Measurement of the length from vocal cord to carina and diameter of the trachea with a three-dimensional chest CT scan in adults; comparison with demographic data

BACKGROUND: Most morphometric studies of the airway have relied on plain radiographs or CT scan with their attendant limitations. We evaluated the length from vocal cord to carina and diameter of the trachea in adults who had no abnormality of the airway using three-dimensional chest CT scan and compared with demographic data. METHODS: We performed a multiplane reconstruction of the airway using axial, sagittal, and coronal slices (aged 18-87, 100 men, 100 women). We measured that the lengths from vocal cord to carina and the diameters (AP, anteroposterior; TR, transverse) of 50 mm above carina of the trachea. RESULTS: The lengths from vocal cord to carina was 130.2 +/- 11.4 mm in men and 119.5 +/- 10.5 mm in women. The AP and TR diameters of the trachea at 50 mm above carina were men; 18.0 +/- 2.4 mm, 17.2 +/- 2.6 mm, women; 14.4 +/- 2.0 mm, 14.4 +/- 1.9 mm, respectively. The correlation between airway length and age and height was statically significant in men and women but less clinically significant. The correlation between diameter of trachea and height was only statically significant in men but less clinically significant. CONCLUSIONS: This study suggests that these measured data are helpful for the endotracheal intubation and endotracheal tube placement in airway management.

The willingness of patients to pay for intravenous patient-controlled analgesia in Korea / 대한마취과학회지

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.

The willingness of patients to pay for intravenous patient-controlled analgesia in Korea / 대한마취과학회지

BACKGROUND: The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. METHODS: We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. RESULTS: For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. CONCLUSIONS: The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea.

The effect of ephedrine on blood pressure and heart rate during propofol-alfentanil anesthesia; compare to the awake patients / 대한마취과학회지

BACKGROUND: Hypotension and bradycardia in the propofol and alfentanil anesthesia are common during induction and maintenance. Ephedrine has been used to attenuate hypotension and bradycardia in the propofol and alfentanil anesthesia. We designed this study to determine whether propofol and alfentanil anesthesia could affect the blood pressure and heart rate response to intravenous ephedrine when compared with the awake state. METHODS: Forty patients of ASA physical status 1 or 2 were assigned to one of two groups (Awake vs Propofol-alfentanil [P-A] group). Each patients received ephedrine 0.15 mg/kg after assessment of baseline hemodynamic values. In the awake patients, ephedrine were administered after hemodynamic parameters are stabilized. If hemodynamic parameters are stabilized after intubation, ephedrine were administered in the propofol-alfentanil anesthesia patients. The changes in systolic/diastolic blood pressure (SBP/DBP), mean blood pressure (MBP), and heart rate (HR) were recorded every one minute for 10 minutes. RESULTS: Ephedrine increased the heart rate significantly in Awake group but not in P-A group. In the P-A group, 3 min after the administration of ephedrine, MBP increased 25.3%. In Awake group, 2 min after the administration of ephedrine, MBP increased only 6.3%. CONCLUSIONS: We conclude that propofol and alfentanil anesthesia augments the BP response to intravenous ephedrine but not HR.

The effect of ephedrine on blood pressure and heart rate during propofol-alfentanil anesthesia; compare to the awake patients / 대한마취과학회지

