The effect of aprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery with intravenous patient controlled analgesia using fentanyl: aprepitant plus ramosetron vs ramosetron alone / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the effect of an aprepitant, neurokinin-1(NK1) receptor antagonist, for reducing postoperative nausea and vomiting (PONV) for up to 24 hours in patients regarded as high risk undergoing gynecological surgery with intravenous patient-controlled analgesia (IV PCA) using fentanyl. METHODS: In this randomized, open label, case-control study 84 gynecological surgical patients receiving a standardized general anesthesia were investigated. Patients were randomly allocated to receive aprepitant 80 mg P.O. approximately 2-3 hours before operation (aprepitant group) or none (control group). All patients received ramosetron 0.3 mg IV after induction of anesthesia. The incidence of PONV, severity of nausea, and use of rescue antiemetics were evaluated for up to 24 hours postoperatively. RESULTS: The incidence of nausea was significantly lower in the aprepitant group (50.0%) compared to the control group (80.9%) during the first 24 hours following surgery. The incidence of vomiting was significantly lower in the aprepitant group (4.7%) compared to the control group (42.8%) during the first 24 hours following surgery. In addition, the severity of nausea was less among those in the aprepitant group compared with the control group over a period of 24 hours post-surgery (P < 0.05). Use of rescue antiemetics was lower in the aprepitant group than in the control group during 24 hours postoperatively (P < 0.05). CONCLUSIONS: In patients regarded as high risk undergoing gynecological surgery with IV PCA using fentanyl, the aprepitant plus ramosetron ware more effective than ramosetron alone to decrease the incidence of PONV, use of rescue antiemetics and nausea severity for up to 24 hours postoperatively.

The analgesic effect of ultrasound-guided transverse abdominis plane block after laparoscopic totally extraperitoneal hernia repair / 대한마취과학회지

BACKGROUND: The ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal hernia repair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP. METHODS: In this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In the TAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 microg was repeatedly injected as per the patient's request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery. RESULTS: In the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 +/- 1.6, 4.9 +/- 1.8) than the control group (6.9 +/- 1.6, 8.0 +/- 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in the TAPB group (3.2 +/- 1.2, 4.2 +/- 1.5) than the control group (5.3 +/- 1.6, 6.5 +/- 1.8) at rest and on coughing. CONCLUSIONS: The ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.

Suspected Anaphylactic Reaction Associated with Microemulsion Propofol during Anesthesia Induction

Although rare, intraoperative anaphylaxis can lead to significant morbidity and mortality. Aquafol(R) (Daewon Pharmaceutical Co. Ltd., Seoul, Korea), a microemulsion propofol, was developed to eliminate lipid solvent-related adverse events, and was used in clinical anesthesia since 2009 with little data about severe side effects such as anaphylaxis. A healthy 16-yr-old male patient who had past medical history with two previous operations of no complications developed cardiovascular shock with generalized erythema following administration of microemulsion propofol during anesthesia induction. Intravenous injection of epinephrine and steroid rescued him. He remained in a stable state without any problems postoperatively and was discharged. Clinicians should consider this rare but serious complication during induction of anesthesia with propofol.

The Effect of Blood Zinc Level on the Growth of Children / 대한소아내분비학회지

PURPOSE: Zinc is an essential nutrient, which is required to maintain the normal structure and/or function of multiple enzymes. Therefore, zinc nutriture has been known to influence the physical growth of young children. This study was desinged to evaluate the relationship between blood zinc levels and growth parameters in children. METHODS: Two hundred eighty three children (150 boys and 133 girls) who visited the Youngdong Severance Hospital as short stature were enrolled in this study. Height standard deviation score (Ht. SDS), weight standard deviation score (Wt. SDS), and pubertal stage were obtained for each children. Blood samples were collected for zinc, alkaline phosphatase (ALP), insulin-like growth factor binding protein-3 (IGFBP-3), insulin-like growth factor-1 (IGF-1), and free thyroxine (fT4). The relationship between blood zinc levels and growth status, and growth factors were analyzed. RESULTS: The Ht. SDS and Wt. SDS were -0.16+/-0.99, 0.16+/-0.88 respectively for the low blood zinc level group; the Ht. SDS and Wt. SDS were -0.16+/-0.97, 0.08+/-0.93 respectively for the normal blood zinc level group. Between two groups, Ht. SDS, Wt. SDS, bone age, pubertal stage, ALP, and IGF-1 showed no significant differences, while IGFBP-3 and fT4 showed significant differences (P<0.05). The mean zinc concentrations showed no significant difference between the normal stature group and short stature group (101.60+/-41.11 microgram/dL, 93.72+/-35.38 microgram/dL respectively). The Ht. SDS, Wt. SDS, pubertal stage, ALP, and IGF-1 showed no significant correlation with the zinc levels, while the IGFBP-3 and fT4 showed significant correlation (P<0.05). CONCLUSION: We could not find any significant relationship between blood zinc level and growth status. However, interpretation of our results should be cautious in aspect that the result might come from the subjects with mild zinc deficiency. Further study is required to investigate the severe zinc deficiency patients and zinc replacement study.

A Case of Huge Mediastinal Lipoma Incidentally Found in a 13-Year-Old Boy / 소아알레르기및호흡기학회지

Lipomas are the most common benign neoplasm and usually arise in the subcutaneous tissue. The trunk and proximal limbs are the most frequent sites. Mediastinal lipoma is an uncommon benign neoplasm of mediastinum(1-5% of all lipomas). They are most often located in the anterior mediastinum. They can occur singly or multiply in the mediastinum and can stimulate cardiomegaly or pleural effusion on chest X-ray. They are usually well circumscribed and encapsulated but can grow to be quite large:greater than 20 cm and 4 kg in size. A 13-year-old boy was asymptomatic and coincidentally found to have a large soft tissue density in chest X-ray. Computer tomography showed an anterior mediastinal mass consistent of a fat density and vascular structure. Thymus, in the right upper lobe showed mass effect. The mass was surgically excised and pathologically confirmed lipoma. We hereby present the case with review of literature.