The effect of shift work on high sensitivity C-reactive protein level among female workers

BACKGROUND: This study assessed the association between shift work and high-sensitivity C-reactive protein (hs-CRP) level, a risk factor for cardiovascular disease (CVD), in female workers in electronics manufacturing services (EMS). METHODS: Female EMS workers who received special medical examinations for workers in Gyeongnam, Korea between January 2017 and December 2017 were enrolled in this study. Their age, marital status, education level, alcohol consumption, smoking habit, regular exercise, quality of sleep, work stress, and depression were investigated, and blood tests were conducted. The t- and χ2 tests were conducted to compare the general and biochemical characteristics between daytime and shift worker groups. Age-adjusted partial correlation analysis was performed to examine the linear relationship between hs-CRP level and other risk factors for CVDs. In addition, the difference in hs-CRP levels according to work schedule was analyzed by ANCOVA after adjusting for variables that could affect the hs-CRP level. RESULTS: Although the average hs-CRP levels did not differ significantly between daytime and shift workers (0.92 ± 1.87 and 1.07 ± 2.20 mg/dL, respectively), shift workers tended to show a higher hs-CRP level (p = 0.067). After adjusting for variables that can affect the hs-CRP level, the estimated average hs-CRP level was significantly higher in shift workers (1.325 ± 0.156 mg/dL) than that in daytime workers (0.652 ± 0.350 mg/dL) (p = 0.003). CONCLUSIONS: The results of this study identified a relationship between shift work and hs-CRP level increase in women. Because multiple studies have reported associations between increased hs-CRP and CVD, follow-up of hs-CRP may help early detection of CVD in shift workers.

The relationship between serum vitamin D levels and sleep quality in fixed day indoor field workers in the electronics manufacturing industry in Korea

BACKGROUND: Although recent studies have investigated the influence of vitamin D on sleep patterns, there is a lack of research on the relationship between vitamin D and sleep patterns in Korean workers. This study focused on the relationship between serum vitamin D levels and sleep in fixed day indoor field workers in the electronics manufacturing industry in Korea. METHODS: The 1472 subjects who were included in this study were selected from fixed day workers in the electronics manufacturing industry who had received a worker’s special health examination at a hospital in Changwon, South Gyeongsang Province between January 2015 and December 2015. Nighttime workers and those who showed symptoms of depression were excluded from this study. The sociodemographic and lifestyle variables of the participants were investigated, including age, sex, marital status, level of education, body mass index, smoking habits, alcohol consumption habits, and regular exercise. Work-related factors were evaluated, such as employee tenure and occupational stress. Serum 25-hydroxyvitamin D was measured as an indicator of vitamin D levels, and quality of sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI) translated into Korean. RESULTS: The subjects had a mean serum vitamin D level of 13.70 ± 5.93 ng/mL. Vitamin D deficiency, defined as a serum vitamin D level of <10 ng/mL, was found in 24.8% of males and significantly more frequently in females (47.6%). Poor sleep quality was reported by 19.8% of participants with serum vitamin D levels ≥10 ng/mL and by 21.7% of those with serum vitamin D levels <10 ng/mL, which was a significant difference (P = .007). Multiple logistic regression analysis adjusting for significant variables found that poor sleep quality was more likely in those with vitamin D deficiency than those with higher serum vitamin D levels (odds ratio = 1.36; 95% CI, 1.01–1.82). A comparison of serum vitamin D levels and PSQI components showed that the mean scores for subjective sleep quality, sleep latency, and sleep duration were significantly higher in the vitamin D-deficient participants, indicating that the vitamin D-deficient participants had poorer sleep quality. CONCLUSIONS: This study investigated serum vitamin D levels in fixed day indoor field workers in the manufacturing industry in Korea and analyzed the relationship of vitamin D deficiency with sleep quality. A significant correlation was found between serum vitamin D deficiency and poor sleep quality. Based on the results of this study, sleep disorder management for workers can be improved by providing regular examinations checking their serum vitamin D levels and supplying vitamin D to workers with serum vitamin D deficiency to enhance their quality of sleep.