BACKGROUND: Hypotension and bradycardia in the propofol and alfentanil anesthesia are common during induction and maintenance. Ephedrine has been used to attenuate hypotension and bradycardia in the propofol and alfentanil anesthesia. We designed this study to determine whether propofol and alfentanil anesthesia could affect the blood pressure and heart rate response to intravenous ephedrine when compared with the awake state. METHODS: Forty patients of ASA physical status 1 or 2 were assigned to one of two groups (Awake vs Propofol-alfentanil [P-A] group). Each patients received ephedrine 0.15 mg/kg after assessment of baseline hemodynamic values. In the awake patients, ephedrine were administered after hemodynamic parameters are stabilized. If hemodynamic parameters are stabilized after intubation, ephedrine were administered in the propofol-alfentanil anesthesia patients. The changes in systolic/diastolic blood pressure (SBP/DBP), mean blood pressure (MBP), and heart rate (HR) were recorded every one minute for 10 minutes. RESULTS: Ephedrine increased the heart rate significantly in Awake group but not in P-A group. In the P-A group, 3 min after the administration of ephedrine, MBP increased 25.3%. In Awake group, 2 min after the administration of ephedrine, MBP increased only 6.3%. CONCLUSIONS: We conclude that propofol and alfentanil anesthesia augments the BP response to intravenous ephedrine but not HR.

Evaluation of the Spreading Effect of Injection Volume due to Use of the Modified Injection Technique in Stellate Ganglion Block / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) results in a sympathetic block of the head, neck, and upper extremities. In a previous study, the modified injection technique (MIT) was found to exert a better sympathetic block effect on the upper extremities than the classic injection technique (CIT). Therefore, this study was conducted to evaluate the spreading effect of injection volume when the MIT was used in the paratracheal SGB at the 6th cervical level. METHODS: One hundred patients were equally divided into 4 groups. Patients in Groups I, II, and III were subjected to paratracheal SGB at the 6th cervical level with 6 ml, 8 ml, 10 ml of 0.5% mepivacaine administered using the CIT, respectively, whereas patients in Group IV were subjected to block with 6 ml of 0.5% mepivacaine by the MIT using a method such as strong pressure at the cephalad portion of the needle entry point. The skin temperature of the second finger was measured before and after SGB, and the occurrence of warm sensation on the face and upper extremities, and the occurrence of hoarseness were evaluated. RESULTS: The increase in the skin temperature of patients in Groups I, II, III, and IV were 0.28 +/- 0.29, 0.52 +/- 0.58, 0.82 +/- 0.77, and 0.80 +/- 0.72, respectively, with the increases in skin temperature observed in the Groups III and IV being statistically significant when compared to Group I (P < 0.05). There were no significant differences observed in the occurrence of warm sensations on the face and upper extremities, or in the occurrence of hoarseness among the groups. CONCLUSIONS: The results of this study could not differentiate the spreading effect of injection volume that occurred when the MIT was used from the effect that occurred as a result of injection of 8 or 10 ml using the CIT. However, the MIT showed better sympathetic block on the upper extremities than the CIT when the same volume was used. Taken together, these results suggest that the spread effect of 6 ml administered by MIT is similar to that of 10 ml administered by CIT.

Effects of Female Hormones and the Menstrual Cycle on Postoperative Pain / 대한마취과학회지

BACKGOUND: This study was designed to examine the effects of female hormones and the menstrual cycle on postoperative pain. METHODS: Ninety women who underwent gynecologic surgery involving a lower abdominal incision were asked for information regarding their menstrual cycles, and blood samples were obtained to determine the progesterone and estrogen levels of the patients at the time of surgery. Patient controlled analgesia was applied to control postoperative pain and an estimate of the consumption of analgesic drugs by the patients was made. Analgesic consumption and pain scores were recorded at 2, 24, and 48 hours after operation. RESULTS: There was no relationship observed between the concentration of progesterone and estrogen and the consumption of analgesic drugs. However, patients that were in the luteal phase at the time of surgery consumed a significantly lower amount of analgesic drugs during the 2-24 hours following surgery than patients that were in the follicular phase (19.4 +/- 6.5 ml vs 24.6 +/- 11.0 ml, P < 0.05), Theree was, no significant difference in pain scores between two menstrual phases. CONCLUSIONS: This study demonstrates that there is less postoperative pain experienced by patients that are in the luteal phase of their menstrual cycle at the time of surgery than in patients that were in the follicular phase of their menstrual cycle, however, the results of this study did not reveal a relationship between the blood concentration of female hormones and postoperative pain.

