Survey of Surgery-controlled Time in a University Hospital / 대한마취과학회지

BACKGROUND: The authors studied the causes of the cancellation of elective surgeries and identified higher and lower cancellation rate groups. The most common cause of cancellation was excessive scheduling. Till now many studies were focused on anesthesia-controlled time (ACT) in operating room utilization. Therefore, we thought that there must be differences in the surgery-controlled time (SCT) of the high cancellation rate group and the low cancellation rate group. METHODS: We examined elective operations of the high and low cancellation rate groups which do not require arterial and central venous lines in an University Hospital for 15 days. The examined SCT variables were total case time (TCT), the time when the operator started the surgical procedure, operator procedure time (OPT), closing time, and OPT/TCT. ACT and between case time (BCT) were also examined. RESULTS: We found that ACT, TCT, the time when the operator started the surgical procedure and operator procedure time showed statistically significant differences in the two groups. Other variables showed no significant differences. CONCLUSIONS: These findings show that higher cancellation rate group of surgeries have longer SCT. The most meaningful difference between two groups is total case time.

Peripheral Analgesic Effects of NSAIDs and Expressions of Cyclooxygenase-1 and Cyclooxygenase-2 in Acute Arthritic Model in Rats / 대한마취과학회지

BACKGROUND: Theoretically, an NSAID that inhibits COX-2 selectively should decrease inflammation but not influence normal physiologic functions and thus should cause fewer side effects. In the present study, to investigate the extent of peripheral nociception and inflammation of COX-1 and COX-2, diclofenac (non-selective COX inhibitor), SC-560 (selective COX-1 inhibitor) and NS-398 (selective COX-2 inhibitor) were injected intra-articularly on acute arthritic model in rats and COX-1 and COX-2 mRNA expression were measured by reverse transcription polymerase chain reaction (RT-PCR). METHODS: Arthritis was induced with 2% lambda-carrageenan into the right knee joint cavity under enflurane anesthesia (2-4%). Four and a half hours after the carrageenan injection, diclofenac, SC-560 or NS-398 was injected intra-articularly. The weight loads, diameters of knee joints and body weights were measured. The expressions of COX-1 and COX-2 were investigated in the inflammatory control group by RT-PCR. RESULTS: The weight loads predominantly increased and the diameters of the knee joints decreased in the diclofenac group, but not in the SC-560 and NS-398 groups. After the induction of arthritis, COX-1 and COX-2 mRNA expression increased with peak response at 9 and 6 hours after the induction, respectively. CONCLUSIONS: These results suggested that the non-selective COX inhibitor, diclofenac, which was injected intra-articularly, showed effective analgesic and anti-inflammatory effects in acute arthritic rats, and that the expressions of COX-1 and COX-2 mRNA were increased after induction of arthritis.

Does Propofol Improve Postischemic Myocardial Dysfunction by Reducing the Postischemic Adhesion of Polymorphonuclear Neutrophils? / 대한마취과학회지

BACKGROUND: Adhesion of polymorphonuclear neutrophils (PMNs) to the coronary vascular endothelium is a crucial step in the development of postischemic myocardial injury. Propofol, a free radical scavenger has been demonstrated to provide cardioprotective effects by attenuating ischemia and reperfusion injury. The purpose of this study was to investigate whether propofol inhibits the postischemic coronary vascular adhesion of PMNs and results in a reduction of postischemic myocardial dysfunction in isolated guinea pig hearts. METHODS: 42 male guinea pigs were used in this study. Hearts were isolated and perfused with modified Krebs-Hanseleit solution. All isolated hearts were subjected in turn to stabilization for 10 min, perfusion for 15 min, global ischemia for 30 min and reperfusion for 60 min. The isolated hearts were then divided into 6 groups. Each group was subjected to different interventions as follow so. C group: No intervention was performed, except ischemia/reperfusion injury. PPF group: Propofol (4 microgram/ml) was infused from the start of perfusion to 5 min after the start of reperfusion. PMN group: PMNs were infused for 1 min on 2 minutes after reperfusion. P2PMN group: Propofol (2 microgram/ml) was infused from the start of perfusion to 5 min after the start of reperfusion, and PMNs were infused for 1 min on 2 minutes after reperfusion. P4PMN group: Propofol (4 microgram/ml) was infused from the start of perfusion to 5 min after the start of reperfusion, and PMNs were infused for 1 min on 2 minutes after reperfusion. IL-PMN group: Intralipid (0.4 mg/ml) was infused from the start of perfusion to 5 min after the start of reperfusion, and PMNs were infused for 1 min on 2 minutes after reperfusion. PMNs adhesion (%), left ventricular developed pressure (LVDP), dP/dt, heart rates and coronary flow were measured. RESULTS: Propofol (2 microgram/ml, 4 microgram/ml) significantly reduced postischemic PMNs adhesion compared with that of the PMN group (54.0+/-8.0%, 50.0+/-5.0% vs 72.5+/-6.5% P <0.05 respectively) and prevented the deterioration of myocardial function seen after PMNs application (LVDP 74.5+/-7.3%, 60.3+/-4.5% vs 48.4+/-2.7% respectively). CONCLUSIONS: These results show that propofol reduces the postischemic coronary vascular adhesion of PMNs and prevents postischemic myocardial dysfuncion.

