Factors in patient dissatisfaction and refusal regarding spinal anesthesia / 대한마취과학회지

BACKGROUND: Spinal anesthesia is the most common regional anesthesia conducted for many surgical procedures. Multiple factors can affect the success, the side effects, and patient satisfaction with the procedure. This study was undertaken prospectively to discover factors affecting dissatisfaction and refusal of spinal anesthesia. METHODS: Starting in December 2007, patients who underwent spinal anesthesia in the operating rooms of our hospital were surveyed over a period of a year. Before attempting the procedure, patient characteristics and previous history of anesthesia were recorded. Spinal anesthesia was administered with 0.5% heavy bupivacaine combined with fentanyl 0-20 microgram. Intraoperative data and postoperative data on the day after surgery were collected. The patients were also asked about their general satisfaction with spinal anesthesia, causes of dissatisfaction with the procedure, and causes of their refusal to have spinal anesthesia again. RESULTS: Six patients among 1,197 cases were excluded from the study because of spinal anesthesia failure. The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%, and its risk factors were postoperative backache and dissatisfaction. CONCLUSIONS: Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.

Influence of isoflurane, sevoflurane, desflurane and propofol on the neuromuscular blocking effect of rocuronium

BACKGROUND:Rocuronium is widely used because of rapid onset and intermediate duration of action.The volatile anesthetics potentiate the effect of nondepolarizing muscle relaxants. This study was designed to compare effects of inhalational agents with that of propofol on the muscle relaxation of rocuronium. METHODS:One hundred and thirty-six patients were divided four groups, which were given sevoflurane, isoflurane, desflurane and propofol.Anesthesia was induced with propofol 2 mg/kg and fentanyl 100microg.A ulnar nerve was stimulated with supramaximal stimuli.Anesthesia was maintained with 1.25 MAC inhalational agents or propofol of 7 mg/kg/hr for twenty minutes.Rocuronium 0.1, 0.15 or 0.2 mg/kg was administered.The degree and onset time of maximal depression was recorded.A supplementary dose of rocuronium was given so that all patients received a cumulative dose of rocuronium 0.6 mg/kg. We measured 10% recovery time. RESULTS:The ED50 of rocuronium were 0.157 in the sevoflurane, 0.167 in the isoflurane, 0.169 in the desflurane, and 0.187 mg/kg in the propofol. The ED95 were 0.296 in the sevoflurane, 0.313 in the isoflurane, 0.325 in the desflurane, and 0.407 mg/kg in the propofol.The onset time to maximal depression was prolonged in inhalational agent groups which were administered rocuronium 0.2 mg/kg. The 10% recovery time was delayed in inhalational agent groups than in propofol group. CONCLUSIONS:The inhalational anesthetics had more potent muscle relaxation effect than propofol.We suggest that the dose of rocuronium for adequate muscle relaxation be adjusted according to anesthetics used.

Influence of isoflurane, sevoflurane, desflurane and propofol on the neuromuscular blocking effect of rocuronium

BACKGROUND:Rocuronium is widely used because of rapid onset and intermediate duration of action.The volatile anesthetics potentiate the effect of nondepolarizing muscle relaxants. This study was designed to compare effects of inhalational agents with that of propofol on the muscle relaxation of rocuronium. METHODS:One hundred and thirty-six patients were divided four groups, which were given sevoflurane, isoflurane, desflurane and propofol.Anesthesia was induced with propofol 2 mg/kg and fentanyl 100microg.A ulnar nerve was stimulated with supramaximal stimuli.Anesthesia was maintained with 1.25 MAC inhalational agents or propofol of 7 mg/kg/hr for twenty minutes.Rocuronium 0.1, 0.15 or 0.2 mg/kg was administered.The degree and onset time of maximal depression was recorded.A supplementary dose of rocuronium was given so that all patients received a cumulative dose of rocuronium 0.6 mg/kg. We measured 10% recovery time. RESULTS:The ED50 of rocuronium were 0.157 in the sevoflurane, 0.167 in the isoflurane, 0.169 in the desflurane, and 0.187 mg/kg in the propofol. The ED95 were 0.296 in the sevoflurane, 0.313 in the isoflurane, 0.325 in the desflurane, and 0.407 mg/kg in the propofol.The onset time to maximal depression was prolonged in inhalational agent groups which were administered rocuronium 0.2 mg/kg. The 10% recovery time was delayed in inhalational agent groups than in propofol group. CONCLUSIONS:The inhalational anesthetics had more potent muscle relaxation effect than propofol.We suggest that the dose of rocuronium for adequate muscle relaxation be adjusted according to anesthetics used.

