Effects of Low and High Molecular Weight Hyaluronic Acids on Peridural Fibrosis and Inflammation in Lumbar Laminectomized Rats

BACKGROUND: Postlaminectomy peridural fibrosis is inevitable. Some studies have compared and identified the effects of high molecular weight hyaluronic acids (HMWHA) and low molecular weight hyaluronic acids (LMWHA) on peridural fibrosis in postlaminectomy animal models. However, no studies have been found that compare pain behaviors between hyaluronic acids or among hyaluronic acids and other solid materials. The purpose of this study was to examine the correlation between pain-related behaviors and histopathologic changes in laminectomized rats using various peridurally administered materials. METHODS: Forty male Sprague-Dawley rats, laminectomized at the L5 and L6 levels, were divided into four groups: group C, laminectomy only; group L, laminectomy and LMWHA application; group H, laminectomy and HMWHA application; group F, laminectomy and fat interposition. Pain behaviors were checked before, 3 days, 1 week, and 3 weeks after surgery. Histopathological changes were checked at the L5 level 3 weeks after the surgery. RESULTS: The 50% withdrawal thresholds in groups L and H were higher than that in groups C and F three days after laminectomy (P < 0.05). The paw withdrawal time did not change among the groups and in each group during the study period. Peridural fibrosis in group F was significantly lower than in the other groups (P < 0.05). CONCLUSIONS: Hyaluronic acids significantly reduced mechanical allodynia but not thermal hyperalgesia. Peridural fibrosis did not show any correlation with pain behaviors. There have been limited studies on the correlation between peridural fibrosis and pain behavioral change, which should be verified by further studies.

Anesthetic Management during Laparoscopic Excision of an Urachal Cyst in a Pediatric Patient: A case report / 대한마취과학회지

A 14-month-old female patient was admitted for the laparoscopic excision of a complicated urachal cyst. General anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane and the intermittent administration of vecuronium. During the insufflation of CO2 her intra-abdominal pressure was maintained below 12 cmH2O to avoid excessive hypercarbia. Thirty minutes after CO2 insufflation initiation, end tidal CO2 increased to 74 mmHg at a peak inspiratory airway pressure of 24 cmH2O. Laparoscopic excision of the urachal cyst was performed within 2 hours without a further change in end tidal CO2, blood pressure, heart rate, or O2 saturation. Before extubation, O2 saturation by pulse oxymetry was 99% and end tidal CO2 was 45-50 mmHg. The patient was discharged without any problem 5 days after the operation. We report on this clinical experience and include a brief review of the literature.

Effect of Hyperglycemia on the Length of Postoperative Hospital Stay / 대한마취과학회지

BACKGROUND: Diabetes mellitus is the most common endocrinopathy encountered in the perioperative period and has long been assumed to increase perioperative risk. However, when diabetes mellitus was segregated from old age and the complications of it, it was questioned that diabetes mellitus itself increased perioperative risk. In this study, we investigated the influence of hyperglycemia on the length of postoperative hospital stay. METHODS: We studied 100 patients undergone intra-abdominal operations with general anesthesia. These patients were divided into the hyperglycemic group (n = 20) with postoperative blood glucose level higher than 10 mM and the non-hyperglycemic group (n = 80) with glucose level lower than 10 mM and we investigated the length of postoperative hospital stay, serum electrolyte, serum chemistry, arterial blood gas values, and base excess by unmeasured anions. We also divided these patients into the diabetic patients group (n = 15) and the non-diabetic patients group (n = 85) and compared the same variables. RESULTS: The length of postoperative hospital stay was significantly prolonged in the hyperglycemic group (20.9 +/- 9.0 days) compared with the non-hyperglycemic group (16.2 +/-8.5 days), and the cumulative postoperative hospital stay curves based on Kaplan-Meier method also showed significant difference between the two groups. When we compared the length of postoperative hospital stay between the diabetic and the non-diabetic patients, there was no significant difference. CONCLUSIONS: This study demonstrated that hyperglycemia prolonged the length of postoperative hospital stay. This finding suggests that the patient's glucose level should be monitored and controlled within an adequate range perioperatively.

Influence of Unmeasured Anions Identified by Stewart Principle on the Length of Postoperative Hospital Stay / 대한구급학회지

BACKGROUND: Calculation of the base excess (BE) and the anion gap (AG) is commonly used to identify the presence and to analyze the cause of metabolic acidosis in critically ill patients. However, the calculation of BE assumes normal water content, electrolytes, and albumin, changes in these values will change the calculated BE. Calculation of the AG does not control for changes in albumin and cannot distinguish plasma concentration changes of negatively charged protein (albumin) from that of other anions. Based on Stewart's physicochemical principles, Gilfix et al developed equations to calculate the BE caused by unmeasured anions (BEua) taking into account changes in free water, chloride, albumin, and PCO2 that theoretically should reflect metabolic changes better than the less complete biochemical measurements. This study was designed to evaluate the influence of BEua and other variables on the length of postoperative hospital stay. METHODS: The data from 100 consecutive patients were collected prospectively in patients who underwent intra-abdominal operations under general anesthesia and admitted to the adult intensive care unit. All samples were routine samples taken from arterial lines postoperatively and analyzed for arterial blood gas, plasma electrolytes, inorganic phosphates and albumin concentrations. BEua was calculated from the equations developed by Gilfix et al. We also calculated AGNa, K (Na++K+-Cl--HCO3-) and AGNa (Na+-Cl--HCO3-). Correlations between the length of postoperative hospital stay and these variables were studied using linear regression analysis. RESULTS: BEua and BE were significantly correlated with the length of ICU stay (r=0.295, p<0.01 and r=0.249, p<0.05). Neither AGNa, K nor AGNa was correlated with the length of ICU stay. Significant correlation was observed between the length of postoperative hospital stay and BEua (r=0.316, p<0.01), BE (r=0.288, p<0.01), AGNa, K (r=0.284, p<0.01), and AGNa (r=0.263, p<0.05). CONCLUSIONS: In this study BEua was significantly correlated with the length of ICU stay and postoperative hospital stay compared with other variables. This finding suggests that BEua may be used as a more reliable predictor of outcome in ICU patients.