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1.
Article | WPRIM | ID: wpr-830307

ABSTRACT

Background@#Bile duct ligation (BDL) has been used for experimental research on hepatic encephalopathy (HE) caused by chronic liver disease. However, little research has been done on a BDL model in C57BL/6 mouse. Therefore, we evaluated the suitability of a BDL model in C57BL/6 mouse for the study of HE and determined which behavioral tests are appropriate for the identification of HE in this model. @*Methods@#Twelve to fourteen-week-old male C57BL/6 mice were randomly assigned to either sham group or BDL group. Histological changes in liver were confirmed by hematoxylin/ eosin and Masson’s trichrome staining. Liver function alterations were detected by alanine aminotransferase (ALT) and ammonia levels. To identify behavioral changes, open field, elevated plus maze, novel object recognition, and passive avoidance tests were performed. @*Results@#Inflammatory liver injury and fibrosis were observed 14 days after BDL. ALT and ammonia levels were significantly higher in BDL group than in sham group. There were no differences in general locomotor activity or anxiety between the groups. No difference was observed between these two groups in the novel object recognition test, but BDL group showed significant learning/memory impairment in the passive avoidance test compared to sham group. @*Conclusions@#Fourteen days of BDL in 12–14-week-old male C57BL/6 mice is a clinically relevant model for HE, as these mice have liver fibrosis with impaired liver function, hyperammonemia, and learning/memory impairment. Passive avoidance can be used as the major behavioral test in this model of HE.

2.
Article | WPRIM | ID: wpr-830299

ABSTRACT

Background@#Patients with hemifacial microsomia may have a difficult airway due to the accompanying mandibular deformity. Fiberoptic bronchoscope-guided intubation is commonly used method for difficult airway management. However, awake fiberoptic nasotracheal intubation has several disadvantages, including difficulty in advancement of the endotracheal tube (ETT) due to the resistance between the ETT and bronchoscope. Wire-guided fiberoptic nasotracheal intubation may help to overcome the drawbacks of the conventional method.Case: An 18-year-old man with hemifacial microsomia was scheduled for double-jaw surgery. In preoperative evaluation, he had severe retrognathia and expected difficult airway. We successfully performed wire-guided fiberoptic nasotracheal intubation combined with high-flow nasal cannula and deep sedation without any complications. @*Conclusions@#A guidewire may be useful, in case of difficultly in advancing the ETT or if a smaller tube is required, while performing intubation with FOB in patients with difficult airways.

3.
Yonsei Medical Journal ; : 291-297, 2019.
Article in English | WPRIM | ID: wpr-742532

ABSTRACT

PURPOSE: Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose of this study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factors in patients with preserved ejection fraction following KT. MATERIALS AND METHODS: We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preand post-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measured using the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′). RESULTS: Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e′ after KT (11.9±4.4 to 10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e′ (odds ratio, −0.056; 95% confidence interval, −0.014 to −0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients), the amount of intraoperative fluid administration was related to E/e′ changes (odds ratio, 0.003; 95% confidence interval, 0.000 to 0.005; p=0.029). CONCLUSION: KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LV diastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients with preexisting diastolic dysfunction.


Subject(s)
Cause of Death , Filtration , Humans , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Renal Insufficiency, Chronic , Retrospective Studies , Risk Factors
4.
Yonsei Medical Journal ; : 735-741, 2019.
Article in English | WPRIM | ID: wpr-762112

ABSTRACT

PURPOSE: The most common method of monitoring cardiac output (CO) is thermodilution using pulmonary artery catheter (PAC), but this method is associated with complications. Impedance cardiography (ICG) is a non-invasive CO monitoring technique. This study compared the accuracy and efficacy of ICG as a non-invasive cardiac function monitoring technique to those of thermodilution and arterial pressure contour. MATERIALS AND METHODS: Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured by thermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Bland-Altman analysis to assess the degree of agreement. RESULTS: The difference by thermodilution and ICG was 1.13 L/min/m², and the limits of agreement were −0.93 and 3.20 L/min/m². The difference by thermodilution and arterial pressure contour was 0.62 L/min/m², and the limits of agreement were −1.43 and 2.67 L/min/m². The difference by arterial pressure contour and ICG was 0.50 L/min/m², and the limits of agreement were −1.32 and 2.32 L/min/m². All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed between CI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilution and arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. CONCLUSION: Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation with thermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely require further studies in other settings.


