Domino living donor liver transplantation of familial amyloid polyneuropathy patient - A case report -

Background@#Familial amyloid polyneuropathy (FAP) is caused by mutation in a gene transcribing transport protein produced mainly by the liver. Liver transplantation is required to stop FAP progression, but the pathology causes anesthetic management challenges.Case: We report a case of domino living donor liver transplantation in an FAP patient. No intraoperative events occurred; however, during postoperative day 1 in the intensive care unit (ICU), the FAP patient underwent multiple cardiopulmonary resuscitation (CPR) sessions due to pulseless electrical activity following a sudden drop in blood pressure and ventricular tachycardia. Despite ICU management, the patient died after the third CPR session. @*Conclusions@#Various anesthetic management techniques should be considered for FAP patients. Anesthetic management was carefully assessed with the use of isoflurane, isoproterenol, and an external patch. The cause of deterioration in the ICU is unclear, but further investigation is needed to prevent and better manage postoperative morbidity and mortality.

Optimal head rotation and puncture site for internal jugular vein cannulation after laryngeal mask airway insertion

<p><b>INTRODUCTION</b>We studied the effect of head rotation on the relative position of the right common carotid artery (CCA) and the right internal jugular vein (IJV) in patients with laryngeal mask airway (LMA) insertion to evaluate the accuracy of anatomical landmarks for right IJV cannulation.</p><p><b>METHODS</b>We simulated needle insertion to the right IJV on sonograms via the central landmark approach and an approach using the external jugular vein, in patients with LMA insertion (n = 50) or endotracheal intubation (E-tube, n = 50). Overlap index and successful simulation rates were measured according to the different degrees of head rotation.</p><p><b>RESULTS</b>The overlap index between the right CCA and the right IJV increased with greater degrees of head rotation. It was significantly greater in the LMA insertion group than in the E-tube group in the following head rotation positions: neutral, 15° and 45°. The success rate of the simulation was lower in the LMA insertion group than in the E-tube group. In the LMA insertion group, the success rate of the simulation was highest (62%) with the central landmark approach and in the 15° head rotation position.</p><p><b>CONCLUSION</b>In the LMA insertion group, the overlap index increased incrementally with greater head rotation degrees (from neutral to 45°). The central landmark approach and 15° head rotation position appear to be the optimal puncture site and degree of head rotation for right IJV cannulation in patients with LMA insertion.</p>

Ultrasound-guided femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block for femoro-popliteal or tibial arterial bypass surgery on patients with cardiac dysfunction: Report of two cases

We report two cases of high-risked patients with cardiac dysfunction undergoing femoro-popliteal or tibial arterial bypass surgery anesthetized by ultrasound guided peripheral nerve blocks; femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block. We used an anesthetic solution consisting of 0.375% ropivacaine with epinephrine. We provided sufficient surgical anesthesia. These nerve blockades provided stable intraoperative and postoperative hemodynamic status, which is valuable knowledge from the perspective of postoperative pain control as well as satisfaction of both patients and surgeons. We believe that femorosciatic nerve block with concurrent femoral branch block of genitofemoral nerve could be an excellent anesthetic choice for patients receiving femoro-popliteal or tibial arterial bypass surgery, especially in patients with cardiac dysfunction.

Ultrasound-guided femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block for femoro-popliteal or tibial arterial bypass surgery on patients with cardiac dysfunction: Report of two cases

We report two cases of high-risked patients with cardiac dysfunction undergoing femoro-popliteal or tibial arterial bypass surgery anesthetized by ultrasound guided peripheral nerve blocks; femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block. We used an anesthetic solution consisting of 0.375% ropivacaine with epinephrine. We provided sufficient surgical anesthesia. These nerve blockades provided stable intraoperative and postoperative hemodynamic status, which is valuable knowledge from the perspective of postoperative pain control as well as satisfaction of both patients and surgeons. We believe that femorosciatic nerve block with concurrent femoral branch block of genitofemoral nerve could be an excellent anesthetic choice for patients receiving femoro-popliteal or tibial arterial bypass surgery, especially in patients with cardiac dysfunction.

