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Purpose This study was to identify factors affecting postoperative nausea and vomiting (PONV) and to investigate the incidence of PONV for the first 24 hours after operation. Design The prospective research was performed in an 1,100-bed university hospital, from April to December, 2011. The sample consisted of 609 patients with elective surgery. Methods Factors affecting PONV were identified by multiple logistic regression. Findings Incidence of PONV was 27.1% for the first postoperative 24 hours. Insertion of nasogastric tube (OR, 4.54, P = .002), history of PONV (OR, 3.24, P P = .002), history of motion sickness (OR, 2.33, P P = .004) were high risk factors of PONV. The nonadministration of antiemetics during operation (OR, 1.70, P = .014) and nonuse of intravenous patient-controlled analgesia (OR, 1.54, P = .038) increased PONV during the first postoperative 24 hours. Conclusions Patients of female gender, history of motion sickness and PONV, general anesthesia, and nasogastric insertion are more likely to experience PONV.

Purpose: The study was conducted to identify factors affecting the intraoperative core body temperature (CBT) of surgical patients under general anesthesia. Methods: This study was performed through a prospective descriptive research design. The sample consisted of 138 patients who had undergone elective laparotomy surgery. Age, weight, height, the basal preoperative CBT, blood pressure, and heart rate were collected. CBT was again measured at induction of anesthesia, 1 hour, 2 hours, and 3 hours following induction of general anesthesia. Results: Factors affecting intraoperative hypothermia < 36˚C at 1 hour following induction, were CBT at induction and total body fat (TBF) (R 2 = .569, p < .001); at 2 hours after induction, CBT at induction and TBF (R 2 = .507, p < .001); at 3 hours after induction, CBT at induction (β = 0.34), TBF, age and the ambient temperature in the operating room (R 2 = .449, p < .001). Conclusion: CBT at induction and TBF appear to be factors affecting intraoperative CBT within 2 hours after induction of anesthesia; CBT at induction, TBF, advanced age and the ambient temperature after 3 hours following induction. We recommend keeping surgical patients warm before induction of anesthesia and providing intraoperative warming for surgical patients of advanced age with low TBF and when the duration of general anesthesia will last more than 3 hours.

Purpose This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response. Methods Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming. Results Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG (χ²=6.15, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group. Conclusion Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.

PURPOSE The study was conducted to identify preoperative factors affecting the intraoperative core body temperature in abdominal surgery under general anesthesia. DESIGN This study was performed through prospective descriptive research design. SETTING The setting was a 1300-bed university hospital in Incheon, South Korea. SAMPLES The sample consisted of 147 patients who had undergone elective abdominal surgery under general anesthesia. METHODS Age, weight, and height were collected on a preoperative visit to general unit, and body mass index, body surface area, and total body fat were calculated. The basal preoperative core body temperature (CBT), preoperative blood pressure, and heart rate were measured. Core body temperature was again measured at 1, 2, and 3 hours following general anesthesia. RESULTS Predictive factors of intraoperative hypothermia of less than 36°C were preoperative CBT (β = .44), weight (β = .41), preoperative heart rate (β = .20), and age (β = -.13) at 1 hour after anesthesia (R = 0.658, F = 68.3, P < .001); preoperative CBT (β = .33), weight (β = .37), preoperative heart rate (β = .22), and age (β = -.24) at 2 hours after anesthesia (R = 0.631, F = 60.8, P < .001); and age (β = -.34), weight (β = .36), preoperative CBT (β = .30), and preoperative heart rate (β = .20) at 3 hours after anesthesia (R = 0.665, F = 70.6, P < .001). CONCLUSION Low preoperative body temperature and low weight seem to be risk factors of intraoperative hypothermia during 2 hours after anesthesia and advanced age and low weight at 3 hours following anesthesia. IMPLICATIONS We recommend prewarming and intraoperative warming through forced air warming devices and covering a patient with a warm blanket during transportation. This procedure is necessary for the abdominal surgical patients of advanced age with low weight and duration of general anesthesia to last more than 1 hour.

