The effects of etomidate and midazolam on adipose tissue-derived mesenchymal stem cell proliferation / 대한마취과학회지

BACKGROUND: Stem cell therapy using adipose tissue-derived mesenchymal stem cells (ADSCs), which are capable of multipotent differentiation, is currently being investigated in the field of tissue regeneration and the treatment of patients in intensive care units. It is known that type-A γ-aminobutyric acid (GABA(A)) receptor activity has an influence on stem cell proliferation. Thus, we investigated the effects of the clinically available GABA(A) receptor agonists, etomidate and midazolam, on ADSC proliferation measured by the cell counting kit-8 assay. METHODS: ADSCs cultured in control medium or adipogenic differentiation medium for 15 days were divided into 5 treatment groups: non-medicated (Control) and 4 groups including treatment with etomidate or midazolam at 1 and 50 µM (n = 3 per group). The cell counting kit-8 assay was performed for determining the cell proliferation in both medium groups at day 0, 3, 6, 9, 12, and 15 in culture. The absorbance values at 450 nm were then measured by enzyme-linked immunosorbent assay reader and statistically compared among groups. RESULTS: There was no significant difference in cell proliferation profiles among the 5 groups at any time point in both control and adipogenic differentiation media. CONCLUSIONS: Etomidate and midazolam did not influence ADSC proliferation under both media when compared to the non-medicated group and there was no dose-dependent effect of etomidate and midazolam on ADSC viability.

Intrusive luxation of tooth due to bite block after oral endotracheal intubation / 대한마취과학회지

No abstract available.

Effect of preoperative anxiety on spectral entropy during induction with propofol / 대한마취과학회지

BACKGROUND: Anxiety influences brain wave activity. E-Entropy module-derived spectral entropy is an electroencephalographic derivative used to monitor the depth of sedation. This study assessed the effect of preoperative anxiety on the spectral entropy parameters of response entrophy (RE) and state entrophy (SE). METHODS: Trait anxiety was measured in 92 American Society of Anesthesiologists physical status I-II patients with the Spielberger State-Trait Anxiety Inventory (STAI) form X2 and state anxiety with STAI-X1 just before anesthesia. RE, SE, blood pressure and heart rate were measured before induction. Propofol was infused via a target controlled infusion pump. At loss of consciousness (LOC), the effect-site concentration (Ce), RE, SE and total amount of propofol were recorded. Patients were stratified into three groups based on their state and trait anxiety scores to evaluate the effect of anxiety level on entropy values. RESULTS: STAI-X1 was significantly correlated with RE and SE for LOC (rho = 0.230, P = 0.028 and rho = 0.308, P = 0.003, respectively) and also with STAI-X2 (rho = 0.411, P = 0.001, respectively). SE was higher in the high state anxiety group than in the low state anxiety group (P = 0.017). The other measured variables were not correlated with any anxiety scales. CONCLUSIONS: The state of anxiety increases RE and SE values at LOC induced with propofol. High state anxiety is associated with higher SE than apparent at low state anxiety. When determining the propofol-induced LOC by spectral entropy, anxiety levels should be considered.

Endotracheal cuff pressure change during gynecologic laparoscopic surgery: effect on the incidence of postoperative airway complications

BACKGROUND: Laparoscopic surgery with reverse Trendelenburg position and carbon dioxide pneumoperitoneum has been known to increase the endotracheal tube (ETT) cuff pressure and the incidence of postoperative sore throat. The purpose of this study was to evaluate the effect of the Trendelenburg position and pneumoperitoneum on the ETT cuff pressure and the effect of adjustment of ETT cuff pressure on the incidence of sore throat during laparoscopic gynecologic surgery. METHODS: One hundred fifty-four female patients undergoing laparoscopic gynecologic surgery were randomly assigned to either control group or adjusted group. In control group, initial cuff pressure was set at 30 cmH2O in the supine position without any adjustment during surgery. Cuff pressure of adjusted group was adjusted to maintain 30 cmH2O throughout the operation. Cuff pressures at intubation (P(imme)), at carbon dioxide insufflation and the Trendelenburg position (P0), and at 10 minute intervals throughout surgery (P10-P60 and P(end)) were checked. Postoperative airway complications including sore throat, hoarseness, dysphagia and cough were compared between the two groups at 2 hours and 24 hours after surgery. RESULTS: In control group, P0 and P10 were significantly higher than P(imme). The cuff pressure decreased with time, thereby; P50 (28.2 +/- 4.3), P60 (27.5 +/- 4.0) and P(end) (25.9 +/- 4.2) were significantly lower than P(imme) (P < 0.05). The incidences and severity of airway complications were not different between two groups. CONCLUSIONS: ETT cuff pressure decreased in laparoscopic gynecologic surgery. Therefore, controlled cuff pressure does not decrease the incidence of postoperative airway complications.

