Background: Scrubbing of the hands and forearms with a brush and antiseptic agents has been the standard for surgical practice. However, it has been increasingly recognized that brush scrubbing may provoke side effects and that an alcohol-based hand antiseptic used in conjunction with a scrub agent enhances the effectiveness. In this study, two types of alcohol-based agents were used after a povidone-iodine (PVP-I) scrub and compared for their effectiveness. Materials and Methods: The study was conducted as a crossover trial with 20 volunteers. After hand rubbing with PVP-I, either PVP-I-ethanol rubbing or chlorhexidine gluconate-ethanol (CHG-ethanol) rubbing was used for surgical hand cleansing. Samples were collected by the modified glove juice method to count bacteria on hands. Results: In both groups, the bacterial count was significantly reduced after handwashing (p < 0.001), and the reduction was still significant after 2 h (p < 0.001 for PVP-I-ethanol and p < 0.002 for CHG-ethanol). The log₁₀ reduction factor (RF) in the PVP-I-ethanol group was significantly higher than that in the CHG-ethanol group immediately after handwashing (p < 0.001) but significantly lowered after 2 h (p < 0.01) to the level similar to that of CHG-ethanol. Although RF was lower in the CHG-ethanol group immediately after and 2 h after handwashing compared to the PVP-I-ethanol group, it did not decrease with time. Conclusion: Brushless surgical scrubbing with PVP-I-ethanol or CHG-ethanol in conjunction with PVP-I showed antiseptic effects immediately after and 2 h after handwashing. RF immediately after handwashing was significantly higher with PVP-I-ethanol compared to CHG-ethanol, but it was similar in both groups after 2 h. These results suggest that when used in combination with a PVP-I scrub, an alcohol-based hand antiseptic containing the same active agent (PVP-I in this study) has a powerful antiseptic effect; however, when it contains different antiseptic agents (i.e. CHG in this study), it should be selected carefully based on its antiseptic property.

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The relationship between changes in the core and the surface temperature and postanesthetic shivering was studied in 100 patients who underwent general anesthesia. Patients were classified into four groups by the patterns of change in the core and peripheral surface temperature. Type II and type IV groups of patients showed a decrease in surface temperature during the major operation such as gastrectomy and radical mastectomy. Type I and type III groups of patients showed no lowered peripheral surface temperature and with low temperature difference between core and surface temperature during the operation. The patients in type II and IV groups showed increased difference between core and surface temperature. The postanesthetic shivering occurred at significantly higher rate compared to the other two groups. As possible reasons of the shivering, operation of long duration and insufficient circulating blood volume were considered. Shivering reduces the temperature difference in the thermoregulatory homeostasis. However, in patients in type I and III, the rate of shivering was low. Evaluation of the difference between core and peripheral surface temperature may be important to manage body temperature at a steady level during the operation. The monitoring of body temperature difference between core and peripheral surface during the operation may be useful for predicting to occurrence of postanesthetic shivering.

within the hospital. A puncture was made without any difficulty between L3 and L4 by using a disposable 25G needle for spinal anesthesia, and 2 ml of 0.3% dibucaine HCl was injected by using a 5-ml glass syringe that had been sterilized in the hospital. At the completion of the surgical procedure, the patient experienced mild nausea. In the ward 3 h after spinal anesthesia, she developed nausea, headache, a slight fever, and chills. Five hours later, her temperature returned to 37.6°C.A neurological examination was conducted the next day, and no abnormalities of the cranial nerves were recognized; however, headache, nuchal rigidity, and positive Kernig sign were noted. Hematological examination revealed an inflammatory state (white blood cell count, 9990 · mm Ϫ3 ; C-reactive protein, 2.6 mg·dl Ϫ1 ). The results of a lumbar puncture indicated the following: cerebrospinal fluid, slightly turbid; initial pressure, 175 mmH 2 0; cell counts 664/3 mm 3 (poly, 400 and mono, 264); protein, 152 mg·dl Ϫ1 ; sugar, 57 mg·dl Ϫ1 . The patient was treated with piperacillin sodium for 8 days under the diagnosis of meningitis. The cerebrospinal fluid culture yielded no bacterial growth. On the fifth day, she no longer suffered from neurological sequelae and was considered to have recovered completely. Case 2At 12 weeks and 6 days of pregnancy, a 24-year-old woman with cervical incompetence that had been caused by cervical conization was scheduled to undergo cervical cerclage under spinal anesthesia to prevent premature labor. Following handwashing and disinfection, the anesthetic procedure was performed in the same way as in Case 1 using the same drug and equipment set.Throughout the surgical procedure and after the patient was returned to the ward, no changes in vital signs were noted and she reported no subjective symptoms. However, nausea and vomiting developed 90 min and headache 2 h after spinal anesthesia. Twelve hours after

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