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1.
Korean Journal of Family Medicine ; : 274-280, 2023.
Article in English | WPRIM | ID: wpr-1002243

ABSTRACT

Background@#Recent studies have reported that chronic mental health problems often emerge in young adulthood. This study elucidated the independent effects of smoking and drinking on depressed mood in young adults by sex. @*Methods@#We used Data from the Korea National Health and Nutrition Examination Surveys conducted in 2014, 2016, and 2018. A total of 3,391 participants aged 19–35 years, without serious chronic diseases, were recruited for this study. Depression was evaluated using the Patient Health Questionnaire (PHQ-9). @*Results@#Smoking behavior, current smoking, and number of days smoked were significantly associated with higher PHQ-9 scores in both men and women (all P<0.05). However, past and ever smoking were positively associated with PHQ-9 scores only in women (all P<0.001). Regarding alcohol consumption, the age at which drinking first began was negatively associated with PHQ-9 scores in both men and women (all P<0.001), but the amount of alcohol consumed at 1 time was positively associated with PHQ-9 scores only in women (P=0.013). Men who drank 2–4 times a month and women who had not drunk during the past year had the lowest PHQ-9 scores. @*Conclusion@#Smoking and alcohol consumption were independently associated with depressed mood in young Korean adults, which was more pronounced in women, and exhibited sex-specific characteristics.

2.
Korean Journal of Anesthesiology ; : 266-275, 2022.
Article in English | WPRIM | ID: wpr-926576

ABSTRACT

Background@#Prompt insertion and placement of supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of insertion success rate, insertion time, and postoperative complications. @*Methods@#A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digit-based techniques for insertion of SGA devices in anesthetized patients were included. @*Results@#The first-attempt (risk ratio [RR]: 1.16, 95% CI [1.09, 1.25], P < 0.001) and overall success rates (RR: 1.06, 95% CI [1.03, 1.09], P < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference: −4.42 s, 95% CI [−6.70, −2.15 s], P < 0.001). The incidences of postoperative sore throat (RR: 0.63, 95% CI [0.49, 0.83], P < 0.001) and blood staining (RR: 0.28, 95% CI [0.20, 0.39], P < 0.001) were lower in the 90° rotation group. @*Conclusions@#The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases postoperative complications as compared with that of the standard digit-based technique in anesthetized patients.

3.
Anesthesia and Pain Medicine ; : 423-428, 2019.
Article in English | WPRIM | ID: wpr-785366

ABSTRACT

BACKGROUND: Obstetric patients with placenta previa are at risk for sever peripartum hemorrhage. Early detection of anemia and proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin (SpHb) monitoring in patients with placenta previa during cesarean section.METHODS: Parturients diagnosed with placenta previa and scheduled for cesarean section under spinal anesthesia were enrolled. SpHb and laboratory Hb (Lab-Hb) were measured during surgery as primary outcomes.RESULTS: Seventy-four pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between SpHb and Lab-Hb (P < 0.001). The Bland-Altman plot showed a mean difference ± SD of 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were −1.2 to 1.8 g/dl. The magnitude of the difference between SpHb and Lab-Hb was < 0.5 g/dl in 64.9%; however, it was > 1.5 g/dl in 10.8%.CONCLUSIONS: SpHb monitoring had a good correlation with Lab-Hb. A small mean difference between SpHb and lab-Hb might not be clinically significant; however, the limits of agreements were not narrow. In particular, SpHb could be overestimated in the anemic population. Based on our results, further studies investigating the accuracy and precision of SpHb monitoring should be performed in parturients presenting Hb below 10 g/dl.


Subject(s)
Female , Humans , Pregnancy , Anemia , Anesthesia, Spinal , Cesarean Section , Hemorrhage , Observational Study , Peripartum Period , Placenta Previa , Placenta , Prospective Studies
4.
Anesthesia and Pain Medicine ; : 480-488, 2019.
Article in English | WPRIM | ID: wpr-785357

ABSTRACT

BACKGROUND: Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee.METHODS: We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0–3 was assessed using a multivariable generalized linear model.RESULTS: In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0–3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0–3 were not significantly different between the two groups (P > 0.05).CONCLUSIONS: This study showed that there was an increase of morphine equivalent consumption during POD 0–3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.


