Propofol promotes osteoclastic bone resorption by increasing DC-STAMP expression

BACKGROUND: Propofol is an intravenous anesthetic which has antioxidant effects due to its similarity in molecular structure to α-tocopherol. It has been reported that α-tocopherol increases osteoclast fusion and bone resorption. Here, we investigated the effects of propofol on signaling pathways of osteoclastogenic gene expression, as well as osteoclastogenesis and bone resorption using bone marrow-derived macrophages (BMMs). METHODS: BMMs were cultured with macrophage colony-stimulating factor (M-CSF) alone or M-CSF plus receptor activator of nuclear factor kappa B ligand (RANKL) in the presence of propofol (0–50 µM) for 4 days. Mature osteoclasts were stained for tartrate-resistant acid phosphatase (TRAP) and the numbers of TRAP-positive multinucleated osteoclasts were counted. To examine the resorption activities of osteoclasts, a bone resorption assay was performed. To identify the mechanism of action of propofol on the formation of multinucleated osteoclasts, we focused on dendritic cell-specific transmembrane protein (DC-STAMP), a protein essential for pre-osteoclastic cell fusion. RESULTS: Propofol increased the formation of TRAP-positive multinucleated osteoclasts. In addition, the bone resorption assay revealed that propofol increased the bone resorption area on dentin discs. The mRNA expression of DC-STAMP was upregulated most strongly in the presence of both RANKL and propofol. However, SB203580, a p38 inhibitor, significantly suppressed the propofol/RANKL-induced increase in mRNA expression of DC-STAMP. CONCLUSION: We have demonstrated that propofol enhances osteoclast differentiation and maturation, and subsequently increases bone resorption. Additionally, we identified the regulatory pathway underlying osteoclast cell-cell fusion, which was enhanced by propofol through p38-mediated DC-STAMP expression.

Post-operative intravenous patient-controlled analgesic efficacy of morphine with ketorolac versus nefopam after laparoscopic gynecologic surgery: a randomized non-inferiority trial / 대한마취과학회지

BACKGROUND: Nefopam is a non-opioid non-steroidal centrally acting analgesic. This study was conducted to assess the analgesic efficacy of intravenous patient-controlled analgesia (IV-PCA) using nefopam alone, compared with a combination of morphine and ketorolac, after laparoscopic gynecologic surgery. METHODS: Sixty patients undergoing laparoscopic gynecologic surgery received IV-PCA. Group A (n = 30) received IV-PCA with a combination of morphine 60 mg and ketorolac 180 mg, while group B (n = 30) received nefopam 200 mg (basal rate 1 ml/h, bolus 1 ml, and lockout time 15 min for both). The primary outcome evaluated was analgesic efficacy using the visual analogue scale (VAS). Other evaluated outcomes included the incidence rate of postoperative nausea and vomiting (PONV), patient satisfaction of pain control, percentage of patients requiring additional opioids, and incidence rate of postoperative adverse effects. RESULTS: Group B was not inferior to group A in relation to the VAS in the post-anesthesia care unit, and at 12, 24, and 48 h after surgery (mean difference [95% confidence interval], 0.50 [-0.43 to 1.43], -0.30 [-1.25 to 0.65], -0.05 [-0.65 to 0.55], and 0.10 [-0.55 to 0.75], respectively). The incidence rate of nausea was lower in group B than in group A at 12 and 24 h after surgery (P = 0.004 and P = 0.017, respectively). There were no significant differences in the other outcomes between groups. CONCLUSIONS: IV-PCA using nefopam alone has a non-inferior analgesic efficacy and produces a lower incidence of PONV in comparison with IV-PCA using a combination of morphine and ketorolac after laparoscopic gynecologic surgery.

Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration / 대한마취과학회지

BACKGROUND: Gabapentin is a safe and well-tolerated anticonvulsant with a wide therapeutic index, and it is used for neuropathic pain. The aim of this study was to compare previous dosing methods with the administration of four different doses of gabapentin while maintaining the same maximum daily dose for the safe administration of high doses of the medication. METHODS: The subjects were outpatients with various neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. The TID group received equal doses of gabapentin 3 times per day, while the QID group received 4 different doses of gabapentin per day. The pain score, frequency of breakthrough pain (BTP), severity and the duration of pain, sleep disturbance due to nocturnal pain, and adverse effects were recorded each day. RESULTS: The average daily pain score and sleep disturbance were significantly reduced in the QID group between days 3 and 10 of the experiment. The adverse effects of the medication were also reduced in the QID group. However, the frequency of BTP and severity and duration of pain were not significantly different between two groups. CONCLUSIONS: Administration of 4 different doses of gabapentin during the initial titration in outpatients with neuropathic pain resulted in a significant reduction in awakening from breakthrough pain and a reduction in the adverse effects of the medication.

Foreign Body Removal at Right Main Bronchus in A Neonate / 대한구급학회지

Foreign body in the airway could be a life-threatening risk, especially for young pediatric patients. A 6-day old male patient with foreign body, which was located deep in the right main bronchus was being admitted. Although we tried three times to remove it with rigid bronchoscopic forceps under the general anesthesia, we failed. Before switching to surgical treatment, we changed the Trendelenburg position and tapped his back several times in order to alter the foreign body toward the forcep. Finally we were able to catch and extract the foreign body successfully. We suggest that back percussion with the Trendelenburg position is a useful solution to remove a foreign body within a deep airway.

Optimal dose of dexmedetomidine for sedation during spinal anesthesia / 대한마취과학회지

BACKGROUND: Sedation in spinal anesthesia can reduce patient's anxiety and discomfort. Dexmedetomidine has a sedative, hypnotic, analgesic, and minimal respiratory depression effect. However, use of the dexmedetomidine is associated with prolonged recovery. This study was designed to investigate the optimal dose of intravenous dexmedetomidine for proper sedation with minimal recovery time in spinal anesthesia. METHODS: One hundred twenty eight patients, aged 20-70 years (58.8 +/- 0.7), were recruited. After performing the spinal anesthesia with hyperbaric bupivacaine (13 mg), a loading dose of dexmedetomidine (1 microg/kg) was administered for 10 min, followed by the maintenance infusion of the following: Group A (n = 33; normal saline), Group B (n = 35; dexmedetomidine 0.2 microg/kg/hr), and Group C (n = 39; dexmedetomidine 0.4 microg/kg/hr). Heart rate, blood pressure, and the bispectral index score (BIS) were recorded during the operation. In the recovery room, modified aldrete score (MAS) was measured. RESULTS: There were no significant differences in mean blood pressure and heart rate among the three groups. BIS was not significantly different among the three groups from baseline to 60 min after the infusion of dexmedetomidine. BIS were significantly increased in Group A after 70 and 80 min, and Group A and B after 90, 100, 110 min of dexmedetomidine infusion (P < 0.05). MAS was higher in Group A as compared to Group B and C, within 30 min after admission in the recovery room (P < 0.05). CONCLUSIONS: The loading dose (1 microg/kg/10 min) of dexmedetomidine was sufficient for surgery of less than 60 min. Dexmedetomidine infusion followed by maintenance dose (0.2 microg/kg/hr) was sufficient for surgery within 90 min.

Effects of etomidate on bispectral index scale and spectral entropy during induction of anesthesia by means of the raw electroencephalographic and electromyographic characteristics / 대한마취과학회지

BACKGROUND: Etomidate frequently induces myoclonus, so it may affect electromyographics (EMG). And EMG commonly has an effect on the bispectral index scale (BIS) and spectral entropy. This study was performed to compare the effect of etomidate on BIS, response entropy (RE) and state entropy (SE) during induction of anesthesia. METHODS: Fifty patients (ASA I or II) scheduled for elective surgery were included in this study. Anesthesia was induced with etomidate (0.3 mg/kg) and rocuronium (0.6 mg/kg). Patients also inhaled 4 vol% sevoflurane and 100% oxygen and, then intubated. BIS, RE, SE and Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) were measured 4 times (before injection of etomidate [T0], at loss of eyelash reflex [T1], 90 seconds after rocuronium injection [T2], and after intubation [T3]). We also checked whether myoclonus occurred. RESULTS: Baseline values (T0) were 93.1 +/- 4.7 for BIS, 95.8 +/- 3.7 for RE and, 87.3 +/- 3.5 for SE. In comparison with T0, there were significantly differences in BIS (50.2 +/- 16.3), RE (76.8 +/- 18.5) and SE (66.3 +/- 17.4) at T1 (all P < 0.05). There were no significant differences at T2 and T3. Thirty one patients had myoclonus. At the occurrence of myoclonus, RE and SE values significantly increased but not BIS (P < 0.05). CONCLUSIONS: In patients with myoclonus, at the loss of consciousness, spectral entropy did not decrease where as BIS did, suggesting that BIS may evaluate hypnotic levels better than spectral entropy during induction of anesthesia with etomidate.