The effect of midazolam dose and age on the paradoxical midazolam reaction in Korean pediatric patients / 대한마취과학회지

BACKGROUND: Although midazolam administration may occasionally induce a paradoxical episode, such as threatened crying and violent behavior in children, systematic studies on the causes of paradoxical reaction are limited. We investigated the effect of children's age and a dose of midazolam on the paradoxical reaction. METHODS: A total of one hundred sixty four children of 1-3 years and 3-5 years, were enrolled in this study. Each age group randomly received 0.05 mg/kg or 0.1 mg/kg of intravenous midazolam (41 patients/group). RESULTS: The incidence of paradoxical midazolam reaction in the study groups, 1-3 years with 0.1 mg/kg of intravenous midazolam, 1-3 years with 0.05 mg/kg, 3-5 years with 0.1 mg/kg, and 3-5 years with 0.05 mg/kg were as follows: 29.3%, 12.2%, 7.3% and 2.4%, respectively. The incidence among the 4 groups was significantly different (P = 0.002), highest in the 1-3 years receiving 0.1 mg/kg of midazolam (29.3%). Both age (P = 0.004, OR [95%CI] = 5.3 [1.7-16.8]) and dose of midazolam (P = 0.036, OR [95%CI] = 3.0 [1.1-8.4]) were risk factors. Perioperative clinical data including anxiety scales of children were not associated with the paradoxical midazolam reaction. CONCLUSIONS: In conclusion, we suggest that children less than 3 years old receiving higher dose of intravenous midazolam are at risk for the paradoxical midazolam reaction.

Pulse pressure variation and stroke volume variation to predict fluid responsiveness in patients undergoing carotid endarterectomy / 대한마취과학회지

BACKGROUND: During carotid endarterectomy (CEA), hemodynamic stability and adequate fluid management are crucial to prevent perioperative cerebral stroke, myocardial infarction and hyperperfusion syndrome. Both pulse pressure variation (PPV) and stroke volume variation (SVV), dynamic preload indices derived from the arterial waveform, are increasingly advocated as predictors of fluid responsiveness in mechanically ventilated patients. The aim of this study was to evaluate the accuracy of PPV and SVV for predicting fluid responsiveness in patients undergoing CEA. METHODS: Twenty seven patients undergoing CEA were enrolled in this study. PPV, SVV and cardiac output (CO) were measured before and after fluid loading of 500 ml of hydroxyethyl starch solution. Fluid responsiveness was defined as an increase in CO > or = 15%. The ability of PPV and SVV to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Both PPV and SVV measured before fluid loading are associated with changes in CO caused by fluid expansion. The ROC analysis showed that PPV and SVV predicted response to volume loading (area under the ROC curve = 0.854 and 0.841, respectively, P or = 9.5% identified responders (Rs) with a sensitivity of 71.4% and a specificity of 90.9%, and a SVV > or = 7.5% identified Rs with a sensitivity of 92.9% and a specificity of 63.6%. CONCLUSIONS: Both PPV and SVV values before volume loading are associated with increased CO in response to volume expansion. Therefore, PPV and SVV are useful predictors of fluid responsiveness in patients undergoing CEA.

Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery / 대한마취과학회지

BACKGROUND: Perioperative lidocaine infusion improves postoperative outcomes, mostly after abdominal and urologic surgeries. Knowledge of the effect of lidocaine on peripheral surgeries is limited. Presently, we investigated whether intraoperative lidocaine infusion reduced anesthetic consumption, duration of ileus, pain intensity, analgesic consumption and hospital stay after breast plastic surgeries. METHODS: Sixty female patients, aged 20-60 years, enrolled in this prospective study were randomly and equally divided to two groups. One group (n = 30) received a 1.5 mg/kg bolus of lidocaine approximately 30 min before incision followed by continuous infusion of lidocaine (1.5 mg/kg/h) until skin closure (lidocaine group). The other group (n = 30) was untreated (control group). Balanced inhalation (sevoflurane) anesthesia and multimodal postoperative analgesia were standardized. End tidal sevoflurane concentration during surgery, time to the first flatus and defecation, visual analog pain scale (0-10), analgesic consumption and associated side effects at 24, 48, and 72 h after surgery, hospital stay, and patient's general satisfaction were assessed. RESULTS: Compared to the control group, intraoperative lidocaine infusion reduced by 5% the amount of sevoflurane required at similar bispectral index (P = 0.014). However, there were no significant effects of lidocaine regarding the return of bowel function, postoperative pain intensity, analgesic sparing and side effects at all time points, hospital stay, and level of patient's satisfaction for pain control. CONCLUSIONS: Low dose intraoperative lidocaine infusion offered no beneficial effects on return of bowel function, opioid sparing, pain intensity and hospital stay after various breast plastic surgeries.

A survey of user acceptance of electronic patient anesthesia records / 대한마취과학회지

BACKGROUND: An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). METHODS: A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. RESULTS: A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. CONCLUSIONS: Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR.