Myocardial Infarction after an Asthmatic Attack in a Cataract Surgery under Local Anesthesia / 대한마취과학회지

Asthma is characterized by bronchial wall inflammation, airway hyperactivity, and variable degrees of reversible airflow obstruction resulting in wheezing, dyspnea, and coughing. Elderly patients with asthma have a high morbidity and mortality in the perioperative period. In an asthmatic attack, if appropriate therapeutic and preventive measures are not instituted, it can result in severe complications. A 76-year-old male who was scheduled for cataract surgery had a history of bronchial asthma. After the operation, the patient complained of dyspnea at rest and tachycardia and breath sounds bilaterally were decreased with wheezing. To relieve the asthmatic attack, O2 mask ventilation, aminophylline 4 mg/kg, IV and a ventolin nebulizer were applied. However, 30 min after the asthmatic attack, SpO2 dropped to 50 - 60% and stuporous mentality appeared. We report an acute myocardial infarction and pulmonary edema after an asthma attack in a patient undergoing cataract surgery.

Analysis of 1968 Cases of Preoperative Laboratory Screening Test Results / 대한마취과학회지

BACKGROUND: The goal of preoperative screening test is to reduce the perioperative morbidity by patients management in case of abnormal test results. But, in view of the low incidence of perioperative complication in otherwise healthy surgical population and cost of routine preoperative screening tests, further examination of their usefulness is required. METHODS: The charts of 1968 patients performed preoperative screening laboratory tests were reviewed to analyse the results of tests retrospectively. The preoperative screening laboratory tests are hemoglobin, platelet count, bleeding time, prothrombin time, partial thromboplastin time, chest X-ray, electrocardiography (ECG), liver function test (LFT), urinalysis, BUN and creatinine. In cases of abnormal results obtained, further studies (pulmonary function test (PFT), arterial blood gas analysis (ABGA), 2D- echocardiography, holter ECG, coronary angiography and abdominal sonography) were analysed. RESULTS: The incidence of abnormal results of total preoperative screening test is 4.5%. The incidence of abnormal results of ECG, chest X-ray, LFT, hemoglobin, and others are 8.3%, 7.8%, 3.7%, 2% and less than 1% in order. For further study, PFT was done in 58 patients, ABGA in 72 patients, 2D-echocardiography in 96 patients, and Holter ECG in 6 patients. CONCLUSION: This study has shown that routine preoperative laboratory screening tests provided little information. Therefore, further studies would be necessary to evaluate the cost-benefit of preoperative screening test compared with the other methods such as history taking and physical examinations that is needed little cost.

Analysis of 1968 Cases of Preoperative Laboratory Screening Test Results / 대한마취과학회지

BACKGROUND: The goal of preoperative screening test is to reduce the perioperative morbidity by patients management in case of abnormal test results. But, in view of the low incidence of perioperative complication in otherwise healthy surgical population and cost of routine preoperative screening tests, further examination of their usefulness is required. METHODS: The charts of 1968 patients performed preoperative screening laboratory tests were reviewed to analyse the results of tests retrospectively. The preoperative screening laboratory tests are hemoglobin, platelet count, bleeding time, prothrombin time, partial thromboplastin time, chest X-ray, electrocardiography (ECG), liver function test (LFT), urinalysis, BUN and creatinine. In cases of abnormal results obtained, further studies (pulmonary function test (PFT), arterial blood gas analysis (ABGA), 2D- echocardiography, holter ECG, coronary angiography and abdominal sonography) were analysed. RESULTS: The incidence of abnormal results of total preoperative screening test is 4.5%. The incidence of abnormal results of ECG, chest X-ray, LFT, hemoglobin, and others are 8.3%, 7.8%, 3.7%, 2% and less than 1% in order. For further study, PFT was done in 58 patients, ABGA in 72 patients, 2D-echocardiography in 96 patients, and Holter ECG in 6 patients. CONCLUSION: This study has shown that routine preoperative laboratory screening tests provided little information. Therefore, further studies would be necessary to evaluate the cost-benefit of preoperative screening test compared with the other methods such as history taking and physical examinations that is needed little cost.