The changes of mitochondrial cytochrome c and GABAergic neuron in neuropathic pain model / 대한마취과학회지

BACKGROUND: Role of cytochrome c (Cyt c) is an apoptogenic agent under certain conditions. The mitochondrial permeability transition pore (MPTP) plays an important role in cell death since it opens, leading to mitochondrial swelling and release of Cyt c, which initiates apoptosis. By inhibiting the opening of MPTP, cyclosporine A (CSA) may contribute to maintaining mitochondrial homeostasis. We investigate the effects of the partial sciatic nerve injury (PSNI)-induced neuropathic pain model on mitochondrial Cyt c release and the effects of CSA on neuroprotection by mitochondrial stabilizing activity in PSNI rats. METHODS: Rats were assigned to two groups that received different operations (Group P; PSNI operation, Group S; sham operation). The changes of cyt c and GABAergic neuron were evaluated in the spinal cord tissue. After which, PSNI rats randomly received CSA (Group C) or saline (Group S), and the changes of mechanical thresholds with Cyt c and GABAergic neuron were checked. RESULTS: PSNI in rats increased the release of cytosolic Cyt c. However, GABAergic cells were not decreased in the spinal cord level on the ipsilateral side to the PSNI. The second experiment reveal a reduction in Cyt c release, using CSA in PSNI model. Rats receiving CSA were afforded the antiallodynia without decrease of GABAergic cell. CONCLUSIONS: The Cyt c probably contributes to nerve dysfunction after PSNI. PSNI induced neuropathic pain was profoundly linked to mitochondrial stabilization. Thus, the potent neuroprotector, CSA, might produce antiallodynia through its capability to inhibit the opening of MPTP.

Apoptosis of the GABAergic interneuron in the dorsal horn of the chronic post-ischemic pain model / 대한마취과학회지

BACKGROUND: It is well known that the GABAergic inhibitory interneuronal system plays an important role in modulation of the noxious stimulation transmitted from the primary afferent input. Some studies have revealed the role that the GABA inhibitory interneuronal system plays in the modulation of pain transmission and the changes in the GABAergic interneurons that occur during the neuropathic pain. This study was conducted to evaluate the apoptosis of the GABAergic interneuron, which is assumed to contribute to neuropathic pain. METHODS: Male Sprague-Dawley rats weighing 290-310 g were used to create a CPIP (chronic post-ischemic pain) model, which was made by placing a tourniquet on the left hindpaw of the rats. The tourniquet was maintained for 3 hours, after which it was released to allow reperfusion. Thirty minutes prior to reperfusion, N-acetyl-L-cysteine (NAC group) or normal saline (control group) was injected. After reperfusion, mechanical allodynia and cold allodynia were measured. In addition, the release of cytochrome c into the cytosol was evaluated through western blot or immunohistochemistry of the spinal cord. RESULTS: Mechanical and cold allodynia developed and the number of GABA interneurons was reduced in the control group. Additionally, The cytochrome c from the GABA interneuron was released into the cytosol in the control group, but the amount released was reduced in response to treatment with NAC. CONCLUSIONS: The results of this study showed that the GABA interneuron in the Rexed laminae I, II released cytochrome c into the cytosol in CPIP neuropathic pain model, which is known to lead to apoptosis. However, treatment with N-acetyl-L-cysteine prevented this process.

