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1.
Article in English | WPRIM | ID: wpr-875171

ABSTRACT

Background@#Shoulder surgery in the beach chair position frequently causes hypotensive bradycardic events (HBEs), which are potentially associated with an increased risk of cerebral hypoperfusion. Here, we aimed to investigate the incidence and characteristics of symptomatic HBEs that require pharmacological interventions, and to identify specific risk factors associated with symptomatic HBEs. @*Methods@#We retrospectively examined the records of all patients aged ≥ 18 years who underwent shoulder arthrotomy in the beach chair position between January 2011 and December 2018 at Samsung Medical Center. For patients who experienced HBEs while in the beach chair position, the minimum heart rate and systolic blood pressure were noted, as was the total dose of ephedrine or atropine. @*Results@#Symptomatic HBEs occurred in 61.0% of all cases (256/420). Two patients with symptomatic HBEs experienced postoperative neurological complications. Multivariable logistic regression analysis showed that preoperative interscalene brachial plexus block (ISB) and advanced age were risk factors associated with symptomatic HBEs (odds ratio [OR]: 3.240, 95% CI: 2.003, 5.242, P < 0.001; OR: 1.060 for each 1-year increase, 95% CI: 1.044, 1.076, P < 0.001, respectively). Receiver operating curve analysis revealed that a threshold of 62 years of age had a moderate degree of accuracy for predicting symptomatic HBEs (area under curve: 0.764, 95% CI: 0.720, 0.804, P < 0.001). @*Conclusions@#Considering the increasing risk of neurocognitive complications with aging, proactive hemodynamic management is needed, especially for elderly patients undergoing shoulder surgery in the beach chair position using ISB.

2.
Article in English | WPRIM | ID: wpr-759515

ABSTRACT

BACKGROUND: To identify trends in injuries and substandard care associated with anesthesia, we analyzed the Korean Society of Anesthesiologists database for anesthesia-related case files from July 2009 to June 2018. METHODS: Case characteristics, injuries, and outcomes were compared between the first part (July 2009–June 2014, n = 105) and the second part (July 2014–June 2018, n = 92) of the analyzed time period. RESULTS: Overall, 132 cases resulted in death. The proportion of fatal cases for sedation was similar to general anesthesia (66.2% vs. 76.3%). The proportion of cases with permanent injury or death decreased significantly in the second part of the period compared with the first part (76.1% vs. 93.3%, P = 0.002). With a growing trend in the proportion of sedation cases, a similar number of sedation and general anesthesia cases were referred during the overall period (77 and 76 cases, respectively). Propofol-based regimens remained the dominant sedation method (89.7% in the first part vs. 78.9% in the second part). The most common adverse event in cases of permanent injury or death was identified as being respiratory in origin (98/182, 53.8%). Permanent injuries or deaths were related to local anesthetic systemic toxicity (LAST) and beach-chair positioning for shoulder surgery, in 8 and 5 cases, respectively. CONCLUSIONS: Despite the decreasing trend in injury severity with time, several characteristic injury profiles were identified: lack of vigilance in propofol-based sedation, neurological injuries related to the beach-chair position, and LAST occurring during tumescent anesthesia or brachial plexus block.


Subject(s)
Anesthesia , Anesthesia, General , Brachial Plexus Block , Dissent and Disputes , Malpractice , Methods , Shoulder
4.
Article in English | WPRIM | ID: wpr-739813

