Comparison of postoperative renal and hepatic function between desflurane-remifentanil and propofol-remifentanil for nephrectomy

BACKGROUND: Choice of anesthetics in patients with a history of nephrectomy is very important for anesthesiologists. It is important for the anesthesiologist to preserve the ipsilateral kidney function and minimize deleterious effects. This study was performed to compare anesthetic agents on postoperative renal and hepatic function in patients who underwent nephrectomy. METHODS: From 2008 to 2012, 116 patients who underwent nephrectomy in our hospital were evaluated through a retrospective study. Anesthesia was maintained with desflurane-remifentanil in the desflurane group (Group D), and propofol-remifentanil, using a target controlled infusion pump (Group T). In order to evaluate postoperative renal and hepatic function, blood urea nitrogen (BUN), serum creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was measured preoperatively, postoperative day 1, 3 and 7. RESULTS: When compared to preoperative measures, Cr and BUN levels were elevated on postoperative day 1, 3 and 7 while eGFR was decreased in both groups. There was no significant difference between the two groups. AST and ALT were also mildly elevated on postoperative day 1, 3 and 7 in both groups. There was also no significant difference between the two groups. CONCLUSIONS: Anesthesia with desflurane-remifentanil or propofol-remifentanil alter postoperative renal and hepatic function with no significant difference between groups. Both desflurane and propofol may be chosen for general anesthesia undergoing nephrectomy patients.

Comparison of postoperative renal and hepatic function between desflurane-remifentanil and propofol-remifentanil for nephrectomy

BACKGROUND: Choice of anesthetics in patients with a history of nephrectomy is very important for anesthesiologists. It is important for the anesthesiologist to preserve the ipsilateral kidney function and minimize deleterious effects. This study was performed to compare anesthetic agents on postoperative renal and hepatic function in patients who underwent nephrectomy. METHODS: From 2008 to 2012, 116 patients who underwent nephrectomy in our hospital were evaluated through a retrospective study. Anesthesia was maintained with desflurane-remifentanil in the desflurane group (Group D), and propofol-remifentanil, using a target controlled infusion pump (Group T). In order to evaluate postoperative renal and hepatic function, blood urea nitrogen (BUN), serum creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was measured preoperatively, postoperative day 1, 3 and 7. RESULTS: When compared to preoperative measures, Cr and BUN levels were elevated on postoperative day 1, 3 and 7 while eGFR was decreased in both groups. There was no significant difference between the two groups. AST and ALT were also mildly elevated on postoperative day 1, 3 and 7 in both groups. There was also no significant difference between the two groups. CONCLUSIONS: Anesthesia with desflurane-remifentanil or propofol-remifentanil alter postoperative renal and hepatic function with no significant difference between groups. Both desflurane and propofol may be chosen for general anesthesia undergoing nephrectomy patients.

The difference in the dose of vasoactive drugs and rocuronium according to the general anesthesia method during open gastrectomy

BACKGROUND: Recently, balanced anesthesia (BA: halogenated volatile anesthetics + remifentanil) has been useful for abdominal surgery. The authors therefore performed a retrospective study about the difference in the dose of vasoactive drugs and rocuronium according to the general anesthesia type. METHODS: BA was compared with inhalational anesthesia (IA: halogenated volatile anesthetics + N2O) and total intravenous anesthesia (TIVA: propofol + remifentanil). The records of a total of 415 patients (IA : TIVA : BA = 126 : 157 : 132) who received open gastrectomy between 2004 to 2010 were analyzed. The types of vasoactive drugs and dosage as well as infusion time were calculated. The total amounts of vasoactive drugs were scored by two different methods. Infusion drugs were scored as 30 points, whereas bolus drugs were scored as 5 points. Drug score is the total sum of each score, where each drug score point split either into Plus or Minus. Plus means raising the blood pressure whereas Minus means the opposite. For rocuronium dosage, a total of 286 patients (IA : TIVA : BA = 89 : 78 : 119) who met the criteria were enrolled, and this formula was used (total rocuronium/weight/time, microg/kg/hr). RESULTS: The BA group showed a lower (P = 0.01) Minus score (1.8 +/- 4.0) compared to the IA group (3.6 +/- 5.2). Less amount of rocuronium (P = 0.001) was administered in the BA (327 +/- 72 microg/kg/hr), compared to the IA (368 +/- 93 microg/kg/hr) and TIVA (356 +/- 81 microg/kg/hr). CONCLUSIONS: BA seems to require less hypotensive agent and rocuronium compared with IA and TIVA for open gastrectomy. But, well-designed prospective studies are required.