Subject(s)
Arterial Pressure , Cardiac Output , Cardiography, Impedance , Catheters , Electric Impedance , Humans , Liver Transplantation , Methods , Pulmonary Artery , Thermodilution
5.
Article in English | WPRIM | ID: wpr-759521

ABSTRACT

BACKGROUND: Considering the functional role of red blood cells (RBC) in maintaining oxygen supply to tissues, RBC transfusion can be a life-saving intervention in situations of severe bleeding or anemia. RBC transfusion is often inevitable to address intraoperative massive bleeding; it is a key component in safe perioperative patient management. Unlike general medical resources, packed RBCs (pRBCs) have limited availability because their supply relies entirely on voluntary donations. Additionally, excessive utilization of pRBCs may aggravate prognosis or increase the risk of developing infectious diseases. Appropriate perioperative RBC transfusion is, therefore, crucial for the management of patient safety and medical resource conservation. These concerns motivated us to develop the present clinical practice guideline for evidence-based efficient and safe perioperative RBC transfusion management considering the current clinical landscape. METHODS: This guideline was obtained after the revision and refinement of exemplary clinical practice guidelines developed in advanced countries. This was followed by rigorous evidence-based reassessment considering the healthcare environment of the country. RESULTS: This guideline covers all important aspects of perioperative RBC transfusion, such as preoperative anemia management, appropriate RBC storage period, and leukoreduction (removal of white blood cells using filters), reversal of perioperative bleeding tendency, strategies for perioperative RBC transfusion, appropriate blood management protocols, efforts to reduce blood transfusion requirements, and patient monitoring during a perioperative transfusion. CONCLUSIONS: This guideline will aid decisions related to RBC transfusion in healthcare settings and minimize patient risk associated with unnecessary pRBC transfusion.


Subject(s)
Anemia , Blood Transfusion , Communicable Diseases , Delivery of Health Care , Erythrocyte Transfusion , Erythrocytes , Hemorrhage , Humans , Leukocytes , Monitoring, Physiologic , Oxygen , Patient Safety , Prognosis
6.
Article in Korean | WPRIM | ID: wpr-714068

ABSTRACT

Postoperative cognitive dysfunction (POCD) occurs immediately after surgery and is characterized by impairment of memory and changes in cognition. POCD can last for several months or years and have adverse effects including delayed hospital stays, diminished function in daily life, and increased complications and mortality. Despite improvements in surgical technique, anesthesia management, and intensive care, many patients suffer from POCD. POCD is one of the important clinical issues in surgical management and understanding its pathophysiology is necessary. In this review, therefore, we have focused on animal models of POCD and measurements of cognitive ability in preclinical studies, and we have suggested novel approaches for prevention/treatment of POCD. In preclinical studies, major abdominal surgery (laparotomy, hepatectomy, and splenectomy), minor abdominal surgery (laparotomy, probe exploration), and tibial fracture surgery, are used as POCD models. In addition, cognitive function is assessed by Morris water maze, passive avoidance task, elevated plus maze, and T maze test. Neuroinflammation, blood-brain barrier dysfunction, beta amyloid deposition, and tau phosphorylation are suggested as pathological mechanisms of POCD in preclinical studies. Based on several studies of these, we suggest erythropoietin, nuclear factor kappa B, interleukin17A, tumor necrosis factor alpha, and nicotinamide adenine dinucleotide phosphate oxidase 2 as candidates for prevention/treatment of POCD. In the preclinical stage, drug development/exploration and research is being carried out to solve cognitive dysfunction after surgery. Ultimately, based on the results of preclinical studies, we expect to overcome POCD.


Subject(s)
Anesthesia , Blood-Brain Barrier , Cognition , Critical Care , Erythropoietin , Hepatectomy , Humans , Length of Stay , Memory , Models, Animal , Mortality , NADP , NF-kappa B , Oxidoreductases , Phosphorylation , Plaque, Amyloid , Tibial Fractures , Tumor Necrosis Factor-alpha , Water
7.
Article in English | WPRIM | ID: wpr-716934

ABSTRACT

An increasing number of pediatric patients undergo liver transplantation, and it has become an effective and definitive treatment of choice for pediatric end-stage liver disease patients. However, liver transplantation in pediatric patients differs greatly from that in older individuals with respect to not only surgical techniques, immunosuppression, and post-operative managements, but also to intraoperative anesthetic management. The present review provides an overview of the current development and clinical practices in anesthetic management of pediatric liver transplantation.