Unilateral vocal cord paralysis following a short period of endotracheal intubation anesthesia / 대한마취과학회지

No abstract available.

How do you use bispectral index effectively for preventing re-awareness during general anesthesia? / 대한마취과학회지

No abstract available.

The effectiveness of postoperative neutrophils to lymphocytes ratio in predicting long-term recurrence after stomach cancer surgery / 대한외과학회지

PURPOSE: Immunosuppression is a characteristic of cancer recurrence after curative resection. The neutrophil-to-lymphocyte ratio (NL ratio) in peripheral blood is associated with immune function. However, it is not clear whether the postoperative NL ratio is a predictor for cancer relapse after resection. Thus, we investigated the effectiveness of the short-term postoperative NL ratio in the prediction of disease recurrence within 5 years after stomach cancer surgery by a retrospective chart review. METHODS: Ninety-three patients with stomach cancer were enrolled. Significant risk factors for cancer recurrence were determined by multivariate Cox regression. Independent variables to increase the NL ratio to >7.7 by postoperative day (POD) 3 were examined by multivariate logistic regression analysis. RESULTS: The 5-year risk of cancer recurrence after gastrectomy was 4.2 times higher for patients with a POD3 NL ratio of >7.7 (P = 0.005), 3.4 times higher for normal-weight patients compared with overweight patients (P = 0.008), and 20 times higher for stage III compared with stage 0 according to the tumor-node-metastasis cancer staging system (P = 0.003). The surgical duration (hours) increased the chance of high NL ratio >7.7 (odds ratio, 2.5; P = 0.006). CONCLUSION: The postoperative NL ratio, especially the POD3 NL ratio, predicts long-term recurrence after stomach cancer surgery.

Delayed psoas muscle hematoma formation after spinal anesthesia with the paramedian approach in a hemodialysis patient: A case report

We present a patient who developed a psoas muscle hematoma after spinal anesthesia. He had received hemodialysis with heparin every two days because of end stage renal disease. Under the jack-knife position, he underwent spinal anesthesia and a paramedian approach was used for incision and drainage of an anal abscess. The coagulation tests were normal throughout the surgery. Eleven days after the operation, he complained of sudden onset of right buttock pain and a psoas muscle hematoma was diagnosed by CT. Although heparin is recommended after regional anesthesia, it is a major cause of delayed hematoma. Because of this potential complication, anesthesiologists and clinicians should carefully monitor the usage of anticoagulants after spinal anesthesia, and it is necessary to use active diagnostic tools such as CT for early diagnosis when hematoma formation is suspected in patients receiving anticoagulants.

Recurrent unilateral lung ventilation disorder in a patient that experienced rocuronium-induced anaphylactic bronchospasm during laparoscopic rectal surgery: A case report / 대한마취과학회지

Rocuronium is the anesthetic agent most likely to cause anaphylaxis. Immediately after intravenous rocuronium administration, the authors experienced ventilatory impairment due to unilateral bronchospasm (left lung), which was relieved by emergency treatment. However, 80 minutes after beginning laparoscopic surgery for rectal cancer, the left lung suddenly re-collapsed under pneumoperitoneum in the Trendelenburg position. A postoperative intradermal test revealed that rocuronium, vecuronium, atracurium, succinylcholine, or thiopental could induce anaphylaxis in this patient, but it was not established whether the second incident during surgery was due to endobronchial intubation or anaphylactic bronchospasm. This case cautions that under pneumoperitoneum in the Trendelenburg position, patients suspected of being prone to anaphylactic bronchospasm should also be considered at risk of endobronchial intubation.