수술 후 급성 통증은 수술 후 첫 72시간 동안에 발생하는 통증으로 마취 및 수술 관련 불만족의 첫 번째 요인이며(Oh, Kim, Choi, & Chung, 2005) 수술환자의 30-40%가 통증 4 이상의 중등증 통증을 경험하는 것으로 보고되어 있다(Crowe et al., 2008; McGrath et., 2004). 통증은 인체의 중요한 스트레스원으로 신경-내분비계 반응을 유도하여 노어에피네프린의 분비를 증가시켜 심혈관계 질환자에게 부담을 줄 수 있다. 또한 수술 후 통증은 심호흡과 적극적 기침을 방해하여 흡입마취 후 폐의 기능적 잔기량을 증가시키고, 호흡기 분비물의 제거를 방해하여 폐합병증을 유발시키며 조기이상을 방해하여 정맥성 혈전증의 위험을 증가시키기도 한다(Argoff, 2013; Pearse, Caldwell, Lockwood, & Hollard, 2007).

Purpose: This study was aimed to develop fee and a resource-based relative value scale (RBRVS) advanced nursing practices done by nurse anesthetists under the national health insurance. Methods: The classification of practices in Nurse Anesthetists was performed by clinical panel and then the RBRVS of nurse anesthetists for 16 advanced nursing practices was calculated by magnitude estimation method, based on their workload and working time survey in the context of the national health insurance. A cost analysis including direct labor cost and indirect cost for advanced nursing practice was performed to estimate the conversion factor (unit price) for the RBRVS of nurse anesthetists. The share of nurse anesthetists’ contribution to the feefor-service was also analyzed. Results: Calculation of the RBRVS for the 16 advanced nursing practices showed a range of points from 100 to 305.2 with an average of 175.3 points. The relevant conversion factor for advanced nursing practices of nurse anesthetists was estimated at 14.9∼19.4 Korean won. The nursing fee for 16 advanced nursing practice was calculated by multiplying the RBRVS of the each practice and the conversion factor. The contribution rate for advanced nursing practices of nurse anesthetists using the relative value scale of the national health insurance was estimated at 9.3%∼100.0% (indirect cost 10%) with the rate varying widely. Conclusion: In order to address the shortage of anesthetic staffs, the employment of nurses specializing in anesthesia is thought to bring the national interests. In addition, we believe the Nurse Anesthetist system is an effective way to prevent a shortage of anesthetic care providers in South Korea.

Purpose: This study was performed to evaluate the effect of low-dose lidocaine on fentanyl-induced cough and hemodynamic changes under general anesthesia. This research was a randomized trial design and performed using a double-blind method. Methods: Data collection was performed from October 22, 2008, to May 4, 2009. One hundred and thirty two patients were randomly assigned to control group (Con G) and experimental group (Exp G) using a table of random numbers. Exp G (n = 66) were administered 0.5 mg/kg lidocaine and Con G (n = 66)) were administered saline. The occurrence of cough and vital sign were recorded within one minute after fentanyl bolus by an anesthesiologist. Collected data were analyzed using Repeated measures ANOVA using SPSS for Windows (Version 17.0). Results: The incidence of cough in Exp G was 13.6%, while Con G was 53%. The incidence cough in Exp G was significantly lower compared to Con G ( p < .001). Lidocaine seemed not to suppress mean arterial pressure (p = .145), heart rate (p = .508), and oxygen saturation (p = .161). Conclusion: Intravenous administration of 0.5 mg/kg lidocaine seems to suppress fentanyl-induced cough without affecting mean blood pressure, heart rate and oxygen saturation. Therefore, we recommend intrave nous 0.5 mg/kg lidocaine administration to suppress fentanyl-induced cough under general anesthesia.

