Advantages and pitfalls of clinical application of sugammadex

Sugammadex, a modified γ-cyclodextrin, is one of the drugs focused on in the anesthetic field because it provides rapid and complete reversal from neuromuscular blockade (NMB) by encapsulating rocuronium. Its introduction has revolutionized anesthesia practice because it is a safe, predictable, and reliable neuromuscular antagonist. Hence, its use has increased worldwide. Further, it has been in the spotlight for recovering from deep NMB in laparoscopic surgery and improving the surgical condition. Recently, studies have been conducted on the postoperative outcome after deep NMB and use of sugammadex in various clinical conditions. However, with increase in sugammadex use, reports regarding its complications are increasing. Appropriate dosing of sugammadex with quantitative neuromuscular monitoring is emphasized because under-dosing or over-dosing of sugammadex might be associated with unexperienced complications. Sugammadex is now leaping into an ideal reversal agent, changing the anesthesia practice.

The Relations among Sociodemographic, Clinical and Psychological Characteristics and Quality of Life in Patients with Psychotic Disorders and Their Caregivers / 신경정신의학

OBJECTIVES: Quality of life in patients with psychotic disorders and their caregivers has a important role on the treatment and relapse prevention of the patients. This study was intended to investigate the effects of patient's sociodemographic, clinical and psychological(self-esteem, social support and external control) characteristics, and caregivers' sociodemographic and psychological characteristics on quality of life in patients and caregivers. METHODS: The subjects were composed of 48 out-patients (schizophrenic disorder, mood disorders and other psychotic disorders) and 48 caregivers. Patients' clinical characteristics, patients' and their caregivers' sociodemographic, psychological characteristics(self-esteem, social support and external control) and quality of life were investigated. First of all, patients' self-esteem, social support, external control and quality of life were compared with caregivers'. After the correlations among each characteristics in patients and caregivers were calculated, the multiple regression analyses were conducted, where the predictable variables were those that had already shown significant correlations with quality of life. RESULTS: Patients' self-esteem and quality of life were significantly lower than their caregivers'. In patients, high socioeconomic status and self-esteem were correlated with high perception on the social support and quality of life. Also, the satisfaction to the medication was positively correlated with perception on the social support, quality of life and more external control. In addition, high compliance on medication and high perception on the social support were correlated with high quality of life. In caregivers, patients' onset age was positively correlated with caregivers' quality of life. Also, more caregivers' stress was correlated with their lower self-esteem, and higher caregivers' self-esteem was correlated with higher perception on the social support and quality of life. Furthermore, higher caregivers' perception on the social support was correlated with higher quality of life. The characteristics that predicted patients' quality of life significantly were self-esteem and perception on the social support, and the characteristics that predicted caregivers' quality of life significantly were caregivers' perception on the social support and patients' onset age. CONCLUSION: These results suggested that for improving the quality of life of patients and their caregivers, it was important not only to alleviate and treat the patient's symptom, but also to increase self-esteem and provide social support.

The Development of a Korean Modification of the Scale to Measure Subjective Well-Being under Neuroleptic Treatment (KmSWN) / 신경정신의학

OBJECTIVES: The purpose of this study was to develop the Korean modification of SWN (KmSWN), based on the original 38-item SWN (a self-rating scale to measure subjective well-being under neuroleptic treatment) by Naber et. al. in 1994, but containing the reduced number of items and the modified content. METHODS: The KmSWN with 22 items and General Health Questionnaire/Quality of Life-12 (GHQ /QL-12) were administered to 204 out-patients with schizophrenia. Also, their sociodemographic and clinical characteristics were investigated. Data analyses were conducted based on 176 patients whose responses to the scale, as well as whose related informations, were reliable. First, the reliability and validity of KmSWN were assessed comprehensively. Second, the relationships between the total score of KmSWN and the sociodemographic and clinical characteristics were examined. Finally, in order to identify the predictable variables on the total score of KmSWN, the stepwise multiple regression analysis was conducted, where the independent variables were already shown significant correlations with the total score of KmSWN. RESULTS: Three of 22 items of KmSWN were excluded from the following analysis due to their poor internal consistency. KmSWN comprised with 19 items (KmSWN-19) showed high levels of spilthalf reliability (.91), mean of interitem correlations (.38) and internal consistency (Cronbach alpha .92). Factor analysis of the KmSWN-19 revealed that a three-factor solution accounted for 100% of total explained variance. The three factors were interpreted as 'dissatisfaction', 'physical and mental functioning', 'emotional regulation and self-control'. The concurrent validity of KmSWN-19 with GHQ/QL-12 was very high (-.83). Of the sociodemographic and clinical characteristics, age, disposable money, socioeconomic level, number of previous hospitalizations, compliance with medication and satisfaction with medication were positively correlated with the total score of KmSWN-19, while severity of illness, severity of parkinsonism, severity of dyskinesia, administration frequency of medication and omission number of medication were negatively correlated. However, the total score of KmSWN-19 was not correlated with the class and the dose of neuroleptics. In stepwise multiple regression analysis, the satisfaction with medication, the omission number of medication and the disposable money were significantly contributed to the total score of KmSWN-19, and they explained 24% of the variance. CONCLUSIONS: The above findings indicated that KmSWN-19 was a reliable, valid and practical self-rating scale to measure subjective well-being in out-patients with schizophrenia. Moreover, KmSWN-19 seemed to be a general scale applicable to all the schizophrenic or other psychotic patients if they were able to complete it, rather than a specific scale only for the patients undergoing the neuroleptic treatment. Based on the results of the predictable variables on the total score of KmSWN-19, one may argue that intraindividual characteristics such as value, belief and personality traits, although they were not evaluated in this study, should be considered in assessing subjective well-being or the quality of life.