Adequate sevoflurane concentrations in inhalation induction of sevoflurane following administration of remifentanil / 대한마취과학회지

BACKGROUND: Currently, sevoflurane and remifentanil are utilized frequently for the inhalation induction of anesthesia. However, there is currently an insufficient amount of clinical data regarding the inhalation induction of sevoflurane after the administration of remifentanil. METHODS: 80 patients undergoing elective surgery were allocated randomly to four groups. Group A inhaled only sevoflurane at 8 vol%. Other groups were administered 3 ng/ml of remifentanil and inhaled sevoflurane at 8 vol% (group B) or 6 vol% (group C) or 4 vol% (group D). All groups also received 0.6 mg/kg of rocuronium. The blood pressure and heart rate were measured at pre-induction, and before and after tracheal intubation. After operation, the patients??levels of satisfaction with the inhalation induction were evaluated. RESULTS: The time to loss of consciousness was substantially longer in group D than in the other groups, but no significant differences were noted among the groups in terms of satisfaction scores. The HR in groups B, C and D increased significantly after pre-intubation as compared to baseline in group A. The HR decreased significantly during induction as compared to group A. The MAP in groups B, C and D decreased significantly at 1 and 2 minutes after tracheal intubation as compared to group A. In group D only, we noted no significant differences in the MAP as compared to baseline at 1, 2 minutes after tracheal intubation. CONCLUSIONS: 4 vol% sevoflurane was a more appropriate concentration for the inhalation induction of anesthesia when coupled with 3 ng/ml of remifentanil.

An Anesthetic Experience in a Patient with Niemann-Pick Disease: A case report / 대한마취과학회지

Niemann-Pick disease (NPD) is an autosomal recessive, lipid storage disorder caused by the deficiency of the lysosomal enzyme sphingomyelinase or defective cholesterol transport from lysosome to cytosol. The clinical symptoms and signs include dysphagia, loss of motor function, hepatosplenomegaly, recurred respiratory infections, seizure, mental retardation, spasticity, myoclonic jerks and ataxia, but vary depending on the type of this disease. We report a successful anesthetic experience, including endotracheal intubation with Glidescope under propofol and remifentanil infusion without neuromuscular blockade, in a 21-year old woman with Niemann-Pick disease for wound revision of gastrostomy site.

Comparison of intubating conditions according to different doses of rocuronium during propofol-remifentanil target controlled infusion / 대한마취과학회지

BACKGROUND: Many studies have shown that tracheal intubation can be facilitated by propofol-remifentanil without muscle relaxant. But low dose of rocuronium can improve intubating condition and reduce the requirement of remifentanil. This study evaluated the optimal dose of rocuronium for tracheal intubation according to different doses of rocuronium during propofol-remifentanil target controlled infusion (TCI). METHODS: Sixty, ASA I-II patients were randomly divided into three groups (n = 20). Anesthesia was induced with remifentanil 3.0 ng/ml and propofol 3.5 microgram /ml target controlled infusion. After patients lost consciousness, rocuronium was administrated 0.6 mg/kg (R0.6), 0.45 mg/kg (R0.45), 0.3 mg/kg (R0.3) for each group. Three minutes later, a laryngoscope and tracheal intubation were tried, intubating condition were measured. Also blood pressure and heart rate were measured before induction, preintubation, postintubation. RESULTS: Clinically acceptable intubation condition (excellent or good) were observed 100%, 100%, 85% of patients in the R0.6, R0.45, and R0.3 groups. Eighty five percents of patients in groups R0.6, R0.45 had excellent intubation condition. But only 35% in group R0.3 showed excellent intubating condition (P < 0.05) and 15% in group R0.3 showed poor intubating condition. There were no significant elevation mean blood pressure (MBP), heart rate (HR) after tracheal intubation in all groups. And there were no significant differences among groups. CONCLUSIONS: The optimal dose of rocuronium for clinical acceptable intubating condition could be reduced to 1.5 x ED(95) under total intravenous anesthesia with remifentanil 3.0 ng/ml and propofol 3.5 microgram/ml target controlled infusion.

