Comparison of Effectiveness between Abdominal Vibration Stimulation and Walking Exercise for Bowel Cleansing before Therapeutic Colonoscopy

Background/Aims@#Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. @*Methods@#A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. @*Results@#Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction. @*Conclusions@#This study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

The Effect of Well-being, Fatigue, and Self-efficacy on Health Promotion Behaviors among Shift Workers / 산업간호학회지

PURPOSE: This study aimed to identify the factors that affect the health promotion behaviors of shift workers.METHODS: Using self-administered questionnaires, data were collected between August 13th and 31st, 2018. Descriptive statistics were computed, and t-test, analysis of variance, and correlational and multiple stepwise regression analyses were conducted using International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 22.RESULTS: Health promotion behaviors were significantly and positively correlated with psychological well-being (r=.491, p < .001), fatigue (r=.170, p=.030), and self-efficacy (r=.520, p < .001). Psychological well-being (β=.249, p=.014), fatigue (β=.179, p=.007), and self-efficacy (β=.335, p=.001) had significant effects on health promotion behaviors and together explained 31.7% of the variance.CONCLUSION: A systematic educational program that enhances psychological well-being should be developed and implemented to nurture health promotion behaviors among shift workers. Additionally, an intervention program that can enhance health promotion behaviors should be implemented to improve self-efficacy and prevent fatigue among shift workers.

The Effect of Well-being, Fatigue, and Self-efficacy on Health Promotion Behaviors among Shift Workers / 한국직업건강간호학회지

PURPOSE@#This study aimed to identify the factors that affect the health promotion behaviors of shift workers.@*METHODS@#Using self-administered questionnaires, data were collected between August 13th and 31st, 2018. Descriptive statistics were computed, and t-test, analysis of variance, and correlational and multiple stepwise regression analyses were conducted using International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 22.@*RESULTS@#Health promotion behaviors were significantly and positively correlated with psychological well-being (r=.491, p < .001), fatigue (r=.170, p=.030), and self-efficacy (r=.520, p < .001). Psychological well-being (β=.249, p=.014), fatigue (β=.179, p=.007), and self-efficacy (β=.335, p=.001) had significant effects on health promotion behaviors and together explained 31.7% of the variance.@*CONCLUSION@#A systematic educational program that enhances psychological well-being should be developed and implemented to nurture health promotion behaviors among shift workers. Additionally, an intervention program that can enhance health promotion behaviors should be implemented to improve self-efficacy and prevent fatigue among shift workers.

Diagnosis and Treatment for Deep Nontuberculous Mycobacteria Infection of the Hand and Wrist

PURPOSE: The purpose of this study was to present a systematic treatment method for nontuberculous mycobacteria (NTM) infection of the hand and wrist to gain better clinical outcomes. METHODS: 10 patients of deep NTM infection of the hand and wrist were reviewed. Extensive debridement was performed in all cases. When biopsy result suggested mycobacterial infection such as granulomatous inflammation, empirical tuberculosis medication was started. After culture confirmed NTM growth, the species was identified and in vitro sensitivity test was performed. Then medication was switched according to the results. Functional outcomes of the hand and wrist were measured by total active motion of the fingers and by range of motion of the wrist respectively. RESULTS: Diagnosis was tenosynovitis in seven patients, infective arthritis and osteomyelitis combined with tenosynovitis of the wrist in three patients. Two patients had recurred skin ulcer during follow-up period and undergone second debridement. After second operation, no patient had a persistent discharging sinus and all patient were completely healed during follow-up period. Functional outcome of the eight patients who had NTM infection of their hand was excellent in two, good in four, fair in one, poor in one. Mean range of motion of the two patients who had osteomyelitis of their wrist was dorsiflexion 20degrees, volar flexion 15degrees, radial deviation 0degrees, ulnar deviation 15degrees. CONCLUSION: Our standardized treatment protocol can be helpful for treatment of deep NTM infection of the hand and wrist.