Optimal Dose of Ephedrine for Attenuation of Hemodynamic Changes during Propofol-Alfentanil Anesthesia / 대한마취과학회지

BACKGROUND: Propofol and alfentanil are frequently combined for general anesthesia. However, hypotension and bradycardia are common during anesthetic induction and maintenance. The purpose of this study was to compare the response of different doses of ephedrine to investigate an optimal dose of ephedrine for attenuation of the hemodynamic changes. METHODS: Eighty patients of ASA physical status 1 or 2 were assigned to one of four groups. Each patient received normal saline (E0), ephedrine 0.15 mg/kg (E15), 0.2 mg/kg (E20), 0.25 mg/kg (E25) after assessment of baseline hemodynamic values. If hemodynamic parameters are stabilized after intubation, baseline values were assessed by average during 3 minutes. Then each dose of ephedrine was given to each patient. The changes in systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure (MAP), and heart rate (HR) were measured every one minute for 10 minutes. RESULTS: The use of ephedrine was effective for attenuation of the hemodynamic changes. E15, E20, and E25 showed statistical difference in BP and HR compared with E0. There was no statistical difference between E20, E25. Moderate hypertension (SBP 160-179 or DBP 100-109) is occurred each 4, 6 cases in E20, E25. CONCLUSIONS: All group of ephedrine injection resulted in elevation of BP, but did not caused HR change. Injection of ephedrine 0.2 mg/kg or 0.25 mg/kg led to excessive blood pressure elevation. Therefore, we consider more than 0.15 mg/kg of ephedrine is not necessary to minimize hemodynamic changes during propofol-alfentanil anesthesia.

Comparison of Sevoflurane-N2O and Propofol-N2O Anesthesia for Laryngeal Microscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngeal microscopic surgery is stressful as a result of the intubation and suspension laryngoscopy during the short operation time. Therefore, the objectives of the anesthesiologist are to maintain sufficient anesthetic depth, promote rapid awakening, and return the protective airway reflexes. This study compared the hemodynamic responses and recovery patterns between propofol-N2O and sevoflurane-N2O anesthesia. METHODS: Sixty outpatients undergoing laryngeal microscopic surgery were randomly divided into three groups: Endotracheal intubation with the effect-site concentration of propofol fixed at 3 ug/ml (Group P3), 4 ug/ml (Group P4) or endotracheal intubation with sevoflurane anesthesia (Group S). In all groups, the anesthesia was supplemented with up to 50% of N2O. The hemodynamic responses during intubation and suspension laryngoscopy were compared. In addition, extubation time, emergence time and the state of recovery (Steward score) were compared. RESULTS: After intubation and suspension laryngoscopy, the mean arterial pressure was significantly higher in Group S than in Groups P3 and P4 (P < 0.05). The heart rate was significantly higher in Group S than in the Group P4 (P < 0.05). The extubation times were not significantly different. However, the time for responding to a verbal command was significantly faster in Groups P3 (7.8 +/- 2.3 min) and P4 (8.8 +/- 1.9 min) than in Group S (10.6 +/- 1.8 min). The Steward score 1 min after extubation was significantly higher in Group S (P < 0.05). CONCLUSIONS: Propofol-N2O anesthesia can be useful in laryngeal microscopic surgery.