Evaluation of dose effects of magnesium sulfate on rocuronium injection pain and hemodynamic changes by laryngoscopy and endotracheal intubation / 대한마취과학회지

BACKGROUND: Rocuronium produces injection pain in 50-80% of treated patients. Therefore, a variety of pretreatments have been attempted to reduce this issue. We evaluated the efficacy of 3 different doses of magnesium on the rocuronium injection pain and following hemodynamic changes by laryngoscopy and tracheal intubation (LTI). METHODS: Two hundreds patients, ASA I and II, undergoing general anesthesia for elective surgery were randomly divided to 4 groups: group 1, 2, 3, 4 received saline 5 ml, magnesium 5, 10 and 20 mg/kg prior to 0.6 mg/kg of rocuronium, respectively. Then, group 1 only was treated with esmolol (20 mg) before LTI. Pain intensity with rocuronium injection was assessed using a four-point scale according to patient's movement. Cardiovascular responses at baseline, after induction, 1 minutes after LTI were determined. RESULTS: Compared to saline, 10 and 20 mg/kg of magnesium significantly reduced the incidence of overall movement after rocuronium injection (34% and 36% in group 3 and 4, respectively vs. 76% in the group 1) (P < 0.0001). Generalized movement was seen in 4% of patients in groups 3 and 4, respectively. Compared to baseline values, diastolic blood pressure (DBP) immediately after LTI significantly increased within groups 1 and 2 (P < 0.001), but not within groups 3 and 4. CONCLUSIONS: Magnesium (10 and 20 mg/kg) prior to rocuronium was effective in attenuating rocuronium associated injection pain and cardiovascular changes by LTI.

Effect of Combined Single-Injection Femoral Nerve Block and Patient-Controlled Epidural Analgesia in Patients Undergoing Total Knee Replacement

PURPOSE: Total knee replacement is one of the most painful orthopedic procedures, and effective pain relief is essential for early mobility and discharge from hospital. The aim of this study was to evaluate whether addition of single-injection femoral nerve block to epidural analgesia would provide better postoperative pain control, compared to epidural analgesia alone, after total knee replacement. MATERIALS AND METHODS: Thirty-eight patients received a single-injection femoral nerve block with 0.25% levobupivacaine (30 mL) combined with epidural analgesia (femoral nerve block group) and 40 patients received epidural analgesia alone (control group). Pain intensity and volume of patient-controlled epidural analgesia medication and rescue analgesic requirements were measured in the first 48 hours after surgery at three time periods; 0-6 hours, 6-24 hours, and 24-48 hours. Also, side effects such as nausea, vomiting, and pruritus were evaluated. RESULTS: Median visual analog scale at rest and movement was significantly lower until 48 hours in the femoral nerve block group. Patient-controlled epidural analgesia volume was significantly lower throughout the study period, however, rescue analgesia requirements were significantly lower only up to 6 hours in the femoral nerve block group. The incidences of nausea and vomiting and rescue antiemetic requirement were significantly lower in the femoral nerve block group up to 6 hours. CONCLUSION: The combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.

Comparison of coagulation factors and blood loss between O and non-O blood types following hydroxyethyl starch infusion / 대한마취과학회지

BACKGROUND: Individuals with type O blood are more likely to have reduced factor VIII and von Willebrand factor levels compared to their non-O counterparts. Hydroxyethyl starch (HES), which is widely used for blood volume replacement, can induce coagulopathy. Therefore, we tested whether blood type O patients show more coagulopathy and blood loss than non-O patients after infusion of 6% HES. METHODS: Thirty-four non-O and 20 type O patients scheduled for posterior lumbar interbody fusion (PLIF) involving 3 vertebrae or less from June 2007 to August 2008 were enrolled. Fifteen ml/kg of 6% HES was administered during the operation. Coagulation profiles was checked at pre-infusion (T0), 5 min after the end of infusion (T1), 3 hr after the end of infusion (T2), and 24 hr after the end of infusion (T3). Bleeding was measured during and after surgery for 24 hours. RESULTS: Baseline factor VIII concentration was lower and aPTT was longer in type O patients compared to those of non-O patients. 6% HES infusion decreased most of the coagulation factors at T1 in both groups, which were recovered in a time dependent manner. Factor VIII and aPTT of blood type O patients fell off the normal range at T1. However, other coagulation factors, thromboelastography variables, and blood loss were not different between the groups. CONCLUSIONS: Despite inborn low factor VIII which further decreased shortly after HES infusion, blood type O patients did not show more blood loss than non-O blood type after 15 ml/kg of HES infusion in PLIF surgery.