Subject(s)
Anesthesia , Child , Humans , Immunosuppression , Liver Diseases , Liver Transplantation , Liver
8.
Article in English | WPRIM | ID: wpr-120970

ABSTRACT

No abstract available.


Subject(s)
Child , Humans
9.
Article in English | WPRIM | ID: wpr-32630

ABSTRACT

The interleukin-1 receptor antagonist (IL-1RA) is a potential stroke treatment candidate. Intranasal delivery is a novel method thereby a therapeutic protein can be penetrated into the brain parenchyma by bypassing the blood-brain barrier. Thus, this study tested whether intranasal IL-1RA can provide neuroprotection and brain penetration in transient cerebral ischemia. In male Sprague-Dawley rats, focal cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) for 1 h. The rats simultaneously received 50 mg/kg human IL-1RA through the intranasal (IN group) or intraperitoneal route (IP group). The other rats were given 0.5 mL/kg normal saline (EC group). Neurobehavioral function, infarct size, and the concentration of the administered human IL-1RA in the brain tissue were assessed. In addition, the cellular distribution of intranasal IL-1RA in the brain and its effect on proinflammatory cytokines expression were evaluated. Intranasal IL-1RA improved neurological deficit and reduced infarct size until 7 days after MCAO (p<0.05). The concentrations of the human IL-1RA in the brain tissue 24 h after MCAO were significantly greater in the IN group than in the IP group (p<0.05). The human IL-1RA was confirmed to be co-localized with neuron and microglia. Furthermore, the IN group had lower expression of interleukin-1β and tumor necrosis factor-α at 6 h after MCAO than the EC group (p<0.05). These results suggest that intranasal IL-1RA can reach the brain parenchyma more efficiently and provide superior neuroprotection in the transient focal cerebral ischemia.


Subject(s)
Administration, Intranasal , Animals , Blood-Brain Barrier , Brain , Brain Ischemia , Cytokines , Humans , Infarction, Middle Cerebral Artery , Interleukin 1 Receptor Antagonist Protein , Interleukin-1 , Ischemic Attack, Transient , Male , Methods , Microglia , Models, Animal , Necrosis , Neurons , Neuroprotection , Rats , Rats, Sprague-Dawley , Stroke
10.
Korean Circulation Journal ; : 734-738, 2016.
Article in English | WPRIM | ID: wpr-217203

ABSTRACT

Subcutaneous implantation of a cardiac implantable electronic device is the standard method. Occasionally, subpectoral cardiac implantable electronic device (CIED) implantation via axillary incisions is performed in young female patients for cosmetic purposes. Because subpectoral CIED implantation and augmentation mammoplasty involve the same layer, it is feasible to perform both procedures simultaneously. We report a case of combined subpectoral implantation of an implantable cardioverter-defibrillator and augmentation mammoplasty via the axillary approach in a young female patient with dilated cardiomyopathy and small breasts.


Subject(s)
Breast , Cardiomyopathy, Dilated , Defibrillators, Implantable , Female , Female , Humans , Mammaplasty , Methods , Pectoralis Muscles , Young Adult
11.
Article in English | WPRIM | ID: wpr-26735

ABSTRACT

No abstract available.

12.
Article in English | WPRIM | ID: wpr-178037

ABSTRACT

Propofol is an anesthetic agent that gained wide use because of its fast induction of anesthesia and rapid recovery post-anesthesia. However, previous studies have reported immediate neurodegeneration and long-term impairment in spatial learning and memory from repeated neonatal propofol administration in animals. Yet, none of those studies has explored the sex-specific long-term physical changes and behavioral alterations such as social (sociability and social preference), emotional (anxiety), and other cognitive functions (spatial working, recognition, and avoidance memory) after neonatal propofol treatment. Seven-day-old Wistar-Kyoto (WKY) rats underwent repeated daily intraperitoneal injections of propofol or normal saline for 7 days. Starting fourth week of age and onwards, rats were subjected to behavior tests including open-field, elevated-plus-maze, Y-maze, 3-chamber social interaction, novel-object-recognition, passive-avoidance, and rotarod. Rats were sacrificed at 9 weeks and hippocampal protein expressions were analyzed by Western blot. Results revealed long-term body weight gain alterations in the growing rats and sex-specific impairments in spatial (female) and recognition (male) learning and memory paradigms. A markedly decreased expression of hippocampal NMDA receptor GluN1 subunit in female- and increased expression of AMPA GluR1 subunit protein expression in male rats were also found. Other aspects of behaviors such as locomotor activity and coordination, anxiety, sociability, social preference and avoidance learning and memory were not generally affected. These results suggest that neonatal repeated propofol administration disrupts normal growth and some aspects of neurodevelopment in rats in a sex-specific manner.