Subject(s)
Adult , Humans , Analgesics , Analgesics, Opioid , Arthralgia , Arthroplasty, Replacement, Knee , Knee , Linear Models , Medical Records , Morphine , Pain, Postoperative , Retrospective Studies
5.
Psychiatry Investigation ; : 384-389, 2018.
Article in English | WPRIM | ID: wpr-714295

ABSTRACT

OBJECTIVE: The Korean Dementia Screening Questionnaire (KDSQ) is an informant-based instrument used to screen for cognitive dysfunction. However, its ability to only dichotomously discriminate between dementia and normal cognition has been previously investigated. This study investigated the ability of the KDSQ to classify not only dichotomous but also multiple stages of cognitive dysfunction. METHODS: We examined 582 participants. Receiver operating characteristic (ROC) curves were used to determine dichotomous classification parameters. Multi-category ROC surfaces were evaluated to classify the three stages of cognitive dysfunction. RESULTS: Dichotomous classification using the ROC curve analyses showed that the area under the curve was 0.92 for dementia for subjects without dementia and 0.96 for dementia in controls. Simultaneous multi-category classification analyses showed that the volume under the ROC surface (VUS) was 0.57 and that the derived optimal cut-off points were 2 and 8 for controls, MCI, and dementia. The estimated Youden index for the KDSQ was 0.48, and the derived optimal cut-off points were 5 and 10. The overall classification accuracy of the VUS and Youden index was 61.2% and 58.6%, respectively. CONCLUSION: The KDSQ is useful for classifying dichotomous and multi-category stages of cognitive dysfunction.


Subject(s)
Classification , Cognition , Dementia , Mass Screening , Cognitive Dysfunction , ROC Curve
6.
Clinical Pediatric Hematology-Oncology ; : 69-74, 2017.
Article in English | WPRIM | ID: wpr-788593

ABSTRACT

Erdheim-Chester disease (ECD) is a rare form of proliferative non-Langerhans cell histiocytosis that involves multiple organs and is associated with a high mortality. The prognosis of ECD is variable, and it mainly depends on the involved anatomic sites. The treatment modalities have not been standardized, but interferon-α (IFN-α) has been reported to be effective in the management of ECD. ECD usually affects middle aged individuals with a slight male predominance but is extremely rare in children. We present an uncommon case of a 4-year-boy diagnosed with ECD who was treated with IFN-α and corticosteroid. He remained disease-free for 3 years after the completion of treatment.


Subject(s)
Child , Child, Preschool , Humans , Male , Middle Aged , Erdheim-Chester Disease , Histiocytosis , Mortality , Prognosis
7.
Clinical Pediatric Hematology-Oncology ; : 69-74, 2017.
Article in English | WPRIM | ID: wpr-197953

ABSTRACT

Erdheim-Chester disease (ECD) is a rare form of proliferative non-Langerhans cell histiocytosis that involves multiple organs and is associated with a high mortality. The prognosis of ECD is variable, and it mainly depends on the involved anatomic sites. The treatment modalities have not been standardized, but interferon-α (IFN-α) has been reported to be effective in the management of ECD. ECD usually affects middle aged individuals with a slight male predominance but is extremely rare in children. We present an uncommon case of a 4-year-boy diagnosed with ECD who was treated with IFN-α and corticosteroid. He remained disease-free for 3 years after the completion of treatment.


Subject(s)
Child , Child, Preschool , Humans , Male , Middle Aged , Erdheim-Chester Disease , Histiocytosis , Mortality , Prognosis
8.
Chonnam Medical Journal ; : 216-222, 2017.
Article in English | WPRIM | ID: wpr-89698

