Depression and Life Quality in Chronic Renal Failure Patients with Polyneuropathy on Hemodialysis

OBJECTIVE: To investigate the relationship between severity of peripheral polyneuropathy (PPN) and degree of depression and quality of life in chronic renal failure (CRF) patients on hemodialysis (HD). METHOD: Forty seven chronic renal failure patients on hemodialysis were recruited (22 male, 25 female, mean age of 63.17+/-12.52) and etiology, disease duration, hemodialysis duration, creatinine and hemoglobin were recorded. Motor and sensory nerve conduction studies were carried out on bilateral median, ulnar, tibial and peroneal nerves for diagnosis of polyneuropathy according to our laboratory criteria. The Korean version of Beck depression inventory (BDI) questionnaire translated into Korean for diagnosis of depression, and Korean version of Short Form 36 health survey (SF-36) questionnaire for measurement of general health level were measured in those diagnosed with uremic PPN. RESULTS: Out of 52 patients, 47 were diagnosed with polyneuropathy and mean score for BDI was 18.49+/-9.18. Mean scores for each of Mental Component Summary (MCS) and Physical Component Summary (PCS) of SF-36 were 50.84+/-15.42 and 47.41+/-18.68. The correlation between the scores and polyneuropathy were analyzed by Pearson coefficient. The MCS score was the significant (p<0.05) correlation parameter with depression (R=-0.635) and the PCS score was the only parameter with a significant (p<0.05) correlation with polyneuropathy (R=-0.340). CONCLUSION: Uremic polyneuropathy is commonly observed in chronic renal failure patients on hemodialysis. Depression in CRF with uremic PPN is affected by psychological factors other than the PPN itself.

The Effect of Obturator Nerve Block in Cerebral Palsy under Sevoflurane Anesthesia with Face Mask

OBJECTIVE: To investigate the effect of obturator nerve block with 5% phenol under sevoflurane mask inhalation general anesthesia and its influence on vital signs in spastic cerebral palsy children during the procedure. METHOD: 26 cerebral palsy children with spastic hip adductor muscles went under inhalation general anesthesia by anesthesiologist for phenol block of obturator nerve. After induction with thiopental sodium and sustained with sevoflurane by face mask without the use of muscle relaxant, the vital signs including heart rate, blood pressure and oxygen saturation were closely monitored throughout the procedure. The obturator nerve block was carried out with 5% phenol using a stimulator. Modified Ashworth scale (MAS) and range of motion of hip were measured before and after the procedure to compare the effects of nerve block. RESULTS: No significant differences were observed from the vital signs before, during and after the procedure. The MAS score improved from average 2.50+/-0.71 to 1.12+/-0.32. The range of motion increased from 24.31+/-12.32degrees and 25.88+/-12.28degrees right and left relatively to 39.62+/-10.10degrees and 40.96+/-11.14degrees. CONCLUSION: Both spasticity and range of motion of hip adductor muscles improved significantly after obturator nerve block with 5% phenol under inhalation general anesthesia in the operating room with face mask, and no adverse effects or complications were seen in all 26 cerebral palsy children. Therefore phenol nerve block under inhalation general anesthesia in operation room for cerebral palsy children with poor cooperation or positioning difficulty due to spasticity should be considered as a useful method.