The Short Physical Performance Battery in Stroke Patients

OBJECTIVE: To determine the relationship and difference of the Short Physical Performance Battery (SPPB) between normal population and stroke patients, and to examine the relationship of the SPPB that used to assess lower extremity function in old, and Functional Independence Measure (FIM), Modified Barthel Index (MBI) in stroke patients. METHOD: One hundred and fifty nine stroke patients and 159 sex, age-matched normal population were included. All subjects were enrolled to interview and administer the SPPB and FIM, MBI. The SPPB included assessment of standing balance, a walking speed (timed 4 m walk), and chair stand (timed test of rising 5 times from a chair). RESULTS: The stroke patients showed significantly lower SPPB score than control group. The age, sex, direction of affection, and duration of stroke did not influence SPPB score respectively. In comparison of FIM and MBI, SPPB was significantly correlated with FIM and MBI, especially motor subtotal score of FIM. CONCLUSION: SPPB may be useful tool to assess and predict the physical function in stroke patients.

Stress-induced cardiomyopathy during ophthalmologic surgery: A case report / 대한마취과학회지

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is a recently described clinical entity which is associated with a chest pain occurring during a stress, an abnormal ECG and/or an increase in the troponin blood level and a transient left ventricular dysfunction. Transient left ventricular dysfunction generally involves the midsection and the apex of the heart with an akinesis. We reported a case of a 55-year-old female patient who developed a stress-induced cardiomyopathy after local epinephrine use during ophthalmologic surgery.

Comparison of the CobraPLA and the LMA Classic airway devices during volume-controlled ventilation in children / 대한마취과학회지

BACKGROUND: The Cobra Perilaryngeal Airway (CobraPLA) and the Laryngeal Mask Airway (LMA) Classic are supraglottic airway devices. We compared the performance of the CobraPLA and the LMA Classic devices during volume-controlled ventilation in children. METHODS: Eighty children, ASA physical status I-II, aged 1-10 years were randomly assigned with either the CobraPLA or the LMA Classic for airway management. Anesthesia was induced with 1 mg/kg ketamine and 2.0 mg/kg propofol, and muscle relaxation was obtained with the use of 0.5 mg/kg rocuronium. All patients were mechanically ventilated with a tidal volume of 10 m/kg in 1-3% sevoflurane, oxygen and air. The number of insertions, oropharyngeal leak pressure, and fiberoptic airway position were measured. Measurements of blood pressure, heart rate, oxygen saturation, end-tidal carbon dioxide, and peak inspiratory pressure were recorded every 5 minutes. Postoperative adverse events were assessed. RESULTS: There was no significant difference between the use of the two devices with respect to the number of insertions, time of insertion, and fiberoptic score. The oropharyngeal leak pressure was significantly higher for the CobraPLA than the LMA Classic (25.4 +/- 4.9 cmH2O versus 20.3 +/- 5.4 cmH2O; P < 0.001). Hemodynamic and respiratory variables were similar with the use of both devices. The incidence of adverse events was not different with the use of both devices. CONCLUSIONS: Both airway devices provided an adequate airway and effective ventilation during volume-controlled ventilation in children. The CobraPLA had a higher sealing pressure than the LMA Classic.

A Study on Related Factors to Overweight for Primary School Children

The purpose of this study was to investigate the related factors to child overweight through investigation of children aged 6-12. Data on physical examinations, family history and dietary habits were obtained. Children were classified into normal(98 persons) and overweight(118 persons) group using the combination of height for age, weight for age and weight for height standard by the World Health Organization. Children's height, weight and BMI exhibited a significant difference between groups except children aged 8 for height. Unbalanced diet was a risk factors for overweight(Odd ratio : 1.765, 95% CI : 1.022~3.048). Number of brothers showed negative significance especially in two brothers compared to that of one(Odd ratio : 0.456, 95% CI : 0.209~0.995). But Birth weight, feeding practice, overeating, taking nutrition pills, sleeping time, mother's education level and employmental status didn't have any difference. We found out there were different risk factors between obese and overweight group. They should be divided into different groups in studying risk factors. And we should pay much attention to overweight children in order to prevent improving to obesity.