ABSTRACT

OBJECTIVE: To evaluate the effect of high-intensity interval training (HIIT) on psychological symptoms, activity states, and cardiovascular functions in patients with myocardial infarction (MI) of low and moderate risk stratification. METHODS: This prospective study randomly allocated 44 patients with MI to 18 sessions of HIIT or conventional moderate-intensity continuous training (MICT). Outcome measures were assessed at baseline and after 18 sessions. RESULTS: Post-exercise cardiovascular and functional states, maximal oxygen uptake (VO2max), metabolic equivalents (METs), 6-Minute Walking Test (6MWT), and Korean Activity Scale/Index (KASI) scores were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. In particular, VO2max was significantly (p < 0.005) improved in the HIIT group (7.58 mL/kg/min) compared to that in the MICT group (2.42 mL/kg/min). In addition, post-exercise psychological states (i.e., scores of Fatigue Severity Scale [FSS] and depression items of the Hospital Anxiety and Depression Scale [HADS_D]) were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. HADS-D was improved by 1.89 in the HIIT group compared to decrement of 0.47 in the MICT group. FSS was improved by 6.38 in the HIIT group compared to decrement of 0.77 in the MICT group (p < 0.005). CONCLUSION: This study demonstrates that HIIT can improve cardiac function, psychological, and activity states in low and moderate risk MI patients. Compared to conventional MICT, HIIT can improve cardiovascular functions, activity states, depression, and fatigue more effectively.


Subject(s)
Anxiety , Depression , Fatigue , Humans , Metabolic Equivalent , Myocardial Infarction , Outcome Assessment, Health Care , Oxygen , Prospective Studies , Walking
5.
Article in English | WPRIM | ID: wpr-716042

ABSTRACT

BACKGROUND: Despite expanding demands for non-operating room anesthesia (NORA) worldwide, studies in this field are scarce. We compared the overall characteristics and the nature of deaths occurring within 48 hours after surgery between NORA and operating room anesthesia (ORA) cases at a Korean tertiary hospital. METHODS: We retrospectively analyzed the medical records of patients who underwent surgical procedures under anesthesia services in and outside the operating room from January 2013 to November 2017. All of the mortalities were categorized by principal cause into groups such as patient disease or condition, surgery, anesthesia, and others. RESULTS: Overall, 16,383 NORA cases and 183,381 ORA cases were analyzed. Eighty-six deaths were identified. The mortality rate of NORA cases was similar to that of ORA cases (4.9 per 10,000 cases [95% confidence interval (CI), 2.1–9.6] vs. 4.3 per 10,000 cases [95% CI, 3.4–5.3], respectively). Similar to ORA cases, higher American Society of Anesthesiologists physical status and very young age (< 2 years) were significantly associated with mortality in NORA cases. A patient's disease or condition was the most important cause of mortality (65/86, 75.6%), followed by surgery-related causes (16/86, 18.6%). Two cases of anesthesia-related mortality were only identified in the ORA cases, resulting in an overall anesthesia-related mortality of 0.1 per 10,000 cases (95% CI, 0.0–0.4). CONCLUSION: Although NORA cases showed an equivalent perioperative mortality rate compared to ORA cases, there may be more room for improving patient safety when considering their favorable characteristics (healthier patients, less invasive and shorter procedures). Trial registry at Clinical Research Information Service, KCT0002719.


Subject(s)
Anesthesia , Humans , Information Services , Medical Records , Mortality , Operating Rooms , Patient Safety , Perioperative Period , Retrospective Studies , Tertiary Care Centers
6.
Article in English | WPRIM | ID: wpr-145721

ABSTRACT

Anesthesia for a patient with a large mediastinal mass is a challenge for anesthesiologists, given the risk of airway collapse and hemodynamic compromise. Moreover, there are very few reports on the anesthetic management of non-intubated video-assisted thoracoscopic surgery (VATS). Thus, in the following case report, we provide an account of the successful anesthetic management and excisional biopsy of a large anterior mediastinal mass (measuring 13 × 10 cm) utilizing non-intubated VATS. The patient was kept awake, maintaining consciousness and spontaneous respiration throughout the procedure, in order to prevent devastating airway collapse and pain control and cough prevention were achieved by thoracic epidural analgesia and lidocaine nebulization.


Subject(s)
Analgesia, Epidural , Anesthesia , Anesthesia, Epidural , Biopsy , Consciousness , Cough , Hemodynamics , Humans , Lidocaine , Respiration , Thoracic Surgery, Video-Assisted
7.
Article in English | WPRIM | ID: wpr-134085

ABSTRACT

OBJECTIVE: To investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT). METHODS: Medical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function. RESULTS: After ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041). CONCLUSION: CVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.