Post-thoracotomy Analgesia & ICU Length of Stay: Comparison of Thoracic Epidrual Morphine Infusion and Lumbar Epidural Plus Intravenous Morphine Infusion / 대한구급학회지

BACKGROUND: Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group). METHODS: Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed. RESULTS: There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital. CONCLUSIONS: Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.

Comparison of the Effects of Propofol and Ketamine on Respiratory Mechanics during Anesthetic Induction in Children / 대한마취과학회지

BACKGROUND: Propofol and ketamine are believed to reduce airway resistance. The aim of the present study was to compare the effect of propofol and ketamine on respiratory mechanics after endotracheal intubation in children. METHODS: Forty pediatric patients were assigned randomly to two groups: propofol (n = 20) and ketamine (n = 20). Patients were anesthetized with propofol (2 mg/kg) or ketamine (2 mg/kg). All patients were paralyzed with rocuronium (0.8 mg/kg) and intubated and ventilated mechanically (ETCO2: 30-40 mmHg, tidal volume: 10 ml/kg, respiratory rate: 15-25 time/min). Peak inspiratory pressure (PIP), respiratory resistance (Rr), dynamic compliance (Cdyn) and expiratory tidal volume (Vte) measurements were recorded at five time points; 0.5 min after intubation without sevoflurane (baseline), following 2.5 min, 5 min, 7.5 min and 10 min of ventilation with 2% sevoflurane- 50% nitrous oxide. RESULTS: Rr at 0.5 min after intubation was 27.4 +/- 12.7 cmH2O/L/s in the propofol group, and 30.0 +/- 13.5 cmH2O/L/s in the ketamine group. Cdyn at 0.5 min after intubation was 28.0 +/- 9.9 ml/cmH2O in the propofol group, and 25.1 +/- 10.6 ml/cmH2O in the ketamine group. There was no significant difference in the response of PIP, Rr, Cdyn and Vte between two groups and within groups. CONCLUSIONS: We suggest that the effects of propofol and ketamine on respiratory mechanics were similar during anesthetic induction in children.

A Case of Pulmonary Edema which Developed after Difficult Endotracheal Intubation of Hunter Syndrome: A Case Report / 대한구급학회지

Hunter syndrome is one of the mucopolysaccharidoses, characterized by abnormal accumulation and deposition of mucopolysaccharides in the tissues of several organs which are known to complicate anaesthetic and airway management. We experienced a case of pulmonary edema which developed during induction of general anesthesia of Hunter syndrome after several attempts of intubation and airway obstruction.

Temperature Changes and Shivering during Epidural Anesthesia in Women Undergoing Cesarian Delivery / 대한마취과학회지

BACKGROUND: Epidural anesthesia decreases the core temperature triggering vasoconstriction and shivering, presumably by increasing apparent lower-body temperature. We therefore tested the hypothesis that epidural anesthesia in cesarian delivery patients decrease forearm-fingertip skin-surface temperature gradient and it is cause of shivering. METHODS: Twenty-two healthy pregnant women were studied. Epidural anesthesia was induced by 2% lidocaine and 0.75% ropivacaine 24 ml (T4 level) at 25degrees C ambient temperature. Shivering were evaluated by observation. Core temperature was recorded in the external auditory canal using a compensated infrared thermometer. Arteriovenous shunt tone was evaluated with forearm- fingertip temperature gradients; gradients less than 0 were considered evidence of vasodilation. Skin-surface temperature, skin- temperature gradients (forearm-fingertip, calf-toe) and the presence or absence of shivering were measured. RESULTS: Shivering was observed in seven of twenty two patients. Sixty minutes after induction, Tympanic temperature decreased for 0.8 +/- 0.1degrees C in non-shivering patients and 0.9 +/- 0.1degrees C in shivering patients. Forearm temperature decreased for 0.2 +/- 1.7degrees C in non-shivering patients, but increased for 0.5 +/- 0.6degrees C in shivering patients. Upper limb (Forearm-fingertip) skin Temperature gradients continues the plus in non-shivering patients, but maintain minus (45 minutes after induction) in shivering patients. Low limb skin temperature is increases in both group. CONCLUSION: We failed to confirm our hypothesis, but for an expected reason: shivering was preceded by hypothermia and vasoconstriction in the arm. For prevention of hypothermia in epidural anesthesia, not to be monitored core temperature, but also upper limb skin temperature gradients.

