Rates and Related Factors of Progression to Hypertension among Prehypertensive Local Residents Aged 45 or Over in Chuncheon City: Hallym Aging Study from a Community-Based Cross-Sectional Study

BACKGROUND AND OBJECTIVES: Prehypertension (preHT) is considered to a precursor of hypertension and it is a predictor of excessive cardiovascular risk. We investigated the rates and determinants of progression to hypertension (HT) among local residents aged 45 or over, and we compared the differences in demographic factors, anthropometric measurements, life styles and metabolic profiles between the progression individuals and non-progression individuals. SUBJECTS AND METHODS: Data from the Hallym Aging Study, which was conducted 3 years apart were used to form the sample of 489 adults. PreHT was defined by the Joint National Committee (JNC-7) criteria. We conducted interviews to determine the life style (alcohol, smoking and exercise) and the measured obesity indices. The metabolic profiles were fasting blood sugar (FBS), cholesterol, triglyceride and high density lipoprotein (HDL)-Cholesterol. The factors related to progression to HT were examined by using multiple logistic regression analysis. RESULTS: The progression rate to HT was 56.4% (56.9% in men, 55.9% in women). The presence of metabolic syndrome was significantly greater and the body mass index (BMI) and systolic blood pressure were significantly higher in the progression group compared with the non-progression group (p=0.0475, p=0.0099, p=0.0082, respectively). Important determinants of progression to HT are a BMI> or =25 kg/m(2) [odds ratio (OR): 2.26, 95% confidence interval (CI): 1.02-5.22] and a diastolic blood pressure of 85-89 mmHg (OR: 6.11, CI: 1.55-24.13). Changes of FBS (deltaFBS) and pulse pressure (deltaPP) according to a time interval of 3 years are the significant related factors (OR: 3.40, CI: 1.04-11.13 and OR: 9.40, CI: 2.19-40.12, respectively). CONCLUSION: PreHT frequently progresses to HT over a period of 3 years. A higher BMI and diastolic blood pressure at the index survey are significantly related to progression. deltaFBS and deltaPP are also important determinants. Therefore, early recognition of preHT and intensive life style modification are needed to prevent progression to HT.

The Effects of Intrathecal Midazolam Added to Bupivacaine Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal additives are often used to enhance spinal anesthesia. Midazolam has been reported to have a spinally mediated antinociceptive effect. The aim of this study was to evaluate the effect of midazolam in addition to hyperbaric bupivacaine in spinal anesthesia. METHODS: Sixty ASA 1 or 2 adult patients scheduled for lower extremity surgery under spinal anesthesia were studied. Patients were allocated randomly to one of four groups to receive 2.8 ml of one of either of the following intrathecal solutions: hyperbaric bupivacaine 12 mg and normal saline 0.4 ml (group 1; n = 15), hyperbaric bupivacaine 12 mg, midazolam 0.5 mg and normal saline 0.3 ml (group 2; n = 15), hyperbaric bupivacaine 12 mg, midazolam 1 mg, and normal saline 0.2 ml (group 3; n = 15), or hyperbaric bupivacaine 12 mg and midazolam 2 mg (group 4; n = 15). The level, onset, and duration of spinal anesthesia as well as hemodynamic changes and side effects were assessed. RESULTS: The duration of spinal anesthesia was increased in the midazolam addition groups. The duration of anesthesia was significantly increased in group 4 compared to the other 3 groups (P<0.05). The onset, blood pressure, heart rate, and levels of sedation were no different between the 4 groups. No neurological deficit or other significant adverse effects were recorded. CONCLUSIONS: The addition of intrathecal midazolam to hyperbaric bupivacaine significantly improve the duration of spinal anesthesia without significant adverse effects. Therefore, the use of intrathecal midazolam in a dose not exceeding 2 mg can be used as an effective additive for spinal anesthesia.

Pain on Injection of Rocuronium: The Effect of Pretreatment of Lidocaine, Fentanyl, and Ondansetron / 대한마취과학회지

BACKGROUND:Rocuronium is given for precurarization, timing or priming before the induction of anesthesia. The incidence of pain on injecting rocuronium is high and can be very distressing. The goal of this study was to evaluate whether pretreating lidocaine, fentanyl, or ondansetron i.v. can decrease the incidence and severity of injection pain. METHODS: One hundred and fifty patients were randomly allocated into five groups: patients in groups I, II, III, IV, and V received saline (3 ml), lidocaine 30 mg, lidocaine 50 mg, fentanyl 100microgram, or ondansetron 4 mg after manually occluding the forearm. The occlusion was released and rocuronium 0.6 mg/kg was injected. The patients were then observed and asked whether they had pain in the arm, and responses were assessed. RESULTS: The mean (median) pain scores in gorups I, II, III, IV, and V were 1.9 (2), 1.0 (1), 0.73 (1), 1.33 (1), and 1.2 (1), respectively. We found that 7%, 37%, 47%, 20%, and 20% of patients in groups I, II, III, IV and V reported no pain. Moderate to severe pain was seen in 60%, 33%, 20%, 40%, and 33% of patients in groups I, II, III, IV, and V, respectively. CONCLUSIONS: Lidocaine, fentanyl, and ondansetron reduced rocuronium injection pain. Of these drugs, lidocaine seems to be the most effective. Fentanyl and ondansetron proved less effective than lidocaine.