The Effects of Stellate Ganglion Block on the Level of Blood Glucose, Uric Acid, and Catecholamines in the Induced Diabetic Rat / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) has been used to treat over 150 diseases which include diabetes mellitus and gout. This study was planned to investigate whether stellate ganglion block (SGB) could lower the levels of blood glucose, uric acid, epinephrine, and norepinephrine. METHODS: Sixty Sprague-Dawley rats within the weight of 250-350 gm were randomly devided into four groups. CS group was normal group with sham SGB with normal saline, CL group was normal group with SGB with lidocaine, DS group was diabetic group with SGB with normal saline, DL group was diabetic group with SGB with lidocaine. The diabetes was induced by intraperitoneal injection of 40 mg/kg of streptozotocin in citrate buffer (0.01 M, pH 4.5). Nondiabetic groups were given same amount of the citrate buffer. Seven days after the last injection of the streptozotocin blood glucose level was checked and more than 300 mg/dl was considered diabetic. The SGB was performed three times at right superior cervical ganglion two days apart from two days after the conformation of diabetes. Successful SGB was conformed by the ipsilateral ptosis or conjunctival congestion. Blood samplings from tail vein for the check of glucose, uric acid, and catecholamines were done before the injection of streptozotocin, seven days after the last injection of streptozotocin, and two days after the last SGB. RESULTS: The SGB with lidocaine reduced the blood glucose level only in the diabetic rats while SGB with the saline did not. The epinephrine levels were increased in the diabetics and decreased by the SGB with lidocaine without any statistical significance. Norepinephrine and uric acid levels had not been effected by the SGB and both of them had no correlationship with the glucose level. CONCLUSIONS: SGB in the diabetic rats decreases the blood glucose level. But for the effects of the SGB on the level of epinephrine further study would be needed.

Rocuronium Pretreatment for Prevention of Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine induced biochemical changes and fasciculations, myalgia and to compare it with vecuronium pretreatment. METHODS: We have studied 60 patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 0.01 ml/kg (group C), rocuronium 0.05 mg/kg (group R), or vecuronium 0.007 mg/kg (group V). Three minutes after the pretreatment, 1.5 mg/kg succinylcholine was injected. Serum potassium five minutes after succinylcholine and creatine kinase 24 hr after operation were measured. Fasciculations and postoperative myalgia at 24 and 48 h were evaluated. RESULTS: The increase in creatine kinase and incidence of fasciculations were lowest in the rocuronium group (33 IU/L; 15%) and followed by vecuronium group (58 IU/L; 50%) and highest in the control group (101 IU/L; 100%). The increase in serum potassium concentration (0.3 mEq/L) was not attenuated by any regimen. The incidence of postoperative myalgia on day 1 and day 2 was lower in the rocuronium (40%, 30%) and the vecuronium (50%; 35%) group than control group (85%; 75%). CONCLUSIONS: Rocuronium pretreatment is more effective in reducing creatine kinase rise and fasciculations after succinylcholine than vecuronium. However rocuronium and vecuronium are also effective in preventing postoperative myalgia.

Ejaculatory Failure after Chemical Lumbar Sympathectomy / 대한마취과학회지

Neurolytic or surgical lumbar sympathectomy are commonly used for the treatment of intractable pain, peripheral vascular insufficiency and hyperhydrosis. For the procedure, the patient sometimes has to suffer from complications such as major vascular perforation, subarachnoid injection, genitofemoral neuralgia, somatic neuralgia, disc perforation, ureteral stricture, inflammation, ejaculatory failure, chronic lumbago. The authors came across with a case of ejaculatory failure a week after both lumbar sympathetic block with 6 ml of 100% alcohol at L3 level under the control of fluoroscopy. Three months after the block the patient recovered without any treatment.

A Clinical Study on Fatal Cases within 30 Days Following Surgery / 대한마취과학회지

BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.