ABSTRACT

C-peptide is the best indicator of endogenous insulin secretion in patients with diabetes. This study investigated the relationship between C-peptide levels and clinical/laboratory parameters of children with type 1 diabetes mellitus (T1DM), as measured at 6-month intervals after diagnosis. We retrospectively reviewed the data of 34 children with newly diagnosed T1DM. The study subjects were subdivided into a rapid progression group with C-peptide levels 0.6 ng/mL at 36 months (n=7; Group B). Patients in Group A had a younger mean age at diagnosis (A: 9±4.3 years vs. B: 13.6±3.6 years; p=0.013) and lower body mass index (BMI) (A: 15.5±2.5 kg/m² vs. B: 18.7±3.3 kg/m²; p=0.035). There were fewer asymptomatic patients with glucosuria in Group A, with these patients showing more severe symptoms, such as diabetic ketoacidosis (p=0.035), than those in Group B. Group A also had lower initial C-peptide levels (A: 0.5±0.46 ng/mL vs. B: 1.87±1.08 ng/mL; p=0.001). There were no significant intergroup differences in sex, family history, baseline hemoglobin A1c (HbA1c), potential of hydrogen (pH), autoantibodies or serum insulin. Simple correlation analyses showed that C-peptide levels were correlated with age and BMI, but not with pH, insulin, or HbA1c. Younger patients, who had a lower BMI, significant symptoms with complications, and/or a low initial C-peptide level, tended to show a rapid rate of decrease in C-peptide levels. Early intensive insulin therapy to preserve beta-cell function should be considered in these groups.


Subject(s)
Child , Humans , Autoantibodies , Body Mass Index , C-Peptide , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Diagnosis , Hydrogen , Hydrogen-Ion Concentration , Insulin , Retrospective Studies
9.
Chonnam Medical Journal ; : 216-222, 2017.
Article in English | WPRIM | ID: wpr-788386

ABSTRACT

C-peptide is the best indicator of endogenous insulin secretion in patients with diabetes. This study investigated the relationship between C-peptide levels and clinical/laboratory parameters of children with type 1 diabetes mellitus (T1DM), as measured at 6-month intervals after diagnosis. We retrospectively reviewed the data of 34 children with newly diagnosed T1DM. The study subjects were subdivided into a rapid progression group with C-peptide levels <0.6 ng/mL at 36 months (n=27; Group A) and a slow progression group with C-peptide levels >0.6 ng/mL at 36 months (n=7; Group B). Patients in Group A had a younger mean age at diagnosis (A: 9±4.3 years vs. B: 13.6±3.6 years; p=0.013) and lower body mass index (BMI) (A: 15.5±2.5 kg/m² vs. B: 18.7±3.3 kg/m²; p=0.035). There were fewer asymptomatic patients with glucosuria in Group A, with these patients showing more severe symptoms, such as diabetic ketoacidosis (p=0.035), than those in Group B. Group A also had lower initial C-peptide levels (A: 0.5±0.46 ng/mL vs. B: 1.87±1.08 ng/mL; p=0.001). There were no significant intergroup differences in sex, family history, baseline hemoglobin A1c (HbA1c), potential of hydrogen (pH), autoantibodies or serum insulin. Simple correlation analyses showed that C-peptide levels were correlated with age and BMI, but not with pH, insulin, or HbA1c. Younger patients, who had a lower BMI, significant symptoms with complications, and/or a low initial C-peptide level, tended to show a rapid rate of decrease in C-peptide levels. Early intensive insulin therapy to preserve beta-cell function should be considered in these groups.


Subject(s)
Child , Humans , Autoantibodies , Body Mass Index , C-Peptide , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Diagnosis , Hydrogen , Hydrogen-Ion Concentration , Insulin , Retrospective Studies
10.
Anesthesia and Pain Medicine ; : 354-358, 2016.
Article in Korean | WPRIM | ID: wpr-177912

ABSTRACT

BACKGROUND: During cesarean delivery, hypotension is a frequently occurring adverse effect following spinal anesthesia. Our hypothesis was that hypotension could be avoided or delayed with a lateral decubitus position for 10 minutes after intrathecal injection, by reducing the detrimental effects of the aortocaval compression. METHODS: Spinal anesthesia was performed in the lateral decubitus position with 8 mg of 0.5% hyperbaric bupivacaine and 15 µg of fentanyl. Forty-one patients undergoing elective cesarean delivery were randomly assigned to one of two groups. In the experimental group, patients were maintained in the lateral position for 10 minutes following intrathecal injection (group Decubitus). In the control group, patients were repositioned to supine immediately after the injection (group Supine). Incidence of hypotension, the required dose of ephedrine, and characteristics of the sensory blockade, were subsequently investigated. RESULTS: The incidence of hypotension, the incidence of nausea, and total amount of ephedrine, were not statistically different between the two groups. In group Decubitus, the onset of hypotension was delayed significantly (5.6 ± 1.7 min vs. 13.8 ± 1.7 min, P < 0.001), and the maximal blockade level was more cephalad (T3 [T1–T4] vs. T4 [T3–T5], P < 0.001) when compared to that of group Supine. Apgar scores were comparable in both groups. CONCLUSIONS: Maintaining the lateral position for 10 min following intrathecal injection during cesarean delivery did not influence the incidence of maternal hypotension. However, it caused delayed onset of hypotension and higher cephalad spread of sensory block.