The Effective Pressure Value of an Inflatable Wedge in Preventing Postoperative Backache following Surgical Operation in the Lithotomy Position

BACKGROUND: Backache is a common complication following anesthesia and surgery. Previous studies indicated that the use of a lumbosacral wedge was effective in reducing the incidence of postoperative backache. We investigated the effective inflation pressure of an inflatable wedge in preventing postoperative backache following spinal anesthesia and surgery in the lithotomy position. METHODS: A pilot study established a mean comfortable pressure for the wedge when used to support the lumbar curvature. In males and females, the mean pressure values were 23.6 +/- 3.1 mmHg and 18.9 +/- 3.7 mmHg, respectively. The design of the main study was a randomized, controlled trial involving the use of a wedge intra-operatively in patients undergoing spinal anesthesia and urological surgery in the lithotomy position. Fifty male and 50 female patients were included in the main study and randomly allocated to the control or study group. In the study group, the wedge was inserted immediately after the induction of anesthesia and maintained during surgery. On the first day after surgery, all patients were asked whether they had backache. If there was backache, the degree of pain was noted using the numeric rating scale (NRS). RESULTS: In the study and control groups of male patients, the incidence of backache was 16% and 24%, respectively. There was no significant difference between the two groups. In the study and control groups of female patients, the incidence of backache was 20% and 52%, respectively (P < 0.05). Where backache occurred, there was no significant difference in its severity between the study and control groups. CONCLUSIONS: The effective pressure value of an inflatable wedge in preventing postoperative backache following spinal anesthesia and surgical operation in lithotomy position was 19 mmHg in female patients.

Spontaneous Intracranial Hypotension Treated with Epidural Blood Patch: A case report / 대한마취과학회지

Spontaneous intracranial hypotension (SIH) occurs without any preceding events such as lumbar puncture, surgery, trauma, or medical illness. It is characterized by a postural headache that is aggravated in the erect or sitting position, and relieved in the supine position. A postural headache usually resolves either spontaneously or with conservative treatment. An autologous epidural blood patch (EBP) is an effective strategy for managing a postural headache that persists or is aggravated despite conservative treatments. We report a case of SIH with confirmed cerebrospinal fluid (CSF) leakage at the thoracic level, which was managed successfully with an autologous EBP at the lumbar and thoracic levels. We believe that success rate of an epidural blood patch in these cases is dependent on the approximation of the blood injection to the leak site.

Utility of an Imaginary Line between the Both Posterior Superior Iliac Spines for Judgement of L4-5 Interspinous Space / 대한마취과학회지

BACKGROUND: Tuffier's line is often used as a landmark for lumbar puncture. When attempting to identify lumbar interspaces using Tuffier's line, the actual level often turns out to be higher or lower than presumed. The imaginary line that joins both posterior superior iliac spines on the sacrum (posterior superior iliac spine line; PSIS line) can be physically constructed. The purpose of this study was to assess the posibility that the PSIS line could be used as a marker of lumbar spine level. METHODS: After informed consent had been obtained, sixty-seven patients undergoing lumbar spine surgery were examined. The identification of the L4-5 interspinous space was performed in the prone position using a radioluscent wilson frame (RWF-1000 Model 5323, OSI, USA) after general anesthesia. In the same patients, Tuffier's line and the PSIS line were used to determine the level of needle insertion into the L4-5 interspinous space. At first, the L4-5 interspinous space was identified by palpating the interspinous space, two levels above the PSIS line, and then a mark was drawn on the skin. Second, the L4-5 interspinous space was identified and marked by streching a silk between the two iliac crests to construct Tuffier's line. Needles were inserted into the accounted spaces at each marking level. Using a radiologic imaging method, the actual levels were confirmed. RESULTS: By using the Tuffier's line method of identifying the L4-5 interspinous space, 73.1% of needles were inserted correctly, whereas using the PSIS line method of identifying the L4-5 interspinous space, 74.6% of needles were inserted into the correct space. CONCLUSIONS: We conclude that the PSIS line may be as useful as Tuffier's line for determing the lumbar spine level.