Purpose: Influence of benzodiazepine (midazolam)or cholinergic inhibitor (atropine or glycopyrrlate) on intra-operative body temperature remains unclear and controversial. This study compares intra-operative body temperature in 50 abdominal surgical patients under general anesthesia between the administration of midazolam and glycopyrrolate in combination, or glycopyrrolate alone. Methods: Patients who underwent abdominal surgery were recruited from September 2008 through October 2009 at Gachon University Gil hospital in Incheon. Core body temperature was measured in the right ear using a tympanic membrane thermometer at induction of general anesthesia and at 1 hr, 2 hr, and 3 hr after induction. Results: There were no differences in core body temperature at any measurement point between either patient group (F=1.08, p=.377). Core body temperature decreased throughout the 3 hr after induction in both groups (F=9.22, p

Lidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce propofol injection pain.To compare the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain.Prospective, double-blind, randomized controlled trial.The 555 bed, non-teaching National Cancer Center in Kyunggido, South Korea.A total of 96 patients who underwent thyroidectomy under total intravenous general anesthesia with propofol were randomly allocated to the control, lidocaine pre-administration (LA) or local warming (LW) group.All three groups received 2% propofol with an effect-site target at 3μg/mL for induction dose. The control group received 2% propofol with no intervention. The lidocaine pre-administration group received 2% propofol 30s after 1% lidocaine 30mg. The local warming group received 2% propofol after warming of the intravenous access site for 1min using 43°C forced air. Propofol injection pain was assessed by four-point verbal categorial scoring (VCS), numerical rating scale (NRS) and surgical pleth index (SPI).Pain VCS of the LA group (mean±SD, 1.11±0.45) was significantly reduced (U=-3.92, p.001) compared to the control group (mean±SD, 1.71±0.74). Pain VCS of the LW group (mean±SD, 0.76±0.44) was significantly reduced (U=-5.17, p.001) compared to the control group (mean±SD, 1.71±0.74). Pain VCS of the LW group was significantly reduced compared to the LA group (U=-3.33, p=.001]. Pain NRS of the LA group (mean±SD, 4.31±2.32) was significantly reduced (mean difference, 1.82; 95% CI, 0.63-3.00; p=.003) compared to the control group (mean±SD, 6.13±2.39). Pain NRS of the LW group (mean±SD, 3.06±2.37) was significantly reduced (mean difference, 3.07; 95% CI, 1.63-4.51; p.009) compared to the control group. There were significant differences in pain NRS between the LA group and the LW group (mean difference, 1.25; 95% CI, 0.09-2.42; p=.035). SPI of the LA group (mean±SD, 64.1±16.3) was significantly reduced (mean difference control versus LA, 8.36; 95% CI, 1.64-15.1; p=.016) compared to the control group (mean±SD, 72.5±9.56). SPI of the LW group (mean±SD, 55.0±16.2) was significantly reduced (mean difference control versus LW, 17.4; 95% CI, 10.8-24.0; p.001) compared to the control group. There was a significant difference in SPI between the LA group and LW group (mean difference, 9.06; 95% CI, 1.02-17.1; p=.028).Local warming of the intravenous access site by 43°C forced air for 1min is slightly more effective in reducing propofol injection pain compared to lidocaine pre-administration.

The study was conducted to identify the factors predicting catheter-related bladder discomfort (CRBD) in the postanesthesia care unit, to assess the level of CRBD and urinary catheter-related pain for the first 24 hours postoperatively, and to compare UCRP with the postoperative pain in the surgical site.About 20% of hospitalized patients receive an indwelling urinary catheter, and more than half of these patients complain of CRBD or urinary catheter-related pain.This prospective descriptive study conducted in an 800-bed university hospital involved 160 patients who had undergone elective surgery from February 5, 2012 to June 5, 2012.Demographic data including gender, age, American Society of Anesthesiologists class, weight, and height were collected on the preoperative visit. Factors predicting CRBD were identified by multiple logistic regression analysis. Comparison of the UCRP and postoperative pain was analyzed using the Mann-Whitney U test.Multiple logistic regression analysis showed that the factors predicting CRBD ≥2 30 minutes after arrival to the postanesthesia care unit were age50 years (odds ratio [OR], 4.79; P = .005), male gender (OR, 7.07; P = .015), obstetric and gynecological surgery (OR, 11.07; P = .045), and UCRP (OR, 132.3; P .015). Postoperative pain (P .001) was significantly greater than UCRP.Age50 years, male gender, open abdominal surgery, and UCRP ≥4 predict CRBD.Perioperative care providers should screen surgical patients for risk factors of CRBD during the first postoperative 12 hours.