Subject(s)
Humans , Anesthesia, Spinal , Bupivacaine , Ephedrine , Fentanyl , Hypotension , Incidence , Injections, Spinal , Nausea
11.
Korean Journal of Anesthesiology ; : 138-142, 2016.
Article in English | WPRIM | ID: wpr-229064

ABSTRACT

BACKGROUND: Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients. METHODS: This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient's head was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist's discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed. RESULTS: There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups. The discomfort score during tracheal intubation was higher in the 8 cm group when the patient's head was elevated 4 cm first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of head elevation. CONCLUSIONS: A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients.


Subject(s)
Adult , Humans , Airway Management , Anesthesia , Axis, Cervical Vertebra , Head , Intubation , Intubation, Intratracheal , Laryngoscopes , Neck , Prospective Studies , Vocal Cords
12.
The Korean Journal of Gastroenterology ; : 87-92, 2016.
Article in English | WPRIM | ID: wpr-45546

ABSTRACT

Primary gastric tumors are very rare in children. Burkitt lymphoma is a common type of non-Hodgkin's lymphoma, and gastric Burkitt lymphoma usually occurs in the aged. When involving the gastrointestinal tract, primary gastric Burkitt lymphoma is very rare in younger childhood. Many gastric lymphomas including mucosa-associated lymphoid tissue lymphoma are associated with Helicobacter pylori infection or acute bleeding symptom. We report a seven-year-old boy who presented with only some vomiting and postprandial pain. His upper gastrointestinal endoscopy and biopsy revealed a large primary Burkitt lymphoma with no acute bleeding and no evidence of H. pylori infection. After chemotherapy, he remains in remission.


Subject(s)
Child , Humans , Male , Biopsy , Burkitt Lymphoma , Drug Therapy , Endoscopy, Gastrointestinal , Gastrointestinal Tract , Helicobacter pylori , Hemorrhage , Lymphoma , Lymphoma, B-Cell, Marginal Zone , Lymphoma, Non-Hodgkin , Stomach Neoplasms , Vomiting
13.
Korean Journal of Anesthesiology ; : 148-152, 2015.
Article in English | WPRIM | ID: wpr-190108

ABSTRACT

BACKGROUND: This study was designed to determine the optimal anesthetic depth for the maintenance and recovery in interventional neuroradiology. METHODS: Eighty-eight patients undergoing interventional neuroradiology were randomly allocated to light anesthesia (n = 44) or deep anesthesia (n = 44) groups based on the value of the bispectral index (BIS). Anesthesia was induced with propofol, alfentanil, and rocuronium and maintained with 1-3% sevoflurane. The concentration of sevoflurane was titrated to maintain BIS at 40-49 (deep anesthesia group) or 50-59 (light anesthesia group). Phenylephrine was used to maintain the mean arterial pressure within 20% of preinduction values. Recovery times were recorded. RESULTS: The light anesthesia group had a more rapid recovery to spontaneous ventilation, eye opening, extubation, and orientation (4.1 +/- 2.3 vs. 5.3 +/- 1.8 min, 6.9 +/- 3.2 min vs. 9.1 +/- 3.2 min, 8.2 +/- 3.1 min vs. 10.7 +/- 3.3 min, 10.0 +/- 3.9 min vs. 12.9 +/- 5.5 min, all P < 0.01) compared to the deep anesthesia group. The use of phenylephrine was significantly increased in the deep anesthesia group (768 +/- 184 vs. 320 +/- 82 microg, P < 0.01). More patients moved during the procedure in the light anesthesia group (6/44 [14%] vs. 0/44 [0%], P = 0.026). CONCLUSIONS: BIS values between 50 and 59 for interventional neuroradiology were associated with a more rapid recovery and favorable hemodynamic response, but also with more patient movement. We suggest that maintaining BIS values between 40 and 49 is preferable for the prevention of patient movement during anesthesia for interventional neuroradiology.


