Endotracheal cuff pressure change during gynecologic laparoscopic surgery: effect on the incidence of postoperative airway complications

BACKGROUND: Laparoscopic surgery with reverse Trendelenburg position and carbon dioxide pneumoperitoneum has been known to increase the endotracheal tube (ETT) cuff pressure and the incidence of postoperative sore throat. The purpose of this study was to evaluate the effect of the Trendelenburg position and pneumoperitoneum on the ETT cuff pressure and the effect of adjustment of ETT cuff pressure on the incidence of sore throat during laparoscopic gynecologic surgery. METHODS: One hundred fifty-four female patients undergoing laparoscopic gynecologic surgery were randomly assigned to either control group or adjusted group. In control group, initial cuff pressure was set at 30 cmH2O in the supine position without any adjustment during surgery. Cuff pressure of adjusted group was adjusted to maintain 30 cmH2O throughout the operation. Cuff pressures at intubation (P(imme)), at carbon dioxide insufflation and the Trendelenburg position (P0), and at 10 minute intervals throughout surgery (P10-P60 and P(end)) were checked. Postoperative airway complications including sore throat, hoarseness, dysphagia and cough were compared between the two groups at 2 hours and 24 hours after surgery. RESULTS: In control group, P0 and P10 were significantly higher than P(imme). The cuff pressure decreased with time, thereby; P50 (28.2 +/- 4.3), P60 (27.5 +/- 4.0) and P(end) (25.9 +/- 4.2) were significantly lower than P(imme) (P < 0.05). The incidences and severity of airway complications were not different between two groups. CONCLUSIONS: ETT cuff pressure decreased in laparoscopic gynecologic surgery. Therefore, controlled cuff pressure does not decrease the incidence of postoperative airway complications.

Pretreatment of magnesium sulphate improves intubating conditions of rapid sequence tracheal intubation using alfentanil, propofol, and rocuronium: a randomized trial / 대한마취과학회지

BACKGROUND: We investigated the effects of a magnesium sulfate pretreatment on intubating conditions and cardiovascular responses during rapid sequence tracheal intubation (RSI) in this double-blind randomized study. METHODS: Adult patients (n = 154) were randomly allocated to a rocuronium-0.6, rocuronium-0.9, or magnesium group. The magnesium group was pretreated with 50 mg/kg MgSO4, and the other two groups received the same volume of isotonic saline. Anesthesia was induced with alfentanil, propofol, and either 0.6 mg/kg (rocuronium-0.6 and magnesium groups) or 0.9 mg/kg (rocuronium-0.9 group) rocuronium. An anesthesiologist, blinded to the group assignments, performed RSI and assessed the intubating conditions. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before the magnesium sulfate or normal saline was administered, before anesthesia induction, before intubation, and every minute after intubation for 5 min. RESULTS: Airway features were similar among the three groups. The intubating conditions were improved significantly in the magnesium group (P 0.05). No hypertensive episode occurred during the immediate post-intubation period in the magnesium group (P = 0.001), and tachycardia occurred most frequently in the rocuronium-0.6 group (P < 0.05). CONCLUSIONS: MgSO4 administered prior to RSI using alfentanil, propofol, and rocuronium may improve intubating conditions and prevent post-intubation hypertension.

The impact of anthrometric measurements on hypotension during spinal anesthesia for cesarean delivery: comparison of body weight, body height, body mass index, and abdominal circumference