Subject(s)
Acetazolamide , Basal Ganglia , Brain , Cerebrovascular Circulation , Cerebrum , Humans , Medical Records , Motor Cortex , Multivariate Analysis , Occipital Lobe , Parietal Lobe , Prefrontal Cortex , Recovery of Function , Retrospective Studies , Stroke , Temporal Lobe , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-Photon
8.
Article in English | WPRIM | ID: wpr-134084

ABSTRACT

OBJECTIVE: To investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT). METHODS: Medical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function. RESULTS: After ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041). CONCLUSION: CVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.


Subject(s)
Acetazolamide , Basal Ganglia , Brain , Cerebrovascular Circulation , Cerebrum , Humans , Medical Records , Motor Cortex , Multivariate Analysis , Occipital Lobe , Parietal Lobe , Prefrontal Cortex , Recovery of Function , Retrospective Studies , Stroke , Temporal Lobe , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-Photon
9.
Article in English | WPRIM | ID: wpr-136415

ABSTRACT

Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.


Subject(s)
Anesthesia, General , Deep Sedation , Hemostasis , Insufflation , Pneumoperitoneum , Respiratory Insufficiency , Stomach Neoplasms
10.
Article in English | WPRIM | ID: wpr-136414

ABSTRACT

Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.


Subject(s)
Anesthesia, General , Deep Sedation , Hemostasis , Insufflation , Pneumoperitoneum , Respiratory Insufficiency , Stomach Neoplasms
11.
Article in English | WPRIM | ID: wpr-166097

ABSTRACT

BACKGROUND: With the increasing demand for general anesthesia for endoscopic esophageal procedures, anesthesiologists should understand the clinical characteristics of post-procedural complications (PPCs). METHODS: We retrospectively investigated the incidence of and risk factors associated with PPCs of endoscopic esophageal procedures performed under general anesthesia from July 2013 to November 2016. The final analysis included 129 patients; 114 who underwent esophageal endoscopic dissection for esophageal tumors and 15 cases of peroral endoscopic myotomy for achalasia. Frank perforation during the procedure was defined as an endoscopically recognizable or clinically detected perforation during the procedures. A multivariable logistic regression analysis was conducted to identify independent risk factors for PPCs. RESULTS: The overall incidence of PPCs was 19.4% (25/129). All of the PPCs were managed successfully with conservative measures. The most common PPC was symptomatic, radiologically documented atelectasis (11/25, 44.0%), followed by esophageal perforation-related PPCs (symptomatic pneumomediastinum or pneumoperitoneum; 9/25, 36.0%). In the multivariable analysis, frank perforation during the procedure was the only independent risk factor for PPCs (odds ratio, 8.470, 95% CI, 2.051–34.974, P = 0.003). Although frank perforation during the procedure occurred in 13 patients, 38.5% (5/13) of them did not develop any clinical sequelae after their procedures. Compared with patients without PPCs, patients who developed PPCs took longer to their first oral intake and had prolonged hospital stays (P = 0.047 and 0.026, respectively). CONCLUSIONS: Iatrogenic perforation during endoscopic esophageal procedures under general anesthesia was the only independent risk factor for PPCs; therefore, proactive measures and close follow-up are necessary.


Subject(s)
Anesthesia, General , Endoscopy, Gastrointestinal , Esophageal Achalasia , Esophagus , Follow-Up Studies , Humans , Incidence , Length of Stay , Logistic Models , Mediastinal Emphysema , Pneumoperitoneum , Pulmonary Atelectasis , Retrospective Studies , Risk Factors
12.
Article in English | WPRIM | ID: wpr-224017