A Case of Intractable Chest Pain of Unknown Origin which was Suspicious of Complex Regional Pain Syndrome Type I: A case report / 대한마취과학회지

Complex regional pain syndrome (CRPS) type I is an intractable pain syndrome accompanied with autonomic nerve symptoms, but without certain evidence of nerve injury. It is mainly caused by trauma, such as, fracture, sprain, contusion, etc., and is characterized by, pain (either by contact or spontaneously), allodynia, hyperalgia, vasomotor, and autonomic changes (including variable skin color changes), temperature change, swelling, edema, sweating, trophic change, and motor disturbance. We report the case of a 60-year-old woman who had suffered from severe pain on the right chest for several years. She was satisfactorily treated by pharmacologic therapy and continuous epidural nerve block.

Thromboelastographic Evaluation of the Coagulation Profiles of Full-Term Neonates after Cesarean Section Delivery / 대한마취과학회지

BACKGROUND: Neonatal coagulation systems are quantitatively deficient and immature. Clinical experience, however, does not indicate an increased risk of excessive bleeding associated with surgical procedures in the neonatal period. Moreover, the coagulatory function of neonates by thromboelastography (TEG) is not well known. In this study, we used TEG to assess the coagulation system of term neonates and their pregnant mother to obtain TEG variables of term neonates, and to identify differences between the coagulation systems of term neonates and pregnant mother. METHODS: TEG was performed on 30 pregnant women that underwent Cesarean section delivery using native whole blood, and on their 30 neonates delivered by Cesarean section using umbilical cord venous blood. Blood samples were collected immediately after delivery and TEGs were measured. The TEG variables included reaction time (R), clot formation time (K), maximum amplitude (MA), alpha angle, TEG coagulation index and percentage reduction in MA at 30 minutes (LY30) and 60 minutes (LY60). RESULTS: TEG measurements in neonates were R (mm): 9.7 +/- 5.3 (5.0-18.5), K (mm): 7.5 +/- 2.9 (4.0-12.5), MA (mm): 42.4 +/- 7.8 (25-53.0), alpha angle (o): 46.5 +/- 15.1 (31.0-64.5), TEG index: -0.3 +/- 1.3 (-2.58-+ 1.78), LY30 (%): 30.0 +/- 21.4 (1.5-62.5), LY60 (%): 43.4 +/- 24.7 (5.0-64.5). The R, MA and TEG coagulation indexes were significantly lower in neonates than in their pregnant mother (P <0.05). However, LY60 was significantly higher in the neonates than in the pregnant mother (P <0.05). CONCLUSIONS: We obtained TEG measurements in neonates immediately after Cesarean section delivery, and found differences in the TEG-defined coagulation systems of term neonates and their pregnant mother.

Hemodynamic and Analgesic Effects of Intrathecal Clonidine and Neostigmine on Bupivacaine Spinal Anesthesia in Patients Undergoing Cesarean Section / 대한마취과학회지

BACKGROUND: Clonidine is well known to stimulate both peripheral and central alpha-2 adrenergic receptors. After intrathecal administration, a marked analgesic effect and side effects of hypotension, bradycardia, sedation and dryness of mouth would be observed. Unlike direct acting agonists, neostigmine inhibits the breakdown of an endogenous neurotransmitter, acetylcholine, which was shown to cause analgesia. Neostigmine revealed dose-dependent analgesia and also dose-dependent side effects, chiefly nausea, vomiting and motor weakness. This study was designed to evaluate the effects of intrathecal neostigmine and clonidine in patients with cesarean delivery under bupivacaine spinal anesthesia. METHODS: Eighty healthy parturients were divided randomly into 4 groups; Group B (n = 20) received 1.6 ml (8 mg) of 0.5% bupivacaine plus 0.55 ml of normal saline. Group BN (n = 20) received 1.6 ml (8 mg) of 0.5% bupivacaine plus 0.05 ml (25micro gram) of neostigmine plus 0.5 ml of normal saline. Group BC (n = 20) received 1.6 ml (8 mg) of 0.5% bupivacaine plus 0.5 ml clonidine (75micro gram) plus 0.05 ml of normal saline. Group BNC (n = 20) received 1.6 ml (8 mg) of 0.5% bupivacaine plus 0.05 ml of neostigmine (25micro gram) plus 0.5 ml of clonidine (75micro gram). The maximum sensory block level, duration of motor block and analgesia, side effects (hypotension, nausea and vomiting, sedation), and visual analog pain score during rest and movement were recorded. RESULTS: Maximum spread segment, time for maximal segment spread, and the incidence of side effects were similar among the all groups. The duration of analgesia was significantly prolonged in the BNC group compared with other groups (BNC; 165+/-40 min, B; 81+/-24 min, BN; 91+/-26 min, BC; 129+/-28 min, P<0.05). The duration of motor block was significantly prolonged in the BC and BNC groups than the B group (P<0.05). Visual analogue pain scores at 2 hours after operation were significantly lower in the BNC group than the B and BN groups at rest, and than the B, BN and BC groups during movement. CONCLUSIONS: Intrathecal neostigmine (25micro gram) and clonidine (75micro gram) prolonged the duration of analgesia and motor block in spinal anesthesia with 0.5% bupivacaine.

