort during endoscopy in male subjects, in subjects aged 60 and over, or in subjects with previous endoscopic experience with statistical significance (P < 0.05). It also relieved retching during endoscopy in subjects aged 60 and over with statistical significance (P = 0.023). Multiple logistic regression analysis showed that the preparatory education program significantly relieved the discomfort of examinees during endoscopy (P = 0.028). CONCLUSION: We found that the preparatory education program used in this study could significantly relieve the discomfort caused by endoscopy, particularly in subjects aged 60 and over, or in male subjects with a high incidence of stomach cancer in Korea.
Aged ; Anxiety ; Endoscopy ; Endoscopy, Gastrointestinal ; Health Promotion ; Humans ; Incidence ; Korea ; Logistic Models ; Male ; Stomach Neoplasms

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.
Acinetobacter ; Acinetobacter baumannii ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Decision Making ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Rivers ; Staphylococcus aureus ; Urinary Tract Infections

The purpose of this study provides measurements of radiation dose from MDCT of head, chest, abdomen and pelvic examinations. A series of dose quantities that are measured of patient weight to compare the dose received during MDCT examinations. Data collected included: weight together with CT dose descriptors, volume CT dose index (CTDIvol) and dose length product (DLP). The effective dose was also estimated and served as collective dose estimation data. Data from 1,774 adult patients attending for a CT examination of the head (n=520) or chest (n=531) or abdomen (n=724) was obtained from spiral CT units using a same CT protocol. Mean values of CTDIvol was a range of 48.6 mGy for head and 6.9, 10.5 mGy for chest, abdomen examinations, respectively. And mean values of DLP was range of 1,604 mGy.cm for head, 250 mGy.cm for chest, 575 mGy.cm for abdomen examinations, respectively. Mean effective dose values for head, chest, abdominal CT were 3.6, 4.2, and 8.6 mSv, respectively. The degree of CTDIvol and DLP was a positive correlation with weight. And there was a positive correlation for weight versus CTDIvol (r2=0.62), DLP (r2=0.694) in chest. And head was also positive correlation with weight versus CTDIvol (r2=0.691), DLP (r2=0.741). We conclude that CTDIvol and DLP is an important determinant of weight within the CT examinations. The results for this study suggest that CT protocol should be tailored according to patient weight.
Abdomen ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; Cone-Beam Computed Tomography ; Cytarabine ; Gynecological Examination ; Head ; Humans ; Subject Headings ; Thioguanine ; Thorax ; Tomography, Spiral Computed

BACKGROUND/AIMS: Collagenous colitis (CC) and lymphocytic colitis (LC) are characterized by chronic diarrhea and normal radiologic and endoscopic findings. These are currently not uncommon entities whose incidence in increasing as more clinicians take biopsies from macroscopically normal colons. The purpose of this study was to examine the clinical features and characteristics in microscopic colitis. METHODS: From January 2003 to December 2006, medical records were reviewed from 80 patients with chronic diarrhea, who had normal colonoscopic findings but underwent biopsy. Patients with microscopic colitis were identified by reviewing the pathology databases and by reviewing biopsies. RESULTS: Microscopic colitis was diagnosed in 12 patients (15%). Six patients with CC (Male:Female=2:4, mean age 54+/-20.1 years) and 6 patients with LC (Male:Female=5:1, mean age 51.2+/-21.4 years) were identified. Autoimmune disease was diagnosed in 4 patients (33%). Drug-induced disease was suspected in 3 patients (25%). The inciting drugs were NSAIDs, ticlopidine, ranitidine, and acarbose. Complete or partial resolution of diarrhea was achieved in all patients, including spontaneous resolution in 2 patients. Antidiarrheal drugs, mesalazine, and cholestylamine were highly effective in both diseases. Recurrence of symptoms occurred in 2 patients (17%). They are taking medicine at present. CONCLUSIONS: Microscopic colitis is a relatively common cause of chronic diarrhea that appears to be increasing in incidence. We reported clinical features, characteristics, treatment, and response of microscopic colitis in our experience.
Acarbose ; Anti-Inflammatory Agents, Non-Steroidal ; Antidiarrheals ; Autoimmune Diseases ; Biopsy ; Colitis, Collagenous ; Colitis, Lymphocytic ; Colitis, Microscopic ; Colon ; Diarrhea ; Humans ; Incidence ; Medical Records ; Mesalamine ; Ranitidine ; Recurrence ; Ticlopidine

BACKGROUND: Gallstone is the most common disease of the biliary system. Most cases of gallstone are asymptomatic and we incidentally found gallstones during a community health survey. Our study was designed to determine the prevalence and risk factors for gallstone in a population who underwent health screening. METHODS: We enrolled a total of 36,314 persons who visited the health promotion center in Kyungpook National University Hospital in Korea from 1998 to 2004. They had their gallbladder or biliary system examined with using ultrasonography. The body mass index and biochemical parameters from liver function tests, the lipid profiles and the fasting blood sugar were all measured. All the subjects were divided into several groups and the particular prevalence for gallstone disease for each group was calculated. Chi-square tests and logistic regression analysis assessed the risk factors for gallstone disease. RESULTS: Among 36,314 persons, (19,345 males (53.3%) and 16,969 females (46.7%)), gallstone was found in 735 persons (2.0%). On univariate analysis, the risk factors for gallstone disease were age, body mass index, fasting blood sugar, total cholesterol, LDL-cholesterol, triglyceride and serum aspartate aminotransferase. On multivariate logistic regression analysis, the the risk factors were high body mass index, older age and high fasting blood sugar. CONCLUSIONS: The risk factors seem to show a common pathogenesis for gallstone disease. Although the relation between gallstone disease and metabolic syndrome has not been established, it appears to be associated with metabolic syndrome, but further study on a general population is required.
Aspartate Aminotransferases ; Biliary Tract ; Blood Glucose ; Body Mass Index ; Cholesterol ; Fasting ; Female ; Gallbladder ; Gallstones* ; Gyeongsangbuk-do ; Health Promotion ; Health Surveys ; Humans ; Korea ; Liver Function Tests ; Logistic Models ; Male ; Mass Screening ; Prevalence* ; Risk Factors* ; Triglycerides ; Ultrasonography

Acute viral hepatitis in human can be caused by a large number of viruses with a wide range of clinical manifestations and laboratory findings. EBV is a rare causative agent of an acute hepatitis, during the course of infectious mononucleosis. Hepatic manifestations of EBV are usually mild and resolve without serious complications. EBV is rather uncommonly confirmed as an etiologic agent in acute viral hepatitis of adults and it rarely causes cholestatic hepatitis. We report a case of EBV hepatitis with cholestatic feature that was verified through serum viral marker and liver biopsy.
Male ; Humans ; Hepatitis, Viral, Human/complications/diagnosis/*virology ; Epstein-Barr Virus Infections/complications/*diagnosis ; Cholestasis, Intrahepatic/diagnosis/*virology ; Adult ; Acute Disease