Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia / 대한마취과학회지

Background@#Postoperative nausea and vomiting (PONV) commonly occurs after spinal anesthesia; however, its incidence rate and predictors have been scarcely studied. Therefore, we aimed to investigate its incidence rate and potential predictors. @*Methods@#The electronic medical records of 6,610 consecutive patients undergoing orthopedic surgery under spinal anesthesia were reviewed between January 2016 and December 2020. The primary outcome was PONV incidence within 24 h after spinal anesthesia. Along with its incidence rate, we investigated its predictors using multivariable logistic regression analysis. @*Results@#Among the 5,691 patients included in the analysis, 1,298 (22.8%) experienced PONV within 24 h after spinal anesthesia. Female sex (odds ratio [OR]: 3.23, 95% CI [2.72, 3.83], P < 0.001), nonsmoker (OR: 2.12, 95% CI [1.46, 3.07], P < 0.001), history of PONV (OR: 1.52, 95% CI [1.26, 1.82], P < 0.001), prophylactic 5-hydroxytryptamine receptor antagonist use (OR: 0.35, 95% CI [0.24, 0.50], P < 0.001), prophylactic steroid use (OR: 0.53, 95% CI [0.44, 0.62], P < 0.001), baseline heart rate ≥ 60 beats/min (OR: 1.38, 95% CI [1.10, 1.72], P = 0.005), and postoperative opioid use (OR: 2.57, 95% CI [1.80, 3.67], P < 0.001), were significant predictors of the primary outcome. @*Conclusions@#Our study showed the common incidence of PONV after spinal anesthesia and its significant predictors. A better understanding of its predictors may provide important information for its management.

Retrospective analysis of the feasibility and safety of external jugular vein cannulation in surgical patients

Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients forwhom it is difficult to establish peripheral IV access. We aimed to investigate the feasibilityand safety of EJV cannulation in surgical patients.Methods: We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collectedclinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included anyEJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis,pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronicmedical records during the hospitalization period for surgery.Results: We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery(49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%).Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases.The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site(65 cases, 0.7%). There was only one case of unplanned intensive care unit admission dueto swelling related to EJV cannulation.Conclusions: Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.

The Effects of Propofol and Thiopental Continuous Infusion on Serum Potassium Disturbances in Neurosurgical Patients

OBJECTIVE: The potassium disturbance associated with thiopental continuous infusion in neurosurgical patients is well known. However, the effect of propofol continuous infusion on serum potassium levels has not been investigated extensively. METHODS: We reviewed the medical records of 60 consecutive patients who received coma therapy or deep sedation for intracranial pressure control using either thiopental or propofol between January 2010 and January 2012. RESULTS: The overall incidence of hypokalemia (K5.0 mmol/L, 32.4% vs. 4.3%, p=0.010) and the peak potassium concentration (4.8 mmol/L vs. 4.2 mmol/L, p=0.037) after the cessation of therapy were higher in thiopental group. On multivariate analysis, thiopental [8.82 (1.00-77.81); p=0.049] and duration of continuous infusion [1.02 (1.00-1.04); p=0.016] were associated with rebound hyperkalemia once therapy was discontinued. CONCLUSION: Propofol was less frequently associated with moderate to severe hypokalemia after induction and rebound hyperkalemia following the cessation of continuous infusion than thiopental.

100 case of pancreaticoduodenectmy in 1000 beds hospital, 10 years experience / 한국간담췌외과학회지

BACKGROUND/AIMS: The death rates of pancreaticoduodenectomy decreased dramatically in experienced centers and it depends on many variability including nutritional status, better patient selection, hospital volume. We reviewed our experience of 100 pancreaticoduodenectomy for 10 years, 1000 beds hospital METHOD: Between 1990 and 2000, 100 patients underwent a pancreaticoduodenectomy in Dong-A University hospital. Annual number of cases, the disease entity, operative procedures, operation time and transfusion, radicality, external or internal pancreatic stent methods, morbidity and mortality were analyzed retrospectively. RESULTS: 10 cases or less per year until 1998: thereafter, the number of cases increased reaching 24 cases per year recently. Diseases entities were 35 pancreas head carcinomas, 22 common bile duct carcinomas, 20 ampulla vater carcinomas, 8 duodenum carcinomas, 9 chronic pancreatitis, 3 gallbladder carcinomas etc. Operative procedures were 53 whipple's operations, 23 Total pancreaticoduodenectomy, 22 pylorus preserving pancreaticoduodenectomy, 2 hepatopancreaticoduodenectomy. Postoperative morbidity has been decreasing, however, pancreatic leakage is still unresolved problem. Under 10 case annually the overall mortality was 22%, over 15 case annually the mortality reduced 12%(P=0.242). There were no mortality consecutive 30 cases since June, 1999 after changing the internal pancreatic duct stent to external pancreatic duct stent with preoperative total parenteral nutrition, Indocyanine green (ICG) test. The death rate was reduced(P=0.156). CONCLUSION: Pancreaticoduodenectomy has been increasing due to increased incidence of indication and improved resectability. Also preoperative total parenteral nutrition, ICG test, external pancreatic duct stent, successful postoperative embolization techniques decreased mobidity & mortality. It was suggested, pancreaticoduodenectomy could be safely performed in centers with more than 15 pancreatoduodenectomy annually.

The Expression of GLUT-1 Glucose Transporter in the Immunohistological Distinction of Hepatocellular Carcinoma from Intrahepatic Cholangiocarcinoma / 한국간담췌외과학회지

BACKGROUND/AIMS: Malignant cells exhibit increased glycolytic metabolism, and in many cases increased glucose transporter gene expression. We studied the expression of the glucose transporters in hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma(CC). also, examined the usefulness of Glut-1 glucose transporter in the discrimination of HCC from CC. METHODS AND RESULTS: 23 HCC, 15 CC and 8 normal liver tissues were investigated immunohistochemically with Glut-1 glucose transporter. Immunostaning was regarded as positive when more than 5% of cells were stained. Among 38 liver tumor cases, Glut-1 was stained in 15(40%). in 2(9%) of 23 HCC and in 13(87%) of 15 CC were positive.(P=0.001) In HCC, underlying cirrhosis, 18(78%) were negative.(P=0.04) Other prognostic factors: histologic type, lymph node metastasis, distant metastasis did not show any significant correlation. CONCLUSION: Differential diagnosis between HCC and CC could be made by Glut-1 glucose transporter expression

Hepatocholelithiasis due to compression of common hepatic duct by right hepatic artery / 한국간담췌외과학회지

We present two cases of compression of the common hepatic duct by overriding of the right hepatic artery. One case is gall bladder, common hepatic duct stone and one case is right intrahepatic duct stone. We observed the compression of the common hepatic duct caused by overriding of the right hepatic artery in the both cases. The final diagnosis was made at operative fields. These patient were successfully treated by dissection of adhesion, suture, fixation between gall bladder bed and right hepatic artery.