Effects of sevoflurane on wound healing process / 대한마취과학회지

BACKGROUND: Wound healing process is a tissue response to trauma which leads to tissue repair through complex biological stages. Sevoflurane is a widely used inhalation anesthetic for surgery, but there has been no study about its effect on wound healing process. This study was undertaken to evaluate the effect of sevoflurane on wound healing process. METHODS: Male Sprague-Dawley rats (200-300 g) were used. Two circular full-thickness skin defects of 8 mm in diameter were made on dorsum of rats. After wound formation, the animals were divided into 4 groups: 1, 2, 4, 8 hr exposure to sevoflurane, respectively. Wound sizes and regional blood flow around the wounds were measured. The expression of basic fibroblast growth factor (bFGF), transforming growth factor beta1 (TGFbeta1), collagen 1, and collagen 3 mRNA were detected 7 days after wound formation by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Wound size was significantly increased in 8 hr group at 3 and 7 days after wound formation. Regional blood flow was significantly decreased in 4 hr and 8 hr groups at 3 days after wound formation. The bFGF, collagen 1 and 3 mRNA expressions were significantly decreased in 8 hr exposure group. CONCLUSIONS: These results suggest that sevoflurane exposure influences the regional blood flow, wound size, expression of bFGF, and production of collagen 1 and 3 during the wound healing process.

The Antiallodynic Effect and the Change of the alpha2 Adrenergic Receptor Subtype mRNA Expression by Morphine Administration in a Spinal Nerve Ligation Rat Model

BACKGROUND: The neuropathic pain arising from nerve injury is difficult to treat and the therapeutic effects of opioid drugs remain debatable. Agonists acting at the alpha2 adrenergic and opioid receptors have analgesic properties and they act synergistically when co-administered in the spinal cord. The lack of subtype-selective pharmacological agents has previously impeded the synergistic effects that are mediated by the adrenergic receptor subtypes. METHODS: We created neuropathic pain model by ligating the L5 spinal nerve in Sprague-Dawley rats (n = 18). We divided the rats into three groups (n = 6 for each group), and we administered intraperitoneal morphine (1 mg/kg, 3 mg/kg, 5 mg/kg) and then we measured the mechanical allodynia with using von-Frey filaments for 8 hours. We then injected morphine (5 mg/kg) intraperitoneally, twice a day for 2 weeks. We measured the tactile and cold allodynia in the morphine group (n = 9) and the saline group (n = 9). After 2 weeks, we decapitated the rats and harvested the spinal cords at the level of lumbar enlargement. We compared the alpha2 subtype mRNA expression with that of control group (n = 6) by performing real time polymerase chain reaction (RTPCR). RESULTS: Intraperitoneal morphine reduced the neuropathic pain behavior in the dose-dependent manner. Chronic morphine administration showed an antiallodynic effect on the neuropathic pain rat model. The rats did not display tolerance or hyperalgesia. The expression of the mRNAs of the alpha2A, alpha2B, alpha2C subtypes decreased, and morphine attenuated this effect. But we could not get statistically proven results. CONCLUSIONS: Systemic administration of morphine can attenuate allodynia during both the short-term and long-term time course. Morphine has an influence on the expression of alpha2 receptor subtype mRNA. Yet we need more research to determine the precise effect of morphine on the alpha2 subtype gene expression.

Effect of thromboembolic deterrent stockings at spinal anesthesia-induced hypotension / 대한마취과학회지

BACKGROUND: Hypotension during spinal anesthesia is mainly result of sympathetic blockade, which causes pooling of blood into the lower extremities. Mechanical compression of lower limbs prevents venous pooling of blood. Thromboembolic deterrent (TED) stockings are in general surgical use for prophylaxis against lower limb deep vein thrombosis and TED stockings also supply pressure to lower limb. So we investigated the effect of TED stockings to prevent hypotension during spinal anesthesia. METHODS: Sixty patients were randomized to receive fluid loading (crystalloid, 10 ml/kg) or TED stockings. After spinal anesthesia (heavy bupivacaine 14 mg), patients were placed in supine position for 12 minutes and in lithotomy position for 18 minutes. Blood pressure, pulse rates, shivering, and nausea were checked every 3 minutes for 30 minutes. If the systolic blood pressure was less than 90 mmHg or mean blood pressure was less than 80% of baseline mean blood pressure then i.v. ephedrine 5 mg was administered. RESULTS: There was no statistically significant difference in baseline characteristics and blocked sensory level between the two groups. There was no statistically significant difference in the incidence of hypotension and mean arterial blood pressure at each time. CONCLUSIONS: We conclude that, under the conditions of this study, TED stockings decrease the pooling of blood into the lower limbs and prevent hypotension after spinal anesthesia. Although TED stockings prevent hypotension after spinal anesthesia, it does not reduce the incidence of hypotension.