A Case of Pituitary Macroadenoma Concurrently Diagnosed in a Patient Undergoing Antipsychotic Treatment / 대한내과학회지

Antipsychotics are the drug of choice for patients with schizophrenia, but they can induce hyperprolactinemia and growth of pituitary adenomas by blocking dopamine 2 receptors in the pituitary gland. In contrast, the medical treatment for a prolactinoma is a dopamine agonist. Therefore, managing a patient concurrently diagnosed with a prolactinoma and psychosis is challenging. We describe a patient with schizophrenia who was diagnosed with a prolactinoma. We changed his neuroleptic to quetiapine and prescribed bromocriptine for the prolactinoma. As a result, the patient was successfully treated with a dopamine agonist and antipsychotic without psychotic exacerbation. Our case suggests that dopamine agonists can be administrated to patients with schizophrenia and a prolactinoma without adversely affecting their psychopathological status.

The factors associated with longitudinal changes in liver stiffness in patients with chronic hepatitis B

BACKGROUND/AIMS: Liver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS. METHODS: Between April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of 0 kPa, respectively, over a 1-year period), and their data were compared. RESULTS: No differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P<0.001). However, there were no differences in any other clinical characteristic. In the antiviral therapy (-) group, the initial LS was also higher in the LS improvement group (n=29) than in the LS deterioration group (n=26; 8.3 vs. 6.5 kPa, P=0.021), with no differences in any other clinical characteristic. CONCLUSIONS: A higher initial LS was the only factor associated with LS improvement in patients with CHB in this study.

Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

BACKGROUND: We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. METHODS: Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. RESULTS: The mean neck shaft angles were 133.6degrees (range, 100degrees to 116degrees) at immediate postoperative, 129.8degrees (range, 99degrees to 150degrees) at 3 months postoperative and 128.4degrees (range, 97degrees to 145degrees) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8degrees as compared to 1.3degrees in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. CONCLUSIONS: The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.

Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.

A Case of Periureteral Varices with Nutcracker Syndrome Diagnosed by Intravenous Pyelography / 대한신장학회지

Renal pelvic and periureteral varices are rare cause of hematuria. On the intravenous pyelography, periureteral varices show a scalloped corkscrew-like appearance to the ureter without evidence of proximal obstruction. The cause of these varices includes renal vein thrombosis, obstruction of the inferior vena cava, congenital anomalies of the inferior vena cava or renal veins, infection, malignancy and nutcracker syndrome. We report a case of Periureteral Varices Diagnosed by Intravenous Pyelography caused by nutcracker syndrome.

Peritonitis due to Leclercia adecarboxylata in a Patient Receiving Automated Peritoneal Dialysis / 대한신장학회지

Peritonitis in patients undergoing peritoneal dialysis is a major complication and the leading cause of peritoneal dialysis failure. Leclercia adecarboxylata is a motile, gram-negative, facultative anaerobic bacillus of the Enterobacteriaceae family. These bacteria are uncommon pathogen, and rarely isolated from environmental and clinical specimens. Some cases have been reported about peritonitis due to Leclercia adecarboxylata in a patient receiving continuous ambulatory peritoneal dialysis (CAPD). However, there has never been any report about peritonitis in a patient receiving automated peritoneal dialysis (APD). We have isolated Leclercia adecarboxylata from peritoneal fluid in a patient receiving APD, and the patient completely recovered with 14-day treatment of intraperitoneal antibiotics without catheter removal.

The Influence of Bispectral Index and Hemodynamics during Propofol TCI with Intravenous Injection of Lidocaine / 대한마취과학회지

