Relationship between Smoking and Sleep Disturbance / 수면정신생리

Smoking is one of the most harmful causes of disease. Many previous researches have shown that cigarette smoking leads to cardiovascular, respiratory, oncologic, and cerebrovascular diseases. In addition to such adverse effects, the literature indicates that cigarette smoking can worsen sleep quality and induce sleep disorders. This review focuses on the relationship between smoking/nicotine and sleep and sleep disorders of insomnia, obstructive sleep apnea, and restless legs syndrome. Because smoking is a behavioral pattern that can be changed, it is important to quit smoking to improve overall health and sleep.

Ultrasound-guided central cluster approach for the supraclavicular brachial plexus block: a case series / 대한마취과학회지

There are many different approaches to ultrasound-guided supraclavicular brachial plexus block (US-SCBPB), and each has a different success rate and complications. The most commonly performed US-SCBPB is the corner pocket approach in which the needle is advanced very close to the subclavian artery and pleura. Therefore, it may be associated with a risk of subclavian artery puncture or pneumothorax. We advanced the needle into the central part of the neural cluster after penetrating the sheath of the brachial plexus in US-SCBPB. We refer to this new method as the "central cluster approach." In this approach, the needle does not have to advance close to the subclavian artery or pleura. The aim of this study was to evaluate the clinical outcomes of the central cluster approach in US-SCBPB.

Effect of pneumoperitoneum on the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic surgery / 대한마취과학회지

BACKGROUND: This study investigated the effect of pneumoperitoneum on the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic abdominal surgery. METHODS: Thirty adult patients undergoing laparoscopic abdominal surgery were studied. Anesthesia was induced with 1.5 mg/kg of propofol, 12 ug/kg of alfentanil and 0.6 mg/kg of rocuronium and maintained with 2 vol% of sevoflurane and 0.05-0.2 microg/kg/min remifentanil. The neuromuscular relaxation was monitored by Train-of-Four (TOF) and post-tetanic count (PTC). Additional rocuronium of 0.2 mg/kg was administered for deep neuromuscular blockade at 30 min after pneumoperitoneum. Before (PPpre) and 30 min after pneumoperitoneum (PPpost), PTC was measured at 6 min intervals. The relationship between PTC and the time interval to reappearance of T1 response was observed. RESULTS: The mean +/- SD of the intervals between the detection of 4 counts of the PTC and the first response to TOF stimulation was 13.0 +/- 1.1 min and 16.4 +/- 6.3 min PPpre and PPpost, respectively (P = 0.20). There were significant negative relationships between PTC observed and the time interval to reappearance of T1 response (adjusted R2 = 0.869, P < 0.001 for PPpre data, and adjusted R2 = 0.561, P < 0.001 for PPpost data). Comparing the difference of regression equation between PPpre and PPpost data using a parallelism test, there was no statistically significant difference (P = 0.193). CONCLUSIONS: This study showed that PP with intra-abdominal pressure at the level of 13-14 mmHg did not affect the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic abdominal surgery.

A comparison of general anesthesia versus axillary brachial plexus block for hand and wrist surgery in the view of patient satisfaction

BACKGROUND: We evaluated whether the analgesic superiority of regional block over general anesthesia improves patient satisfaction. METHODS: Patients were anesthetized with either general anesthesia (GA) (n = 30) or axillary brachial plexus block (BPB) (n = 30). GA was standardized to include induction with propofol and alfentanil and maintenance with desflurane in an oxygen/nitrous oxide mixture. BPB was performed using an axillary perivascular approach, and 1.5% lidocaine 20 ml with epinephrine (1 : 200,000) and 0.5% levobupivacaine 20 ml were injected. Pain scores and numbers of times pushing the patient-controlled analgesia (PCA) button were measured preoperatively and at 2, 6, and 24 hours after the end of surgery. On the first day after the operation, one of our researchers visited the patients to document their opinions of their anesthetic experiences and their satisfaction scores. RESULTS: Group BPB had lower visual analog scale scores at 2 hours and 6 hours postoperatively. Numbers of times pushing the PCA button was also lower in Group BPB within the first 2 hours and between 2-6 hours postoperatively. However, patient satisfaction scores were not statistically different between the two groups (84 +/- 11 vs. 88 +/- 12, P = 0.177). CONCLUSIONS: BPB provided superior analgesia after upper limb surgery compared to GA, but for a complete understanding of patients' satisfaction, detailed consideration of factors such as sedation would be necessary.