Subject(s)
Humans , Alfentanil , Anesthesia , Anesthesia, General , Arterial Pressure , Consciousness Monitors , Hemodynamics , Phenylephrine , Propofol , Radiology, Interventional , Ventilation
14.
Anesthesia and Pain Medicine ; : 77-81, 2015.
Article in Korean | WPRIM | ID: wpr-68108

ABSTRACT

Preeclampsia is a hypertensive disorder involving multiple organs during the late gestational period. It may cause maternal and fetal morbidity and mortality. Preeclampsia parturients have an increased risk of cesarean delivery for several reasons including growth retardation of the intrauterine fetus, fetal distress and termination of pregnancy for treatment of severe preeclampsia. The hemodynamic state of preeclampsia varies depending on the onset, the severity of preeclampsia and the involved organs. Spinal anesthesia is recommended for preeclampsia parturients because of its rapid onset, stable hemodynamics and fewer neurologic complications. Hypotension during spinal anesthesia occurs less in preeclampsia, as compared to healthy pregnant women. Hemodynamic monitoring and planned fluid administration are important to anesthetic management of preeclampsia parturients.


Subject(s)
Female , Humans , Pregnancy , Anesthesia, Spinal , Fetal Distress , Fetus , Hemodynamics , Hypotension , Mortality , Pre-Eclampsia , Pregnant Women
15.
Anesthesia and Pain Medicine ; : 128-133, 2014.
Article in Korean | WPRIM | ID: wpr-128101

ABSTRACT

BACKGROUND: Magnesium sulfate (MgSO4) is a drug of choice for women with preeclampsia, with evidence that it reduces progression to eclampsia and maternal mortality. However, no previous studies have been conducted on the effect of magnesium sulfate on labor. This retrospective study investigated the effect of magnesium sulfate on the labor duration and the neonatal outcomes in parturients with preeclampsia. METHODS: We reviewed the medical records of 209 women who delivered vaginally with the diagnosis of preeclampsia from January 1, 2003 to June 30, 2013. They were divided into two groups, primipara (Primi group) and multipara (Multi group). Then, each group was subclassified as MgSO4-treated (Mg group) and MgSO4-untreated group (Cont group) again. Collected data included the duration of each stage of labor and neonatal outcomes. RESULTS: The duration of the 1st stage of labor was significantly longer in the Multi-Mg group, compared with the Multi-Cont group (138 +/- 149 min vs. 88 +/- 92 min, P = 0.025). However, the total labor durations were comparable between the two groups. Primi group had no difference in durations of any stage of labor and the total duration. Neonates showed worse outcomes (lower birth weight, lower Apgar, higher NICU admission rate) in the Primi-Mg group than the Primi-Cont group. CONCLUSIONS: Although preeclamptic multiparous parturients treated with MgSO4 showed longer 1st stage of labor than those untreated with MgSO4, the total labor durations were comparable between the groups.


Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Diagnosis , Eclampsia , Infant, Low Birth Weight , Magnesium Sulfate , Maternal Mortality , Medical Records , Pre-Eclampsia , Retrospective Studies
16.
Anesthesia and Pain Medicine ; : 292-297, 2014.
Article in English | WPRIM | ID: wpr-192639