The Effects of Nicardipine on Hemodynamic Responses to Tracheal Intubation in Diabetics with Autonomic Neuropathy / 대한마취과학회지

BACKGROUND: A laryngoscopy and tracheal intubation often provoke an undesirable increase in blood pressure and heart rate. These hemodynamic responses to tracheal intubation in diabetics are blunted due to autonomic neuropathy. This study was designed to determine the optimal dose of nicardipine in diabetic autonomic neuropathy patients. METHODS: According to the nicardipine dose, 80 diabetics were randomly allocated to four groups of 20 patients. Tracheal intubation by direct laryngoscopy was performed. After intravenous thiopental 5 mg/kg, vecuronium 0.13 mg/kg and one of the dosages of nicardipine 3, 5, or 7microgram/kg followed by mask ventilation of three minutes with enflurane, nitrous oxide and oxygen. Heart rate and blood pressure were mesured five times at one minute intervals. RESULTS: There was no significant difference in the 3microgram/kg group compared with the control group. On the other hand, there was a sufficient blood pressure decrease in the 5microgram/kg and 7microgram/kg group. However, in the 7microgram/kg group, 55% of cases showed severe hypotension (< 70 mmHg). CONCLUSIONS: We suggest that the appropriate dose of nicardipine for prevention of tachycardia, and hypertension in diabetic autonomic neuropathy patients is 5microgram/kg.

The Effects of Ketorolac Used for Postoperative Analgesia on Hemostatic Function: A Thromboelastographic Evaluation / 대한마취과학회지

BACKGROUND: Thromboelastography (TEG) has recently become popular for assessment of whole blood coagulation in the operating room. Ketorolac, a potent injectable nonsteroidal anti-inflammatory drug (NSAID), is commonly used for postoperative analgesia. NSAID inhibit platelet aggregation in coagulation process. This study was designed to determine whether ketorolac used for postoperative analgesia can affect hemostatic function using a TEG. METHODS: Seventy-four female patients, ASA physical status 1 or 2, scheduled for an elective gynecologic surgery were randomly allocated into one of four groups (Group 1: n = 10, control without patient-controlled analgesia (PCA); Group 2: n = 21, PCA with morphine 60 mg; Group 3: n = 20, PCA with morphine 30 mg + ketorolac 90 mg; Group 4: n = 23, PCA with ketorolac 180 mg). Blood samples were obtained for TEG analysis preoperatively and 24, 48 and 72 h after surgery. Cumulative drug dosage, visual analog pain scale, satisfaction degree and side effects were measured at 24, 48 and 72 h after surgery. RESULTS: There were no significant differences in TEG parameters among the four groups at each time. There were no significant differences in visual analog pain scales and satisfaction degrees among the three groups using PCA for postoperative analgesia. Among the three groups using PCA for postoperative analgesia, Group 2 experienced more side effects. CONCLUSIONS: Ketorolac does not affect hemostatic function for 3 days after surgery when administrated as a PCA drug.

