The Comparison of Sedation Quality, Side Effects, and Recovery Profiles of Propofol Alone, Propofol-Fentanyl and Porpofol-Ketamine PCS for MAC / 대한마취과학회지

BACKGROUND: Propofol has been the most widely used IV adjuvant during Monitored anesthesia care (MAC), even though it lacksanalgesic properties. This study was designed to compare sedation quality, side effects, and recovery profiles of propofol alone (group P), propofol-fentanyl (group PF) and propofol-ketamine (group PK) using PCS for breast biopsy procedures using local anesthesia. METHODS: Anxiety VAS, pain VAS and digit symbol substitution test (DSST) were measured in 60 excision breast biopsy patients with local anesthesia. Vital signs, respiratory (SpO2, RR, and ETCO2) variables, BIS, and OAA/S scores were recorded. Perioperative side effects (e. g., pain on injection, excessive sedation [OAA/S < 4], hypoventilation [ventilatory frequency 8 bpm], hypotension, dizziness, unpleasant feeling, Nausea) were also noted. RESULTS: There were no differences among the three PCS groups with respect to demographic data (Table 1). A/D ratio in PK group had a significant increase over P group. The incidence of excessive sedation and dizziness were significantly more frequent in the PK group patients (P < 0.05)(Table 1, 2). OAA/S scores were significantly decreased in the PK group during near the end of surgery, whereas BIS scores were only at the end of surgery (P < 0.05)(Fig. 1, 2). During 15 min after arrival at recovery room, significantly less patients in the PK group gave correct responses on the DSST than other groups (P < 0.05)(Fig. 2, 3). CONCLUSIONS: In contrast to past studies of ketamine as an alternative to opioid adjuncts during propofol PCS, it has no more advantage than supplemental fentanyl in terms of sedation level and side effects.

Influence of Routine Calorie and Protein Intake on Nutritional Status in Stable Chronic Hemodialysis Patients : A 18 Months Follow-up Study / 대한신장학회잡지

BACKGROUND: Dialysis patients as a group appear to have a caloric and a protein intake less than the recommended values; because their energy expenditure is not different from that of healthy adults and because amino acid loss and increased catabolism during dialysis they should be in negative caloric & nitrogen balance and lose body mass and protein such as albumin progressively. Recently, papers dissenting about recommended protein intake in DOQI guideline were published. Because Korean people had different body size and dietary pattern from white races, recommanded protein and calorie intake may be different from that of white races. METHODS: We retrospectively analyzed our data in a group of hemodialysis patients who had dietary evaluations and kinetic measurements performed two consecutive times over a period of 18 months. RESULTS: Body weight(55.22+/-.48 kg to 57.39+/-0.29 kg, p=0.008), LBM(lean body mass, 42.79+/-.49 kg to 46.09+/-.13 kg, p=0.000), BMI(Body Mass Index, 21.89+/-.21 kg/m2 to 22.75+/-.53 kg/m2, p=0.007) and serum albumin level(3.65+/-.47 g/dL vs 3.87+/-.42 g/dL, p=0.000) were increased compared to initial values. Fat mass, TSF(Triceps Skin Fold thickness), MAC(Mid-Arm Circumference), MAMC(Mid- Arm Muscle Circumference) were remained stable over this period of time. These results suggested that these patients are not in negative energy and nitrogen balance. CONCLUSION: Albumin and body weight remained stable over a period of 18 months in spite of 27.25+/-.39 kcal/kg calorie intakes and 1.03+/-.43 g/kg protein intakes. Recommanded protein and calorie intake of Korean people may be different from that of white races.