This study was performed to identify changes in blood glucose at preoperative fasting time in surgical patients over 60 yr.Data collection was performed from July, 2008 through July, 2009. Participants consisted of 80 nondiabetic surgical patients. Blood glucose was checked from 3 to 5 times. The 5 times were 2-hr fasting on the pre-operative day (T1, n=80), 8 hr (T2, n=80), 10 hr (T3, n=17), 12 hr (T4, n=34) and 14 hr fasting on the day of the operation (T5, n=29).Of the patients, 27.5% had a blood glucose level of less than 79 mg/dL at T2; 17.6% at T3; 32.4% at T4; and 17.2% at T5. Mean blood glucose levels were 93.8 mg/dL at T1; 88.4 mg/dL at T2; 91.7 mg/dL at T3; 87.4 mg/dL at T4: and 94.1 mg/dL at T5. Blood glucose was the lowest at T2 (p.001).As 17.6-32.4% of the patients showed the blood glucose level of less than 79 mg/dL at 8-14 hr pre-operative fasting, the authors recommend that surgical patients60 yr-of-age be observed for hypoglycemia during pre-operative fasting of more than 10 hr and that surgical patients60 yr-of-age with risks for hypoglycemia be scheduled for operation within 10 hr preoperative fasting.

Background Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants. Objectives The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age. Design Randomized, double-blinded controlled trial. Participants The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I–II, and administration of patient controlled analgesia for the first 48h post-operatively. Methods The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72h post-operatively. The statistical methods included the Mann–Whitney U -test and Spearman correlation. Results There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures ( p =.036) and age ( p =.040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48h post-operative back pain. Pre-operative back pain was positively associated with 48h post-operative back pain ( p Conclusions The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.

Purpose: This study was performed to identify effects of pneumoperitoneum on hemodynamic changes of hypertensive patients undergoing laparoscopic colectomy under general anesthesia. Methods: Data collection was done from January 2 to June 10, 2008. Seventy-six patients, including 38 hypertensive patients, who had taken antihypertensive drugs more than 1 month and 38 normotensive patients undergoing laparoscopic colectomy were enrolled in this study. The hemodynamic parameters were heart rate (HR), mean arterial pressure (MAP) and cardiac output (CO) which were measured 7 times from before induction of anesthesia to 5 min after deflation of the pneumoperitoneum. Collected data were analyzed using Repeated Measures ANOVA and Bonferroni comparison method. Results: HR in the hypertensive group was significantly decreased at deflation of the pneumoperitoneum and 5 min after deflation of the pneumoperitoneum (p=.012). MAP in the hypertensive group was not different from the normotensive group (p=.756). CO in hypertensive group was significantly lower than normotensive group (p

Purpose: This study was performed to find out the effects of lidocaine or 8.4% sodium bicarbonate mixed with rocuronium on mean arterial pressure, heart rate and withdrawal movement. Methods: Data collection was performed from December 15, 2006 through May 31, 2007. Seventy-five patients with American Society Anesthesiologist (ASA) physical status I & II, under general anesthesia, were randomly assigned to 1 of 3 groups: R group (RG) received rocuronium 0.6 mg/kg; RL group (RLG), rocuronium 0.6 mg/kg mixed with 2 mL of 2% lidocaine; RS group (RSG), rocuronium 0.6 mg/kg with the same volume of 8.4% sodium bicarbonate. Mean arterial pressure, heart rate and withdrawal movement were observed from its injection until 5 min after endotracheal intubation. Results: The incidence of withdrawal movement with its corresponding injections was 72%, 40% and 4% in RG, RLG and RSG, respectively (p