Anesthetic management for cesarean delivery in a patient with lymphangioleiomyomatosis: A case report

Lymphangioleiomyomatosis (LAM) is a rare, progressive cystic lung disease, characterized by a proliferation of immature smooth muscle cell (LAM cell) in the airway, parenchyma, lymph nodes and pulmonary vessels. It mainly affects women in their reproductive years. It is clinically manifested by recurrent pneumothorax, progressive dyspnea on exertion and chylothorax; it can also ultimately lead to respiratory failure. However, no curative treatment for LAM is currently available. We report an anesthetic management for cesarean delivery in a parturient newly diagnosed with LAM.

Anesthetic management for cesarean delivery in a patient with lymphangioleiomyomatosis: A case report

Lymphangioleiomyomatosis (LAM) is a rare, progressive cystic lung disease, characterized by a proliferation of immature smooth muscle cell (LAM cell) in the airway, parenchyma, lymph nodes and pulmonary vessels. It mainly affects women in their reproductive years. It is clinically manifested by recurrent pneumothorax, progressive dyspnea on exertion and chylothorax; it can also ultimately lead to respiratory failure. However, no curative treatment for LAM is currently available. We report an anesthetic management for cesarean delivery in a parturient newly diagnosed with LAM.

Survey on the Treatment of Postherpetic Neuralgia in Korea; Multicenter Study of 1,414 Patients

BACKGROUND: Postherpetic neuralgia (PHN) is a serious complication resulting from herpes zoster infections, and it can impair the quality of life. In order to relieve pain from PHN, various treatments, including pharmacological and interventional methods have been used. However, little information on the recommendations for the interventional treatment of PHN, along with a lack of nation-wide surveys on the current status of PHN treatment exists. This multicenter study is the first survey on the treatment status of PHN in Korea. METHODS: Retrospective chart reviews were conducted on the entire patients who visited the pain clinics of 11 teaching hospitals from January to December of 2011. Co-morbid disease, affected site of PHN, routes to pain clinic visits, parenteral/topical medications for treatment, drugs used for nerve block, types and frequency of nerve blocks were investigated. RESULTS: A total of 1,414 patients' medical records were reviewed. The most commonly affected site was the thoracic area. The anticonvulsants and interlaminar epidural blocks were the most frequently used pharmacological and interventional methods for PHN treatment. For the interval of epidural block, intervals of 5 or more-weeks were the most popular. The proportion of PHN patients who get information from the mass media or the internet was only 0.8%.The incidence of suspected zoster sine herpete was only 0.1%. CONCLUSIONS: The treatment methods for PHN vary among hospitals. The establishment of treatment recommendation for PHN treatment is necessary. In addition, public relations activities are required in order to inform the patients of PHN treatments by pain clinicians.

The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia / 대한마취과학회지

BACKGROUND: Perioperative hypothermia can develop easily during shoulder arthroscopy, because cold irrigation can directly influence core body temperature. The authors investigated whether active warming and humidification of inspired gases reduces falls in core body temperature and allows redistribution of body heat in patients undergoing arthroscopic shoulder surgery under general anesthesia. METHODS: Patients scheduled for arthroscopic shoulder surgery were randomly assigned to receive either room temperature inspired gases using a conventional respiratory circuit (the control group, n = 20) or inspired gases humidified and heated using a humidified and electrically heated circuit (HHC) (the heated group, n = 20). RESULTS: Core temperatures were significantly lower in both groups from 30 min after anesthesia induction, but were significantly higher in the heated group than in the control group from 75 to 120 min after anesthesia induction. CONCLUSIONS: In this study the use of a humidified and electrically heated circuit did not prevent core temperature falling during arthroscopic shoulder surgery, but it was found to decrease reductions in core temperature from 75 min after anesthesia induction.