Patient repositioning and the amelioration of airway obstruction by an anterior mediastinal tumor during general anesthesia: A case report / 대한마취과학회지

An 18-year-old male with huge anterior mediastinum mass was scheduled for thoracotomic incisional biopsy under general anesthesia after failed fluoroscopy-guided percutaneous needle biopsy. Under propofol and succinylcholine anesthesia, intubation was successfully achieved using a Univent tube. However, when we changed the patient's position from supine to right lateral decubitus, oxygen saturation declined. He was then positioned supine, but hypoxemia did not improve. Because the tumor expanded toward the left thoracic field, we considered that the left lateral decubitus position might help relieve the mass effect on the main bronchus. His position was changed accordingly and soon after, hypoxemia improved and surgery was undertaken under cardiopulmonary bypass (CPB). The biopsy was successfully performed under CPB without complication.

Small interfering RNA (siRNA): a hope for the loss-of-function studies in anesthesiology? / 대한마취과학회지

No abstract available.

The use of chest band to prevent CO2 subcutaneous emphysema expansion: Two case reports / 대한마취과학회지

CO2 subcutaneous emphysema is one of the complications of laparoscopic surgery using CO2 gas. During laparoscopic surgery, CO2 gas can spread to the entire body surface through the subcutaneous tissue layer. Extensive CO2 subcutaneous emphysema results in hypercarbia and acute respiratory acidosis. Hypercarbia and acidosis can lead to decreased cardiac contractility and arrhythmia. A cloth band, 5 cm in width and 120 cm in length, was made with Velcro tape at both tips, and placed on the patient's xyphoid process level and inframammary fold to prevent CO2 subcutaneous emphysema. This report describes two successful cases using a chest band to prevent the expansion of CO2 subcutaneous emphysema.

Remifentanil for postoperative patient-controlled analgesia after laparoscopic-assisted vaginal hysterectomy: dose-finding study / 대한마취과학회지

BACKGROUND: This randomized, double-blinded clinical study was designed to compare the efficacy and safety of three regimens of intravenous (IV) patient-controlled analgesia (PCA) with remifentanil for postoperative analgesia after laparoscopic-assisted vaginal hysterectomy during the first 24 postoperative hours. METHODS: Thirty-four patients were randomly allocated into three groups. The first group received IV remifentanil PCA at a basal rate of 0.02 microgram/kg/min, a bolus of 0.3 microgram/kg, and a lockout time of 15 min. The second group received IV-PCA at a basal rate of 0.025 microgram/kg/min, a bolus of 0.375 microgram/kg, and a lockout time of 15 min. The third group received IV-PCA at a basal rate of 0.03 microgram/kg/min, a bolus of 0.45 microgram/kg, and a lockout time of 15 min. Age, weight, height, and duration of surgery and anesthesia were recorded. Heart rate, systolic and diastolic blood pressure (BP) and oxygen saturation by pulse oxymetry were recorded in the recovery room as a base line after the operation. Heart rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and postoperative nausea and vomiting (PONV) scores were recorded at 1 h, 3 h, 6 h, 12 h, and 24 h after the initiation of IV-PCA. RESULTS: Thirty two patients were evaluated. The VAS in group 1 at 1, 3 and 6 hours after surgery was significantly higher than in other groups (P < 0.05). There were no clinically relevant differences between the groups in PONV, sedation scores, or hemodynamic parameters. CONCLUSIONS: This study suggests that IV remifentanil PCA with at a basal rate of 0.025 microgramram/kg/min (group 2) provided efficacious analgesia after laparoscopic-assisted vaginal hysterectomy. Special attention must be given to respiratory depression during establishment of PCA with remifentanil.