Does a single dose of intravenous nicardipine or nimodipine affect the bispectral index following rapid sequence intubation? / 대한마취과학회지

BACKGROUND: Theoretically, L-type calcium channel blockers could modulate anesthetic effects. Nicardipine does not affect the bispectral index (BIS), but nimodipine, which can penetrate the blood-brain barrier, has not been studied. The aim of this study was to evaluate whether a single dose of intravenous nicardipine or nimodipine could affect BIS following rapid sequence intubation. METHODS: This study was done in a double-blind, randomized fashion. Anesthesia was induced with fentanyl 2 microgram/kg, thiopental sodium 5 mg/kg, and 100% oxygen. After loss of consciousness, patients received rocuronium 1.0 mg/kg and either a bolus of 20 microgram/kg nicardipine, nimodipine, or a comparable volume of normal saline (n = 20). Intubation was performed 1 min after study drug administration. BIS, mean blood pressure (MBP), and heart rate (HR) were measured before anesthetic induction, after loss of consciousness, before intubation, during intubation, and 1, 2 and 5 min after intubation. RESULTS: BIS dropped rapidly after induction but increased to 60 before intubation in all groups irrespective of study drug. In nimodipine, the increase in BIS during intubation was not significant compared to pre-intubation, in contrast to the other two groups, but there was no difference in BIS during intubation. HR significantly increased, but MBP just rose to pre-induction values after intubation in nicardipine and nimodipine groups. BIS, MBP, and HR following intubation increased in control group. CONCLUSIONS: A single dose of intravenous nicardipine or nimodipine could attenuate blood pressure increases but not affect BIS increases in rapid sequence intubation.

Protective Effects of Gabapentin on Allodynia and alpha2delta1-Subunit of Voltage-dependent Calcium Channel in Spinal Nerve-Ligated Rats

This study was designed to determine whether early gabapentin treatment has a protective analgesic effect on neuropathic pain and compared its effect to the late treatment in a rat neuropathic model, and as the potential mechanism of protective action, the alpha2delta1-subunit of the voltage-dependent calcium channel (alpha2delta1-subunit) was evaluated in both sides of the L5 dorsal root ganglia (DRG). Neuropathic pain was induced in male Sprague-Dawley rats by a surgical ligation of left L5 nerve. For the early treatment group, rats were injected with gabapentin (100 mg/kg) intraperitoneally 15 min prior to surgery and then every 24 hr during postoperative day (POD) 1-4. For the late treatment group, the same dose of gabapentin was injected every 24 hr during POD 8-12. For the control group, L5 nerve was ligated but no gabapentin was administered. In the early treatment group, the development of allodynia was delayed up to POD 10, whereas allodynia was developed on POD 2 in the control and the late treatment group (p<0.05). The alpha2delta1-subunit was up-regulated in all groups, however, there was no difference in the level of the alpha2delta1-subunit among the three groups. These results suggest that early treatment with gabapentin offers some protection against neuropathic pain but it is unlikely that this action is mediated through modulation of the alpha2delta1-subunit in DRG.

Atrial Fibrillation during Ethanol Sclerotherapy in a Patient with Lower Limb Arteriovenous Malformation: A case report / 대한마취과학회지

Alcohol embolization or sclerotherapy has been commonly used for a treatment of arteriovenous malformation (AVM). Alcohol sclerotherapy frequently produces minor local complications but may rarely produce catastrophic cardiopulmonary complications. In this case, general anesthesia was induced and the pulmonary artery pressure was monitored. After absolute alcohol (99.6% ethanol) injection, the systolic pulmonary artery pressure was increased, the systemic blood pressure was decreased and the EKG rhythm revealed supraventricular tachycardia and atrial fibrillation. Nitroglycerine, dobutamine, and milrinone infusions were started for the treatment of pulmonary hypertension. The EKG was restored to normal sinus rhythm two hours after judicious fluid administration and other vital signs were also recovered. The anesthesiologists must be aware of potentially serious cardiopulmonary complications possible with alcohol sclerotherapy and be prepared to manage severe cardiovascular compromise.