Effects of Propofol on Arginine Vasopressin-induced Contraction in Isolated Human Gastroepiploic Artery / 대한마취과학회지

BACKGROUND: Arginine vasopressin has been used by prophylactic treatment of vasodilatory shock during coronary artery bypass graft (CABG). Vasopressin may be a cause of spasm in graft artery during CABG. We evaluated the effect of propofol on vasopressin-induced contraction in human gastroepiploic artery (GEA). METHODS: Human GEA were obtained from 35 patients (43-74 yr), undergoing subtotal gastrectomy. Vasopressin-induced a concentration contractions (10(-9) to 10(-6) M) were measured after exposed to without propofol, propofol 10(-5), 10(-4), 10(-3) M. After endothelium denuding vasopressin-induced a concentration contractions were measured with or without propofol 10(-3) M in calcium free solution. In the denuded vascular rings, with or without pretreatment of glibenclamide (10(-5) M), nicorandil (10(-5) M), or diltiazem (10(-5) M) were exposed to with or without propofol 10(-3) M, and vasopressin-induced concentration contractions were measured. RESULTS: Vasopressin-induced concentration contraction on human GEA was independent of functional endothelium. Propofol (10(-4), 10(-3) M) attenuated the vasopressin-induced contraction in the human GEA. Diltiazem attenuated the vasopressin-induced contraction in the human GEA. ATP-sensitive potassium channel does not affect the inhibition effect of propofol on vasopressin-induced contraction CONCLUSIONS: Usual anesthetic dose of propofol does not inhibit vasopressin-induced contraction on human GEA. High dose (>10(-4) M) propofol attenuated vasopresssi-induced contraction on GEA.

Assessing the Effectiveness of Medical Ethics Education / 한국의학교육

PURPOSE: The purpose of this study is to evaluate the effectiveness of a medical ethics course taught in medical school by examining the students' abilities to identify medical ethics issues, the applicability of a medical ethics course, and self-efficacy. METHODS: 366 subjects were recruited from three different groups (medical students, interns, and residents) who had completed a medical ethics course. Data were collected using a 20-item questionnaire. Analysis was done with a SPSS statistics program. RESULTS: Of the three groups, the students scored the highest in identifying medical ethics issues. When asked how often they see medical ethics issues in real medical situations (students were asked how often they would expect to see these ethical issues in medical settings), the students responded with the highest number, followed by the interns. The residents responded with the lowest number. Regarding the applicability of the medical ethics course, while students believed the course was highly useful and applicable to real medical settings, interns and residents did not agree. The participants' self-efficacy and satisfaction were generally low. The majority of all three groups thought that medical ethics education should be more practical and that it should be taught during internship as well as during residency. CONCLUSION: Our findings suggest two important directions for medical ethics education. First, the current medical ethics curriculum should be offered during both internship and residency. Second, the content should focus more on actual clinical scenarios ('clinical ethics') than theoretical principles.

The Changes of Differences of Pulse Transit Time between Toe and Finger in General and Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Pulse wave velocity (PWV) and pulse transit time (PTT) are influenced by the arterial wall stiffness and compliance. Also, the PTT is dependent on blood pressure changes that can be accompanied by the anesthesia. The simply measured PTT has difficult to discriminate the arterial compliance changes from blood pressure changes. Therefore, we investigated that the differences of PTT between toe and finger as an independent parameter on blood pressure. METHODS: Eighteen patients scheduled for elective lower abdominal gynecologic surgery were studied. General anesthesia was achieved with sevoflurane and epidural block was done with 0.2% ropivacaine and fentanyl 100microgram via epidural catheter inserted into L1 - L2 epidural space. PTT was measured in a finger (PTTf) and a toe (PTTt) by the time difference between the ECG R wave and the pulse wave of PPG. Blood pressure and PTT was measured at three instances such as preinduction (Pre), 5 minutes after intubation (Int5) and 30 minutes after injection of epidural dose (Epi). The time delay of PTT between toe and finger (PTTt-f) was measured. RESULTS: PTTf and PTTt was prolonged at Int5 and Epi. But the PTTt-f was not different between the Int5 and Epi because of prolonged PTTf caused by the blood pressure decrement after the epidural block. CONCLUSIONS: PTTf, PTTt and PTTt-f can be a one of the convenient measurement of the arterial compliance but it was suggested that there need to be a parameter less dependent on the blood pressure changes.

