Comparison of cardiovascular responses measured with a Vigileo-FloTrac device after propofol or etomidate with remifentanil for the induction of general anesthesia in geriatric patients

BACKGROUND: Remifentanil efficiently blunts the stress response during endotracheal intubation, but also causes hypotension, especially in geriatric patients. Hence, this study was designed to compare the hemodynamic changes during the induction with propofol or etomidate in geriatric patients. METHODS: Sixty ASA physical status class I or II geriatric patients, who were scheduled for elective surgery, were randomly assigned to two groups (n = 30 each). Induction was performed with either propofol (2 mg/kg mixed with lidocaine 40 mg, Group P) or etomidate (0.2 mg/kg, Group E). Both groups received a bolus dose of remifentanil (1 microg/kg), followed with continuous administration (0.1 microg/kg/min). An additional bolus dose (50 microg) was repeated, if needed. The systolic, diastolic, mean arterial blood pressure, heart rates and cardiac index were measured before induction (baseline vital signs), after propofol or etomidate administration, before intubation, immediately after intubation and at 1, 3, 5 and 10 minutes after intubation. RESULTS: Patient characteristics and baseline vital signs were similar in both groups. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and cardiac output were significantly decreased in group P compared with those in group E (P < 0.05). Heart rates decreased after the injection of both propofol or etomidate, but were recovered after intubation. 5 patients in group P and 14 patients in group E needed an additional bolus dose of remifentanil (P < 0.05). CONCLUSIONS: Etomidate can be used safely with remifentanil for the stable induction of anesthesia in geriatric patients.

Ultrasound-guided subclavian catheterization in pediatric patients with a linear probe: a case series / 대한마취과학회지

Central venous catheterization (CVC) can be difficult, especially with pediatric patients in critical care. Accessing the subclavian vein (SCV) can cause serious complications, including pneumothorax, arterial puncture, and hemothorax. Recently, the ultrasonographic (USG) technique has gained popularity, but its efficiency is not yet confirmed. Subclavian venous catheterization (SCVC) through the supraclavicular approach (SCA) with USG or accessing the brachiocephalic vein through the infraclavicular approach (ICA) has been reported in the past. A useful technique is reported that involves the use of a 40 mm probe rather than the usual 25 mm probe in order to confirm the location of the needle while successfully performing subclavian venous catheterization in pediatric patients weighing 1.1 kg to 15.0 kg.

Efficacy of the oral neurokinin-1 receptor antagonist aprepitant administered with ondansetron for the prevention of postoperative nausea and vomiting / 대한마취과학회지

BACKGROUND: 5-HT3 receptor antagonist, dexamethasone and droperidol were used for the prevention of postoperative nausea and vomiting (PONV). Recently, neurokinin-1 (NK1) antagonist has been used for PONV. We evaluated the effect of oral aprepitant premedication in addition to ondansetron. METHODS: A total 90 patients scheduled for elective rhinolaryngological surgery were allocated to three groups (Control, Ap80, Ap125), each of 30 at random. Ondansetron 4 mg was injected intravenously to all patients just before the end of surgery. On the morning of surgery, 80 mg and 125 mg aprepitant were additionally administered into the Ap80 group and Ap125 group, respectively. The rhodes index of nausea, vomiting and retching (RINVR) was checked at 6 hr and 24 hr after surgery. RESULTS: Twelve patients who used steroids unexpectedly were excluded. Finally 78 patients (control : Ap80 : Ap125 = 24 : 28 : 26) were enrolled. Overall PONV occurrence rate of Ap125 group (1/26, 3.9%) was lower (P = 0.015) than the control group (7/24, 29.2%) at 6 hr after surgery. The nausea distress score of Ap125 group (0.04 +/- 0.20) was lower (P = 0.032) than the control group (0.67 +/- 1.24) at 6 hr after surgery. No evident side effect of aprepitant was observed. CONCLUSIONS: Oral aprepitant 125 mg can be used as combination therapy for the prevention of PONV.

New Proposal for Adlt's Normal Sinus Heart Rates

BACKGROUND: The normal sinus heart rate standard of 60 to 100 beats per minute was set by the NYHA(New York Heart Association) in 1928. It has long been accepted to physicians, but clinical studies and experience suggest that both these limits are too high. Thus we reexamined to define operationally normal sinus heart rate that are scientifically and clinically acceptable. METHODS: Total 1,930 subjects(aged 20 to 92 years) were analyzed and evaluated for age, sex, body mass index(BMI), systolic blood pressure, diastolic blood pressure, and resting heart rates by electrocardiogram. We used Pearson's correlation test and t-test to analyze these data. RESULTS: Among 1930 subjects, 982 cases were male(51%) and 948 cases were female (49%), whose mean age was 48 years in male and 51 years in female. For the entire sample, mean heart rate and standard deviation was 68 +/- 11 beats/min. There was statistically significant difference between male(67+/-11 beats/min) and female(68+/-10 beats/min)(P<0,05). The prevalence of sinus tachycardia and bradycardia, calculated by current normal standard of 60 to 100 beats/min, was 22.0% (424 cases) and 0.9% (18 cases). Mean +/- two standard deviation yields rounded extremes of 46 to 89 beats/min for normal sinus heart rate. A positive correlations between resting heart rate and age(r=0.11), systolic blood pressure(r =0.17), diastolic blood pressure(r=0.12) were found(P<0.01). CONCLUSIONS: Two extremes of the normal sinus heart rate standard of 60 to 100 beats/min are set too high. They result in lower sensitivity for tachycardia and lower specificity for bradycardia. We propose that normal range for sinus heart rate should be 50 to 90 beats/min which is statistically justified, more realistic for clinical investigation.

Seropositivity of Anti-HCV in Intravenous drug abusers

BACKGROUND: From 1980s the methamphetamine(phillopon) was suddenly spread to our country and it becomes a serious social problem. Although the proportion of transfusion associated hepatitis C declined after introduction of Anti-HCV assay as screening test of blood donors, the overall prevalence of hepatitis C has remained the same, primarily because of increase of the proportion of hepatitis C patients among intravenous drug abusers. So we studied about prevalence of Anti-HCV, and other viral infectious disease transmission by intravenous drug abuse. METHODS: Total 202 drug abusers who had been admitted to Taegu Medical Center in 1994-1996 were tested for the presence of Anti-HCV. Epidemiologic data and histories related to drug use were obtained, as were serum test for hepatitis B, aminotransferase, HIV. RESULTS: The overall seropositivity of anti-HCV was 79.2%. Patients In HCV positive group were significant old age(34.0 yrs) and had long duration of injection(3.0 yrs) and the number of patient who had elevated aminotransferase level were significantly more than HCV negative group(p<0.05). No significant difference in sex, prevalence of HBs Ag and Anti HBc were observated between HCV positive group and negative group. The prevalence of Anti HBc was 52.1% and HBs Ag was 4.2%, but anyone was not detected for AIDS. CONCLUSIONS: The seropositivity of Anti-HCV in intravenous drug users in Taegu, Korea was 79.2%, comparable to that in Europe and U.S.A. This finding suggest that its time to hurry up for medical and public walfare service personal to concern and education of drug abusers, and inview of preventive medical care the need of general public information and education is pressing.