ABSTRACT

OBJECTIVE: To investigate the characteristics and risk factors of dysphagia with the Videofluoroscopic Dysphagia Scale (VDS) using a videofluoroscopic swallowing study (VFSS) in patients with ruptured aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Data of 64 patients presenting with first-ever ruptured aSAH were analyzed. Characteristics of dysphagia were evaluated using VFSS and all subjects were divided into a high (>47) and low risk group (≤47) by the VDS score. Clinical and functional parameters were assessed by medical records including demographics, hypertension and diabetes mellitus (DM), the Glasgow Coma Scale (GCS), the Hunt and Hess scale, endotracheal intubation, acute management modalities, as well as Korean version of the Mini-Mental Status Examination (K-MMSE) and Korean version of Modified Barthel Index (K-MBI). Radiologic factors identified the amount of hemorrhage, ventricular rupture, and aneurysmal location. RESULTS: About a half of the subjects showed oral phase abnormalities and the oral transit time was delayed in 46.8% of the patients. The pharyngeal transit time was also prolonged in 39.0% of the subjects and the proportion of penetration and aspiration observed was 46.8%. The parameters-GCS score (p=0.048), hemorrhagic volume (p=0.028), presence of intraventricular hemorrhage (p=0.038), and K-MMSE (p=0.007)-were predisposing factors for dysphagia in patients with aSAH. CONCLUSION: Abnormalities in the oral phase were more prominent in patients with aSAH than in those with other types of stroke. The risk factors associated with dysphagia persisting over 6 months after stroke onset were the initial GCS, hemorrhage volume, presence of intraventricular hemorrhage, and cognitive status as measured by the K-MMSE.


Subject(s)
Aneurysm , Aneurysm, Ruptured , Causality , Deglutition , Deglutition Disorders , Demography , Diabetes Mellitus , Fluoroscopy , Glasgow Coma Scale , Hemorrhage , Humans , Hypertension , Intubation, Intratracheal , Medical Records , Risk Factors , Rupture , Stroke , Subarachnoid Hemorrhage
13.
Immune Network ; : 116-125, 2016.
Article in English | WPRIM | ID: wpr-168216

ABSTRACT

Medical records of 139 tumors from 114 dogs that underwent surgery from May 2010 through March 2015 were retrospectively reviewed. Among 114 dogs, females (64.9%) were significantly more common than males (35.1%) (p<0.05). Dogs aged 6 to 10 years were more presented than non-tumor patients, however, there was no significant difference. The mean age (±SD) was 10.3±3.0 years. Although we found no significant difference of breed predisposition, the most common breed was Maltese (19.3%), followed by Shih-Tzu (14.0%), and Yorkshire terrier (13.2%). Proportional morbidity ratios (PMRs) of mammary gland, oral cavity, and skin tumors were high in Poodles, Yorkshire terriers, and Golden retrievers, respectively. Mammary gland (36.0%) was the most common site, followed by skin and soft tissues (12.2%), oral cavity (10.8%), and digestive organs (8.6%), but there was no significant difference. The objectives of surgery were curative surgery (86.2%), biopsy (4.9%), and palliative surgery (6.5%). In this study, 123 of 139 tumors had histopathological diagnoses. Adenocarcinoma was the most common type (n=24), followed by adenoma (n=17), soft tissue sarcoma (n=13), benign mixed tumor (n=5), and others (n=64). Recurrence or suspected metastasis was identified in 26 dogs. Median survival times of malignant mammary gland tumors, skin and subcutaneous tumors, and splenic tumors were 1,563.0±1,201.7, 469, and 128 days, respectively.


Subject(s)
Adenocarcinoma , Adenoma , Animals , Biopsy , Diagnosis , Dogs , Female , Humans , Male , Mammary Glands, Human , Medical Records , Mouth , Neoplasm Metastasis , Palliative Care , Recurrence , Retrospective Studies , Sarcoma , Skin
14.
Article in English | WPRIM | ID: wpr-41320