The Change of Neuropathic Pain and Pain Related Gene Expression following Exposure to Chronic Smoking / 대한마취과학회지

BACKGROUND: Several studies have reported reduced pain and anxiety in smokers, and considerable evidence shows that smoking induces analgesia, which is thought to be nicotine-mediated. We investigated if smoking could reduce the development of neuropathic pain and nociceptive transmission in the spinal cord. METHODS: Sprague Dawley rats weighing 130-150 g were used for this experiment. The Animals were divided into two groups: the smoking group (S group) was exposed to cigarette smoking for 5 hours per day for 6 weeks at self-made smoking chamber: the control group (C group) was exposed to room air. After a 4-week exposure period, neuropathic pain was induced by left L5 spinal nerve ligation (SNL). Mechanical threshold and withdrawal response to 100% acetone were measured throughout the experiment. The changes in the expression of the c-fos and BDNF genes in the spinal cord were compared using real time PCR. RESULTS: Mechanical allodynia was induced after SNL in both groups, but no significant difference was observed between two groups. Cold allodynia after SNL was significantly less in S group than C group. In S group, the expression of c-fos was decreased at 5th day, but that of BDNF expression was significantly elevated at 5th day after SNL compared to C group. CONCLUSIONS: Chronic exposure to cigarette smoke reduced the cold allodynia in neuropathic rats. The decreased expression of c-fos and elevated expression of BDNF in the spinal cord after SNL may contribute to antinociception.

Comparison of Pain Control Method and Assessment on Postoperative Pain in Pediatric Urological Surgery of Penoscrotal and Inguinal Regions / 대한비뇨기과학회지

PURPOSE: This study was designed to evaluate the effects of caudal block or/and local infiltration on postoperative pain control in pediatric patients, and whether the faces pain rating scale (FPS), visual analogue scale (VAS) or sleep disturbance scale (SDS) values were estimator dependent (parents, doctors and nurses). MATERIALS AND METHODS: Thirty four children (average age 2.8+/-2.4 years), undergoing inguinal and scrotal surgery, were randomly allocated to one of three groups; combined caudal block with local infiltration (group I), caudal block only (group II) and neither of the above two (group III). Parents, doctors and nurses assessed the FPS, VAS and SDS before and after surgery, and the side effects were assessed after surgery. RESULTS: The mean SDS, FPS and VAS values in Group III were significantly higher than those in groups I and II at 1 and 3 hours postoperatively. All patients slept with a discontented look 1 hour postoperatively, but gradually improved and normalized 12 hours postoperatively. The mean FPS and VAS values were highest 1 hour postoperatively, and decreased with time in all groups. The mean pain value, as assessed by parents, tended to be higher than those assessed by healthcare professionals - doctors and nurses, but the correlation between the parents and healthcare professionals for the SDS, FPS and VAS assessments was statistically significant (intraclass correlation coefficients; 0.64, p<0.05). There were no side effects in any patient. CONCLISIONS: This study suggests that caudal block with local infiltration may be more useful for postoperative pain control, and all three pain scales are useful for assessing the postoperative pain associated with pediatric urological surgery of the penoscrotal and inguinal regions.

Sevoflurane Does not Adversely Affect Myocardial Function after Ventricular Septal Defect Repair in Children / 대한마취과학회지