Subject(s)
alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid , Anesthesia , Animals , Anxiety , Avoidance Learning , Blotting, Western , Body Weight , Humans , Injections, Intraperitoneal , Interpersonal Relations , Learning , Male , Memory , Motor Activity , N-Methylaspartate , Propofol , Rats , Weight Gain
13.
Article in English | WPRIM | ID: wpr-153539

ABSTRACT

BACKGROUND: The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. METHODS: Fifty patients aged 65-85 years (elderly group) and 50 patients aged 20-40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study. Manipulations required during insertion, success rate, insertion time, oropharyngeal leak pressure, gastric insufflation, and intraoperative inadequate ventilation with the LMA-C were assessed. Fiberoptic evaluation was used to determine the position of the LMA-C. RESULTS: In the elderly group, the insertion success rate on the first attempt was significantly lower than that in the young group (84 vs. 96%, P = 0.02). The insertion time in the elderly group was significantly longer than that in the young group (28.5 +/- 19.6 vs. 22.2 +/- 6.4 seconds, P = 0.001). However, there was no difference in oropharyngeal leak pressure or fiberoptic grade between the two groups after proper placement of the LMA-C. During the surgery, inadequate ventilation events occurred more frequently in the elderly group than in the young group (31.3 vs. 4.0%, P < 0.001). CONCLUSIONS: The clinical efficacy of the LMA-C in elderly patients was inferior to that in young adult patients. Therefore, further studies are required to determine the type of SGA that can provide excellent clinical efficacy in the geriatric population.


Subject(s)
Aged , Anesthesia, General , Humans , Insufflation , Laryngeal Masks , Prospective Studies , Treatment Outcome , Ventilation , Young Adult
14.
Article in English | WPRIM | ID: wpr-67424

ABSTRACT

BACKGROUND: Intravenous tissue-type plasminogen activator (tPA) is recognized as the standard treatment for ischemic stroke. However, its narrow therapeutic window and association with an increased risk of intracranial hemorrhage have required caution when used. In this context, several approaches are required to deal with the shortcomings of such a double-edged drug. Anesthetics are known to protect against ischemic reperfusion injury, and their protective role in ischemic post-conditioning is crucial for reducing ischemia-related injury. The aim of this study was to assess the effect of isoflurane post-treatment on intracranial hemorrhage and cerebral infarction after tPA treatment for transient cerebral ischemia. METHODS: Cerebral ischemia was modeled in male Sprague-Dawley rats (n = 32) by occluding the right middle cerebral artery for 1 h, followed by intravenous tPA administration. Rats were randomly divided into control and isoflurane post-treatment group, and isoflurane post-treatment group was post-treated by administering 1.5% isoflurane for 1 h from the start of reperfusion. Twenty-four h after reperfusion, neurobehavioral changes were assessed. The extent of cerebral infarction and intracranial hemorrhage were also assessed by quantification of infarction volume and cerebral hemoglobin concentration from brain tissue, respectively. RESULTS: Neurobehavioral testing showed better functional outcomes in the isoflurane post-treatment group than the control group. The extent of cerebral infarction and intracranial hemorrhage were both reduced in isoflurane post-treatment group compared to control group. CONCLUSIONS: Isoflurane post-treatment may mitigate infarction volume and intracranial hemorrhage in tPA-exaggerated brain injury. Our findings provide an encouraging novel approach for enhancing clinical outcomes in tPA-exaggerated brain injury.