Approximate entropy as the measurement of the electroencephalographic effect during sevoflurane induction / 대한마취과학회지

BACKGROUND: The processed electroencephalograms are useful surrogate measures of quantification of volatile anesthetics effect. We hypothesized that there is a certain relationship between the end-tidal concentration of sevoflurane and approximate entropy (ApEn). The aim of this study was to investigate the effect of sevoflurane on ApEn during induction. METHODS: Fourteen patients were enrolled. With recording of the electroencephalogram at the F3, F4, P3, and P4 montages, anesthesia was induced by increasing the vapor setting of sevoflurane by 1 vol% up to 8 vol% via a facemask. When the end-tidal concentration of sevoflurane did not show any further change, we increased vapor setting of sevoflurane by 1 vol%. When the end-tidal concentration of sevoflurane did not show any further change with 8 vol% of sevoflurane vapor setting, measurement of electroencephalogram was finished. The relation between end-tidal sevoflurane concentration and ApEn was tested by Spearman correlation. RESULTS: ApEn showed a significant correlation (R = -0.7551, P < 0.0001) with end-tidal sevoflurane concentration. The final pharmacodynamic parameters estimated by a sigmoid E(max) model were described as follows: E(0) = 0.91, E(max) = 0.28, C(e50) = 1.36 vol%, gamma = 1.27, kappa(e0) = 0.67 min(-1). CONCLUSIONS: Sevoflurane induction with gradual increase of end-tidal sevoflurane concentration increases the amount of regularity in approximate entropy.

Vancomycin-induced Hypersensitivity Reaction with Slow Infusion : A case report

Vancomycin is a bacteriocidal antibiotic experiencing a resurgence of utility because of increasing clinical problems with methicillinresistant staphylcoccal infections. Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. There is a consensus that slow intravenous administration of vancomycin should minimize the risk of infusion related adverse effects. We report a case of vancomycin hypersensitivity reaction with slow infusion of vancomycin.

Bilateral Interscalene Brachial Plexus Block for Surgery on Both Upper Extremities in a Patient with Unilateral Vocal Cord Paralysis : A case report

The interscalene approach of the brachial plexus block is a common technique for surgery on the upper extremities as it provides good intraoperative anesthesia and postoperative analgesia. However, bilateral blockade of both brachial plexuses has rarely been performed because it could lead to respiratory insufficiency and local anesthetic toxicity owing to the large amount of drug administered. We report a case of a successful bilateral interscalene brachial plexus block in a patient with unilateral vocal cord paralysis observed after a conventional endotracheal intubation.

Accidental Epidural Injection of Ondansetron : A case report / 대한마취과학회지

We encountered a case of an accidental epidural injection of ondansetron through an epidural catheter. No neurological complications were noted. This case highlights the need for more attention to minimize the risk of epidural injections.

Open Lock of the Jaw on Induction of Anesthesia: A case report / 대한마취과학회지

The temporomandibular joint can be dislocated during anesthesia as a result of excessive oral opening and direct laryngoscope handling. Occasionally, yawning can be observed during the induction of anesthesia with propofol. The forceful and voluntary yawning after a propofol injection can lead to a dislocation of the temporomandibular joint. We report a case of an anterior dislocation of the temporomandibular joint upon induction with propofol, which caused difficulties in mask ventilation and endotracheal intubation. Although intubation had been carried out successfully in this case, an unanticipated difficult airway can be confronted at anytime. Therefore, anesthesiologists should be aware of the management of a difficult airway and practice various methods according to a difficult airway algorithm.

Anesthetic Management of a Patient with Pheochromocytoma in Pregnancy: A case report / 대한마취과학회지

Pheochromocytoma with pregnancy is very uncommon but it is associated with very high maternal and fetal morbidity and mortality. Antepartum diagnosis and proper management can prevent mother and fetus from potentially lethal outcome. Since pheochromocytoma produces and secretes catecholamines, hemodynamic instability can be brought. The aim of anesthetic management is the avoidance of drugs and episodes that will result in hypertensive crisis, and the selection of safe anesthetic measures and anesthetics to mother and fetus. We report a case of pheochromocytoma with pregnancy managed with combined anesthetic technique-epidural anesthesia for cesarean section and general anesthesia for resection of pheochromocytoma 3 weeks after cesarean section. ?

The Amount of Blood Use and Reorganization of Maximal Surgical Blood Order Schedule (MSBOS) in Elective surgery / 대한수혈학회지

BACKGROUND: Overpreparation of Red Blood Cells for elective surgery causes problems, such as returning of blood, inefficient task of the blood bank and waste of blood resources. At The National Medical Center, Maximal Surgical Blood Order Schedule(MSBOS) was organized for the first time in 1994. Recently, blood use is decreased as various transfusion side effects become known, and operation technique and anesthetic methods develop. As a result, we try to revise MSBOS investigating RBC utilization for elective surgery in 2002. METHODS: We investigated RBC utilization for elective surgery, the number of transfused patient, mean blood amount of all patient having been operated in. It was accomplished by referring to anesthesiologic records and blood delivery sheet at The National Medical Center during the 12 months from January through December in 2002. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For one year, the total number of surgery was 3,204, and transfusion was done in 1095 cases of surgery. Average transfusion rate is 34.4%. In 8 kinds of surgery(275 case, 9.3%), average amount of transfusion was under 0.5 unit and Type and Screen(T&S) is transduced for the elective surgery. Except for Cesarean section(C/S), blood use is decreased significantly, compared with the MSBOS organized at 1994. CONCLUSION: We could revise the guidelines for ordering blood on the basis of above results. And MSBOS should be revised at regular intervals, which can decrease blood disuse and medical cost.