ABSTRACT

BACKGROUND: Hemodialysis via the internal jugular vein (IJV) has been widely used for patients with end stage renal disease (ESRD) patients, as they have a higher risk of arterial diseases. We investigated the ultrasonographic findings of the IJV and carotid artery (CA) in recipients of kidney transplantation (KT) and identified factors influencing IJV/CA abnormalities. METHODS: We enrolled 120 adult KT recipients. Patients in group A (n = 57) had a history of IJV hemodialysis, while those in group B (n = 63) were not yet on dialysis or undergoing dialysis methods not involving the IJV. The day before surgery, we evaluated the state of the IJV and CA using ultrasonography. We followed patients with IJV stenosis for six months after KT. RESULTS: Ultrasonography revealed that four patients (7%) in group A had IJV abnormalities, while no patients in group B had abnormalities (P = 0.118). Of the four patients with abnormalities, one with 57.4% stenosis normalized during follow- up. However, another patient with 90.1% stenosis progressed to occlusion, while the two patients with total occlusion remained the same. Twenty patients in group A (n = 11) and B (n = 9) had several CA abnormalities (P = 0.462). Upon multivariate analysis with stepwise selection, height and age were significantly correlated with IJV stenosis (P = 0.043, odds ratio = 0.9) and CA abnormality (P = 0.012, odds ratio = 1.1), respectively. CONCLUSIONS: IJV abnormalities (especially with a history of IJV hemodialysis) and CA abnormalities may be present in ESRD patients. Therefore, we recommend ultrasonographic evaluation before catheterization.


Subject(s)
Adult , Carotid Arteries , Catheterization , Catheterization, Central Venous , Catheters , Constriction, Pathologic , Dialysis , Humans , Jugular Veins , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Multivariate Analysis , Odds Ratio , Renal Dialysis , Transplant Recipients , Ultrasonography
15.
Article in English | WPRIM | ID: wpr-23578

ABSTRACT

BACKGROUND: It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. METHODS: The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. RESULTS: Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). CONCLUSIONS: We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI.


Subject(s)
Constriction, Pathologic , Fluoroscopy , Humans , Intervertebral Disc , Magnetic Resonance Imaging , Medical Records , Neck Pain , Neck , Retrospective Studies , Spinal Stenosis , Visual Analog Scale
16.
Article in English | WPRIM | ID: wpr-204522

ABSTRACT

BACKGROUND/OBJECTIVES: Natural products or active components with a protective effect against oxidative stress have attracted significant attention for prevention and treatment of degenerative disease. Oligonol is a low molecular weight polyphenol containing catechin-type monomers and oligomers derived from Litchi chinensis Sonn. We investigated the protective effect and its related mechanism of oligonol against oxidative stress. MATERIALS/METHODS: Oxidative stress in C6 glial cells was induced by hydrogen peroxide (H2O2) and the protective effects of oligonol on cell viability, nitric oxide (NO) and reactive oxygen species (ROS) synthesis, and mRNA expression related to oxidative stress were determined. RESULTS: Treatment with oligonol inhibited NO and ROS formation under cellular oxidative stress in C6 glial cells. In addition, it recovered cell viability in a dose dependent-manner. Treatment with oligonol also resulted in down-regulated mRNA expression related to oxidative stress, nuclear factor kappa-B (NF-kappaB) p65, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS), compared with the control group treated with H2O2. In particular, expression of NF-kappaB p65, COX-2, and iNOS was effectively reduced to the normal level by treatment with 10 microg/mL and 25 microg/mL of oligonol. CONCLUSIONS: These results indicate that oligonol has protective activity against oxidative stress-induced inflammation. Oligonol might be a promising agent for treatment of degenerative diseases through inhibition of ROS formation and NF-kappaB pathway gene expression.


Subject(s)
Biological Products , Cell Survival , Cyclooxygenase 2 , Gene Expression , Hydrogen Peroxide , Inflammation , Litchi , Molecular Weight , Neuroglia , NF-kappa B , Nitric Oxide , Nitric Oxide Synthase Type II , Oxidative Stress , Reactive Oxygen Species , RNA, Messenger
17.
Article in Korean | WPRIM | ID: wpr-218293