BACKGROUND: Hypotension is a common complication of spinal anesthesia for cesarean delivery. The incidence and severity of hypotension is reported higher compared with other surgeries due to aortocaval compression. We evaluated whether body weight, body height, body mass index (BMI) and abdominal circumference effected on the incidence of hypotension and ephedrine requirement. METHODS: A total of 55 parturients undergoing elective cesarean delivery were enrolled in this prospective observational study. Preeclampsia or eclampsia was excluded. Abdominal circumference, body weight, body height were assessed before anesthesia. Spinal anesthesia was conducted in the right lateral position using 8 mg of 0.5% hyperbaric bupivacaine and 15 microg of fentanyl. Blood pressure was measured before anesthesia and at 1 min interval after intrathecal injection. Nausea was assessed during spinal anesthesia. Hypotension was defined that blood pressure decreased below 80% of baseline value and ephedrine was given if blood pressure dropped below 70% (severe hypotension). RESULTS: The total incidence of hypotension was 65% (36/55) and ephedrine was administered in 38% (21/55) of parturients. Except height, abdominal circumference, body weight and body mass index were associated with the incidence of hypotension (P < 0.05). However, severe hypotension requiring ephedrine (P = 0.001, OR = 1.16, [95% CI 1.04-1.30]), ephedrine requirement (P = 0.001, R = 0.43) and nausea (P = 0.026, R = 0.31) were significantly related only with abdominal circumference. CONCLUSIONS: Abdominal circumference of parturients may be a good parameter to predict both of the incidence and the severity of hypotension during spinal anesthesia for cesarean delivery.

Percutaneous cardiopulmonary support for the management of recurrent cardiac arrest during scoliosis correction surgery in the prone position: A case report

Effective cardiopulmonary resuscitation (CPR) is difficult for a patient undergoing surgery in the prone position. We report a successful CPR in a prone-positioned patient. This case is the first case report of successful management of recurrent cardiac arrest using percutaneous cardiopulmonary support (PCPS) during a prone-position surgery. A 18-year-old female patient with severe scoliosis underwent a deformity correction surgery. Sudden cardiac arrest occurred immediately after the insertion of a rod in the surgical field for correcting the spine alignment. The patient's position was promptly changed to the supine position, and cardiopulmonary resuscitation was performed. After the return of spontaneous circulation, the second operation was followed after three weeks. During the second operation, cardiac arrest recurrently occurred whenever the rod was inserted. Cardiopulmonary resuscitation was performed in a prone position. After returing of spontaneous circulation, patient was repositioned to a supine position and the PCPS was started. Under PCPS support, the operation was successfully completed in a prone position, and the patient was successfully weaned from PCPS.

The effect of tracheal tube size on air leak around the cuffs / 대한마취과학회지

BACKGROUND: This randomized single-blinded, cross-over study was done to evaluate the influence of the size of tracheal tubes on air leaks around the cuffs. METHODS: In a benchtop model, the number of longitudinal folds on the cuffs was evaluated for different sizes of tracheal tubes. In an anesthetized patient study, thirty patients scheduled for elective surgery under general anesthesia were included. After induction of anesthesia, the trachea was intubated with two sizes of tracheal tubes in a random sequence: in men, internal diameter of 7.5 mm and 8.0 mm; in women, internal diameter of 7.0 mm and 7.5 mm. After tracheal intubation with each tube, air leak pressures were evaluated at intracuff pressures of 20, 25 and 30 cmH2O by auscultation. To calculate the tracheal tube resistance (R), an inspiratory pause of 20% was applied and the resulting peak airway pressure (Ppeak), plateau pressure (Ppl) and mean expiratory tidal volume (Flow) were inserted in the formula R = (Ppeak - Ppl)/Flow. RESULTS: More longitudinal folds of the tracheal tube cuffs occurred in larger sized tubes compared to the smaller ones in a benchtop model. Air leakage was significantly less for the smaller tracheal tubes than for the larger ones for each gender at intracuff pressures of 20, 25 and 30 cmH2O. Tracheal tube resistances were not significantly altered by the size of tracheal tube. CONCLUSIONS: The use of a smaller tracheal tube within an acceptable size can reduce air leakage around the cuff without significantly changing the tracheal tube resistance.

Effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery / 대한마취과학회지

BACKGROUND: Emergence agitation in children is frequently associated with sevoflurane general anesthesia. We measured the effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. METHODS: Ninety pediatric patients receiving sevoflurane anesthesia for elective strabismus surgery were enrolled. They were randomized to receive either saline (Group S), propofol 1 mg/kg (Group P), or nalbuphine 0.1 mg/kg (Group N) at the end of surgery. We evaluated the incidence of emergence agitation and recovery in the postanesthesia care unit. RESULTS: The time to recovery was similar between the three study groups. The incidence of agitation was significantly lower in Group N compared with Group S, but the incidence of agitation between Group S and Group P was not different. CONCLUSIONS: Nalbuphine 0.1 mg/kg at the end of strabismus surgery under sevoflurane anesthesia effectively reduced emergence agitation in children without delaying recovery, but propofol did not.

Effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery / 대한마취과학회지

BACKGROUND: Emergence agitation in children is frequently associated with sevoflurane general anesthesia. We measured the effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. METHODS: Ninety pediatric patients receiving sevoflurane anesthesia for elective strabismus surgery were enrolled. They were randomized to receive either saline (Group S), propofol 1 mg/kg (Group P), or nalbuphine 0.1 mg/kg (Group N) at the end of surgery. We evaluated the incidence of emergence agitation and recovery in the postanesthesia care unit. RESULTS: The time to recovery was similar between the three study groups. The incidence of agitation was significantly lower in Group N compared with Group S, but the incidence of agitation between Group S and Group P was not different. CONCLUSIONS: Nalbuphine 0.1 mg/kg at the end of strabismus surgery under sevoflurane anesthesia effectively reduced emergence agitation in children without delaying recovery, but propofol did not.

Comparison of the Two Impairment Classes Publicized by the American Medical Association in Complex Regional Pain Syndrome Patients / 대한통증학회지

BACKGROUND: Complex regional pain syndrome (CRPS) is not regarded as an impairment in Korea. Guidelines for rating this impairment are under development by the Korean Academy of Medical Science based on that of the American Medical Association (AMA). However, no studies have been done on the validity of these guidelines in Korea. We therefore evaluated the validity of these guidelines using the criteria from the chapter on the central and peripheral nervous system (CNS-PNS class) and the worksheet for calculating total pain-related impairment score (TPRIS class). METHODS: TPRIS and CNS-PNS classes were calculated through interviews of 28 CRPS patients. The correlation between the two classes was calculated. RESULTS: TPRIS class and CNS-PNS class were well correlated (r = 0.593, P < 0.05). CONCLUSIONS: Both TPRIS or CNS-PNS classes were well correlated and could be used for evaluation of impairment. However, the CNS-PNS class is simpler and quicker to complete.

Altered Expression of Peritoneal Aquaporin-in Response to Osmotic Stimuli and Glucocorticoid / 대한신장학회잡지

BACKGROUND: To examine the changes of peritoneal aquaporin-1 (AQP-1) expression and peritoneal transport in rats in response to continuous exposure of same osmotic stimuli which was induced by either mannitol or glucose in dialysis solution or glucocorticoids co-reatment. METHODS: Twenty-eight male Sprague-awley rats were divided into three groups:group I (n=10) rats were dialyzed with 5% mannitol solution (0.27 M); group II (n=9) rats were dialyzed with 5% glucose solution (0.28 M): and group III (n=9) rats were dialyzed with 5% glucose solution (0.28 M) accompanied by daily injection of dexamethasone (2 mg/kg, im) for the last 7 days of the 1 month dialysis period. Dialysis exchanges were performed 2 times a day for 1 month with 25 mL per exchange. Immunohistochemistry was performed using a polyclonal anti AQP-1 antibody. The peritoneal membrane (PM) function was assessed by one-hour PET for comparing transport characteristics. PM transport rates were assessed by D/P of urea nitrogen and D/Do of glucose. Water transport of peritoneal membrane was assessed by D/P of sodium at 1 month. RESULTS: The immunolabeling intensity of peritoneal AQP-1 was markedly increased and the most prominent in rats dialyzed with 5% glucose solution accompanied by injection of dexamethasone (group III). Consistent with this, D/P of sodium in rats of group III was significantly decreased (p<0.05), indicating an increased water permeability and ultrafiltration. In contrast, peritoneal AQP-1 labeling intensity was weaker in PD groups dialyzed with mannitol (group I) and glucose (group II) solution having an identical osmolality and was not different between the groups. Rats in group I exhibited significantly lower D/Do of glucose and increased D/P of urea nitrogen, suggesting high PM transport. CONCLUSION: These results indicate that the change of peritoneal AQP-1 expression is not specific to the glucose itself, but rather it could be altered in response to the changes of osmolality per se in PD solution. Moreover, corticosteroid up-egulates peritoneal AQP-expression, which is paralleled by an increased water permeability.