Radiation Safety and Education in the Applicants of the Final Test for the Expert of Pain Medicine

BACKGROUND: The C-arm fluoroscope is known as the most important equipment in pain interventions. This study was conducted to investigate the completion rate of education on radiation safety, the knowledge of radiation exposure, the use of radiation protection, and so on. METHODS: Unsigned questionnaires were collected from the 27 pain physicians who applied for the final test to become an expert in pain medicine in 2011. The survey was composed of 12 questions about the position of the hospital, the kind of hospital, the use of C-arm fluoroscopy, radiation safety education, knowledge of annual permissible radiation dose, use of radiation protection, and efforts to reduce radiation exposure. RESULTS: In this study, although most respondents (93%) had used C-arm fluoroscopy, only 33% of the physicians completed radiation safety education. Even though nine (33%) had received education on radiation safety, none of the physicians knew the annual permissible radiation dose. In comparing the radiation safety education group and the no-education group, the rate of wearing radiation-protective glasses or goggles and the use of radiation badges or dosimeters were significantly higher in the education group. However, in the use of other protective equipment, knowledge of radiation safety, and efforts to reduce radiation exposure, there were no statistical differences between the two groups. CONCLUSIONS: The respondents knew very little about radiation safety and had low interest in their radiation exposure. To make the use of fluoroscopy safer, additional education, as well as attention to and knowledge of practices of radiation safety are required for pain physicians.

Development of complex regional pain syndrome at independent arm associated with lateral decubitus position: A case report

A 27-year-old man underwent excision of a mediastinal mass using video-assisted thoracoscopic surgery (VATS) performed in the right lateral position. Postoperatively, he complained of pain in the left upper arm and chest wall, limitation of the left shoulder joint, allodynia, hyperalgesia, spontaneous pain in left finger, edema, hypohidrosis, and change of skin color of the left hand. We diagnosed the patient with complex regional pain syndrome (CRPS) by using the proposed modified International Association of the Study of Pain (IASP) research diagnostic criteria, and initiated treatment through medication and interventional management. After 3 months of treatment, the pain intensity reduced to below 2 cm on the VAS. In this study, we describe a case of postoperative CRPS, which is believed to have been caused by excessive stretching of the brachial plexus. Careful positioning of patients on the operating table with proper padding will reduce injuries to the peripheral nerves.

A Study to Compare the Radiation Absorbed Dose of the C-arm Fluoroscopic Modes

BACKGROUND: Although many clinicians know about the reducing effects of the pulsed and low-dose modes for fluoroscopic radiation when performing interventional procedures, few studies have quantified the reduction of radiation-absorbed doses (RADs). The aim of this study is to compare how much the RADs from a fluoroscopy are reduced according to the C-arm fluoroscopic modes used. METHODS: We measured the RADs in the C-arm fluoroscopic modes including 'conventional mode', 'pulsed mode', 'low-dose mode', and 'pulsed + low-dose mode'. Clinical imaging conditions were simulated using a lead apron instead of a patient. According to each mode, one experimenter radiographed the lead apron, which was on the table, consecutively 5 times on the AP views. We regarded this as one set and a total of 10 sets were done according to each mode. Cumulative exposure time, RADs, peak X-ray energy, and current, which were viewed on the monitor, were recorded. RESULTS: Pulsed, low-dose, and pulsed + low-dose modes showed significantly decreased RADs by 32%, 57%, and 83% compared to the conventional mode. The mean cumulative exposure time was significantly lower in the pulsed and pulsed + low-dose modes than in the conventional mode. All modes had pretty much the same peak X-ray energy. The mean current was significantly lower in the low-dose and pulsed + low-dose modes than in the conventional mode. CONCLUSIONS: The use of the pulsed and low-dose modes together significantly reduced the RADs compared to the conventional mode. Therefore, the proper use of the fluoroscopy and its C-arm modes will reduce the radiation exposure of patients and clinicians.

The changes of skin temperature in lower extremity during spinal anesthesia and general anesthesia

BACKGROUND: Skin temperature is well known to increase after spinal anesthesia due to sympathetic blockade and vasodilation. The purpose of this study is to find the changes of skin temperature in lower extremities during spinal and general anesthesia. METHODS: Patients were divided into three groups: SA (spinal anesthesia), GA (general anesthesia) and control (N) group. Skin temperature was recorded in the ventral aspect of mid thigh before induction and 5, 15, 30 min after induction. RESULTS: In all groups, skin temperature increased after 5, 15, 30 min significantly. And temperature gradients between before induction and after 30 minutes did not differ significantly in the three groups (P < 0.05). CONCLUSIONS: The changes of skin temperature in the lower extremities are similar with spinal anesthesia and general anesthesia.

The Effect of Dexamethasone on Postoperative Pain and Nausea and Vomiting after Laparoscopic Cholecystectomy in Younger and Older Patients / 대한마취과학회지

BACKGROUND: Although postoperative pain is reduced compared with an open cholecystectomy, effective analgesic treatment after a laparoscopic cholecystectomy has remained a clinical challenge. METHODS: Of sixty patients having general anesthesia for laparoscopic cholecystectomy, thirty received intravenous dexamethasone 8 mg (Dexa group) and thirty received intravenous normal saline (Control group) before induction of anesthesia. Again, Dexa and Control group was divided the Younger group (20-50 yrs) and Older group (> or =65 yrs). Pain was assessed 1, 6, 12 and 24 hours after surgery and recorded on a visual analog scale (VAS). Experiences of Nausea and vomiting were assessed within the first postoperative 24 hours. RESULTS: In the Younger group, the VAS scores at postoperative 1 and 6 hours were significantly lower in the Dexa group than Control group. In the Older group, the VAS scores at postoperative 12 and 24 hours were significantly lower in the Dexa group than Control group. In the Dexa group, the incidence of postoperative nausea and vomiting of the Younger group was significantly lower than the Older group. CONCLUSIONS: There were differences in the analgesic effects of dexamethasone after laparoscopic cholecystectomy between the younger and older patients. Dexamathasone wasn't effective for postoperative nausea and vomiting in the older patients.

Obstruction of the Scavenging Pathway during Surgery: A case report / 대한마취과학회지

An acute obstruction of the breathing circuit can be devastating situation. An 56-year old man who was diagnosed distal femur fracture underwent open reduction with internal fixation. During surgery, an obstruction of the breathing circuit occurred and we found the cause of obstruction was the plugging of a gas disposal tube with ice and dust accumulation. After removing the ice and dust, ventilation normalized. We report this case of an obstruction of the scavenging pathway with a review of the relevant literature.