Non-neurologic complications following surgery for scoliosis / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the prevalence of non-neurologic complications following surgery for scoliosis and to identify factors that can increase this risk. METHODS: The demographic data, medical and surgical histories, and prevalence of non-neurologic complications were reviewed in a retrospective cohort of 602 patients, who had undergone corrective surgery for scoliosis between January 2001 and June 2011. RESULTS: There were 450 patients under 20 years old (U20) and 152 of patients above 20 years old (A20) enrolled in this study. Forty-nine patients in U20 (10.9%) and 18 patients in A20 (11.8%) had post-operative complications. Respiratory complications were most common in U20 (4%) and gastrointestinal complications were most common in A20 (7%). There was no significant difference between the 2 groups in the prevalence of complications. Logistic regression revealed that factors that correlated with an increased odds for complications were Cobb angle (P = 0.001/P = 0.013, respectively), length of operation time (P = 0.003/P = 0.006, respectively), duration of anesthesia (P < 0.001/P = 0.005, respectively) and transfusion (P = 0.003/P = 0.015, respectively) in U20 and A20. Also, comorbidities (P = 0.021) in U20, and decreased body mass index (P = 0.030), pre-operative forced vital capacity (P = 0.001), forced expired volume in 1s (P = 0.001), increased numbers of vertebrae fused (P = 0.004), blood loss (P = 0.001) in A20 were associated with increased odds for complications. CONCLUSIONS: There was no difference in the prevalence of complication in scoliosis patients by age. The prevalence of complication was dependent on Cobb angle, length of operation time, duration of anesthesia and transfusion of PRBC. Deterioration of preoperative pulmonary function significantly increased risk of post-operative complications in adult patients.

Anesthetic efficacy of etomidate, propofol and thiopental sodium during electroconvulsive therapy

BACKGROUND: Electroconvulsive therapy (ECT) is effective for major psychosis and affective disorder. The ideal anesthetics for ECT provide rapid induction and recovery, and they attenuate the adverse effects of ECT. We compared the effects of etomidate, propofol and thiopental sodium during ECT. METHODS: Nine patients were enrolled in this double blinded cross over design study. The ECT was done 3 times per week for two weeks. We monitored the patients with electrocardiography, pulse oximetry, the bispectral index score and the blood pressure. We recorded the data at the time of arrival to the therapy room, just before ECT and at 1, 2, 3, 4, 5, 7 and 10 minutes after ECT. Hypnosis was induced with 3 mg/kg of thiopental sodium (group T), 1.5 mg/kg of propofol (group P) or 0.15 mg/kg of etomidate (group E). The ECT was done after administering 1 mg/kg of succinylcholine. The duration of seizure were measured after ECT. RESULTS: There were significantly different durations of motor seizure among the three groups. The duration of EEG seizure in group E was longer than that of group P and group T. The blood pressure and the heart rate of group P were significantly lower than that of the other groups (P < 0.05). CONCLUSIONS: Compared to thiopental sodium and etomidate, propofol was not associated with clinically significant changes in the duration of seizure and hemodynamic stability. It has a good hypnotic effect and it did not affect the therapeutic efficacy of ECT. Etomidate is effective for patients for achieving a short duration of seizure after ECT is applied.

Anesthetic care for electroconvulsive therapy during pregnancy: A case report / 대한마취과학회지

Electroconvulsive therapy (ECT) is recommended for patients with psychotic disorders that do not respond to medication. Usually, many psychotropic medications have teratogenic effects on the fetus. ECT seems to be a relatively safe and effective treatment during pregnancy. We report here on a 33-year-old primigravida patient in her third trimester receiving ECT.