Effects of incrementally increasing tidal volume on the cross-sectional area of the right internal jugular vein / 대한마취과학회지

BACKGROUND: Different tidal volume (TV) settings during mechanical ventilation alter intrathoracic blood volume, and these changes could alter central venous pressure and the cross sectional area (CSA) of the right internal jugular vein (RIJV). The aim of this study was to determine the optimal TV for maximizing the CSA of the RIJV in the supine and Trendelenburg positions in anesthetized patients. METHODS: Forty patients were randomly allocated to a supine group (Group S, n = 20) or a Trendelenburg group (Group T, n = 20) by computer generated randomization. RIJV CSAs were measured repeatedly after increasing the inspiratory volume in 1 ml/kg increments from a TV of 8 ml/kg to 14 ml/kg using ultrasound images. RESULTS: Peak inspiratory pressure increased significantly on increasing TV from 11 ml/kg to 14 ml/kg and between baseline (TV 8 ml/kg) and 11 ml/kg in both groups (P < 0.05). RIJV CSA was not increased versus baseline even after TV changes in either group and no intergroup difference was found. CONCLUSIONS: TV increases do not increase the CSA of the RIJV within the TV range 8 to 14 ml/kg in the supine or 10degrees Trendelenburg position.

Total intravenous anesthesia for Kartagener's syndrome: A case report

Kartagener's syndrome (KGS) is an autosomal recessive disorder which possible to link the occurrence of abnormal ciliary movement and abnormal position of the body organs. Considering the fact that airway ciliary function plays an important role in the primary pulmonary defense mechanism, prevent the ciliodepressant actions are also important for anesthetic management. We described successful anesthetic management of a 44-year-old male scheduled for endoscopic sinus surgery who had a history of frequent epistaxis, anosmia and situs inversus totalis. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion device.

An anesthetic experience of a patient with paraneoplastic encephalitis: A case report

Paraneoplastic encephalitis associated with an ovarian teratoma has been related to the development of antibodies to specific heteromers of the N-methyl-D-aspartate receptor (NMDAR). The disorder, known as anti-NMDAR encephalitis, is characterized by psychiatric symptoms, seizures, mood and behavioral changes as well as involuntary movement. Since the NMDAR is the target of many anesthetic drugs, the presence of anti-NMDAR antibodies might influence the requirements of anesthetics or their effects. We report the presentation and anesthetic experience of a young patient with anti-NMDAR encephalitis undergoing surgical excision of two ovarian teratomas, and we also review the relevant literature.

Anesthetic management of HELLP syndrome complicating primary antiphospholipid syndrome: A case report / 대한마취과학회지

Antiphospholipid syndrome (APS) is defined as an autoimmune disorder characterized by recurrent thrombosis or obstetrical morbidity. A 29-year-old woman who was diagnosed with APS underwent emergency cesarean delivery at 23 weeks' gestation. She had a seizure attack and her laboratory findings were: AST/ALT 1459/1108 IU/L, LDH 1424 IU/L, 30% hematocrit, a platelet count of 43 x 10(3)/ml and urine protein (4+). We describe the anesthetic experience of catastrophic HELLP syndrome with antiphospholipid syndrome and we review the relevant literature.

