Chronic exposure to dexamethasone may not affect sugammadex reversal of rocuronium-induced neuromuscular blockade: an in vivo study on rats

Background@#Chronic glucocorticoid exposure is associated with resistance to nondepolarizing neuromuscular blocking agents. Therefore, we hypothesized that sugammadex-induced recovery would occur more rapidly in subjects exposed to chronic dexamethasone compared to those who were not exposed. This study evaluated the sugammadex-induced recovery profile after neuromuscular blockade (NMB) in rats exposed to chronic dexamethasone. @*Methods@#Sprague–Dawley rats were allocated to three groups (dexamethasone, control, and pair-fed group) for the in vivo study. The mice received daily intraperitoneal dexamethasone injections (500 μg/kg) or 0.9% saline for 15 days. To achieve complete NMB, 3.5 mg/kg rocuronium was administered on the sixteenth day. The recovery time to a train-of-four ratio ≥ 0.9 was measured to evaluate the complete recovery following the sugammadex injection. @*Results@#Among the groups, no significant differences were observed in the recovery time to a train-of-four ratio ≥ 0.9 following sugammadex administration (P = 0.531). The time to the second twitch of the train-of-four recovery following rocuronium administration indicated that the duration of NMB was significantly shorter in Group D than that in Groups C and P (P = 0.001). @*Conclusions@#Chronic exposure to dexamethasone did not shorten the recovery time of sugammadex-induced NMB reversal. However, the findings of this study indicated that no adjustments to sugammadex dosage or route of administration is required, even in patients undergoing long-term steroid treatment.

Effects of etomidate use in ICU patients on ventilator therapy: a study of 12,526 patients in an open database from a single center / 대한마취과학회지

Background@#There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients. @*Methods@#This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate. @*Results@#All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR, 1.84; 98.75% CI, 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]). @*Conclusions@#Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.

Effects of etomidate use in ICU patients on ventilator therapy: a study of 12,526 patients in an open database from a single center / 대한마취과학회지

Background@#There is a debate regarding the safety of etomidate. We evaluated the effects of etomidate on mortality in a large cohort of critical care patients. @*Methods@#This retrospective matched-cohort study was performed using the Medical Information Mart for Intensive Care version 3 (MIMIC-III) database. Among 12,526 adult patients who were prescribed etomidate or propofol on the first day of mechanical ventilation, 625 patients administered etomidate were statistically matched with 6,250 patients administered propofol. The primary outcome measures were all-cause in-hospital mortality, 48-hour survival, cardiovascular morbidity, and infectious morbidity. Logistic regression analysis with stepwise selection of variables was performed to examine the dose–mortality relationship of etomidate. @*Results@#All-cause in-hospital mortality was 1.84 times higher in the etomidate cohort (OR, 1.84; 98.75% CI, 1.42, 2.37). Compared to the propofol cohort, the etomidate cohort showed 57% lower odds of 48-hour survival (0.43 [0.27, 0.73]), no difference in odds of cardiovascular morbidity (0.86 [0.66, 1.12]), and 1.77 times higher odds of infectious morbidity (1.77 [1.35, 2.31]). Additionally, the odds of mortality increased by 1.36 times per 0.1 mg/kg of etomidate (1.36 [95% CI: 1.23, 1.49]). @*Conclusions@#Etomidate is a poor choice as a hypnotic drug on the first day of mechanical ventilation, as it is associated with a dose-dependent increase in all-cause mortality, and does not improve survival for the first 48 h.

Does the minimal occlusive volume technique provide adequate endotracheal tube cuff pressure to prevent air leakage?: a prospective, randomized, crossover clinical study

Background@#Methods of determining proper endotracheal tube (ETT) cuff pressure to prevent air leakage include the minimal occlusive volume (MOV) technique, which uses auscultation, and the spirometer technique, which directly measures inspiratory and expiratory breathing volumes. Spirometers may measure even small air leakage, therefore, the spirometer technique requires a higher cuff pressure than the MOV technique to completely seal the airway. This study aimed to evaluate the difference in cuff pressure between the two techniques used to seal the airway. @*Methods@#Thirty-five female patients were intubated using an ETT with a cuff, and cuff inflation was performed with both techniques at a 10-min interval in random order—the MOV technique and then the spirometer technique or vice versa. The cuff pressure was measured at each period. @*Results@#The cuff pressures were 16.7 ± 1.2 cm H2O and 18.7 ± 1.3 cm H2O for the MOV and spirometer techniques, respectively. The cuff pressure for the spirometer technique was 2 cm H2O higher than that for the MOV technique and this difference was statistically significant (95% confidence interval, 0.7–3.3; P = 0.003). Considering the upper end (3.3 cm H2O) of the 95% confidence interval and the size of one scale unit (2 cm H2O) of a manometer, the difference in cuff pressure was up to 4 cm H2O in practice. @*Conclusions@#Even though the air leakage sound disappears on auscultation, unlike the previous recommendation, the airway sealing would be completed only by increasing the cuff pressure by approximately 4 cm H2O.