Subject(s)
Anesthetics , Animals , Brain , Brain Injuries , Brain Ischemia , Cerebral Infarction , Humans , Infarction , Intracranial Hemorrhages , Ischemic Attack, Transient , Ischemic Postconditioning , Isoflurane , Male , Middle Cerebral Artery , Rats , Rats, Sprague-Dawley , Reperfusion , Reperfusion Injury , Stroke , Tissue Plasminogen Activator
15.
Yonsei Medical Journal ; : 1401-1407, 2015.
Article in English | WPRIM | ID: wpr-39976

ABSTRACT

PURPOSE: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. MATERIALS AND METHODS: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol. Predicted mortality rates were calculated using POSSUM and P-POSSUM equations and were compared with actual outcomes using exponential and linear analyses. In addition, a receiver operating characteristic curve analysis was undertaken, and area-under-the-curve (AUC) values with confidence intervals (CIs) were calculated for POSSUM and P-POSSUM. RESULTS: Among the 51 patients with intraoperative cardiac arrest, 32 (62.7%) died within 30 days postoperatively. The overall predicted 30-day mortality rates using POSSUM and P-POSSUM were 65.5% and 57.5%, respectively. The observed-to-predicted (O:E) ratio for the POSSUM 30-day mortality was 1.07, with no significant difference between the observed and predicted values (chi2=4.794; p=0.779). P-POSSUM predicted mortality equally well, with an O:E ratio of 1.10 (chi2=8.905; p=0.350). AUC values (95% CI) were 0.771 (0.634-0.908) and 0.785 (0.651-0.918) for POSSUM and P-POSSUM, respectively. CONCLUSION: Both POSSUM and P-POSSUM performed well to predict overall 30-day mortality following intraoperative cardiac arrest in adults undergoing non-cardiac surgery at a university teaching hospital in Korea.


Subject(s)
Adult , Aged , Female , Heart Arrest/complications , Humans , Incidence , Intraoperative Complications/mortality , Male , Middle Aged , Morbidity , Postoperative Period , ROC Curve , Republic of Korea/epidemiology , Retrospective Studies , Risk Assessment/methods , Severity of Illness Index , Surgical Procedures, Operative/mortality
16.
Yonsei Medical Journal ; : 1408-1414, 2015.
Article in English | WPRIM | ID: wpr-39975

ABSTRACT

PURPOSE: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedation may lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration (Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. MATERIALS AND METHODS: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedation and airway obstruction levels were assessed using the Observer's Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. RESULTS: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect> or =m) for sedation scores (m> or =2, 3, 4, and 5) and airway-obstruction scores (m> or =2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 microg/mL and 1.53, 1.64, and 2.09 microg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). CONCLUSION: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.


Subject(s)
Adult , Aged , Airway Obstruction/drug therapy , Anesthesia , Anesthetics, Intravenous/blood , Female , Humans , Hypnotics and Sedatives/pharmacology , Male , Middle Aged , Probability , Propofol/pharmacology , Sleep Apnea, Obstructive/physiopathology
17.
Yonsei Medical Journal ; : 1106-1114, 2014.
Article in English | WPRIM | ID: wpr-207151

ABSTRACT

PURPOSE: Epidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy. MATERIALS AND METHODS: Sixty-four patients undergoing conventional open gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine combined with intravenous patient-controlled analgesia (IT) group or patient-controlled thoracic epidural analgesia (EP) group. The IT group received preoperative 0.3 mg of ITM, followed by postoperative IVPCA. The EP group preoperatively underwent epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores were assessed until 48 hrs after surgery. Adverse effects related to analgesia, profiles associated with recovery from surgery, and postoperative complications within 30 days after surgery were also evaluated. RESULTS: This study failed to demonstrate the non-inferiority of ITM-IVPCA (n=29) to PCTEA (n=30) with respect to VAS 24 hrs after surgery. Furthermore, the IT group consumed more fentanyl than the EP group did (1247.2+/-263.7 microg vs. 1048.9+/-71.7 microg, p<0.001). The IT group took a longer time to ambulate than the EP group (p=0.021) and had higher incidences of postoperative ileus (p=0.012) and pulmonary complications (p=0.05) compared with the EP group. CONCLUSION: ITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.


Subject(s)
Adult , Analgesia, Epidural/methods , Analgesia, Patient-Controlled/methods , Analgesics, Opioid/administration & dosage , Female , Gastrectomy/methods , Humans , Male , Middle Aged , Morphine/administration & dosage , Pain Management/methods , Pain, Postoperative/drug therapy
18.
Yonsei Medical Journal ; : 508-516, 2014.
Article in English | WPRIM | ID: wpr-47151

