Nutritional Intake and Postoperative Pulmonary Complications among Lung Cancer Patients who Underwent Pulmonary Resection

Purpose@#The aim of this study was to examine the nutritional intake status of the lung cancer patients who underwent pulmonary resection and to analyze the relationship between the status of the nutritional intake and the occurrence of postoperative pulmonary complications. @*Methods@#This study was a secondary analysis to determine whether the changes in the nutritional intake after surgery were related to pulmonary complications. Data of a total of 89 patients were included in the analysis and the nutritional intake status was confirmed using a 24-hour dietary recall method. The data were analyzed by descriptive statistics, chi-square or Fisher’s exact test, and ANOVA using the SPSS WIN 26.0 program and word clouds were generated using the R software program. @*Results@#Overall, a decrease in the postoperative nutritional intake was observed in the patients who underwent pulmonary resection, except for the intake of fat. The pulmonary complications were identified to be associated with BMI and the presence of comorbidity. Twenty-three out of 74 patients with vitamin E levels below the Estimated Average Requirements developed pulmonary complications after surgery. @*Conclusion@#Lung cancer patients who underwent pulmonary resection generally have difficulty in acquiring appropriate nutritional intake and need balanced nutritional management. Future investigations on the impact of increased vitamin E intake on postoperative pulmonary complications may provide better insight into the relationship between vitamin E intake and pulmonary complication among patients who underwent pulmonary resection.

Delayed Detection of Middle Turbinate Fracture after Nasotracheal Intubation: Any Tips for Prevention?

Nasotracheal intubation is valuable during intra-oral surgery. A common complication of this technique is epistaxis. We experienced a case of middle turbinate fracture which showed no immediate signs of fracture such as bleeding or avulsed particles. Two months later, it was discovered in the form of nasal obstruction with a mass-like lesion. Symptoms associated with traumatic intubation usually develop during surgery, and it is rare to be found a long time after surgery. We will review the anatomical and technical aspects for safe nasotracheal intubation.

Anesthetic Experience of Unexpected Change to One-Lung Ventilation with Bronchial Blocker

One-lung ventilation is an anesthesiological technique to accomplish surgical visualization during thoracic surgical procedures, and is often required unexpectedly during surgery. Traditionally the double lumen tube is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker to establish one-lung ventilation. We have experienced unexpected change to one-lung ventilation with bronchial blocker. A 40-year-old (158 cm, 48 kg) woman was scheduled for emergency exploratory laparotomy due to panperitonitis. A sudden diaphragmatic perforation occurred during the operation. Since oxygen saturation was reduced, intraoperative tube change was not available. Therefore, one-lung ventilation was done with bronchial blockers. After the bronchial blocker was placed, one-lung ventilation was well maintained and the operation was terminated successfully.

Epinephrine-Induced Acute Pulmonary Edema during Septoplasty

Epinephrine is used with lidocaine to provide bloodless surgical field and to prolong the action of local anesthetics. But epinephrine also has many adverse reactions, such as agitation, restlessness, headache, tachycardia, hypertension, and some significantly more dangerous conditions including myocardial ischemia, ventricular arrhythmia, cerebral hemorrhage and pulmonary edema, cardiac arrest, etc. We have experienced epinephrine-induced acute pulmonary edema due to submucosal intranasal application of epinephrine soaked gauze during septoplasty. The patient was successfully treated in intensive care unit with positive pressure ventilation, diuretics, and inotropic support. He was extubated after 5 hours and discharged after 7 days without any complications.

Development of the Geop-Pain questionnaire for multidisciplinary assessment of pain sensitivity / 대한마취과학회지

BACKGROUND: To assess the multidisciplinary aspects of pain, various self-rating questionnaires have been developed, but there have not been sufficient relevant studies on this topic in South Korea. The aim of this study was to develop a new pain sensitivity-related questionnaire in the Korean language that would be simple and would well reflect Koreans' senses. METHODS: A new pain assessment questionnaire was developed through a pre-survey on "geop", which is the Korean word expressing fear, anxiety, or catastrophizing. We named the new assessment questionnaire the Geop-Pain Questionnaire (GPQ). The GPQ was composed of 15 items divided into three categories and rated on a 5-point scale. As a preliminary study, internal consistency and test-retest reliability analyses were conducted. Subsequently, 109 individuals completed the GPQ along with three pain-related questionnaires translated into Korean (Pain Sensitivity Questionnaire [PSQ], Pain Anxiety Symptoms Scale [PASS], and Pain Catastrophizing Scale [PCS]), and the correlations were analyzed. RESULTS: All items in the GPQ showed appropriate internal consistency, and the test-retest reliability analysis showed no statistically significant differences. The correlations between the GPQ and the existing questionnaires revealed that the GPQ scores had mid-positive correlations with the PSQ scores and strong positive correlations with the PASS and PCS scores. CONCLUSIONS: This study attempted to develop a questionnaire assessing pain sensitivity multidimensionally using the Korean word geop for the first time. The self-rating GPQ showed high correlations with the existing questionnaires and demonstrated potential to be utilized as a pain prediction index in clinical practice.