Analysis of Factors related to Postoperative Nausea and Vomiting after Laparoscopic Hysterectomy / 대한마취과학회지

BACKGROUND: Despite new anesthetic drugs and antiemetics, the incidence of postoperative nausea and vomiting remains between 20% and 70%. The authors tested the hypothesis that seasonal diet and temperature change and preoperative gastric emptying time affects the incidence of postoperative nausea and vomiting. METHODS: We conducted a retrospective cohort study of 626 women had undergone laparoscopic hysterectomy. Patients were anesthetized with nitrous oxides and inhalation anesthetics or propofol and injected butorphanol or nalbuphine or patient-controlled analgesia for postoperative pain control. Data were collected from records of recovery room and ward nurse's record and analysed with student t-test or chi-square test and logistic regression. Results are presented as mean +/- SD; P <0.05 was considered significant. RESULTS: The incidence of PONV was 19.2%. Younger age, intraoperative dehydration, non-anemic preoperative state, usage of nalbuphine increase the incidence of PONV. But the incidence of PONV was not increased by type of anesthetic agent (inhalation or propofol), BMI, duration of operation, preoperative gastric emptyng time. CONCLUSION: There are controversy in cause of PONV. Further well-controlled, double-blind prospective study may be needed.

Core Temperature and Skin-Surface Temperature Gradients of Ketamine and Propofol for Anesthetic Induction in Children / 대한마취과학회지

BACKGROUND: Hypothermia after induction of anesthesia results initially from core-to-peripheral redistribution of body heat. Both central inhibition of tonic thermoregulatory vasoconstriction in arteriovenous shunts and anesthetic induced vasodilation contribute to core-to-peripheral redistribution of heat. Ketamine increases peripheral arteriolar resistance uniquely; in contrast, propofol causes profound venodilatation that other anesthetics do not. The aim of the present study is to evaluate core temperature and skin-surface temperature gradients in use of ketamine for anesthetic induction compared with propofol in children. METHODS: Forty pediatric patients of ASA status I or II, undergoing elective surgery for strabismus or inguinal hernia were studied. The patients were allocated randomly to one of two groups: (i) GROUP P (n = 20): Anesthesia was induced with propofol and maintained with sevoflurane in combination with 60% nitrous oxide in oxygen. (ii) GROUP K (n = 20): Anesthesia was induced with ketamine and maintained with sevoflurane in combination with 60% nitrous oxide in oxygen. Core temperature, forearm skin temperature, fingertip skin temperature and Forearm minus fingertip, skin-temperature gradients were recorded before induction of anesthesia, 3 min after administering ketamine or propofol (just before endotracheal intubation), 5 min, and at 5-min intervals after induction of anesthesia. RESULTS: After induction of anesthesia, core temperature in the two groups was decreased but results did not differ significantly between two groups. Forearm skin temperature was increased significantly after 20 min of anesthesia in propofol group and 15 min of anesthesia in ketamine group, but results did not differ significantly between two groups. Finger tip skin temperature was increased significantly after 3 min of anesthesia in the propofol group and 10 min of anesthesia in the ketamine group. Finger tip skin temperature of 5 min of anesthesia in propofol group increased significantly greater than in ketamine group. Forearm minus finger skin surface temperature gradients was decreased statistically significantly at 3 min of anesthesia in the propofol group and 10 min of anesthesia in the ketamine group, gradients of 5 min of anesthesia was presented statistically significant between two groups. CONCLUSIONS: For pediatric patients, after induction of anesthesia with ketamine arteriovenous shunt vasomoter status was well maintained. And maintaining vasoconstriction during induction of anesthesia reduced the magnitude of redistribution hypothermia.

The Neuromuscular Effects of Glucocorticoid Administration on the Skeletal Muscle of Rats / 대한마취과학회지