Accuracy of three-dimensional cephalograms generated using a biplanar imaging system / 대한치과교정학회지

OBJECTIVE: Biplanar imaging systems allow for simultaneous acquisition of lateral and frontal cephalograms. The purpose of this study was to compare measurements recorded on three-dimensional (3D) cephalograms constructed from two-dimensional conventional radiographs and biplanar radiographs generated using a new biplanar imaging system with those recorded on cone-beam computed tomography (CBCT)-generated cephalograms in order to evaluate the accuracy of the 3D cephalograms generated using the biplanar imaging system. METHODS: Three sets of lateral and frontal radiographs of 15 human dry skulls with prominent facial asymmetry were obtained using conventional radiography, the biplanar imaging system, and CBCT. To minimize errors in the construction of 3D cephalograms, fiducial markers were attached to anatomical landmarks prior to the acquisition of radiographs. Using the 3D Ceph™ program, 3D cephalograms were constructed from the images obtained using the biplanar imaging system (3D cephbiplanar), conventional radiography (3D cephconv), and CBCT (3D cephcbct). A total of 34 measurements were obtained compared among the three image sets using paired t-tests and Bland–Altman plotting. RESULTS: There were no statistically significant differences between the 3D cephbiplanar and 3D cephcbct measurements. In addition, with the exception of one measurement, there were no significant differences between the 3D cephcbct and 3D cephconv measurements. However, the values obtained from 3D cephconv showed larger deviations than those obtained from 3D cephbiplanar. CONCLUSIONS: The results of this study suggest that the new biplanar imaging system enables the construction of accurate 3D cephalograms and could be a useful alternative to conventional radiography.

Characteristics of the similarity index in a Korean medical journal / 대한마취과학회지

BACKGROUND: Journal editors have exercised their control over submitted papers having a high similarity index. Despite widespread suspicion of possible plagiarism on a high similarity index, our study focused on the real effect of the similarity index on the value of a scientific paper. METHODS: This research examined the percent values of the similarity index from 978 submitted (420 published) papers in the Korean Journal of Anesthesiology since 2012. Thus, this study aimed to identify the correlation between the similarity index and the value of a paper. The value of a paper was evaluated in two distinct phases (during a peer-review process vs. after publication), and the value of a published paper was evaluated in two aspects (academic citation vs. social media appearance). RESULTS: Yearly mean values of the similarity index ranged from 16% to 19%. There were 254 papers cited at least once and 179 papers appearing at least once in social media. The similarity index affected the acceptance/rejection of a paper in various ways; although the influence was not linear and the cutoff measures were distinctive among the types of papers, both extremes were related to a high rate of rejection. After publication, the similarity index had no effect on academic citation or social media appearance according to the paper. CONCLUSIONS: The finding suggested that the similarity index no longer had an influence on academic citation or social media appearance according to the paper after publication, while the similarity index affected the acceptance/rejection of a submitted paper. Proofreading and intervention for finalizing the draft by the editors might play a role in achieving uniform quality of the publication.

Comparison of the endotracheal tube intracuff pressure with cylindrical and tapered cuffs during nitrous oxide exposure: a randomized single-blinded clinical study

BACKGROUND: Tracheal complications caused by excessive mucosal pressure from an inflated endotracheal tube are major concerns during anesthesia; hence, an intracuff pressure of 20–30 cmH₂O is recommended as a clinically acceptable intracuff pressure. Diffusion of nitrous oxide (N₂O) into the endotracheal tube cuff increases the intracuff pressure, which may also be influenced by the cuff shape. Therefore, we investigated whether the intracuff pressure of a tapered cuff was different from that of a cylindrical cuff in patients undergoing general anesthesia using 60% N₂O. METHODS: Twenty-six patients who underwent general anesthesia using 60% N₂O in supine position were randomly allocated to the cylindrical cuff group (Group C) or tapered cuff group (Group T). The baseline intracuff pressure was set at 20 cmH₂O, and measured every 10 minutes for 60 minutes. RESULTS: The primary outcome was the intracuff pressure at 60 minutes after N₂O exposure, which was 40 cmH₂O in Group C (95% CI 36–44) and 40 cmH₂O (95% CI 35–45) in Group T (P = 0.895). The lower confidence limit of the intracuff pressures in both groups exceeded 30 cmH₂O at 60 minutes of N₂O exposure, which is the upper limit for clinically acceptable intracuff pressure (20–30 cmH₂O). CONCLUSIONS: There was no significant difference in the intracuff pressures between cylindrical and tapered cuffs. Continuous or frequent monitoring is recommended regardless of the duration of the 60% N₂O exposure because the intracuff pressure can exceed 30 cmH₂O within an hour.

