BACKGROUND: Most morphometric studies of the airway have relied on plain radiographs or CT scan with their attendant limitations. We evaluated the length from vocal cord to carina and diameter of the trachea in adults who had no abnormality of the airway using three-dimensional chest CT scan and compared with demographic data. METHODS: We performed a multiplane reconstruction of the airway using axial, sagittal, and coronal slices (aged 18-87, 100 men, 100 women). We measured that the lengths from vocal cord to carina and the diameters (AP, anteroposterior; TR, transverse) of 50 mm above carina of the trachea. RESULTS: The lengths from vocal cord to carina was 130.2 +/- 11.4 mm in men and 119.5 +/- 10.5 mm in women. The AP and TR diameters of the trachea at 50 mm above carina were men; 18.0 +/- 2.4 mm, 17.2 +/- 2.6 mm, women; 14.4 +/- 2.0 mm, 14.4 +/- 1.9 mm, respectively. The correlation between airway length and age and height was statically significant in men and women but less clinically significant. The correlation between diameter of trachea and height was only statically significant in men but less clinically significant. CONCLUSIONS: This study suggests that these measured data are helpful for the endotracheal intubation and endotracheal tube placement in airway management.
Adult ; Airway Management ; Female ; Humans ; Intubation, Intratracheal ; Male ; Thorax ; Trachea ; Vocal Cords

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.
Adult ; Analgesia, Patient-Controlled ; Humans ; Insurance ; Korea ; Patient Satisfaction ; Postoperative Complications

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.
Adult ; Analgesia, Patient-Controlled ; Humans ; Insurance ; Korea ; Patient Satisfaction ; Postoperative Complications

BACKGROUND: Stellate ganglion block (SGB) results in a sympathetic block of the head, neck, and upper extremities. In a previous study, the modified injection technique (MIT) was found to exert a better sympathetic block effect on the upper extremities than the classic injection technique (CIT). Therefore, this study was conducted to evaluate the spreading effect of injection volume when the MIT was used in the paratracheal SGB at the 6th cervical level. METHODS: One hundred patients were equally divided into 4 groups. Patients in Groups I, II, and III were subjected to paratracheal SGB at the 6th cervical level with 6 ml, 8 ml, 10 ml of 0.5% mepivacaine administered using the CIT, respectively, whereas patients in Group IV were subjected to block with 6 ml of 0.5% mepivacaine by the MIT using a method such as strong pressure at the cephalad portion of the needle entry point. The skin temperature of the second finger was measured before and after SGB, and the occurrence of warm sensation on the face and upper extremities, and the occurrence of hoarseness were evaluated. RESULTS: The increase in the skin temperature of patients in Groups I, II, III, and IV were 0.28 +/- 0.29, 0.52 +/- 0.58, 0.82 +/- 0.77, and 0.80 +/- 0.72, respectively, with the increases in skin temperature observed in the Groups III and IV being statistically significant when compared to Group I (P < 0.05). There were no significant differences observed in the occurrence of warm sensations on the face and upper extremities, or in the occurrence of hoarseness among the groups. CONCLUSIONS: The results of this study could not differentiate the spreading effect of injection volume that occurred when the MIT was used from the effect that occurred as a result of injection of 8 or 10 ml using the CIT. However, the MIT showed better sympathetic block on the upper extremities than the CIT when the same volume was used. Taken together, these results suggest that the spread effect of 6 ml administered by MIT is similar to that of 10 ml administered by CIT.
Blood Proteins ; Fingers ; Head ; Hoarseness ; Humans ; Mepivacaine ; Neck ; Needles ; Sensation ; Skin Temperature ; Stellate Ganglion ; Upper Extremity