ABSTRACT

PURPOSE: Genetic polymorphisms in antioxidant defense and detoxification genes may modulate the levels of oxidative stress biomarkers. METHODS: A total of 301 healthy preschool-aged children in the Seoul and Kyung-gi areas were recruited. DNA was extracted from blood for genotyping of manganese superoxide dismutase (Mn-SOD) Val16Ala, glutathione S-transferase (GST) P1 Ile105Val, GSTT1 present/null, and GSTM1 present/null polymorphisms by PCR-restriction fragment length polymorphism or multiplex PCR analyses. In addition to a questionnaire survey, the levels of urinary 8- hydroxyl-2-deoxiguanosine (8-OHdG) and plasma malondialdehyde (MDA) were measured by ELISA. RESULTS: Significantly higher urinary 8-OHdG concentrations were observed in GSTP1 Ile/Val + Val/Val genotype (p = 0.030), and tended to be higher in Mn-SOD Val/Val genotype (p = 0.065). On the other hand, exposure to environmental tobacco smoking (ETS) and interaction between ETS and gene polymorphisms did not significantly influence either urinary 8-OHdG concentrations or serum MDA. CONCLUSION: Based on our findings, GSTP1 Ile/Val gene polymorphisms might modulate the levels of oxidative stress biomarkers in healthy preschool children.


Subject(s)
Biomarkers , Child , Child, Preschool , DNA , Enzyme-Linked Immunosorbent Assay , Genotype , Glutathione Transferase , Hand , Humans , Malondialdehyde , Multiplex Polymerase Chain Reaction , Oxidative Stress , Plasma , Polymorphism, Genetic , Seoul , Smoking , Superoxide Dismutase
18.
Article in English | WPRIM | ID: wpr-128100

ABSTRACT

Common peroneal neuropathy during normal delivery is associated with instrumentation and prolonged time spent in a certain position. We report a case of unilateral common peroneal neuropathy in a vaginal delivery patient under labor analgesia with the combined spinal-epidural technique. A 29-year-old woman complained of weakness and numbness of the left foot two days after vaginal delivery. Neurologic examination and electrodiagnostic testing confirmed left common peroneal neuropathy. The patient was referred for rehabilitation, which substantially improved her mobility and function, and prevented secondary damage. The patient had not fully recovered at three months after the delivery. The possible etiology of the postpartum common peroneal neuropathy was most likely prolonged and excessive pressure around the knee by assistants. Excessive compression during delivery should be minimized or avoided. Patient education and awareness among the labor and delivery team will prevent this complication. Neurologic complications related to epidural analgesia should also be ruled out in these patients.


Subject(s)
Adult , Analgesia , Analgesia, Epidural , Female , Foot , Humans , Hypesthesia , Knee , Labor, Obstetric , Neurologic Examination , Patient Education as Topic , Peroneal Neuropathies , Postpartum Period , Pregnancy , Rehabilitation
20.
Article in English | WPRIM | ID: wpr-105213

ABSTRACT

BACKGROUND: Intrathecal labor analgesia using new local anesthetics such as ropivacaine or levobupivacaine becomes more popular by virtues of their safety and decreased motor weakness. However, the analgesic efficacy of the clinically effective intrathecal doses of these new local anesthetics combined with fentanyl has yet to be determined. METHODS: Sixty parturients who requested neuraxial analgesia in early active labor were randomly assigned to either ropivacaine (group R, n = 30) or levobupivacaine (group L, n = 30) group. Group R received 3 mg of intrathecal ropivacaine and the group L received 3 mg of intrathecal levobupivacaine mixed with 20 microg of fentanyl as part of a combined spinal-epidural (CSE) technique. The associated block parameters, such as pain scores, duration of analgesia, the highest levels of the sensory block and motor block scores 30 mins after the injection were compared between two groups. RESULTS: Intrathecal ropivacaine offered shorter analgesia (87 +/- 41 min vs. 122 +/- 56 min, P < 0.05) with lower sensory height (T8.5 vs. T6, P < 0.05) and led to lower incidence of complete analgesia (73 vs. 97%, P < 0.05) compared with intrathecal levobupivacaine. Although motor weakness was comparable in both groups, significantly weak perineal squeezing was noticed in Group L (7 of 30 parturients vs. 16 of 30, P < 0.05). CONCLUSIONS: Clinically relevant doses of intrathecal levobupivacaine in combination with fentanyl as part of a CSE technique provides more effective analgesia than equivalent doses of intrathecal ropivacaine in early labor, but is accompanied by slight motor weakness.


Subject(s)
Analgesia , Anesthetics, Local , Fentanyl , Incidence , Injections, Spinal , Virtues
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