The Effective Dose (ED50, ED95) of Alfentanil to Minimize the Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Intravenous alfentanil is one of the effective methods to minimize the hemodynamic responses to laryngoscopy and endotracheal intubation. The purpose of this study is to get effective dose (ED50, ED95) of alfentanil to minimize the hemodynamic responses to laryngoscopy and endotracheal intubation. METHODS: Sixty patients were divided into four groups. Each group received intravenous normal saline 5 ml (Control group), alfentanil 10microgram/kg (Al10), alfentanil 20microgram/kg (Al20) and alfentanil 30microgram/kg (Al30), respectively. Mean arterial pressure (MAP) and heart rate (HR) were measured before and after intubation. We considered the doses of alfentanil effective when the increase in MAP and HR after intubation did not exceed 10% of those before intubation. RESULTS: The ED50 of alfentanil was 12.7 (8.6-16.4)microgram/kg for MAP, 20.1 (15.7-25.6)microgram/kg for HR, respectively. The ED95 of alfentanil was 26.4 (21.7-36.2)microgram/kg for MAP, 38.6 (31.2-56.7)microgram/kg for HR, respectively. CONCLUSIONS: Alfentanil was effective to minimize the hemodynamic responses to laryngoscopy and endotracheal intubation with its ED50 and ED95 as mentioned earlier.

Pain on Injection of Rocuronium: Influence of Two Methods of Lidocaine Injection / 대한마취과학회지

BACKGROUND: Many trials have been conducted on the prevention of pain induced by intravenous rocuronium. The aim of this study was to assess the effectiveness of lidocaine preinjection compared with rocuronium premixed with lidocaine in minimizing pain on injection. METHODS: Seventy five patients, ASA physical status I or II, were randomly allocated to one of three groups. In the control group (n = 25), patients received saline 3 ml, followed 20 slater by rocuronium (0.6 mg/kg) only. In the lidocaine premixture group (PM, n = 25), normal saline 3 ml and rocuronium(0.6 mg/kg) premixed with lidocaine 30 mg were given intravenously, and in the lidocaine preinjection group (PI, n = 25), lidocaine 30 mg was administered before injection of rocuronium (0.6 mg/kg). Pain was assessed verbally as none, mild, moderate, and severe by the same observer. RESULTS: There was a significant reduction in the incidence and severity of pain in the PI group. Only 6 patients (24%) in the PI group experienced pain as compared to 16 patients (64%) in the PM group and 22 patients (88%) in the control group. CONCLUSIONS: Lidocaine 30 mg given before the administration of rocuronium significantly reduced the incidence and severity of rocuronium induced pain. But, lidocaine rocuronium premixtures did not significantly reduce the incidence of pain.

Pulmonary Embolism after Spinal Anesthesia Induction for the Surgical Reduction of a Femur Neck Fracture: A case report / 대한마취과학회지

This case involved a pulmonary thromboembolism, which originated from the lower extremity. A 68-year-old female, with a femur neck fracture, underwent spinal anesthesia with 0.5% heavy bupivacaine 11 mg for total hip arthroplasty. Ten minutes after the induction of spinal anesthesia, dyspnea, tachycardia and hypotension appeared. Under the impression of a pulmonary embolism, intubation was done and dopamine and epinephrine were infused. The operation stopped and she was sent to the intensive care unit. On the spiral CT chest angiogram, a pulmonary embolism was found. Deep venous thrombosis was detected in the left lower extremity on the venogram. Heparin therapy was started at a rate of 800 U/hour with a bolus of 5000 U. A consultative operation for the removal of deep vein thrombosis was performed by a chest surgeon, and total hip arthroplasty was performed successfully under spinal anesthesia.