Extreme Hypotension Followed by an Intravenous Indigo Carmine Injection during a Radical Prostatectomy: A case report / 대한마취과학회지

Indigo carmine (sodium indigotin disulfonate) is a blue dye that is generally regarded as a safe and inactive material. It is widely used in urology and gynecology to identify the ureteral orifice. Occasionally it causes high blood pressure, bradycardia, nausea and vomiting as side effects. Though rare, it can cause a skin rash, pruritus, and bronchospasm as well. However, it is known that hypotension is extremely uncommon. We report an experience of extreme hypotension that happened immediately after an intravenous indigo carmine injection during a radical prostatectomy under general anesthesia.

Effects of Propofol on the Cytosolic Calcium Concentration of the Astrocytoma Cells / 대한마취과학회지

BACKGROUND: Propofol is a widely-used intravenous anesthetic with a rapid onset, short duration of action and rapid elimination but the molecular mechanisms of action are not completely understood. Not only neurons but astrocytes are potential substrates for anesthetics, specifically for propofol. Intracellular calcium ion ([Ca2 ]i) is known to play a key role in the transduction and propagation of various chemical signals in astrocytes. METHODS: In the present study, the effects of propofol on the intracellular calcium concentration of astrocytoma cells by using a fura-2 fluorescence spectroscopy was investigated. RESULTS: In an isotonic standard solution, propofol (50 and 500microM) produced a transient increase in [Ca2 ]i while the intralipid did not change [Ca2 ]i. In several cells (20%), a transient increase in [Ca2 ]i was followed by sustained elevation which was sensitive to depletion of external calcium. A propofol-induced increase in [Ca2 ]i was not altered by an L-type calcium channel blocker (nifedipine 2microM). In cells bathed in a Ca2 -free external solution, a transient increase in [Ca2 ]i was observed. After the pretreatment of cyclopiazonic acid (CPA), an endoplasmic reticulum Ca2 -ATPase blocker, propofol 500microM did not produce any significant increase in [Ca2 ]i. Carbachol, which is known to release calcium from the inositol 1,4,5-triphosphate (IP3)-induced calcium release (IICR) stores, prevented the [Ca2 ]i increase by propofol and vice versa. High concentrations of caffeine (10 mM), which release calcium from the calcium-induced calcium release (CICR) stores, had no effect on [Ca2 ]i. CONCLUSIONS: From the above results, it is suggested that an increase in [Ca2 ]i by propofol in astrocytoma cells is mainly due to calcium release from the IICR stores.

Pathophysiology of Pin

According to the International Association for the Study of Pain (IASP), pain is un unpleasant sensory and emotional experience signaling the presence of actual or potential tissue damage, or described in terms of such damage. Clinically, however, pain without proven evidence for its origin, should also be considered and treated nonetheless. Pain is classified as acute and chronic, or nociceptive and neuropathic pain. Acute pain is an adaptive, beneficial response which is necessary for the preservation of tissue integrity. When it becomes a chronic pain, which is a pain that has outlived its usefulness, it may be a timeless, endless, and meaningless perception, bringing the subject a sense of isolation and despair. Therefore, adequate management of pain is absolutely mandatory using whatever modalities. Nociceptive pain is initiated by noxious stimuli, whereas the neuropathic pain is induced by injury to either peripheral or central nervous system. If the pain is not treated or undertreated, noxious stimuli evoke long-term and persistent changes in the dorsal horn neurons in the spinal cord. These changes engrave the memory of the stimuli and sensitize the dorsal horn neurons. Subsequent pain stimuli evoke a even greater response, which results in a centrally mediated secondary hyperalgesia, and is mediated through glutamate acting on the N-methyl-diaspartate (NMDA) receptors. Mechanisms and pathophysiology of each pain are described briefly.