BACKGROUND: The administration of high doses of glucocorticoids can produce significant side effects including skeletal muscle atrophy, weakness and aberrant pharmacology. However, available reports have yielded conflicting results ranging from facilitatory to no change to inhibitory action of glucocoticoids on neuromuscular transmission. Also, the mechanisms for such changes are not known. Therefore, this study investigated the changes in muscle contractility and pharmacology after prednisolone administration in vivo. METHODS: With institutional approval, Sprague-Dawley rats were randomly allocated to 3 treatment groups, namely prednisolone (10 mg/kg daily for 7 days), saline control (equal volume of saline daily for 7 days) and an age-matched food-restriction group which grew at the same rate as the prednisolone group. On day 8 the rats were anesthetized, mechanically ventilated and the twitch response of the tibialis muscle to supramaximal stimulation of the sciatic nerve at 2 Hz for 2 sec every 12 sec, or at 50 or 100 Hz tetanus for 5 sec were monitored. The peak twitch and tetanic tensions were measured and tetanic fade was calculated. The cumulative dose-response curves of d-tubocurarine (d-TC) in the tibialis muscles were determined. The tibialis muscle weight relative to body weight was measured (muscle index), and the tension per unit muscle mass (i.e., specific tension) was calculated. The control and treatment groups were compared by a one way ANOVA test and P>0.05 was regarded as significant. RESULTS: Prednisolone caused a decline in growth rate and the ED50 of dTC relative to saline. Food-restriction caused a decline in growth rate and an increase in muscle index relative to saline, and a decline in tension relative to prednisolone. CONCLUSIONS: These results indicate that prednisolone can alter the sensitivity of skeletal muscles to dTC even without or before changes in neuromuscular contractility become apparent. Therefore, titration of doses of nondepolarizing neuromuscular blocking agents may be indicated in patients receiving glucocorticoid therapy.

Myoclonic and Tonic-Clonic Seizures after Propofol Sedation during a Brachial Plexus Block: A case report / 대한마취과학회지

Propofol has become a popular intravenous agent for the induction and maintenance of total intravenous anesthesia (TIVA). However, the pro- or anticonvulsant properties of propofol remain controversial and abnormal muscle movement and convulsive activity are possible side-effects. We report a case in which a healthy 42-year-old man developed myoclonic and tonic-clonic seizures related to the use of propofol for sedation during a brachial plexus block.

Myoclonic and Tonic-Clonic Seizures after Propofol Sedation during a Brachial Plexus Block: A case report / 대한마취과학회지

Propofol has become a popular intravenous agent for the induction and maintenance of total intravenous anesthesia (TIVA). However, the pro- or anticonvulsant properties of propofol remain controversial and abnormal muscle movement and convulsive activity are possible side-effects. We report a case in which a healthy 42-year-old man developed myoclonic and tonic-clonic seizures related to the use of propofol for sedation during a brachial plexus block.

Effect of Lidocaine and Ketorolac on Propofol Injection Pain / 대한마취과학회지

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketorolac pretreatment on propofol injection pain. METHODS: Sixty children, aged 7 - 12 years, scheduled for general anesthesia were randomly divided into three groups; saline group (n = 20), lidocaine group (n = 20), and ketorolac group (n = 20). All patients were inserted with a 20 G or 22 G angiocatheter into the veins on the dorsal hand or antecubital fossa. After applying an arm tourniquet at an inflation pressure of 30 - 40 mmHg, the saline group received 2 ml of 0.9% saline, the lidocaine group received lidocaine 0.75 mg/kg mixed with 2 ml of 0.9% saline, and the ketorolac group received ketorolac 0.75 mg/kg mixed with 2 ml of 0.9% saline. The tourniquet was released 1 minute later, followed by an intravenous injection of 2.5 mg/kg of propofol. Pain and involuntary movement at propofol injection and changes of blood pressure and heart rate were compared. RESULTS: 1. The incidence of pain diminished significantly in the lidocaine group (15%) and the ketorolac group (25%) compared with the saline group (80%) at the time of injection of propofol and there was no significant difference between the lidocaine group and the ketorolac group. 2. The incidence of involuntary movement diminished significantly in the lidocaine group (grade 0: 80%, grade 1: 20%, grade 2: 0%) and the ketorolac group (grade 0: 65%, grade 1: 30%, grade 2: 5%) compared with the saline group (grade 0: 10%, grade 1: 25%, grade 2: 65%) at the injection of propofol and there was no significant difference between the lidocaine group and the ketorolac group. 3. Blood pressure and heart rate significantly increased after intubation in all groups. CONCLUSIONS: From the above results, both intravenous lidocaine and ketorolac pretreatment are effective in alleviating propofol injection pain and involuntary movement, but there is no significant difference between the lidocaine group and the ketorolac group.

A Study on Modified Triple Test for Palpable Breast Mass / 한국유방암학회지

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USG, and FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION:The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.