Sleep Pattern, Job Satisfaction and Quality of Life in Nurses on Rotating Shift and Daytime Fixed Work Schedules / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate(1)the differences in the sleep pattern, job satisfaction, the quality of life between the rotating shift work nurses and the nurses on a fixed day schedule and (2)the effects of the individual(circadian rhythm and personality)and the work system factors on the job satisfaction and the quality of life. METHODS: Sleep Questionnaire, Korean translation of Composite Scale(KtCS) Job Satisfaction Index, General Health Questionnaire, Eysenck's Personality Questionnaire were administered to 85 rotating shift work nurses(the rotating group)and 70 nurses on a fixed day schedule(the daytime group) We compared the weekday sleep pattern, the frequency of sleep disorders during the last month, circadian rhythm patterns, job satisfaction, and the quality of life between the two groups. Also, we conducted the stepwise multiple regression analysis, where the independent variables were circadian rhythm, work schedule, extroversion, and neurotism and the dependent variables were the job satisfaction and the quality of life. RESULTS: Between the two groups, there were significant differences in the sleep pattern including the regularity of sleep and the frequency and duration of naps. The rotating group had more frequent sleep problems, poorer job satisfaction and quality of life as compared with the daytime group. The job satisfaction and quality of life were poorer in the nurses who were on a rotating shift work schedule and who had higher neurotic trend. On contrary, The job satisfaction and the quality of life were better in those who were on a fixed daytime shift work schedule and who had more an extroversive trend. However, the circadian rhythm had no significant effect on the job satisfaction and quality of life. CONCLUSIONS: The sleep pattern, job satisfaction, and the quality of life were significantly poorer in the rotating group than in the daytime group, as expected. In terms of individual factors which determine the job satisfaction and quality of life, the personality dimensions had a significant effect, whereas the circadian rhythm did not. These results suggest that the circadian rhythms of shift workers may be realigned and that personality characteristics may be an important factor in coping with shift work.

Cross Validation of the Korean Translation of Composite Scale(KtCS) to Measure Morningness-Eveningness / 신경정신의학

OBJECTIVES: It is necessary to develop a questionnaire to classify the circadian rhythm for studying circadian rhythms and predicting shift work adaptability. This study attempted to confirm the general applicability of "Korean translation of Composite Scale(KtCS)" by Jin-Sang Yoon et al(1997), a Korean version of Composite Scale(CS) by Smith et al(1989). METHODS: KtCS and Life Habit Questionnaire(LHQ) were administered to 155 nurses(85 rotating shift nurses, 70 nurses on a fixed day schedule) and 247 female university students. We tested the distribution of KtCS scores and then subjects were categorized on the basis of their KtCS scores into evening(E), intermediate(I), and morning(M) types. Cut-off points for these categories were set at the 10th and 90th percentiles. We obtained the results of the internal consistency and the structure of factors of KtCS. We also compared the differences of life habits according to the circadian rhythm types. RESULTS: In both groups, nurses and female university students, the distributions of KtCS scores were negatively skewed but not significantly and the KtCS mean score was not significantly different. In nurses, Cronbach's alpha was 0.836, and three extracted factors were 'preferred times of performance and going to bed', 'rising time' and 'morning alertness'. In female university students, Cronbach's alpha was 0.787, and the same three factors as nurses were confirmed. However, only item 11 was loaded to factor 1 for the nurse group, whereas it was loaded to factor 2 for the student group. Life habits significantly differed among the three circadian rhythm types. The time of perceived peak alertness(mental and physical) was the latest in the E-type. The quality of academic performance during the morning was the highest in the M-type, and during the evening it was the highest in the E-type, but during the afternoon there was no significant differences among the three types. The bedtime and the rising time were latest in E-type, but the sleep lengths were not significantly different among the three types in both groups. CONCLUSIONS: The psychometric properties of KtCS in nurses were very similar to those of female university students and the previous findings of Jin-Sang Yoon et al(1997). This result supports that KtCS can be generally applied.