The trend of prevalence of pain in Korea from 2005 to 2016

Background@#Korean society is afflicted with rapid aging. Aging is a risk factor for pain, and pain can reduce patients’ quality of life. Thus, adequate management and monitoring of changing trends accompanying the demographic shift are highly valuable. However, this study was conducted because no studies have investigated the recent changes in the prevalence of pain. @*Methods@#The extent of the prevalence of pain was determined by questions related to quality of life based on the data derived from the Korea National Health and Nutrition Survey (KNHNS) from 2005 to 2016. The annual frequencies of the pain group and severe pain group were calculated using the survey questionnaire. Multiple logistic regression analysis was performed to determine possible differences in prevalence by year. @*Results@#The prevalence of pain in all populations was 30.6% in 2005 and 18.9% in 2016. The average prevalence from 2005 to 2016 was 21.9%. A declining trend occurred over time with an odds ratio of 0.929 per year (95% CI: 0.921-0.938).The prevalence of severe pain was 2.35% in 2005 and 1.88% in 2016. Likewise, a decrease was observed over time, with an odds ratio of 0.920 per year at 95% CI 0.901-0.939. The decline in age-/sex-stratified analysis also showed a statistically significant trend in all groups. @*Conclusions@#The prevalence of pain in Korean society, based on the KNHNS, has declined since 2005. Such a trend was observed in all ages and sexs, and was most significant in the elderly.

Comparison between cerebral state index and bispectral index during desflurane anesthesia / 대한마취과학회지

BACKGROUND: Cerebral state index (CSI) is an anesthesia depth monitor alternative to bispectral index (BIS). Published comparative studies have used propofol or sevoflurane. However, studies using desflurane have not been reported yet. Different volatile anesthetics have different electroencephalography signatures. The performance of CSI may be different in desflurane anesthesia. Therefore, the objective of this study was to compare CSI and BIS during desflurane anesthesia. METHODS: Thirty-three patients were recruited. Desflurane and remifentanil were used to maintain general anesthesia. BIS and CSI were recorded simultaneously every minute. End-tidal concentration of desflurane was maintained at 4% from the beginning of surgery for 5 minutes. Pairwise data of CSI and BIS were obtained five times at one-minute intervals. This process was repeated in the order of 6%, 8%, and 10%. RESULTS: BIS and CSI were negatively correlated with the end-tidal concentration of desflurane with a similar degree of correlation (correlation coefficient BIS: –0.847, CSI: –0.844). The relationship between CSI and BIS had a good linearity with a slope close to 1 (R2 = 0.905, slope = 1.01). For the relationship between CSI and BIS at each end-tidal concentration of desflurane, CSI and BIS showed good linearity in 4% and 10% (R2 = 0.559, 0.540). However, the linearity and slope were decreased in 6% and 8% (R2 = 0.163, 0.014). CONCLUSIONS: CSI showed an equivalent degree of overall performance compared to BIS in desflurane anesthesia. Accounting for previous literature, CSI can be used as a good substitute for BIS regardless of the kind of anesthetics used.

Iatrogenic Development of Cerebrospinal Fluid Leakage in Diagnosing Spontaneous Intracranial Hypotension / 가정의학회지

A 34-year-old woman came to the emergency room complaining of a severe orthostatic headache. Results of a cerebrospinal fluid tap and brain computed tomography were normal. Based on her history and symptoms, she was found to have spontaneous intracranial hypotension. She was hospitalized and her symptoms improved with conservative treatment. On the next day, her headache suddenly worsened. Cisternography was performed to confirm the diagnosis and determine the spinal level of her cerebrospinal fluid leak. It revealed multiple cerebrospinal fluid leaks in the lumbar and upper thoracic regions. It was strongly believed that she had an iatrogenic cerebrospinal fluid leak in the lumbar region. An epidural blood patch was performed level by level on the lumbar and upper thoracic regions. Her symptoms resolved after the epidural blood patch and she was later discharged without any complications. In this case, an iatrogenic cerebrospinal fluid leak was caused by a dural puncture made while diagnosing spontaneous intracranial hypotension, which is always a risk and hampers the patient's progress. Therefore, in cases of spontaneous intracranial hypotension, an effort to minimize dural punctures is needed and a non-invasive test such as magnetic resonance imaging should be considered first.

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients: A case report

During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department.

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients: A case report

During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department.

Unilateral sudden sensorineural hearing loss after combined spinal-epidural anesthesia for emergency cesarean section: A case report

A 30-year-old primigravida with gestational age of 25 weeks and 4 days was admitted for emergency cesarean section. She was diagnosed as pre-eclampsia with fetal distress. We anesthetized the patient through the combined spinal-epidural anesthetic technique, and there was no specific event throughout the surgical procedures and in post anesthetic care unit. Subsequently, she complained of unilateral hearing difficulty in the ward and an otolaryngology consultation was obtained. She was diagnosed with left sudden sensorineural hearing loss in full frequency range after an acoustic examination. She received intravenous and local steroid treatments for 4 weeks. She showed 32 dB on pure tone audiometry after 5 months. However, we could not continue follow-up testing on the patient because she stopped visiting the hospital since the last examination. We reported a case of uncommon unilateral sudden sensorineural hearing loss after a combined spinal-epidural anesthesia for emergency cesarean section.