• The Korean Journal of Pain
• /
• 제19권1호
• /
• pp.87-90
• /
• 2006

Background: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. Methods: In a double blind randomized controlled trial, 50 patients received either fentanyl $0.3{\mu}g/kg/h$ and ketamine 0.1 mg/kg/h (Group FK) or fentanyl $0.3{\mu}g/kg/h$, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl $50{\mu}g$. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. Results: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. Conclusions: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

• Journal of Gastric Cancer
• /
• 제3권4호
• /
• pp.182-185
• /
• 2003

Purpose: Preoperative staging of gastric cancer is crucial because the treatment modality and the prognosis depend upon the stage of gastric cancer. Current treatment modalities for early gastric cancer have focused on the quality of life. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) are commonly used diagnostic tools to evaluate the invasiveness (T stage) of the primary tumor. The purpose of this paper is to evaluate the sensitivity and the specificity of preoperative EUS and CT in comparison with postoperative pathology. Materials and Methods: From October 2001 to October 2002, EUS and abdominal CT were performed simultaneously on 75 patients who underwent radical gastric surgery for the treatment of gastric cancer. Through analyzing the clinical T stage and the pathologic T stage, We evaluated the diagnostic sensitivities and specificities of endoscopic ultrasonography and abdominal computed tomography. Results: The male-to-female sex ratio was 1 : 0.6 (males: 47, females: 28). The mean age was 55.4 years in males (range: $28\~81$) and 54.4 years in females (range: $23\∼77$). The clinical T stage based on EUS included 22 T1mm, 7 T1sm, 22 T2, and 24 T3. The clinical T stage based on CT included 20 Tx, 23 T2, and 32 T3. The permanent pathologic report confirmed 23 T1mm, 10 T1sm, 17 T2, 24 T3, and 1 T4. The sensitivity and specificity of EUS were $84.2\%\;and\;94.7\%$, respectively. However, the sensitivity and specificity of abdominal CT were $53.3\%\;and\;77.0\%$, respectively. Conclusion: Our data suggest that EUS is a very useful diagnostic tool for evaluating the T stage of gastric cancer because EUS has higher specificity than abdominal CT. Therefore, EUS may have a significant role as a preoperative diagnostic modality in patients undergoing minimally invasive surgery.

• 기본간호학회지
• /
• 제16권2호
• /
• pp.214-222
• /
• 2009

Purpose: The purpose of this study was to evaluate the effects of a walking-support program on the pulmonary ventilatory functions of elderly people who had undergone upper-abdominal surgery. Method: The study was a quasi-experimental research design. There were 26 partcipants who were admitted for upper-abdominal surgery to P University Hospital in B city. Walking exercise education was provided individually to the experimental group the day before their operation and 20 minutes a day for five days after the surgery using the 'Walking Exercise Guide Document'. Pulmonary ventilatory function was with FVC (Forced Vital Capacity), PEF (Peak Expiratory Flow), FEVI (Forced Expiratory Volume in 1 Second), FER (Forced Expiratory Ratio), Oxygen Saturation, and VAS (Visual Analog Scale). Results: The objective indexes of pulmonary ventilatory function were not significantly different between the two groups, but the subjective index was significantly different. Conclusion: With the above results, the walking support program could be an effective nursing intervention for improving pulmonary ventilatory function of surgical patients.

• Journal of Medicine and Life Science
• /
• 제16권1호
• /
• pp.13-16
• /
• 2019

In a patient with blunt abdominal trauma with small bowel injury, early diagnosis is clinically challenging due to unclear clinical symptoms and signs in the early stage of an injury. On the other hand, a delay of diagnosis of bowel disruption may lead to increased complication and mortality. The diagnostic laparoscopy is very useful for the evaluation of the small bowel injury. Laparoscopy can reduce unnecessary open surgery in a patient with blunt abdominal trauma with subtle symptoms and imprecise findings on abdominal computed tomography. Also it can prevent delay of treatment and be converted immediately to open surgery as soon as bowel damage is revealed. Furthermore, extracorporeal repair of small bowel via mini-laparotomy after a single incision diagnostic laparoscopy in a patient with traumatic small bowel perforation was a feasible and safe alternative to conventional laparoscopy. We are pleased to introduce successfully treated cases by extracorporeal repair of small bowel via mini-laparotomy after a single incision diagnostic laparoscopy in a patient with small bowel perforation after blunt trauma.