BACKGROUND: Hypotension and bradycardia in the propofol and alfentanil anesthesia are common during induction and maintenance. Ephedrine has been used to attenuate hypotension and bradycardia in the propofol and alfentanil anesthesia. We designed this study to determine whether propofol and alfentanil anesthesia could affect the blood pressure and heart rate response to intravenous ephedrine when compared with the awake state. METHODS: Forty patients of ASA physical status 1 or 2 were assigned to one of two groups (Awake vs Propofol-alfentanil [P-A] group). Each patients received ephedrine 0.15 mg/kg after assessment of baseline hemodynamic values. In the awake patients, ephedrine were administered after hemodynamic parameters are stabilized. If hemodynamic parameters are stabilized after intubation, ephedrine were administered in the propofol-alfentanil anesthesia patients. The changes in systolic/diastolic blood pressure (SBP/DBP), mean blood pressure (MBP), and heart rate (HR) were recorded every one minute for 10 minutes. RESULTS: Ephedrine increased the heart rate significantly in Awake group but not in P-A group. In the P-A group, 3 min after the administration of ephedrine, MBP increased 25.3%. In Awake group, 2 min after the administration of ephedrine, MBP increased only 6.3%. CONCLUSIONS: We conclude that propofol and alfentanil anesthesia augments the BP response to intravenous ephedrine but not HR.
Alfentanil ; Anesthesia ; Blood Pressure ; Bradycardia ; Ephedrine ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Propofol

BACKGROUND: Hypotension and bradycardia in the propofol and alfentanil anesthesia are common during induction and maintenance. Ephedrine has been used to attenuate hypotension and bradycardia in the propofol and alfentanil anesthesia. We designed this study to determine whether propofol and alfentanil anesthesia could affect the blood pressure and heart rate response to intravenous ephedrine when compared with the awake state. METHODS: Forty patients of ASA physical status 1 or 2 were assigned to one of two groups (Awake vs Propofol-alfentanil [P-A] group). Each patients received ephedrine 0.15 mg/kg after assessment of baseline hemodynamic values. In the awake patients, ephedrine were administered after hemodynamic parameters are stabilized. If hemodynamic parameters are stabilized after intubation, ephedrine were administered in the propofol-alfentanil anesthesia patients. The changes in systolic/diastolic blood pressure (SBP/DBP), mean blood pressure (MBP), and heart rate (HR) were recorded every one minute for 10 minutes. RESULTS: Ephedrine increased the heart rate significantly in Awake group but not in P-A group. In the P-A group, 3 min after the administration of ephedrine, MBP increased 25.3%. In Awake group, 2 min after the administration of ephedrine, MBP increased only 6.3%. CONCLUSIONS: We conclude that propofol and alfentanil anesthesia augments the BP response to intravenous ephedrine but not HR.
Alfentanil ; Anesthesia ; Blood Pressure ; Bradycardia ; Ephedrine ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Propofol

BACKGOUND: This study was designed to examine the effects of female hormones and the menstrual cycle on postoperative pain. METHODS: Ninety women who underwent gynecologic surgery involving a lower abdominal incision were asked for information regarding their menstrual cycles, and blood samples were obtained to determine the progesterone and estrogen levels of the patients at the time of surgery. Patient controlled analgesia was applied to control postoperative pain and an estimate of the consumption of analgesic drugs by the patients was made. Analgesic consumption and pain scores were recorded at 2, 24, and 48 hours after operation. RESULTS: There was no relationship observed between the concentration of progesterone and estrogen and the consumption of analgesic drugs. However, patients that were in the luteal phase at the time of surgery consumed a significantly lower amount of analgesic drugs during the 2-24 hours following surgery than patients that were in the follicular phase (19.4 +/- 6.5 ml vs 24.6 +/- 11.0 ml, P < 0.05), Theree was, no significant difference in pain scores between two menstrual phases. CONCLUSIONS: This study demonstrates that there is less postoperative pain experienced by patients that are in the luteal phase of their menstrual cycle at the time of surgery than in patients that were in the follicular phase of their menstrual cycle, however, the results of this study did not reveal a relationship between the blood concentration of female hormones and postoperative pain.
Analgesia, Patient-Controlled ; Analgesics ; Estrogens ; Female* ; Follicular Phase ; Gynecologic Surgical Procedures ; Humans ; Luteal Phase ; Menstrual Cycle* ; Pain, Postoperative* ; Progesterone