ABSTRACT

BACKGROUND: Using rotational thromboelastometry (ROTEM) analysis, we investigated the difference in blood hemostasis, based on the primary anesthetic agents used during general anesthesia. METHODS: Sixty-six adult patients scheduled for elective ophthalmic surgery under general anesthesia were evaluated with regard to changes in each parameter in INTEM, EXTEM, and FIBTEM analyses. The patients received intravenous anesthesia with propofol and remifentanil (TIVA group) or inhalation anesthesia with sevoflurane (SEVO group). The ROTEM tests were performed 10 min before starting anesthesia and 1 h after finishing anesthesia. The INTEM and EXTEM analyses included the clotting time (CT), clot firmness time (CFT), alpha angle (alpha), and maximum clot firmness (MCF). The FIBTEM analyzed only MCF. Maximum clot elasticity (MCE) was calculated by (MCF x 100) / (100 - MCF). The platelet component of clot strength was calculated as follows: MCE(platelet) = MCE(EXTEM) - MCE(FIBTEM). RESULTS: The preoperative and postoperative parameters (CT, CFT, alpha, and MCF) in the INTEM, EXTEM, and FIBTEM analyses were not significantly different between the two groups. The MCE(platelet) also did not show a significant difference. CONCLUSIONS: Presuming that the ophthalmic surgery had a minimal traumatic effect, we conclude that both anesthetic agents cause negligible changes in ROTEM analyses postoperatively.


Subject(s)
Adult , Humans , Anesthesia , Anesthesia, General , Anesthesia, Inhalation , Anesthesia, Intravenous , Anesthetics , Blood Platelets , Elasticity , Hemostasis , Propofol , Thrombelastography
17.
Korean Journal of Anesthesiology ; : 279-282, 2014.
Article in English | WPRIM | ID: wpr-136224

ABSTRACT

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.


Subject(s)
Adult , Female , Humans , Pregnancy , Anesthesia , Anesthesia, Epidural , Anesthesia, Spinal , Cesarean Section , Erythrocytes , Fetus , Hemorrhage , Leiomyoma , Placenta , Placenta Previa , Postpartum Hemorrhage , Postpartum Period , Uterine Artery , Uterine Artery Embolization
18.
Korean Journal of Anesthesiology ; : 279-282, 2014.
Article in English | WPRIM | ID: wpr-136221

ABSTRACT

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.


Subject(s)
Adult , Female , Humans , Pregnancy , Anesthesia , Anesthesia, Epidural , Anesthesia, Spinal , Cesarean Section , Erythrocytes , Fetus , Hemorrhage , Leiomyoma , Placenta , Placenta Previa , Postpartum Hemorrhage , Postpartum Period , Uterine Artery , Uterine Artery Embolization
19.
Korean Journal of Anesthesiology ; : 290-294, 2014.
Article in English | WPRIM | ID: wpr-173044

ABSTRACT

BACKGROUND: Sevoflurane and propofol are used widely for interventional neuroradiology (INR). Using the bispectral index (BIS), we compared the clinical properties of sevoflurane and propofol anesthesia in patients undergoing INR at comparable depths of anesthesia. METHODS: The patients were allocated randomly into two groups. The sevoflurane group received propofol (1.5 mg/kg), alfentanil (5 microg/kg), and rocuronium (0.6 mg/kg) for induction, and the propofol group was induced with a target effect-site concentration of propofol (4 microg/ml), alfentanil (5 microg/kg), and rocuronium (0.6 mg/kg). After intubation, anesthesia was maintained with sevoflurane or propofol with 67% nitrous oxide in 33% oxygen. Sevoflurane and propofol concentrations were titrated to maintain the BIS at 50-60. Phenylephrine or opioid was used to maintain the mean arterial pressure within 20% of the baseline values. The amounts of phenylephrine or alfentanil used, the number of patients showing movement during the procedure, and the recovery times were recorded. RESULTS: Compared to the propofol group, the sevoflurane group showed faster recovery in spontaneous ventilation, eye opening, extubation, and orientation (4 vs. 7 min, 7 vs. 9 min, 8 vs. 10 min, 10 vs. 14 min, respectively; P < 0.01). In the propofol group, significantly greater amounts phenylephrine were used (P < 0.05), and more patients moved during the procedure (P < 0.05). CONCLUSIONS: The use of sevoflurane in maintaining anesthesia during INR was associated with faster recovery, less patient movement during the procedure, and a more stable hemodynamic response when compared to propofol.


Subject(s)
Humans , Alfentanil , Anesthesia , Arterial Pressure , Hemodynamics , International Normalized Ratio , Intubation , Nitrous Oxide , Oxygen , Phenylephrine , Propofol , Radiology, Interventional , Ventilation
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