Occlusal Surface Analysis of Mandibular Premolars in Koreans / 체질인류학회지

The aim of this study was to investigate the characteristics of mandibular premolars regarding size and morphology in Koreans. Moreover, comparisons of gender difference in mandibular premolars were examined to expand anatomical database in Koreans. Data was obtained from students in School of Dentistry, Chonnam National University, Gwangju, Korea. The total number of participants was 66 (33 men and 33 women) and dental casts were fabricated. A total of nine items was investigated using a digital measuring software. Five measurements were performed including intercuspal distance (ID), buccolingual diameter (BL), mesiodistal diameter (MD), total crown area, and each cusp area. One item as each cusp area ratio was calculated, and three items were observed including the number of lingual cusp, occlusal groove patterns, and mesiolingual developmental groove. Comparison measurements were analyzed using paired t-tests, independent t-tests and Pearson correlation tests. Average values in mandibular second premolars were larger than first premolars in most of measurements with a significance with the exception of mesiodistal diameter (p=0.223). Overall average values were significantly higher in male than in female except intercuspal distance (p=0.607) and lingual cusp area (p=0.070) in mandibular premolars. The presence of mesiolingual developmental grooves in the first premolars was 59.1% (male 51.5%, female 66.7%). The most common occlusal groove patterns of the second premolar were a Y pattern, followed in order by H and U patterns. These results provide valuable morphological characteristics of mandibular premolars in Koreans.

Clinical Manifestations and Prognostic Factors of IgA Nephropathy with Long-Term Follow-Up / 대한내과학회지

BACKGROUND/AIMS: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis worldwide. Although several studies have identified IgAN prognostic factors in Korea, the follow-up period was insufficient to evaluate the natural history of IgAN. METHODS: A total of 471 patients were diagnosed with IgAN after percutaneous renal biopsy between April 1985 and March 2003. Patients with secondary IgAN and patients with a follow-up 1.3 mg/dL, estimated glomerular filtration rate or = 1 g/day, and severe renal pathology by the Haas sub-classification were significantly associated with ESRD. When these factors were included in multivariate Cox regression analyses, only severe renal pathology by the Haas sub-classification was an independent prognostic factor for IgAN. CONCLUSIONS: Careful follow-up and treatment is recommended, particularly in patients with IgAN and severe renal pathology by the Haas sub-classification.

A Case of Complete Recovery from Late Insidious Type of Acute Phosphate Nephropathy / 대한내과학회지

The widespread use of colonoscopy for early detection of colorectal pathology has increased the use of osmotic laxatives for colonic cleansing. Among these, oral sodium phosphate preparations can cause renal insufficiency through the development of acute phosphate nephropathy. Acute phosphate nephropathy can be distinguished as early symptomatic and late insidious patterns. Patients whose presentation is insidious are easily overlooked and can progress to chronic kidney disease. We report a case of complete recovery from the late insidious type of acute phosphate nephropathy.

Complication of Augmentation Mammoplasty using Polysaccharide Hydrogel Breast implant: Two Cases Report

After the use of silicone-filled breast implant was restricted in 1992, PIP Hydrogel (Poly Implant Prosthesis, France) was temporarily used as an alternative which is an organic polymer of polysaccharide and water. This case report draws attention to an unusual presentation following the insertion of a PIP Hydrogel implant for breast augmentation. The first case is about 43-year-old woman who has undergone breast augmentation using PIP Hydrogel implant was admitted to the hospital because of painful swelling in her right breast. On examination, the right breast was larger than the left. At the operation, it was found that the implant on the right side has a large tear in the shell. And the other case is about 47-year-old woman who had capsular contracture on the outer-lower quadrant of both breasts. She came to our institution to replace bigger implants. We removed existing both breast implants (170cc, subglandular), and replaced cohesive gel implant (300cc, submuscular). From 1992 to 2000, the breast implant filled with a polysaccharide gel had been widely used because of its viscoelastic properties and biodegradability. However, there is no long-term safety data that the filler material as a polysaccharide hydrogel is toxic to humans or not. We wish to highlight its unpredictability and unreliability.