BACKGROUND: Lidocaine has been used for attenuating cardiovascular responses to endotracheal intubation and thought to have the sedative effect. The sedative effect of lidocaine has not been known well. The BIS (bispectral index) has been used an indicator of the sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to evaluate sedative and cardiovascular effects of lidocaine during TCI (target controlled infusion) of propofol by monitoring BIS and hemodynamics. METHODS: Fifty ASA patient status 1 and 2, aged from 20 to 65 years patients (n = 50, 2 groups) undergoing elective surgeries with general anesthesia. These patients were randomly allocated to group C or L. Patients in Group L received 1.5 mg/kg injection and 40microgram/kg/min infusion of lidocaine. Patients in Group C received normal saline. The BIS, blood pressure and heart rate were mesasured before injection of drug, 1, 2 minute after injection of drug, just before intubation, 1, 2, 5 and 10 min after intubation. RESULTS: The BIS of group L more decreased than group C at 1, 2, 5 and 10 min after endotracheal intubation. The blood pressure and heart rate did not show any differences between two groups. CONCLUSIONS: Intravenous injection of lidocaine reduced BIS. Lidocaine had sedative effects under propofol target controlled infusion. But Cardiovascular variables of this study failed to show any differences between two groups (P < 0.05).

Cognitive Changes after Open Heart Surgery with Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Cognitive dysfunction after open heart surgery under the cardiopulmonary bypass is one of major problems in modern cardiac surgery. We designed this study to evaluate the incidence of postoperative neuropsychological changes after routine cardiac surgery with the cardiopulmonary bypass. METHODS: We assessed the patients with four cognitive function tests on the day before, 4-5 days after and 9-10 days after cardiac surgery. The test batteries which used in this study were Trail-Making Test part A, Digit Substitution test, Digit Span Test, Grooved Pegboard test. RESULTS: The incidence of cognitive dysfunction was 12.8-25% at postoperative 4-5 days, 2.3-11.5% at postoperative 9-10 days. About 80% of patients who showed cognitive dysfunction at postoperative 4-5 days had gained normal cognitive function score at postoperative 9-10 days. CONCLUSIONS: The incidence of cognitive dysfunction after heart surgery is not low, and we must try to find how to reduce these complications.

In vivo Proton Magnetic Resonance Spectroscopy Based Study of Metabolic Changes in Rabbit Brain under Intravenous Anesthesia with Thiopental Sodium and Propofol / 대한마취과학회지

BACKGROUND: It is well known that both thiopental sodium and propofol reduce the cerebral metabolic rate. The author investigated whether these drugs have similar effects on neurobiochemical compounds by using 1H-NMR, which enables noninvasive in vivo measurements of brain biochemistry. METHODS: Six healthy white New Zealand rabbits (2.5-3.0 kg) were studied. A marginal ear vein was punctured for continuous intravenous infusion. Spontaneous breathing was maintained during the anesthesia. Neurobiochemical compounds such as N- acetylaspartate (NAA), choline-containing compounds (Cho), creatine plus phosphocreatine (Cr), myoinositol (MI), and lactate were examined at 30, 45 and 60 min during intravenous anesthesia induced with thiopental sodium (n = 3) and propofol (n = 3). RESULTS: The signals of NAA, Cho, Cr and MI were unchanged during thiopental anesthesia, but the NAA signal was reduced at 45 and 60 min, and that of Cr was reduced from 30 min until the end of the propofol anesthesia. The Cho signal was increased at 45 and 60 min during propofol anesthesia. Thiopental sodium signal were detected through the study, but propofol was detected only at 30 min. On comparing metabolic ratios in the two groups, the ratio of NAA/Cr was reduced and those of Cho/Cr and MI/Cr were higher in propofol group than in the thiopental sodium group. CONCLUSIONS: Our results suggest that thiopental sodium has a cerebral protective function. Howerver, further study is needed upon the cerebral protective function of propofol anesthesia. Propofol is more useful for total intravenous anesthesia than thiopental sodium.

The Effect of a Priming Dose of Atracurium on the Onset Time in Rapid Sequence Tracheal Intubation / 대한마취과학회지