Effects of different sample volumes on arterial blood gas and electrolytes testing

BACKGROUND: Insufficient sample volume can cause unnecessary blood loss and inaccurate arterial blood gas and electrolytes testing. The aim of this study was to determine the adequate sample volume, that is required for accurate arterial blood gas and electrolyte testing from arterial catheters. METHODS: Patients had four different arterial blood samples (0.2 ml, 0.4 ml, 0.6 ml and 1 ml [control], respectively) taken sequentially in random order. Samples were analyzed for pH, PaCO2, PaO2, hematocrit, Na+, K+, Ca2+ and Mg2+ using NOVA blood gas analyzer. RESULTS: A total of 27 patients were recruited for the study. All sample volumes tested provided the results of pH, PaCO2, PaO2 and hematocrit that were statistically similar to control values. However, the results of electrolytes (K+, Ca2+ and Mg2+) in all sample volumes tested were significantly lower than the control values and an increasing sample volume equated to blood results trending closer to those obtained with the control sample. CONCLUSIONS: This study showed that there is not one sample volume that will provide accurate results for all blood components. The study tested a variety of sample volumes and found that although even small sample volume of 0.2 ml provided accurate results for pH, PaCO2, PaO2 and hematocrit. No sample volume that was tested provided accurate results for K+, Ca2+ and Mg2+.

The preventative effect of ramosetron on postoperative nausea and vomiting after total thyroidectomy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) frequently develops in patients undergoing thyroidectomy, and propofol-based total intravenous anesthesia (TIVA) has been reported to reduce the incidence of PONV. The present study was undertaken to compare the effects of ramosetron on PONV in women following total thyroidectomy under TIVA. METHODS: One hundred and thirty women scheduled for thyroidectomy were allocated to either a control group (n = 65) or a ramosetron group (n = 65). Propofol in combination with remifentanil was used for TIVA in all patients. 2 ml of either intravenous saline (control group) or 0.3 mg of ramosetron (ramosetron group) were administered at the end of the surgery. Fentanyl-based patient-controlled analgesia was implemented for 48 h after surgery in all patients. The incidences and severities of PONV, pain scores, administrations of rescue antiemetics, and the side effects of the antiemetics were documented during the first 48 h after surgery. RESULTS: The incidences of complete response (no PONV, no rescue) in the control and ramosetron groups were 71% and 88%, respectively, during the first 6 h (P = 0.029), 85% and 94% during the next 6 to 24 h period (P = 0.155), and 97% and 95% during the last 24 to 48 h period (P = 1.00). During the first 6 h, the severity of nausea and the use of rescue antiemetic medication were significantly lower in the ramosetron group. CONCLUSIONS: Ramosetron was found to be effective at reducing the incidence and severity of postoperative nausea in women that underwent total thyroidectomy with propofol-based TIVA, especially during the first 6 hours postoperatively.

Venous air embolism during hepatic resection in a patient with liver cirrhosis: A case report

Venous air embolism (VAE) is a potentially fatal complication in patients with chronic liver disease during liver surgery, although VAE is unlikely to occur during laparotomy in a supine position. We report a case presenting unexpected cardiovascular collapse due to venous air embolism in a patient with liver cirrhosis during hepatic resection.

The effects of peripheral hypothermia on monitoring the recovery from deep neuromuscular blockade with rocuronium

BACKGROUND: The skin temperature is often decreased during anesthesia because of a cool ambient temperature in the operating room. Contractility of the muscles may be affected by lowering the muscle temperature. This study was designed to verify that efforts to maintain normothermia on the monitored arm can make recovery from deep neuromuscular blockade more reliable. METHODS: A total of 60 patients were enrolled in this study. Each patient was randomly assigned to group 1 (the monitored arm was shielded with a passive warming protector) or group 2 (the monitored arm was was exposed to the ambient operating room temperature). Conventional inhalation anesthesia was induced with propofol and alfentanil, and this was maintained with O2, N2O and isoflurane. The twitch response of the adductor pollicis muscle was recorded. After calibration of the TOF watch(R), 0.6 mg/kg of rocuronium was injected. During anesthesia, the post tetanic count (PTC) was checked every 5 to 6 minutes until the first response to a train-of-four (TOF) stimulations appeared. The ambient operating room temperature, the core temperature and the skin temperature were checked simultaneously. RESULTS: The skin temperature of group 2 was lower than that of group 1 (33.89 +/- 0.81 degreesC and 35.41 +/- 0.45 degreesC, respectively, P < 0.05). When the data was plotted with the equation y=be(-ax), this equation well represented the data of group 1 (R2 = 0.82), but it did not well represent the data of group 2 (R2 = 0.54). CONCLUSIONS: During recovery from deep neuromuscular blockade with using rocuronium, it may be desirable to maintain normothermia at the thenar area for a better recovery time from a given PTC.