A Study on Modified Triple Test for Palpable Breast Mass: A prospective study

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USGand FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION: The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.

Pressure Distribution on the Human Body Surface by Position Change under General Anesthesia: Preliminary report / 대한마취과학회지

BACKGROUND: While sleeping, humans frequently change their position; this is done to avoid direct and excessive pressure on the body surface, and is considered to be very important for the prevention of pressure sores. A patient who is under general anesthesia, however, cannot perform this reflex movement; maintaining the same position during an entire operation causes concentrated pressure on specific body surfaces, and this may result in complications such as allopecia, back pain, pressure sores and peripheral nerve damage. Because little is known about the relationship between surgical position and pressure on the body surface, position is in most clinical situations decided on the basis of experience and informed guesswork. In order to qualitatively and quantitatively determine weight-bearing areas, pressure on the body surface of patients was evaluated under general anesthesia. METHOD: Ten patients scheduled for elective surgery were selected for this study. They were all aged over 20 and ASA class 1. A mattress equipped with a force sensing resistor was placed on the operating table and used to determine pressure on the body surface. Pressure was measured before and after anesthesia was induced in the supine, lateral and prone position. The signal generated by this mattress was processed using an analogue-digital (AD) converter, then displayed as pressure distribution on a computer screen. Pressure points were compared qualitatively, and for quantitative measurement were digitally expressed. 'Pressure' here is mean pressure at each point calculated among ten patients. RESULTS: In the supine position, pressure was concentrated on the shoulder and sacral areas. Pressure distribution in these areas was 29.8% (shoulder) and 26.0% (sacral area) before anesthesia was induced, and 20.3% (shoulder) and 25.8% (sacral area) after induction. In the lateral position, the shoulder and trochanteric areas were identified as the main weight-bearing areas; pressure distribution was 11.2% and 8.1% before induction, and 21.6% and 15.3% after induction, respectively. In the prone position, the chest and abdomen were the main weight-bearing areas. Pressure distribution in the chest area was 30.8% before induction and 24.4% after. Operating table tilt in each surgical position also produced marked changes in pressure distribution. CONCLUSIONS: In each surgical position, weight-bearing areas were qualitatively and quantitatively determined before and after anesthesia.

Effects of Epinephrine on Cardiovascular Toxicity of Bupivacaine and the Mixture of Tetracaine and Lidocaine / 대한마취과학회지

BACKGROUND: Effects of epinephrine on the cardiovascular toxicity of intravenously injected bupivacaine and mixture of tetracaine and lidocaine were studied in fifty rats. Vasoconstrictors such as epinephrine are frequently used with local anesthetics to prevent rapid vascular absorption and/or to prolong the duration of local anesthetic action. Epinephrine is also believed to antagonize the cardiovascular depressive effects induced by local anesthetics. METHODS: To determine whether the addition of epinephrine to local anesthetics protects from cardiovascular toxicity induced by intravenously administerd local anesthetics, bupivacaine, the mixture of tetracaine and lidocaine, and epinephrine were administerd to anesthetized rats with thiopental sodium i.p. For the injection of local anesthetics and epinephrine, a femoral vein was cannulated, and baseline blood gas analysis was measured. Fifty rats were randomly allocated to one of five group to receive commercially available bupivacaine(0.5%) at 4 mg/1kg(group 1), the mixture of tetracaine(0.2%) and lidocaine(0.8%) at 0.8 ml/Kg(group 2). Epinephrine(1 : 200,000) was added to group 1 for group 3, and to group 2 for group 4, respectively.In group 5, normal saline (0.8 ml/kg) and epinephrine (1 : 200,000) were administerd. Rats were classified as survivors and non-survivors. Rats with severe bradycardia, ventricular fibrillation and ventricular tachycardia were considered dead. And we measured the times to circulatory arrest in each group. RESULTS: Rats given epinephrine and bupivacaine showed the larger numbers of death than those given bupivacaine alone. Mean survival time and time to circulatory arrest were shortest in rats given bupivacaine and epinephrine. Only one rat was dead among those given normal saline and epinephrine, suggesting that epinephrine itself was not toxic. CONCLUSIONS: This study demonstrated that concomitantly administered i.v. epinephrine doesn't protect rats from local anesthetics-induced cardiovascular toxicity in spite of its non-toxic effect as shown in rats given normal saline with epinephrine.