Intraoperative Detection of Rate Dependent Left Bundle Branch Block

Rate dependent left bundle branch block (RDLBBB) is an uncommon case. RDLBBB is defined as an intraventricular conduction defect that may return, if only temporarily, to sinus rhythm at lower heart rates. It appears when the heart rate exceeds a certain critical value. Although RDLBBB is usually benign, its diagnosis and treatment have clinical importance for association of RDLBBB and myocardial ischemia and infarction. Therefore, in the case of detection of intraoperative RDLBBB, a clear differentiation should be done as soon as possible. Also it is important to start appropriate treatment and to do clinical follow-up examination. We report a case of intraoperative RDLBBB during general anesthesia for laparoscopic cholecystectomy in 82 years old female patient who has a history of hypertension.

Effect of stellate ganglion block on laryngopharyngeal reflux disease / 대한마취과학회지

BACKGROUND: Laryngopharyngeal reflux (LPR) disease has many symptoms such as globus pharyngeus, excessive throat clearing and hoarseness. The aim of this study was to investigate the effect of stellate ganglion block (SGB) in addition to proton pump inhibitors (PPI) on LPR. METHODS: Fifty patients complaining of more than 3 typical LPR symptoms for over 3 months were enrolled in the study. The P group took PPI for 8 weeks. The SP group took PPI and interwent a series of 8 SGB procedure once a week during the period of treatment. The blocks were performed one at a time unilaterally on the right and left stellate ganglions by injecting 1% mepivacaine 6 ml. We evaluated the reflux symptom index (RSI) before treatment and following 4 weeks and 8 weeks of treatment in both groups. RESULTS: After 4 weeks of treatment, the RSI of the P group decreased, but not significantly, to 16.6 +/- 6.8 compared with the baseline value of 19.2 +/- 2.7 (P = 0.093), whereas the RSI of the SP group decreased significantly to 9.8 +/- 3.3 compared with the baseline value of 19.0 +/- 4.7 (P = 0.000). After 8 weeks of treatment, the RSI of the P group decreased significantly to 13.7 +/- 6.7 (P = 0.001) and the RSI of the SP group also decreased significantly to 7.7 +/- 3.4 (P = 0.000). There were significant differences in the RSI between the two groups after 4 weeks (P = 0.000) and 8 weeks (P = 0.001) of treatment. CONCLUSIONS: The symptoms of LPR improved earlier when PPI therapy was combined with SGB compared with PPI therapy alone.

Anesthetic Management of a Patient with Mitochondrial Myopathy Undergoing Orthopedic Surgery

Mitochondria myopathies consist of large heterogeneous groups of disorders resulting from primary dysfunction of the mitochondrial respiratory chain and causing muscle disease. These disorders involve the multiple organ system and appear to be extensive variability in clinical presentation. Therefore anesthetic management of patients with mitochondrial myopathies should begin with careful preoperative investigation and preparation. We report successful general anesthesia in a 22-year-old man with mitochondrial myopathy undergoing orthopedic surgery.

An anesthetic management of a patient with Klippel-Trenaunay syndrome / 대한마취과학회지

No abstract available.

Designation of a new drug as a controlled substance

Opioids are widely used as painkillers and anesthetics. Though we use opioids to relieve pain, these drugs can induce mood elevation, dependency, and withdrawal symptoms. This is why opioids are controlled-substances. Most physicians think that some substances should be controlled if they have opioid-like pharmacological properties, especially a long duration, preservation of respiration, and dependency. It is noteworthy that short-acting substances, such as midazolam and thiopental, are included in controlled substances. Their abuse is very dangerous because they frequently induce severe respiratory depression due to a narrow therapeutic window. Teaching point of this article is that designation of a new drug as a controlled substance requires scientific evidence of its link to dependency and/or withdrawal symptoms. However, this does not require abusers' convenience (long duration) or safety (maintenance of respiration). The authors present the addiction and abuse patterns of propofol as an reasons for the Korean Food and Drug Administration to designate propofol as a controlled substance. As a future study, an animal and/or a clinical model for dependency is needed to identify addictive substances. Though several neurotransmitters and their loci in the central nervous system have been studied, the precise mechanism for addiction is unknown. Also, it should be recognized that the potential for drug addiction and abuse could be masked in the early marketing period of a new drug. Physicians should monitor patients' responses carefully when they deal with the drug.

