The Effects of Lidocaine on Pain Due to Rocuronium / 대한마취과학회지

BACKGROUND:Rocuronium is a non depolarizing muscle relaxant of rapid onset and of intermediate action duration. It is particularly suitable for short operation and rapid control airway. But, intravenous rocuronium cause pain and a withdrawal movement. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain and withdrawal movement in patients receiving rocuronium. METHODS: The study was approved by our institutional review board, and informed consent was obtained from all patients. One hundred and twenty patients, ASA physical status 1-2 undergoing general anesthesia for elective surgery were randomly enrolled. Allergy history to trial drug, chronic pain, pregnancy, patient on analgesics, difficult vein access and deeply sedated patients were excluded. Patients were not premedicated, and had a 20-18 G intravenous catheter inserted into a hand dorsum before operation. On arrival in the operation room, routine non-invasive monitors were placed and the free flow of intravenous fluid without edema, redness or hardness was confirmed. A subparalyzing dose of rocuronium 0.06 mg/kg (RS group) or vecuronium 0.01 mg/kg (VS group) was administered after 2 ml of 0.9% NaCl in one group, and a subparalyzing dose of rocuronium 0.06 mg/kg (RL group) or vecuronium 0.01 mg/kg (VL group) was administered after 2 ml of 2% lidocaine injection in a second group. All patients then received 5 mg/kg of 2.5% thiopental sodium and 0.6 mg/kg rocuronium (RS and RL group) or 0.1 mg/kg of vecuronium (VS and VL group). Muscle relaxant-induced pain and withdrawal movements were assessed using 4-grade scales (0-3). Vein redness was measured just after administration and vein hardness five minutes after intubation using 4-grade scales (0-3). RESULTS: Incidence of pain (8.2 times) and withdrawal movement (6.2 times) was more frequent in the rocuronium group than in the vecuronium group (P< 0.01). Lidocaine pretreatment decreased the incidence of pain significantly (5.7 times, P < 0.01). CONCLUSIONS: Rocuronium causes more pain and withdrawal movements than vecuronium. Lidocaine pretreatment significantly reduced the incidence and severity of pain, and withdrawal movements in both groups.

The Effect of Lidocaine on Withdrawal Movement Due to Rocuronium Injection in Pediatric Patients / 대한마취과학회지

BACKGROUND:Rocuronium is a non depolarizing muscle relaxant of rapid onset and of intermediate duration. It is useful for short operations and for rapid control of the airway in pediatric patients. However the intravenous injection of rocuronium cause pain and a withdrawal movement. The purpose of this study was to evaluate the effect of lidocaine pretreatment in pediatric patients receiving rocuronium (10 mg/ml) and diluted rocuronium (1 mg/ml) on withdrawal movement METHODS: The study was approved by our institutional review board, and informed consent was obtained from all parents. One hundred and twenty five patients, aged from 4 months to 10 years, ASA physical status 1-2 undergoing general anesthesia for elective surgery were randomly enrolled in the study. Allergy history to a trial drug, pediatric patients on analgesics, difficult vein access and severely crying pediatric patients on arrival were excluded. All patients were non-premedicated and had a 22 G i.v. catheter inserted into the dorsum of hand before operation. On arrival in the operation room, routine non invasive monitors were placed and a free flow of i.v. fluid without edema, redness, hardness or pain was confirmed. After the administration of glycopyrrolate 0.004 mg/kg, inhalational induction was performed with 4-8 vol% sevoflurane by face mask fitting. One group received rocuronium 0.3 mg/kg (RS group) or vecuronium 0.05 mg/kg (VS group) was administered after 0.5 ml of 0.9% NaCl. A second group received rocuronium 0.3 mg/kg (RL group) or vecuronium 0.5 mg/kg (VL group) after lidocaine 1 mg/kg. A third group received rocuronium 1 mg/ml diluted with 0.9% NaCl (1:9) (RD group). Muscle relaxant-induced withdrawal movements were assessed by using a 4-grade scales (0-3). We also observed pulse rate alterations. Vein redness was evaluated just after administration and vein hardness five minutes after intubation by using a 4-grade scale (0-3). RESULTS: Withdrawal movements were more intense in the rocuronium group (R group, 3.8 times, P < 0.01) than in the vecuronium group (V group). Lidocaine pretreatment (L group, 1.8 times, P < 0.01) or diluted rocuronium (RD group, 1.9 times, P < 0.01) decreased withdrawal movement incidence. Withdrawal movement incidence was positive correlated with a change in pulse rate (Spearman's rho = 0.36, P < 0.01). CONCLUSIONS: Lidocaine pretreatment in patients receiving rocuronium (10 mg/ml) or diluted rocuronium (1 mg/ml) effectively reduces withdrawal movement during the administration of rocuronium.

Validation of an Abridged Korean Version of the International Index of Erectile Function (IIEF-5) as a Diagnostic Tool for Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: An abridged 5-item version of the 15-item International Index of Erectile Function (IIEF) was developed and its validity has been proven in the western medical community. This study was designed to assess the validity of the abbreviated Korean version of the IIEF as a diagnostic tool for ED. MATERIALS AND METHODS: Patients who visited the Andrology Clinic of the Asan Medical Center with a chief complaint of ED fall into the patient group. Patients who visited the Family Medicine Clinic of the same hospital with chief complaints other than ED, and checked no ED in the self-assessment questionnaire, fall into the control group. Patients, both of the patient group and control group, were asked to fill out the self-administered IIEF-5 and the questionnaire asking the severity of the ED. RESULTS: Collected questionnaires from a total of 309 subjects (the patient group: 149; the control group: 160) were used for statistical analysis. Mean ages were 43 and 52 for the control group and the patient group, respectively. A Receiver Operating Characteristics (ROC) Curve analysis indicated that there is a close correlation between IIEF-5 total scores and the presence of ED (area under the ROC curve=0.961). The most appropriate cutoff score between ED and no ED was 17 (sensitivity=91.3%, specificity=86.3%). Substantial consistency existed between the predicted and the patient-answered ED severity levels (Weighted Kappa=0.681). CONCLUSIONS: The Korean version of IIEF-5 is highly effective in detecting the presence and assessing the severity of ED. The result of our study supports its validity as a diagnostic instrument in the clinical setting.