Anesthetic Management for a Patient with Charcot-Marie-Tooth Disease Using Propofol and Rocuronium / 대한마취과학회지

This case involves a 43-year-old man who had been diagnosed as having Charcot-Marie-Tooth disease (CMTD) 9 years ago and was scheduled to undergo posterior fusion of its spine due to a compression fracture. General anesthesia using propofol was selected as the anesthetic method, in order to avoid the occurrence of malignant hyperthermia due to inhalation anesthetics. The patient was given 100 mg of propofol for anesthetic induction, and then propofol was infused at a rate of 4-5 mg/kg/h with intermittent administration of fentanyl for anesthetic maintenance. Rocuronium 50 mg was injected for endotracheal intubation, and then rocuronium 10 mg was injected at 45 min intervals. There was no delay in awakening, and the patient experienced no problems postoperatively. Intravenous anesthesia using propofol is thought to be a safe and effective method of anesthesia for patients with CMTD.

Use of Nicardipine and Esmolol in the Anesthetic Management for Bilateral Pheochromocytoma: A case report / 대한마취과학회지

Pheochromocytoma stems from the chromaffin cell and mostly is located in the adrenal medulla. It is an important cause of secondary hypertension due to correction of hypertension by a resection of the tumor. Because it produces and secretes catecholamine, it bothers anesthesiologists with excessive hypertension, tachycardia and arrhythmia during the anesthetic period. Therefore, anesthetic management is directed to avoid these conditions. We report a case of bilateral pheochromocytoma successfully managed intraoperatively with an infusion of nicardipine and an intermittent esmolol injection.

The Effects of the Combination of Ketamine and Midazolam for Sedation during Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Epidural anesthesia is becoming an increasingly important aspect of anaesthetic practice because it has many advantages. To achieve the appropriate sedation, various methods have been described. The authors applied the ketamine for this purpose in subanesthetic dose and compared with the midazolam that has been most commonly used for intravenous sedation. METHODS: Fifty-seven adult patients undergoing lower abdominal and extremity surgery who were receiving epidural anesthesia were randomely enrolled into this clinical study. They were allocated to three groups to receive only normal saline (group C), midazolam 0.05 mg/kg (group M) and ketamine 0.5 mg/kg midazolam 0.05 mg/kg (group K) in normal saline 10ml, respectively. Hemodynamic and respiratory measurements were recorded at baseline, 1 minute, 3 minute, 5 minute, 10 minute, 20 minute and 30 minute after sedation. The degree of sedation was assessed by a blinded observer using sedation score. RESULTS: There were no significant differences for hemodynamic and respiratory parameters, but decrements of arterial pressure at 1 minute after sedation were most remarkable in the group M. Sedation was satisfactorily achieved by combination of ketamine and midazolam without significant emergence reaction. CONCLUSIONS: The combination of ketamine and midazolam was judged to be suitable alternative for sedation during epidural anesthesia.

Intraoperative Coagulation Management by TEG in a Patient with Aplastic Anemia: A case report / 대한마취과학회지

This case was an acquired aplastic anemia patient who required a major operation for excision of a mediastinal mass. The authors previewed that the coagulation abnormalities would be developed due to major operation. Thus we decided to monitoring the coagulation function using the thromboelastography during the perioperative period and checked the complete blood count, concommitantly. The total blood volume lost during operation was 1800 ml, so we gave him a transfusion of 10 U's of platelet concentrate, 10 U's of pheretic platelet rich plasma and 5 U's of whole blood. The thromboelastography was a good guide that helped us to avoid excessive treatment of the coagulation abnormalities. We concluded that the thromboelastograhy was a reliable and effective monitoring system at the intraoperative coagulation management.

Augmentin-Induced Coagulation Abnormalities as Measured by Thromboelastography / 대한마취과학회지

BACKGROUND: Antibiotics are used prophylactically in surgery to prevent postoperative infection. However, antibiotics administered in large doses can cause a bleeding diathesis as a result of platelet dysfunction. We wondered whether these antibiotics might impair platelet function by interfering with the initial step of platelet activation: the binding of agonists to their specific receptors on the platelet surface. METHODS: In 30 patients (male 18, women 12) undergoing primary elective knee arthroscopic surgery, the whole blood coagulation system was prospectively evaluated before, and 10 and 40 minutes after administration of 1 g of augmentin. All patients who had abnormal preoperative coagulation profiles or who received anticoagulant or antiplatelet, antibiotics therapy within 7 days prior to surgery were precluded. RESULTS: At 10 minutes after augmentin administration 25 of 30 patients had a significant impairment in all phases of whole blood coagulation as monitored by thromboelastography. In contrast, three of 30 patients had a significantly decreased coagulation time. Two of 30 patients had no significant changes of TEG variables. TEG variables were restored toward baseline in fourty minutes after augmentin administration. CONCLUSIONS: Augmentin can cause a significant but transient change in the viscoelastic properties of blood. Coagulation parameters of the TEG should be measured prior to augmentin administration to prevent and prospect a bleeding diathesis as a result of platelet dysfunction.