ABSTRACT

PURPOSE: Emergence agitation (EA) is frequently observed in children undergoing general anaesthesia. This study tested whether the addition of an intra-operative low-dose infusion of dexmedetomidine to fentanyl treatment reduced the incidence of emergence delirium following desflurane anesthesia in children undergoing strabismus surgery. MATERIALS AND METHODS: A total of 96 children (1-5 years old) undergoing strabismus surgery were enrolled. Anaesthesia was induced with propofol and maintained with desflurane. After induction, fentanyl (1 microg/kg) was administered to all children. During surgery, patients were infused with 0.2 microg/(kg.h)-1 dexmedetomidine (Group FD, n=47) or normal saline (Group F, n=47). Postoperative objective pain score (OPS), Paediatric Agitation and Emergence Delirium (PAED) score, and EA score were documented every 10 minutes in the post-anaesthesia care unit. RESULTS: There were no significant differences between the two groups in demographic characteristics and haemodynamic changes. The mean values of maximum EA, maximum PAED, and maximum OPS score were significantly lower in Group FD than in Group F at 0, 10, and 20 minutes after arrival at the post-anaesthesia care unit (p<0.001). The frequency of fentanyl rescue was lower in Group FD than in Group F (p<0.001). The incidence of severe EA was significantly lower in Group FD than in Group F (12.8% vs. 74.5%, p<0.001). CONCLUSION: Intra-operative low-dose infusion of dexmedetomidine in addition to fentanyl reduces EA following desflurane anaesthesia in children undergoing strabismus surgeries.


Subject(s)
Anesthesia , Child , Delirium , Dexmedetomidine , Dihydroergotamine , Fentanyl , Humans , Incidence , Methods , Pediatrics , Propofol , Strabismus
19.
Article in English | WPRIM | ID: wpr-41281

ABSTRACT

We report a case of possible venous air embolism (VAE) during trans pars plana vitrectomy with air-fluid exchange of the vitreous cavity. Shortly after initiation of air-fluid exchange, decreases in end-tidal CO2, oxygen saturation, and blood pressure were observed. The patient rapidly progressed to cardiac arrest unresponsive to cardiopulmonary resuscitation, and recovered after the application of percutaneous cardiopulmonary support. Prompt termination of air infusion is needed when VAE is suspected during air-fluid exchange, and extracorporeal life support should be considered in fatal cases. Although the incidence is rare the possibility of VAE during ophthalmic surgery clearly exists, and therefore awareness and vigilant monitoring seem critical.


Subject(s)
Blood Pressure , Cardiopulmonary Resuscitation , Embolism, Air , Heart Arrest , Humans , Incidence , Ophthalmologic Surgical Procedures , Oxygen , Vitrectomy
20.
Yonsei Medical Journal ; : 732-738, 2013.
Article in English | WPRIM | ID: wpr-211913

ABSTRACT

PURPOSE: In earlier analyses, desflurane has been shown to reduce average extubation time and the variability of extubation time by 20% to 25% relative to sevoflurane in adult patients. We undertook this study to determine which agents prompt less recovery time in pediatric patients undergoing minor surgery. MATERIALS AND METHODS: After obtaining Institutional Review Board approval, we retrospectively reviewed the anesthesia records of 499 patients, with an average age of 5 years, who underwent minor surgeries at Severance Eye and Ear, Nose and Throat Hospital between May 2010 and April 2011. Anesthesia was induced with propofol and rocuronium. Anesthesia was maintained with sevoflurane (n=340) or desflurane (n=159) with 50% air/O2. Time from cessation of anesthetics to recovery of self-respiration, eye opening on verbal command and extubation were compared between the two groups. Additionally, the incidences of postoperative respiratory adverse events were also compared. RESULTS: Times to self-respiration recovery, eye opening on verbal command, and extubation were significantly faster in the desflurane group than the sevoflurane group (4.6+/-2.5 min vs. 6.9+/-3.8 min, 6.6+/-3.0 min vs. 9.2+/-3.6 min, and 6.2+/-2.7 min vs. 9.3+/-3.7 min, respectively, p<0.005). There were no statistically significant differences between the two groups with respect to adverse respiratory events during the peri-operative period (38.2% vs. 34.6%, p=0.468). CONCLUSION: Emergence and recovery from anesthesia were significantly faster in the desflurane group of children undergoing minor surgery. Desflurane did not result in any differences in respiratory adverse events during recovery compared to sevoflurane.


Subject(s)
Anesthesia Recovery Period , Child , Child, Preschool , Female , Humans , Isoflurane/adverse effects , Male , Methyl Ethers/adverse effects , Perioperative Period , Minor Surgical Procedures , Time Factors
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