Application and Efficacy Evaluation of Nutritional Screening Tool

PURPOSE: Malnutrition has been frequently reported for patients on their admission to the hospital and it has been associated with an increase in morbidity, mortality and the length of the hospital stay. Although a number of screening tools have been developed to identify those patients at risk for malnutrition, there is no 'gold standard' for defining malnutrition and the malnourished patients remain largely unrecognized. The aim of this study is to evaluate the efficacy of a nutritional screening tool for use in Dankook University Hospital. METHODS: Nutritional evaluation was performed for 53 patients who were admitted to the department of surgery and internal medicine between October and December 2004. The screening tool was completed by the ward nurse and the nutritional support team nurse on the same patients within 24 hours of admission. The nutritional support team nurse performed the full assessment. The screening sheet included 4 questions regarding body mass index, recent unintentional weight loss, food intake and disease severity. Each answer was scored and a total of 5 was tested as the criterion for malnutrition. The full assessment included current body weight, recent weight loss, triceps skinfold thickness, mid- arm muscle circumference, serum albumin and total lymphocyte count. Malnutrition was defined by 3 or more values below the reference values. The reliability of the screening tool was assessed using kappa statdtatistic. Sensitivity, specificity and accuracy were calculated to evaluate the validity of the screening tool. The receiver operating characteristic (ROC) curve was drawn to choose a cutoff value that maximizes sensitivity and specificity. RESULTS: The level of agreement between the ward nurse and the NST nurse was good for BMI and food intake and moderate for weight loss and disease severity. The full assessment identified 7 patients (13.2%) as malnourished. The screening sheet had a sensitivity of 86% and a specificity of 80%. According to the ROC curve, a score of 5 points provided the best validity. CONCLUSION: The nutritional screening tool is reliable when completed by different observers and it is valid for nutritional assessment.

Primary Irritant Dermatitis to Povidone-Iodine after Caudal Anesthesia: A Case Report / 대한마취과학회지

Povidone-iodine (PVP-1) is a widely used antiseptic because of its low toxicity and germicidal effect. A 16 year old patient who had undergone incision and debridement of an anal abscess developed contact dermatitis on his buttocks postoperatively. The lesion had been exposed to a gauze immersed in a 10% povidone-iodine solution for 8 hours, but the skin around the surgical field directly painted with 10% povidone-iodine solution didn't show any effect. A patch test with povidone-iodine produced a negative response in this patient. These observations indicate that prolonged exposure to wet povidone-iodine is harmful. It is important that povidone-iodine be used carefully to prevent contact dermatitis.

Comparison of Changes in Arterial Blood Gases during Endoscopic Thyroidectomy, Laparoscopic Cholecystectomy and Gynecologic Laparoscopic Surgery / 대한마취과학회지

BACKGROUND: Because laparoscopic surgery has many advantages compared with conventional methods, it has recently been applied to not only intraabdominal or intrathoracic surgery but also thyroidectomy. It is possible that arterial blood gases and hemodynamic variables can be changed by patient position and insufflation of pressurized CO2 into extraperitoneal or intraperitoneal space, so we examined the changes in arterial blood gases, end tidal CO2 (P(ET)CO2) and hemodynamic variables during an endoscopic thyroidectomy with extraperitoneal CO2 insufflation, laparoscopic cholecystectomy and gynecologic laparoscopic surgery with intraperitoneal CO2 insufflation under N2O, enflurane inhalational general anesthesia. METHODS: Forty ASA class I or II patients were included in this study, endoscopic thyroidectomy group (n = 10), laparoscopic cholecystectomy group (n = 18), gynecologic laparoscopic surgery group (n = 12). All patients were underwent controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 12/min) and the ventilator mode was fixed in this volume and rate until the end of the operation. The position of patients during the endoscopic thyroidectomy and laparoscopic cholecystectomy were under 5 degree reverse Trendelenburg position, whereas the gynecologic laparoscopic surgery was under a 10 degree head-down lithotomy position. Variables were measured before CO2 insufflation (10 minute after induction), 10, 20 and 30 minutes after CO2 insufflation and 40 minutes after CO2 deflation. RESULTS: PaCO2 and P(ET)CO2 were significantly increased during CO2 insufflation compared with preinsufflation values in all groups, but the magnitude of increases of PaCO2 and PETCO2 was not significantly different among the three groups. The mean magnitude of increases of PaCO2 at 10 minutes after CO2 insufflation were as follows: gynecologic laparoscopic surgery (6.21 +/- 2.0 mmHg), endoscopic thyroidectomy (5.07 +/ 2.3 mmHg), and laparoscopic cholecystectomy (5.01 +/- 2.2 mmHg). CONCLUSIONS: We concluded that PaCO2 and P(ET)CO2 were significantly increased during CO2 insufflation compared with the preinsufflation values in all groups, but the magnitude of increases of PaCO2 and P(ET)CO2 was not significantly influenced by CO2 insufflation site and patient position.