The effects of the oxygen flow rate on heart rate variability in the PACU after TIVA

BACKGROUND: Oxygen increases the cardiac vagal tone, blood pressure, systemic vascular resistance and vascular tone in healthy adults.This study assessed the autonomic tone according to different oxygen flow rates via different types of masks with using the heart rate variability (HRV) in the PACU after total intravenous anesthesia (TIVA). METHODS: We prospectively studied 27 patients after TIVA in the PACU.The 5 L group received oxygen via a simple mask with an oxygen rate of 5 L/min and the 10 L group received oxygen via a mask with a reservoir bag at a rate of 10 L/min in the PACU. We evaluated the HRV at the point of stabilization before anesthesia (BL), 5 min in the PACU (PACU 5), 30 min in the PACU (PACU 30) and 60 min in the PACU (PACU 60). RESULTS: In the 5 L group, the nuHF was increased to 42.4 +/- 24.2 at 60 min in the PACU as compared with 27.1 +/- 19.1 at 5 min in the PACU.In the 5 L group, the LFHFr was decreased to 2.3 +/- 2.1 at PACU 60 as compared with 6.6 +/- 9.7 at PACU 5 and the nuLF was decreased to 56.9 +/- 23.2 at PACU 60 as compared with 72.9 +/- 19.0 at PACU 5.There were no significant changes between the two groups at PACU 5, PACU 30 and PACU 60.The oxygen saturation was increased at PACU 60 compared with PACU 5 in the two groups. CONCLUSIONS: These finding indicates that 1 h of oxygen administration with 5 L/min during emergence from anesthesia increased the relative vagal tone, and the arterial blood pressure is stable irrespective of the oxygen flow rate.

Interrupted aortic arch diagnosed with loss of femoral pulse in a patient undergoing patent ductus arteriosus ligation: A case report / 대한마취과학회지

A 12-year-old boy with ventricular septal defect and patent ductus arteriosus was presented to the operating room. Upon clamping the patent ductus arteriosus, the femoral arterial pressure curve was lost; however, it returned upon unclamping. Upon further dissection, an interrupted aortic arch was found between the left subclavian artery and patent ductus arteriosus. The surgery was discontinued for further evaluation.

Anesthetic management for a patient with Eisenmenger syndrome undergoing dacryocystorhinostomy: A case report

Eisenmenger syndrome is defined as pulmonary hypertension at or close to systemic values, with an intracardiac or aortopulmonary communication resulting a bidirectional or right-to-left shunt.Patients with Eisenmenger syndrome require a close monitoring while undergoing non-cardiac surgery because these patients are very vulnerable to alteration in hemodynamics induced by anesthetics or surgery.Therefore we report the successful management of a patient with Eisenmenger syndrome undergoing a dacryocystorhinostomy under desflurane and ketamine based general anesthesia.

Atrial flutter associated with high pressure pneumoperitoneum during laparoscopic gastrectomy: A case report

Pneumoperitoneum associated with carbon dioxide (CO2) insufflation may induce alterations in electrocardiographic variables, which may produce severe atrial and ventricular arrhythmias.We now present a case in which atrial flutter developed after CO2 insufflation in a patient undergoing laparoscopic subtotal gastrectomy.Although the ECG change was reversed after desufflation, one should keep in mind the increased propensity to atrial and ventricular arrhythmias during laparoscopy with high intra-abdominal pressure.