BACKGROUND: Backache is a common complication following anesthesia and surgery. Previous studies indicated that the use of a lumbosacral wedge was effective in reducing the incidence of postoperative backache. We investigated the effective inflation pressure of an inflatable wedge in preventing postoperative backache following spinal anesthesia and surgery in the lithotomy position. METHODS: A pilot study established a mean comfortable pressure for the wedge when used to support the lumbar curvature. In males and females, the mean pressure values were 23.6 +/- 3.1 mmHg and 18.9 +/- 3.7 mmHg, respectively. The design of the main study was a randomized, controlled trial involving the use of a wedge intra-operatively in patients undergoing spinal anesthesia and urological surgery in the lithotomy position. Fifty male and 50 female patients were included in the main study and randomly allocated to the control or study group. In the study group, the wedge was inserted immediately after the induction of anesthesia and maintained during surgery. On the first day after surgery, all patients were asked whether they had backache. If there was backache, the degree of pain was noted using the numeric rating scale (NRS). RESULTS: In the study and control groups of male patients, the incidence of backache was 16% and 24%, respectively. There was no significant difference between the two groups. In the study and control groups of female patients, the incidence of backache was 20% and 52%, respectively (P < 0.05). Where backache occurred, there was no significant difference in its severity between the study and control groups. CONCLUSIONS: The effective pressure value of an inflatable wedge in preventing postoperative backache following spinal anesthesia and surgical operation in lithotomy position was 19 mmHg in female patients.
Anesthesia ; Anesthesia, Spinal ; Back Pain* ; Female ; Humans ; Incidence ; Inflation, Economic ; Male ; Pilot Projects

BACKGROUND: Propofol and alfentanil are frequently combined for general anesthesia. However, hypotension and bradycardia are common during anesthetic induction and maintenance. The purpose of this study was to compare the response of different doses of ephedrine to investigate an optimal dose of ephedrine for attenuation of the hemodynamic changes. METHODS: Eighty patients of ASA physical status 1 or 2 were assigned to one of four groups. Each patient received normal saline (E0), ephedrine 0.15 mg/kg (E15), 0.2 mg/kg (E20), 0.25 mg/kg (E25) after assessment of baseline hemodynamic values. If hemodynamic parameters are stabilized after intubation, baseline values were assessed by average during 3 minutes. Then each dose of ephedrine was given to each patient. The changes in systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), and heart rate (HR) were measured every one minute for 10 minutes. RESULTS: The use of ephedrine was effective for attenuation of the hemodynamic changes. E15, E20, and E25 showed statistical difference in BP and HR compared with E0. There was no statistical difference between E20, E25. Moderate hypertension (SBP 160-179 or DBP 100-109) is occurred each 4, 6 cases in E20, E25. CONCLUSIONS: All group of ephedrine injection resulted in elevation of BP, but did not caused HR change. Injection of ephedrine 0.2 mg/kg or 0.25 mg/kg led to excessive blood pressure elevation. Therefore, we consider more than 0.15 mg/kg of ephedrine is not necessary to minimize hemodynamic changes during propofol-alfentanil anesthesia.
Alfentanil ; Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Hypotension ; Intubation ; Propofol

BACKGROUND: Laryngeal microscopic surgery is stressful as a result of the intubation and suspension laryngoscopy during the short operation time. Therefore, the objectives of the anesthesiologist are to maintain sufficient anesthetic depth, promote rapid awakening, and return the protective airway reflexes. This study compared the hemodynamic responses and recovery patterns between propofol-N2O and sevoflurane-N2O anesthesia. METHODS: Sixty outpatients undergoing laryngeal microscopic surgery were randomly divided into three groups: Endotracheal intubation with the effect-site concentration of propofol fixed at 3 ug/ml (Group P3), 4 ug/ml (Group P4) or endotracheal intubation with sevoflurane anesthesia (Group S). In all groups, the anesthesia was supplemented with up to 50% of N2O. The hemodynamic responses during intubation and suspension laryngoscopy were compared. In addition, extubation time, emergence time and the state of recovery (Steward score) were compared. RESULTS: After intubation and suspension laryngoscopy, the mean arterial pressure was significantly higher in Group S than in Groups P3 and P4 (P < 0.05). The heart rate was significantly higher in Group S than in the Group P4 (P < 0.05). The extubation times were not significantly different. However, the time for responding to a verbal command was significantly faster in Groups P3 (7.8 +/- 2.3 min) and P4 (8.8 +/- 1.9 min) than in Group S (10.6 +/- 1.8 min). The Steward score 1 min after extubation was significantly higher in Group S (P < 0.05). CONCLUSIONS: Propofol-N2O anesthesia can be useful in laryngeal microscopic surgery.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Outpatients ; Propofol ; Reflex