Rebounded Response in Propofol Coma Therapy / 대한마취과학회지

Barbiturate has been used for the therapy of increased intracranial pressure (ICP) patients. However, it has some serious side effects such as rebound response or convulsion. According to recent reports, propofol can be used for coma therapy and the therapeutic result has been satisfactory. We used propofol instead of barbiturate in coma therapy and experienced a case of rebound response. On admission day, a 20-year-old female patient received an endovascular embolization for an arteriovenous malformation (AVM) in the left occipital lobe. The next day, she went into a coma and the brain CT showed a massive intracerebral hematoma at the AVM site. The patient was transferred to the operating room for decompressive surgery. At the end of the surgery, the brain edema did not subside. The patient was infused with propofol (4 mg/kg/h) after the surgery for propofol coma therapy. During the 6 day propofol therapy, ICP was effectively controlled under 20 mmHg. After completion of the propofol coma therapy, the patient was revived enough to verbally obey. 16 hours later, ICP increased to more than 30 mmHg and the patient was reinfused with propofol. We experienced a rebound response in propofol coma therapy similar to that in barbiturate coma therapy.

The Effects of Intrathecal Ketamine Isomers on Formalin-Evoked Behavior and Spinal c-fos Expression in Rat / 대한마취과학회지

BACKGROUND: This study was designed to investigate the different analgesic potency and the action mechanism of the intrathecal isomers of ketamine. For these purpose, we evaluated the effect of intrathecal ketamine isomers on the behavioral response and the spinal c-fos expression in the formalin tested rats. METHOD: The subjects were divided into 2 groups(NF group, Fgroup). The NF group was designed for the purpose of the drug itself's effect on the induction of c-fos. Saline(NF/saline group), S(+) ketamine(NF/SK group), R(-) ketamine(NF/RK group) and ketamine(NF/K group) were administered intrathecally to be examined by immunocytochemical method. Same drugs were administered in the F group(F/saline, F/SK, F/RK, F/K) and formalin was injected into right hind paw of the rats after 30 minutes of intrathecal drug administration. The number of flinching was counted at intervals of 5 minutes for 60 minutes. In NF and F group, Fos immunoreactive neurons was counted after 2 hours of formalin injection and intrathecal drug injection respectively. RESULTS: In F/saline group, flinching was developed immediately after formalin injection and revealed biphasic response. The number of flinching in F/SK group, F/RK group, F/K group was significantly smaller than that of F/saline group. The number of flinching of F/SK group by comparison of F/SK vs F/RK was significantly smaller, and that of F/K group by comparison of F/RK vs F/K was significantly smaller. There was no significant difference among NF group on the total number of Fos immunoreactive neurons. In F group, Fos immunoreactive neurons increased significantly in comparison with NF group. The total number of Fos immunoreactive neurons in F/SK group, F/RK group and F/K group were significantly smaller than that of F/saline group. Of F group, the number of Fos immunoreactive neurons of F/SK was the smallest and F/K, F/RK followed increasing order. Attenuation of Fos induction by the ketamine isomers was observed in the whole spinal cord of F/SK group and F/K group but in the superficial and deep laminae of F/RK group. CONCLUSION: This study suggests that intrathecal ketamine isomers have an inhibitory effect on pathologic pain and c-fos expression in the rats and different analgesic effect which is lamina specific.

The Inhibition of Stress-Induced c-fos Expression by Superior Cervical Ganglion Block in Rat Brain / 대한마취과학회지

BACKGROUND: Using c-fos expression one of the immediate early gene, as a marker of altered neuronal response, we investigated the effect of superior cervical ganglion block (SCGB) exhibiting the same effect of SGB of human on the activity of several brain regions which are considered as located on autonomic neural pathway and neuroendocrine axis in rat. METHOD: The 48 Sprague-Dawley strain rats were divided into 4 groups, as saline/stress (control) group, SCGB/stress (tested) group, saline group, SCGB group. Superior cervical ganglion block was conducted in the SCGB/stress group and SCGB group while saline/stress and saline group were sham operated. After then restraint stress was imposed on the animals of SCGB/stress group and saline/stress group. And 2 hour after injection (saline, SCGB group) or restraint stress (saline/stress, SCGB/stress group), c-fos protein (Fos) was localized by immunocytochemistry. RESULTS: Much stronger Fos immunoreactivity was induced in the several brain region of control group rats compared to other three groups and the numbers of Fos positive cell count of tested group were significantly decreased in paraventricular hypothalamic nucleus (p<0.01), A5 (p<0.01), raphe pallidus (p<0.05), nucleus tractus solitaius (p<0.01) compared to control group. CONCLUSION: This study demonstrate that superior cervical ganglion block attenuates stress induced neuronal activities of paraventricular hypothalamic nucleus, A5, raphe pallidus, nucleus tractus solitarius.