A survey on informed consent process for epidural analgesia in labor pain in Korea / 대한마취과학회지

BACKGROUND: There is a legal obligation to explain the procedure and use of epidural analgesia in labor primarily due to the possibility of potential risks and associated complications. The present study details on the survey carried out to ascertain the current status of obtaining informed consent (IC) for explaining the epidural analgesia in labor. METHODS: The present study is based on a survey through a telephone questionnaire that covered all the hospitals in Korea where the anesthesiologists' belonged to and are registered with Korean Society of Anesthesiologists. The questionnaire included questions pertaining to administration of epidural analgesia to a parturient, information on different steps of obtaining an IC, whether patient status was evaluated, when the consent was obtained, and the reasons behind, if the consent had not being given. RESULTS: A total of 1,434 respondents took part in the survey, with a response rate of 97% (1,434/1,467). One hundred seventy-four hospitals had conducted epidural analgesia on the parturient. The overall rate of obtaining IC for epidural analgesia during labor was 85%, of which only 13% was conducted by anesthesiologists. The rate of evaluating preoperative patient status was 74%, of which 45% was conducted by anesthesiologists. Almost all of the consent was obtained prior to the procedure. CONCLUSIONS: The rate of obtaining IC for epidural analgesia in labor is relatively high (85%) in Korea. However, it is necessary to discuss the content of the consent and the procedure followed for obtaining IC during the rapid progress of labor.

Propofol Abuse of the Medical Personnel in Operation Room in Korea / 대한법의학회지

BACKGROUND: Propofol is a widely used anesthetic in anesthesia and sedation. Though it is not regulated under the controlled substance act, the public media broadcasted apprehensive programs about propofol abuse of laypersons. We attempted to determine whether the propofol is abused by the medical personnel working in the operation room in Korea. METHODS: We surveyed the 95 delegates who sat in the back benches in the Korean Society of Anesthesiologists. The questionnaire included the job of the propofol abuser, the rehabilitation, drug abuse history, stressful condition, family history of drug abuse in medical personnel in operation room. Additional question was what is the adequate method to prevent propofol abuse. RESULTS: Seventy two delegates among 95 candidates were responded. Seven of 72 responders answered that they knew 9 medical personnel who abused propofol in operation room. Four of them were anesthesiology residents, two were other departments' residents, one was a nurse in anesthesiology and the other two were unknown. Among nine subjects, two had tried to rehabilitate but failed, and all abusers quit working within 1 year. As for the prevention methods, 9 of 12 responders suggested that propofol should be controlled like other centrally acting anesthetics. CONCLUSION: Although propofol has not been traditionally considered a drug of abuse, a few medical team members abuse it working in operation room. A stricter pharmacy control of propofol or controlled substance act for propofol should be needed to prevent abusing it and to protect medical team members.

Screw Joint Stability under Cyclic Loading of Zirconia Implant Abutments / 대한치과보철학회지

PURPOSE: The purpose of this study was to evaluate the effect of abutment material on screw-loosening before and after cyclic loading. Among the different materials of abutments, zirconia and metal abutment were used. MATERIAL AND METHODS:: Two types of implant systems: external butt joint (US II, Osstem Implant, Korea) and internal conical joint (GS II, Osstem Implant, Korea) were used. In each type, specimens were divided into two different kinds of abutments: zirconia and metal (n = 5). The implant was rigidly held in a special holding to device ensure fixation. Abutment was connected to 30 Ncm with digital torque gauge, and was retightened in 30 Ncm after 10 minutes. The initial removal torque values were measured. The same specimens were tightened in 30 Ncm again and held in the cycling loading simulator (Instron, USA) according to ISO/FPIS 1480. Cycling loading tests were performed at loads 10 to 250 N, for 1 million cycles, at 14 Hz, (by subjecting sinusoidal wave from 10 to 250 N at a frequency of 14 Hz for 1 million cycles,) and then postload removal torque values were evaluated. RESULTS: 1. In all samples, the removal values of abutment screw were lower than tightening torque values (30 Ncm), but the phenomenon of the screw loosening was not observed. 2. In both of the implant systems, initial and postload removal torque of zirconia abutment were significantly higher than those of metal abutment (P .05). 4. In metal abutments, the removal torque ratio of GS II system (internal conical joint system) was lower than that of US II system (external butt joint system) (P .05). CONCLUSION: Zirconia abutment had a good screw joint stability in the condition of one million cycling loading.

Discharge Nursing Needs of Patients having Surgery with Gastric Cancer / 성인간호학회지

PUPPOSE: The purpose of this descriptive study was to identify the discharge nursing needs of patients who received gastrectomy. METHOD: The subjects of this study consisted of 100 patients who had gastric surgery in 4 university hospitals in chungnam province. The instrument for this study was developed by the researcher based on literature through in-depth interviews. Data was collected from October 4 to October 30, 2000. RESULT: The results were as follows: Discharge nursing needs were classified in 8 main categories. The 8 categories were 'emotional and spiritual support', 'nutrition and diet control', 'medication', 'treatment planning and follow up care', 'activity level', 'symptom management' 'health seeking behavior' and 'social support'. The total mean score for nursing needs was 3.89. 'Nutrition and diet control' was the highest degree of nursing needs and 'activity level' was the lowest degree of nursing needs. There were significant differences in degrees of nursing needs between different ages(F=2.74, p=.048), level of education(F= 2.91, p=.038) and period since diagnosis(F= 4.46, p=.037). CONCLUSION: This study looked at 8 categories of discharge nursing needs. Patients identified 'nutrition and diet control' as the highest need and 'activity level' as the lowest need. Further research needs to be done to identify discharge educational needs for various age groups, educational level and for patients with varing lengths of diagnosis time to surgery.