Comparison of Dextrose Water and Hartmann's Solution in Each Low and High Doses for Adult Ambulatory Anesthesia: Effect on Recovery from Anesthesia / 대한마취과학회지

BACKGROUND: Adequate fluid administration for ambulatory anesthesia has not been widely studied because most patients are healthy and operations are short durations and not invasive. However, long pre-operative nothing per os (NPO) time is known to affect post-operative complications like pain, headache, dizziness, drowsiness, fatigue, nausea, vomiting, thirsty, sore throat, or well-being sensation. And amount of administered fluid or inclusion of dextrose during the operation could exercise great influence on those symptoms. Therefore, we compared four fluid regimens; 5% dextrose water 2 ml/kg (D/W2), 20 ml/kg (D/W20) and Hartmann's solution 2 ml/kg (H/S2), 20 ml/kg (H/S20) regarding to post-operative complications of ambulatory anesthesia. METHODS: One hundred and sixty ambulatory anesthesia patients of ASA 1 or 2 undergoing general anesthesia or monitored anesthesia care were randomly assigned into D/W2, D/W20, H/S2 or H/S20. Each group of patients received 5% dextrose water 2 ml/kg, 20 ml/kg, Hartmann's solution 2 ml/kg, or 20 ml/kg for 30 min, respectively. Complications like pain, headache, dizziness, drowsiness, fatigue, nausea, vomiting, thirsty, sore throat, or well-being sensation of patients were checked with systemized questionnaire check box graded 4 scales at recovery room, at evening and at 24 hours later. RESULTS: H/S20 group was better in nausea, thirsty and well-being sensation. Sixteen percent of patients showed hypoglycemia before anesthesia. Dextrose water resulted transient hyperglycemia and osmotic diuresis. CONCLUSIONS: Large amount of Hartmann's solution was generally better regarding post-operative complications. We should pay attention at peri-operative hypoglycemia for ambulatory anesthesia.

Effects of Gender on White Blood Cell Populations and Neutrophil-Lymphocyte Ratio Following Gastrectomy in Patients with Stomach Cancer

Alterations of absolute number or percentage of circulating white blood cell (WBC) subsets are associated with psychological and physical stress. Gender effects on the changes of circulating WBC subsets following surgical treatment have not been determined. Therefore, the current study aimed to determine whether circulating neutrophils, lymphocytes and monocytes, and neutrophil-lymphocyte ratio (N/L) are different following major surgery according to the gender. We studied 409 male patients and 212 female patients who underwent total or subtotal gastrectomy due to stomach cancer, from 1 January to 31 December in 2005. The WBC count and percentage of its subsets were obtained from database and N/L was directly calculated from the full blood count preoperatively, immediate postoperatively, and postoperative day 1, 3, 5 in a retrospective manner. Compared to preoperative values, neutrophilia, lymphopenia, monocytopenia, and increased N/L were associated with gastrectomy in all patients. In the comparison study between genders, there were significantly increased proportion of neutrophils, decreased lymphocytes and monocytes, and higher N/L in female patients than in male patients after gastrectomy. These findings indicate that female patients showed more immune-compromised response to gastrectomy than male patients.

Effect of Intraoperative 80% Inspired Oxygen on Postoperative Nausea and Vomiting in Patients undergoing Vitreoretinal Surgery / 대한마취과학회지

BACKGROUND: Most recently, the antiemetic effects of high inspired oxygen have been discussed and various results have been reported according to the types of surgeries and the groups of patients. In ophthalmic surgical patients, surgical procedures involving intraoperative manipulation of the eye and giving rise to residual eye discomfort were associated with the increased incidences of postoperative nausea and vomiting (PONV). The antiemetic effect of 80% inspired oxygen for the patients undergoing vitreoretinal surgery is unknown. Therefore, we examined the efficacy of 80% inspired oxygen in the decrease of the PONV incidences after vitreoretinal surgery under general anesthesia. METHODS: 170 adults under 70 years of age have received standardized sevoflurane anesthesia. After tracheal intubation, they were randomly assigned to two groups: 30% inspired oxygen in air (Group 30), and 80% inspired oxygen in air (Group 80). Postoperative nausea and vomiting were evaluated at the 2, 6, and 24 h postoperatively by an investigator unaware of patients' allocation. RESULTS: There was a significantly lower incidence of PONV during the first 2 h postoperatively in the Group 80 (22%) compared with the Group 30 (40%) (P = 0.024). The Group 80 (33.8%) showed the decreased incidence of PONV during the first 24 h postoperatively compared with the Group 30 (48.8%), but these differences were not statistically significant (P = 0.081). CONCLUSIONS: The use of 80% inspired oxygen during vitreoretinal surgery reduced the incidence of PONV during the first 2 h postoperatively.