The effect of ultrasonic cleaning on the elimination of postoperative residual protein from the proseal(TM) laryngeal mask airway / 대한마취과학회지

BACKGROUND: Reusable Proseal(TM) laryngeal mask airways (PLMAs) can act as a vector for the transmission of prion diseases such as variant Creutzfeldt-Jacob disease. This study tested the hypothesis that supplementary ultrasonic cleaning facilitates the removal of protein deposits on PLMAs after anesthesia. METHODS: After clinical use, 40 PLMAs were randomly allocated into two groups. In the first group, the PLMAs were washed by hand and were then subsequently placed in an autoclave at 134degrees C for 40 min (Group 1, n = 20). In the second group, the PLMAs were washed by hand and ultrasonic cleaning using an enzymatic solution for 5 min, and were then subsequently placed in an autoclave (Group 2, n = 20). In both groups, protein deposits were detected on PLMAs by erythrosin staining. A staining score designated as none (0%), mild (0-20%), moderate (20-80%) and severe (80-100%), was assigned to each site (outer surface, inner surface and edges of the cuff, airway and drain tube, finger strap) according to the percentage of the stained surface area. RESULTS: Despite the cleaning of the masks, residual protein was found on the outer surface, inner surface and edge of the cuff, airway and drain tube, and finger strap of the PLMAs in both groups. Similar scores were observed for each part of the cleaned PLMAs in both groups, except for the outer surface of the PLMAs in Group 2 (P < 0.05). CONCLUSIONS: We conclude that the use of an ultrasonic cleaner with an enzymatic solution may be effective to cleanse the outer surface of the PLMAs, but there were no differences in the total scores for both groups.

Myoclonic Seizures Occurred during the Brain Tumor Resection in a Patient of the Recurred Malignant Meningioma of Cerebral Frontal Lobe : A case report / 대한마취과학회지

Several suspected etiologies can cause seizures during the resection of a brain tumor via a craniotomy: the tumor itself, intracranial hypertension or the anesthetic agents used, etc. Generalized myoclonic seizures, during general anesthesia in a 44 year old man, who underwent a resection for a relapsed frontal meningioma, were experienced. Anesthesia was induced and maintained using propofol and remifentanil. The myoclonic seizures began 30 minutes after the induction of anesthesia. The administration of rocuronium was unable to stop the involuntary movement. Midazolam was given to cease the seizures, but they continued for a further 105 minutes. After opening the dura mater, the seizures immediately disappeared and did not recur thereafter.

The Influence of Propofol on Cell Viability after Reoxygenation in Rat Embryonic Heart H9c2 Cells / 대한마취과학회지

BACKGROUND: Although reperfusion is a salvaging method for an acute myocardial infarction, the act of reperfusion itself can paradoxically result in reactive oxygen species (ROS) mediated myocyte death. Propofol has been reported to remove ROS. This study tested the hypothesis that propofol protects H9c2 cardiomyoblasts against hypoxia/reoxygenation (H/R) injury. METHODS: For the H/R group of cells, hypoxia was induced by replacing the culture medium with serum-/-glucose free Dulbecco's modified Eagle's medium (DMEM) and by exposing cells to 0.5% O2 for 24 h. Following hypoxia, the cells were reoxygenated. The medium was then replaced with fresh medium for maintenance and propofol (0, 25, 50, 250micrometer) was added to the cells (n = 3 for each concentration). In the normoxia group of cells (n = 3), cells were incubated under 21% O2 for 48 h without propofol. The MTT (3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay was performed 8 and 24 h after reoxygenation for the H/R group of cells, and 32 and 48 h for the normoxia group of cells. The results of the MTT assay were determined with an ELISA spectrometer at a wavelength of 595 nm. RESULTS: At 8 and 24 h after reoxygenation, MTT formazans in the H/R group of cells were significantly reduced as compared with the normoxia group of cells (P < 0.05). In the presence of 25, 50 and 250micrometer propofol, the MTT activity at 8 and 24 h after reoxygenation was diminished when compared to exposure to 0micrometer propofol (P < 0.05). However, the formazans produced when cells were exposed to a concentration of 25micrometer in propofol convalesced to the level of 0micrometer propofol at 24 h after reoxygenation. CONCLUSIONS: These results suggest that propofol may play a role in increasing the number of non-viable cells during reoxygenation of the heart.