• 성인간호학회지
• /
• 제20권2호
• /
• pp.311-320
• /
• 2008

Purpose: The study was done to analyze the effects of aroma inhalation method on preoperative anxiety of abdominal surgical patients. Methods: The research design was a nonequivalent control group non-synchronized design. The data were collected from July 25 to October 21, 2005 at C Medical Center in Seoul. The patients were divided into two group of 24 subjects each. In order for measuring the all patient's anxiety before operation and aroma inhalation, Spidlberger(1975) trait anxiety, VAS(visual analogue scale) state anxiety, blood pressure, pulse rate were taken. After experimental group was taken aroma inhalation, VAS state anxiety, blood pressure, pulse rate were measured for two group. Results: After aroma inhalation, VAS state anxiety level, systolic blood pressure, diastolic blood pressure, pulse rate of the experimental group were decreased significantly than those of control group(p = .000, p = .000, p = .030. p = .000). Conclusion: The aroma inhalation method can be considered an effective nursing intervention that relieves the preoperative anxiety of abdominal surgical patients and stabilizes vital signs.

• The Korean Journal of Pain
• /
• 제9권1호
• /
• pp.159-165
• /
• 1996

Background: Epidural analgesia has been widely used for postoperative pain relief. However, it is not known which regimen provides the best result due to many variety. The aim of this study is to evaluate the analgesia and side effects of epidural mixute of fentanyl, bupivacaine and clonidine, as one kind of regimen. Methods: One hundred adult patients scheduled for upper abdominal surgery under general anesthesia were evaluated. Epidural catheterization was done after operation. A bolus, 0.1% bupivacaine 10 ml containing fentanlyl 100 ${\mu}g$, was administered and followed up with continuous infusion of mixture of fntanyl 600 ${\mu}g$, 0.5% bupivacaine 20ml and clonidine 150 ${\mu}g$ at a rate of 2ml/hr for 50 hours. Analgesia was assessed using VAS, PHS and PRS. Side effects and number of patients who took additional analgesics were evalutated. Plasma samples were obtained to determine fentanyl concentration. Results: After the administrations of drugs, patients pain scores decreased notably, and pain relief scores increased significantly. Minimum side effects were noted. Twenty-one patients required additional analgesics. Plasma concentration of fentanyl was 0.07~0.14 ng/ml. Conclusion: Epidural infusion of mixture of fentanyl, bupivacaine and clonidine is an effective regimen for postoperative pain relief after upper abdominal surgery.

• Archives of Plastic Surgery
• /
• 제41권6호
• /
• pp.702-708
• /
• 2014

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery. Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level. Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (${\pm}12.87$) mm, and -8.14 (${\pm}15.24$) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (${\pm}0.39$) mm and 1.37 (${\pm}0.33$) mm, and they were found at a mean depth of 9.75 (${\pm}2.67$) mm and 8.33 (${\pm}2.65$) mm, respectively. Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

• The Korean Journal of Pain
• /
• 제34권2호
• /
• pp.193-200
• /
• 2021

Background: Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. Methods: Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients' sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. Results: The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. Conclusions: Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제19권3호
• /
• pp.193-198
• /
• 2016

Purpose: Spontaneous colon perforations are usually encountered as necrotizing enterocolitis in the neonatal period, but occur rarely in infants and children without pathological conditions. This study was conducted to describe its clinical implication beyond the neonatal period. Methods: Cases of spontaneous colon perforation confirmed after the operation were reviewed retrospectively and the clinicopathological characteristics were analyzed. Clinical data were compared according to the presence of pneumoperitoneum as initial findings. Results: Eleven patients were included in the study period and showed a history of hospitalization before transfer due to management for fever, respiratory or gastrointestinal problems. Six patients showed a sudden onset of abdominal distention and only seven patients showed a pneumoperitoneum as initial radiologic findings, however there were no significant clinicopathological differences. Perforation was found evenly in all segments of the colon, most commonly at the sigmoid colon in four cases. There were no specific pathologic or serologic causes of perforation. Conclusion: When previously healthy infants and children manifest a sustained fever with a sudden onset of abdominal distention during management for fever associated with respiratory or gastrointestinal problems, there is a great likelihood of colon perforation with no pathological condition. Prompt surgical management as timely decision-making is necessary in order to achieve a good progress.

• Journal of Trauma and Injury
• /
• 제26권1호
• /
• pp.22-25
• /
• 2013

Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.