The Effect of High FiO2 Plus Liberal Intraoperative Fluid on the Early PONV and Pain in Patients undergoing Intra-abdominal Surgery / 대한마취과학회지

BACKGROUND: The previous studies on the influence of perioperative supplemental oxygen or generous fluid on postoperative nausea and vomiting (PONV) were inconsistent. We hypothesized in this trial that together with supplemental intraoperative oxygen and liberal fluid therapy would decrease PONV and pain. METHODS: Two hundred ASA 1 or 2 patients undergoing laparotomy and laparoscopic abdominal or gynecological surgery were randomly assigned to one of 4 groups: intraoperative FiO2 0.3 and crystalloid 6 ml/kg/h; FiO2 0.3 and 18 ml/kg/h; FiO2 0.8 and 6 ml/kg/h; FiO2 0.8 and 18 ml/kg/h. The incidence of PONV, nausea and pain scores, and amount of rescue antiemetic and analgesic drugs were studied. RESULTS: Overall incidence of PONV was 38%, 50%, 48%, 44% for group 1, 2, 3, and 4, respectively. There were no statistically significant differences among the 4 groups in the incidence of PONV, degree of nausea and pain, and the amount of antiemetics and analgesics in 2, 6, and 24 h postoperatively. The number of laparotomy and laparoscopy, and gender ratio were similar among the groups. CONCLUSIONS: We could not demonstrate an advantage of combination of intraoperative supplementary oxygen and liberal fluid in reducing PONV, pain, and amount of antiemetics and analgesics after intra-abdominal surgery.

The Effects of Supplemental Oxygen on Postoperative Nausea and Vomiting, Pain, and Stress Hormones / 대한마취과학회지

BACKGROUND: Supplemental oxygen has been reported to diminish postoperative nausea and vomiting (PONV). Surgical trauma causes increased response of stress hormones. Therefore, we aimed to investigate whether supplemental oxygen attenuates release of adrenocorticotrophic hormone (ACTH) and cortisol as well as PONV in patients undergoing thyroidectomy. METHODS: One hundred female patients were randomly assigned to two groups: 30% oxygen (Group 30) and 80% oxygen (Group 80). The incidence and the severity of PONV and pain score were evaluated 2, 6, 24 h postoperatively. PaO2, ACTH and cortisol were measured in 40 patients before tracheal intubation under 100% oxygen and at the end of surgery under designated oxygen concentration. RESULTS: The PaO2 at induction was similar between the groups, but significantly higher in the group 80 than group 30 at the end of surgery. There were no differences in the incidence and the severity of PONV and pain score postoperatively between the groups. ACTH increased significantly at the end of surgery in both groups, but cortisol did not. There were no differences in ACTH and cortisol between the groups. CONCLUSIONS: Supplemental oxygen during thyroidectomy did not reduce the incidence and severity of PONV, postoperative pain, and stress hormone responses.

The Incidence Rate and Risk Factors of Pressure-induced Skin Breakdown during Operation / 대한마취과학회지

BACKGROUND: Pressure-induced skin breakdown is not only a painful inconvenience to the patient, but it is also associated with a prolonged hospital stay. This study examined the incidence of pressure-induced skin breakdown in attempt to identify the associated risk factors during elective surgery. METHODS: Data were collected from 808 subjects who underwent orthopedic, thoracic, neuro- or plastic surgery over a six-month period. The data included age, gender, weight, height, body mass index, ASA status, surgical position, operation time, estimated blood loss, preoperative hemoglobin concentration, serum albumin, co-morbidity, and intraoperative hypotension. The patient's skin was inspected closely within 24 hours after surgery. The sites and severity of skin breakdown were assessed. RESULTS: Of the 808 patients in this study, 192 patients (23.8%) developed skin breakdown during surgery. The incidence of blisters, abrasion, or blister and abrasion was 6.1%. The patient's weight, operation time, estimated blood loss, malignancy, and intraoperative hypotension were significantly related to the development of skin breakdown (P < 0.05). The incidence of pressure-induced skin breakdown was highest in the prone position (P = 0.000). Age, gender, body mass index, hypertension, diabetes, preoperative hemoglobin and albumin level were not found to be risk factors of skin breakdown. CONCLUSIONS: The early identification of a patient at risk is a first step in a scientifically based approach for preventing the development of pressure sores. Although intervention will not always prevent the development of pressure sores, a medical team must recognize the risk factors associated with skin breakdown and carry out careful intervention during the perioperative period.