The Influence of Propofol Concentration on the Generation of Reactive Oxygen Species after Reoxygenation in Rat Embryonic Heart H9c2 Cell / 대한마취과학회지

BACKGROUND: Reoxygenation of an ischemic heart causes a decrease in the cardiac function, which is known as reperfusion injury that is associated with an increase in the concentration of reactive oxygen species (ROS). This study examined the effect of the propofol concentration on the generation of ROS during reoxygenation in rat embryonic heart H9c2 cells. METHODS: Cultured H9c2 cells were examined in the following sequences: Prehypoxic, Hypoxic and Reoxygenation period. Each period required 60 minutes. The cells were exposed to propofol at the beginning of the prehypoxic period. Thirty minutes later, DCFH-DA (dichlorofluorescin diacetate) 10 micrometer was added to detect the ROS. The propofol concentrations used were 0, 5, 25, 50, 250 micrometer in the first experiment and 0, 1, 2, 3, 4, 5 micrometer in the second experiment. The ROS level was estimated using a fluorometer at 5-minute intervals from 5 to 60 minutes after reoxygenation. RESULTS: When the propofol concentrations was > 5 micrometer, the ROS levels were significantly lower than those of the untreated group (P0) (P 5 micrometer inhibited ROS production over the whole period, and even 1micrometer showed some inhibition of ROS.

General Anesthesia for Cesarean Section in a Patient with Moyamoya Disease and Sick Sinus Syndrome: A case report / 대한마취과학회지

Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We experienced a case of general anesthesia in a patient with Moyamoya disease and sick sinus syndrome who underwent a cesarean section. General anesthesia was performed using laryngeal mask airway ProSeal(TM) in order to avoid the hemodynamic response to tracheal intubation. INVOS(R) 5100 was used to monitor the level of cerebral oxygenation. The patient was kept stable hemodynamically and her level of cerebral oxygenation was kept at the optimal level during the operation.

Tearing of the Lingual Frenulum Caused by Insertion of the LMA-ProSeal by the Introducer: A case report / 대한마취과학회지

The LMA (laryngeal mask airway)-ProSeal introducer was developed for easy insertion and fewer PLMA related complications. We experienced tearing of the lingual frenulum incidentally caused by insertion of the PLMA with the introducer. We believe that the introducer may have some advantages concerning insertion PLMA but some disadvantages because it hinder patient tongue control.

Changes in Position and Intraabdominal Pressure do not Influence Oropharyngeal Leak Pressure in Laparoscopic Surgery Maintained with a ProSeal Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: It is known that pneumoperitoneum and changes of body position during laparoscopic surgery influenced peak inspiratory pressure (PIP). We asked the question whether oropharyngeal leak pressure (OLP) is changed by changes in intraabdominal pressure and position during laparoscopic surgery with a ProSeal laryngeal mask airway (PLMA). Since gynecological laparoscopic surgery (Lap-Gy) and laparoscopic cholecystectomy (Lap-C) require different surgical positions, we included both surgeries in this study so that we could investigate the effects of various positions on OLP. METHODS: Lap-Gy (n = 15) was performed in the trendelenburg position combined with the lithotomy position, whereas Lap-C (n = 10) was performed in the reverse trendelenburg position. The measured variables were PIP and OLP. We also marked the fiberoptic score to determine the intraoral position (FP) of the PLMA. OLP was measured using a manometric stability test. The variables were measured in a regular sequence as follows: S-0o-0, L-0o-0, L-0o-15, L-(-15o)-15, L-(-30o)-15 in Lap-Gy and S-0o-0, S-0o-15, S-(+15o)-15, S-(+30o)-15 in Lap-C. At each measured point, the capital S means supine and L lithotomy. Intermediate numbers with a 'o' superscript are table angles to the horizontal plane (degrees) , '-' means the trendelenburg position and '+', the reverse trendelenburg position, and the last number represents intraabdominal pressure (mmHg). RESULTS: PIP was significantly increased when L-0o-0 changed to L-0o-15, L-0o-15 to L-(-15o)-15 and L-(-15o)-15 to L-(-30o)-15 in Lap-G, and when S-0o-0 was changed to S-0o-15 in Lap-C (P < 0.05). But, OLP and FP were not significantly altered by changes in postion or intraabdominal pressure in both Lap-Gy and Lap-C. CONCLUSIONS: PIP was affected by pneumoperitoneum and positional changes. But, increases in intraabdominal pressure by pneumoperitoneum and changes in position during laparoscopic surgery had no effect on OLP and FP of PLMA.