Long-term Prognostic Value of Dipyridamole Stress Myocardial SPECT / 대한핵의학회잡지

PURPOSE: Dipyridamole stress myocardial perfusion SPECT could predict prognosis, however, long-term follow-up showed change of hazard ratio in patients with suspected coronary artery disease. We investigated how long normal SPECT could predict the benign prognosis on the long-term follow-up. MATERIALS AND METHODS: We followed up 1169 patients and divided these patients into groups in whom coronary angiography were performed and were not. Total cardiac event rate and hard event rate were predicted using clinical, angiographic and SPECT findings. Predictive values of normal and abnormal SPECT were examined using survival analysis with Mantel-Haenszel method, multivariate Cox proportional hazard model analysis and newly developed statistical method to test time-invariance of hazard rate and changing point of this rate. RESULTS: Reversible perfusion decrease on myocardial perfusion SPECT predicted higher total cardiac event rate independently and further to angiographic findings. However, myocardial SPECT showed independent but not incremental prognostic values for hard event rate. Hazard ratio of normal perfusion SPECT was changed significantly (p<0.001) and the changing point of hazard rate was 4.4 years of follow up. However, the ratio of abnormal SPECT was not. CONCLUSION: Dipyridamole stress myocardial perfusion SPECT provided independent prognostic information in patients with known and suspected coronary artery disease. Normal perfusion SPECT predicted least event rate for 4.4 years.

Comparision of doctors' experience with and attitudes toward complementary and alternative medicine between western medicine and korean traditional medicine in office-based settings

BACKGROUD: Primary care physicians (PCPs) and ariental medical dactors (OMDs), as primary healthcare providers, could directly affect patients use of complementary and alternative medidne(CAM). This study was carried out to compare the practice experience with, the knowledge about, and the attitudes taward CAM between PCPs and OMDs in Korea. METHODS: A total of 502 PCPs and 500 OMDs in urban area of Karea were selected by the proportionate quota and systematic sampling methood. Face-to-face interviews were done with structured questionnaire. RESULTS: The rate af practice experience with and referral rate af CAM were reported 13.7% and 38.6% in PCPs, 76.8% and 85.4%. in OMDs respectively. OMDs evaluated the efficacy of each CAM higher than PCPs. Both doctors had wide variatians of knowledge in how to practice each CAM. However more than half OMDs knew how to practice chiropracic, taping therapy, aromatherapy, and iridology respectively, about 30% of PCPs high colic/enema and chiropractic. PCPs had mcire negative attitudes toward CAM and the advertisement of the other professional medidne (korean traditional medicine) than OMDs. OMDs more strongly supported the natural healing process, health-disease continuum, and psychological effect on health, and opposed Descares view on human body than PCPs. CONCLUSIONS: This study showed OMDs had more experience with, knowledge about, positive attitudes toward and supportive health concepts to CAM than PCPs. CAM practice would be diffused with chiropractic, taping therapy, aromatherapy, and iridolagy in OMDs; high colic/enema and chiropractic in PCPs.

Methodologic Considerations on the Cohort Study of Risk Factors of Stomach Cancer: On the Incompleteness of Case Ascertainment / 한국역학회지

BACKGROUND AND PURPOSE: The authors conducted the study to evaluate the incompleteness of follow-up as well as the validity of the diagnostic code in the medical insurance databases in a cohort study. They also suggested several useful regression models for the analysis of such incomplete data. METHODS: The subjects of Seoul Cohort(n=14,533) were followed up for three and a half years. Based on the chart reviews of the subjects who had the diagnostic code of gastric cancer in the medical insurance databases, forty-four cases of gastric cancer were idenfified, using cancer registry databases and death certificates as the secondary source. Regression coefficients and the associated p-values were estimated using the following six methods and the results were compared with each other. Method 1: The subjects with the diagnostic code in the medical insurance databases were considered as the cases of gastric cancer. Method 2: The confirmed cases were considered as the cases of gastric cancer. Method 3: The cases were the subjects with the diagnositc code whose diagnosis was confirmed by medical chart reriew. Method 4: Ordinal logistic regression. Method 5: Weighted logistic regression. Method 6: Polytomous logistic regression RESULTS: A total of 12,541 subjects were followed up excluding censored cases. One hundred and nine subjects were diagnosed with gastric cancer in the medical utilization databases: forty-three were probable cases whose dianosis was not confrimed by chart review, twenty-six were ruled out and 26 were confirmed cases. Another 14 cases were confirmed using the cancer registry and death certificates. Using the secondary sources, four another cases were confirmed and 44 cases were confirmed during follow-up. In method 1, past history of gastritis and gastric ulcer was significant risk factor whereas intake frequency of fresh vegetable, ice cream and coffee was associated with significantly decreased risk. In the second and the sixth method, green tea was a significant protective factor, whereas in methods 3-5, no significant variables were found. CONCLUSIONS: Polytomous logistic regression was the preferred method in the cohort study using secondary sources of information for the follow-up, and it provided additional information for the risk factor identification, especially for the specificity of the risk factors.