The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery / 대한마취과학회지

Background@#Although the quality of postoperative recovery may be affected by factors, there are few investigations whether the type of anesthesia also affects it. In this single-blinded, prospective, observational study, we compared the quality of postoperative recovery in patients undergoing orthopedic forearm surgery under general or regional anesthesia (brachial plexus block). @*Methods@# Ninety-seven subjects, aged 18–65 years and American Society of Anesthesiologists physical status I or II, undergoing orthopedic forearm surgery, were allocated to general or regional anesthesia group. The quality of postoperative recovery was assessed using a validated Korean version of Quality of Recovery-40 (QoR-40K) questionnaire. Patients were surveyed three times, the day before surgery (baseline) and 1st and 7th day after the surgery, and the scores of both groups were compared. @*Results@# We analyzed 47 and 50 patients in general and regional anesthesia, respectively. The global QoR-40K score and those of each of its five dimensions were not significantly different between the two groups at baseline, 1st and 7th day postoperatively. In two-way RM ANOVA, the global QoR-40K score at postoperative 1st day was significantly lower than that of baseline (P < 0.001) and postoperative 7th day (P < 0.001), respectively, in both general and regional anesthesia groups. However, there was no significant difference at each timepoint between the two groups. @*Conclusions@# The present study suggests that brachial plexus block with intravenous dexmedetomidine infusion does not improve the quality of postoperative recovery compared to sevoflurane inhalation anesthesia with remifentanil infusion in patients undergoing orthopedic forearm surgery.

The change of stroke volume variation during thoracotomy or one lung ventilation

BACKGROUND: Stroke volume variation (SVV) is based on cyclic changes of intrathoracic pressure during respiratory cycle. Thoracotomy and one-lung ventilation (OLV) can lead to changes in airway and intrathoracic pressure. The aim of this study was to determine whether thoracotomy and converting from two lung ventilation to OLV could affect SVV values. METHODS: Thirty patients who were scheduled for pulmonary lobectomy or pneumonectomy requiring OLV were enrolled. Induction and maintenance of anesthesia were performed with propofol and remifentanil via total intravenous anesthesia. Hemodynamic variables including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and SVV were measured at intervals of 1 min for 10 min after thoracotomy and OLV, respectively. RESULTS: MAP and HR increased from baseline at intervals between 3 and 10 min and between 4 and 10 min after thoracotomy, respectively (P < 0.001). CI increased between 4 and 10 min (P < 0.001). SVV did not change for 10 min after thoracotomy. After OLV, MAP decreased between 4 and 10 min (P = 0.112). SVV was the highest at 1 min after OLV. It returned to the baseline value at 7 min (P < 0.001). CI decreased between 8 and 10 min after OLV (P < 0.001). CONCLUSIONS: SVV can increase after OLV temporarily. Transient increase of SVV may be considered when fluid responsiveness is predicted by SVV during early period after OLV.

The comparison of two different intraarticular injections using a sonographic anterolateral approach in patients with osteoarthritic knee

BACKGROUND: The intraarticular (IA) injection has become popular for the management of the osteoarthritic knee without an effusion. The success rate of IA injection would be better if it was able to be visually confirmed. We hypothesized that an anterolateral approach, which targets the synovial membrane of the lateral condyle using ultrasound, would provide an equivalent alternative to the anterolateral approach, targeting the synovial membrane of the medial condyle for IA injection of the knee. METHODS: A total of 96 knees with osteoarthritis were randomized placed into the two groups, which were group I (anterolateral approach to the medial condyle) and group II (anterolateral approach to the lateral condyle). The primary outcome was to compare the success rate of the two methods of IA injection. The required length of the needle for injection was also measured and compared. Pain intensity was assessed using the Numeric Rating Scale in order to evaluate the success of injection. RESULTS: There were no significant differences in the success rate between both groups. The success rate of group I and group II were 87.8% (95%, CI 78.7–97.0) and 91.5% (95%, CI 83.6–99.5), respectively (P = 0.549). The needle depth was 5.0 ± 0.8 (3.0 to 6.1 cm) in group I, and 3.0 ± 0.8 (1.5 to 5 cm) in group II (P < 0.001). CONCLUSIONS: The anterolateral approach to the lateral femoral condyle, using ultrasound, is an alternative method to the approach targeting the medial femoral condyle, using shorter needle.