BACKGROUND: Myocardial dysfunction after cardiopulmonary bypass (CPB) is a significant cause of morbidity and mortality after congenital cardiac surgery. The aim of this study was to evaluate myocardial function on sevoflurane anesthesia after CPB during ventricular septal defect repair. METHODS: Forty patients were randomly allocated into two groups: sevoflurane-fentanyl was used in group S, midazolam-fentanyl in group M. Myocardial performance index (MPI) and ejection fraction (EF) were measured by transesophageal echocardiography before incision and after operation. Serum cardiac Troponin-I (cTnI) levels were measured before incision, and at 0, 12, and 24 h after operation. RESULTS: MPI increased after operation in both groups (S: 0.35 +/- 0.06 vs. 0.43 +/- 0.05, M: 0.36 +/- 0.07 vs. 0.46 +/- 0.06 [P < 0.05]), but there was no significant difference between groups. EF decreased after operation in both groups (S: 65.1 +/- 5.5% vs. 62.7 +/- 3.9%, M: 64.9 +/- 5.3% vs. 61.4 +/- 4.4% ([P < 0.05]), but there was no significant difference between groups. cTnI was markedly elevated after operation, and decreased thereafter. There was no significant difference between groups. CONCLUSIONS: Both groups showed decreased myocardial function after CPB, but there were no difference between groups. Sevoflurane did not adversely affect intraoperative myocardial function compared to midazolam.

The Effect of Remifentanil on Delirium after Sevoflurane Anesthesia in the Pediatric Patients / 대한마취과학회지

BACKGROUND: Sevoflurane is commonly used anesthetics for pediatric surgical patients. Emergence delirium is more frequent when recovering from sevoflurane anesthesia than other anesthetics. In this study, we evaluated the effect of remifentanil to reduce emergence delirium after sevoflurane anesthesia in pediatric patients. METHODS: Children (3-7 yrs) were randomly assigned to three groups: sevoflurane with normal saline in group N (0.06 ml/kg/ hr), sevoflurane with remifentanil (0.1microgram/kg/min) in group R, and sevoflurane with remifentanil (0.1microgram/kg/min) and remifentanil (0.05microgram/kg/min) till the recovery room in group RC. Time to extubation, Pediatric Anesthesia Emergence Delirium Scale (PAEDS), Objective Pain Scale (OPS), Modified Aldrete Score (MAS), and postoperative side effects in the recovery room were compared among three groups. RESULTS: Time to extubation (N; 9.3 +/- 3.5, R; 12.2 +/- 6.4, RC; 12.7 +/- 5.3 min) in R and RC group was prolonged compared with N group (P < 0.05). There were no differences among three groups in MAS. OPS has variable differences among the groups (P < 0.05). PAEDS was significantly reduced in RC group compare with R and N group (P < 0.05). CONCLUSIONS: Remifentanil did not reduce the incidence of emergence delirium after sevoflurane anesthesia in pediatric tonsillectomy. Emergence delirium after sevoflurane anesthesia was reduced by remifentanil infusion till the recovery room.

Assessment of Depth of Anesthesia / 대한마취과학회지

No Abstract available.

A Study on the Electroencephalographic Characteristics at Each Anesthetic Steps / 대한마취과학회지

BACKGROUND: Bispectrum and bicoherence analysis that is the frequency domain methods of EEG analysis was examined to elucidate the correlation with the depth of anesthesia. METHODS: 25 patients under the gynecological surgery were studied. EEG was surveyed by PhysioLab 400. Analysis of EEG was done according to the progress of anesthesia, normal state before anesthesia, before incision of skin, operation 1, operation 2, awake and post-anesthesia. EEG is applied to filtering of signal, base line correction, linear detrend removal to get more reliable analysis. The appearance rate of bispectrum peaks are calculated by bispectrum operation. And bicoherences are calculated by bispectrum and power spectrum of AR model. RESULTS: In awaking state of patient in pre-anesthesia and post anesthesia, appearance rate of bispectral coupling was observed that a strong appearance rate was represented in all area (0-35 Hz). During the anesthesia, the low frequency area (3-15 Hz) revealed a strong appearance. Also the 2D map of a appearance rate is divided into four sections for more objectivity. Of four sections Bipara#4 is considered that the best parameter which showed progress of anesthesia (P < 0.01). In bicoherence study, in awake state which patient is in pre-anesthesia and post anesthesia, appearance rate of bicoherence value was observed that a strong appearance rate was represented in high frequency range (15-30 Hz). However, under the anesthesia of patients, the low frequency area (0-10 Hz) revealed a strong appearance. And, of four sections Bicpara#2 and Bicpara#4 are considered that the best parameter which showed progress of anesthesia effectively (P < 0.01). CONCLUSIONS: The analysis of the peak appearance of bispectrum and bicoherence is useful monitoring for the depth of anesthesia.