Purpose: The purpose of this study was to compare the effects of ondansetron combined with dexamethasone on Post-Operative Nausea and Vomiting (PONV) and pain with ondansetron alone in patients with laparoscopy assisted vaginal hysterectomy under general anesthesia. Methods: Data were collected from April 1 through September 30, 2005 using a double blind method. Ondansetron 4 mg and dexamethasone 10 mg were administered to the experimental group (25 patients), and ondansetron 4 mg only to the control group (25 patients). The medications were administered through an intravenous line at the beginning peritoneum suture. PONV by Index of Nausea Vomiting and Retching (INVR), nausea by Visual Analogue Scale (VAS), and pain (VAS) were assessed at postoperative 1 hr, 3 hr, 6 hr, 24 hr, and 48 hr. Data were analyzed using repeated measures ANOVA, and Bonferroni methods. Results: The experimental group that received ondansetron combined with dexamethasone had less PONV (p=.048), and nausea (p=.012) than control group that received ondansetron alone. However, there was no difference in pain (p=.557) between the patients in the two groups. Conclusion: We conclude that the administration of ondansetron combined with dexamethasone is more effective than the administration of ondansetron alone to reduce PONV in patients with laparoscopic hysterectomy.

This study investigated the preemptive analgesic effects of Morphine and Ketorolac on postoperative pain, cortisol, O2 saturation and heart rate for the first 24 hr after abdominal surgery. Methods: Data collection was performed from April 1 to September 30, 2006. Forty patients undergoing a gastrectomy under general anesthesia were randomly allocated to the experimental or control group. The experimental group (20 patients) was administered Morphine and Ketorolac approximately 1 hr prior to skin incision, but the control group (20 patients) was administered Morphine and Ketorolac at peritoneum closure through a patient-controlled analgesia (PCA) pump. Postoperative pain, blood pressure, heart rate, cortisol, O2 saturation, frequency of the PCA button pressed and doses of additional analgesics were observed through post operative 24 hr. Collected data was analyzed using t-test, χ 2 test, repeated measures ANOVA, and Bonferroni methods. Results: Postoperative pain, cortisol, the frequency of PCA button pressed, and dose of additional analgesics of the experimental group were significantly lower than the control group. There were no statistical differences in blood pressure, heart rate and O2 saturation between the experimental group and control group. Conclusions: We concluded that administration of morphine and ketorolac at 1 hr prior to skin incision resulted in decreasing postoperative pain, but it didn’t affect blood pressure, heart rate or O2 saturation for 24 hr after abdominal surgery.

PURPOSE The purpose of this study was to compare the effects of intravenous fluid warming and skin surface warming on peri-operative body temperature and acid base balance of abdominal surgical patients under general anesthesia. METHOD Data collection was performed from January 4th, to May 31, 2004. The intravenous fluid warming(IFW) group (30 elderly patients) was warmed through an IV line by an Animec set to 37 degrees C. The skin surface warming (SSW) group (30 elderly patients) was warmed by a circulating-water blanket set to 38 degrees C under the back and a 60W heating lamp 40 cm above the chest. The warming continued from induction of general anesthesia to two hours after completion of surgery. Collected data was analyzed using Repeated Measures ANOVA, and Bonferroni methods. RESULTS SSW was more effective than IFW in preventing hypothermia(p= .043), preventing a decrease of HCO(3)(-)(p= .000) and preventing base excess (p= .000) respectively. However, there was no difference in pH between the SSW and IFW (p= .401) groups. CONCLUSION We conclude that skin surface warming is more effective in preventing hypothermia, and HCO(3)(-) and base excess during general anesthesia, and returning to normal body temperature after surgery than intravenous fluid warming; however, skin surface warming wasn't able to sustain a normal body temperature in elderly patients undergoing abdominal surgery under general anesthesia.

The sample comprised of 302 women over 40 years.The study lasted from February 2008 to November 2009. Data about daytime frequency and nocturia were gathered from 48 hour bladder diary. Further, a PVRV was as-sessed through a bladder ultrasonography. Data were analyzed using the t-test, Mann Whitney test, Kruskal Wallis test and multiple regression.