The effects of sevoflurane with propofol and remifentanil on tracheal intubation conditions without neuromuscular blocking agents / 대한마취과학회지

BACKGROUND: Propofol and remifentanil are used for tracheal intubation in the absence of neuromuscular blocking agents. We hypothesized that the addition of sevoflurane to propofol and remifentanil would improve intubation conditions and provide hemodynamic stability. METHODS: Seventy-six patients scheduled for elective surgery were randomly allocated to be ventilated with either 4% (group I) or 7% sevoflurane (group II) after propofol injection (2 mg/kg). All patients received remifentanil (1 microgram/kg) 30 seconds after administration of propofol. Ninety seconds after remifentanil was given, laryngoscopy and tracheal intubation were performed. Intubation conditions and hemodynamic changes were evaluated. RESULTS: The overall incidence of clinically acceptable intubation conditions was significantly higher in group II (92%) than group I (58%) (P = 0.001). Scores for vocal cord position, coughing, and limb movement were significantly better in group II (P < 0.05). Mean blood pressure remained significantly lower than the pre-induction level throughout the investigation in both groups (P < 0.001), but there was no incidence of bradycardia or hypotension requiring treatment. CONCLUSIONS: Tracheal intubation without neuromuscular blocking agents can be achieved safely and reliably by adding 7% sevoflurane to propofol (2 mg/kg) and remifentanil (1 microgram/kg).

Effects of Nutrition Education on Nutritional Status of Hemodialysis Patients

Malnutrition is a common problem in patients undergoing maintenance hemodialysis (HD) and compromised food intake is an important cause. Malnutrition is one of the important factors influencing mortality in these patients. This study was conducted to evaluate the effectiveness of nutrition education at improving nutritional status of 23 Korean HD patients (mean : 48.6 +/- 10.4 years, men : 8, women : 15). Anthropometric indices, nutrient intakes, and biochemical blood indices were measured before and after a 6-month nutrition education intervention. Anthropometric indices such as percent ideal body weight [PIBW (%)], body fat, body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), and calculated arm muscle area (CAMA) of subjects were within the normal range and not changed by nutrition education. Subjective global assessment (SGA) was significantly increased (p<0.05) after nutrition education. Intake of total energy, carbohydrate, lipid, Ca, and vitamin B1 was increased significantly (p<0.05) but intake of phosphorus, potassium, and sodium was decreased (p<0.05). The serum concentrations of albumin, total protein, and Ca were significantly increased (p<0.05), but levels of P and K were decreased (p<0.05) after the intervention. These findings suggest that nutrition education for HD patients can be effective for positively changing nutrient intakes, leading to improvements in blood indices and nutritional status.

Influence of Routine Calorie and Protein Intake on Nutritional Status in Stable Chronic Hemodialysis Patients : A 18 Months Follow-up Study / 대한신장학회잡지

BACKGROUND: Dialysis patients as a group appear to have a caloric and a protein intake less than the recommended values; because their energy expenditure is not different from that of healthy adults and because amino acid loss and increased catabolism during dialysis they should be in negative caloric & nitrogen balance and lose body mass and protein such as albumin progressively. Recently, papers dissenting about recommended protein intake in DOQI guideline were published. Because Korean people had different body size and dietary pattern from white races, recommanded protein and calorie intake may be different from that of white races. METHODS: We retrospectively analyzed our data in a group of hemodialysis patients who had dietary evaluations and kinetic measurements performed two consecutive times over a period of 18 months. RESULTS: Body weight(55.22+/-.48 kg to 57.39+/-0.29 kg, p=0.008), LBM(lean body mass, 42.79+/-.49 kg to 46.09+/-.13 kg, p=0.000), BMI(Body Mass Index, 21.89+/-.21 kg/m2 to 22.75+/-.53 kg/m2, p=0.007) and serum albumin level(3.65+/-.47 g/dL vs 3.87+/-.42 g/dL, p=0.000) were increased compared to initial values. Fat mass, TSF(Triceps Skin Fold thickness), MAC(Mid-Arm Circumference), MAMC(Mid- Arm Muscle Circumference) were remained stable over this period of time. These results suggested that these patients are not in negative energy and nitrogen balance. CONCLUSION: Albumin and body weight remained stable over a period of 18 months in spite of 27.25+/-.39 kcal/kg calorie intakes and 1.03+/-.43 g/kg protein intakes. Recommanded protein and calorie intake of Korean people may be different from that of white races.