BACKGROUND: Depolarizing muscle relaxant, frequently used for rapid sequence endotracheal intubation in clinical field, has serious complication that occur intermittently, such as, hyperkalemia, increased intraoccular pressure and sudden cardiac arrest, especially in infants and adolescents. So the priming principle, i.e., the administration of a subparalyzing dose of a nondepolarizing muscle relaxant (priming dose) prior to the intubating dose, was developed for rapid sequence endotracheal intubation with nondepolarizing muscle relaxant. However, the priming dose sometimes causes complications, such as, swallowing difficulty or pulmonary aspiration, and this can cause patient discomfort or fatal complications. In this study we examined proper atracurium priming dose and evaluated possible complications of priming doses. METHODS: One hundred patients, scheduled for elective surgery were randomly allocated into five groups according to the priming dose used (group 1; 0, group 2; 0.03, group 3; 0.06, group 4; 0.09, group 5; 0.12 mg/kg). Patients received a midazolam and fentanyl injection, the base line TOF ratio was measured, and an intubating dose was given. We also examined changes in vital sign for 20 minutes after injection and noted the time when the twitch height became zero (onset time). RESULTS: In group 1, the onset time was 107 +/- 22.9 sec, and in groups 4 and 5, the onset times were 85.0 +/- 15.6 and 69.9 +/- 19.3 sec, respectively. But, in group 5, some patients showed tachycardia and swallowing difficulty. CONCLUSIONS: The optimal priming dose of atracurium was determined as 0.09 mg/kg, in most cases, however patients sensitivity to the atracurium should be considered.

Do Microencapsulated Bovine Adrenal Medullary Chromaffin Cells Transplanted in Rats' Spinal Cord Produce Analgesic Effects? / 대한마취과학회지

BACKGROUND: Pain remains the chief complaint that brings patients to physician's office, despite recent insights into underlying mechanism and the identification of potential new therapeutic targets. In recent years, however, with the development of molecular biology cell transplantation gives us a new chance for treating intractable chronic pain. The major purpose of the present study was to determine if the chromaffin cells that were encapsulated with 1.3% (w/v) sodium alginate-poly-l-lysine-alginate (APA) had robust analgesic effects in the spinal atlanto-occipital subarachnoid space even without nicotine stimulation. METHODS: In order to determine whether microencapsulated bovine adrenal medullary chromaffin cells transplanted in the spinal cord can produce analgesic effects, we microencapsulated adrenal medullary chromaffin cells with APA and implanted them into the subarachnoid space of rats' (n = 10) spinal cord, and investigated the hot sensitivity of rats' hind-paw by a light-beam test. RESULTS: It was found that compared with the control group, hot response latency of the group which received adrenal medullary chromaffin cells increased from the 12th day and the analgesic efficacy was maintained for at least 75 days. CONCLUSIONS: Microencapsulated bovine adrenal medullary chromaffin cells transplanted in the rats' spinal cord may provide a permanent and locally available source of neuropeptides for the relief of intractable pain. Furthermore, these kinds of analgesic effect were produced without any stimulation such as nicotine.

Spectral Analysis of Heart Rate Variability during General Anesthesia in Diabetes Mellitus Patients / 대한마취과학회지

BACKGROUND: This study was undertaken to elucidate the effects of general anesthesia by power spectral analysis of heart rate variability in diabetic and non-diabetic patients. METHODS: EKG was measured in 35 patients, 17 without diabetes (control group) and 18 with diabetes (DM group). EKG and signal were digitized at 500 Hz for; 3 min in the period before anesthesia, during 1 to 5 min after intubation, 5 to 10 min after intubation and 30 min after skin incision. We also measured systolic and diastolic blood pressure, and heart rate in each period. The signal was analyzed using a fast Fourier transform algorithm to yield the power spectrum of the heart rate variability. Low frequency (LF, 0.04-0.15 Hz), high frequency (HF, 0.15-0.5 Hz) powers and the LF/HF ratio were obtained. RESULTS: The blood pressure was increased transiently by tracheal intubation but decreased gradually while anesthesia progressed. To maintain a minimal pressure range, ephedrine 10mg was injected into 11 patients in the DM group. Heart rate also showed the same trend as blood pressure, and no difference between the two groups. LF and HF power of heart rate variability, which was measured before induction, were significantly decreased in the DM group compared to the control group. As anesthesia was applied, overall frequency power was significantly attenuated in both groups. As the operation proceeded, frequency power gradually recovered only in the control group. Changes of the LF/HF ratio in the control group were 2.58+/-0.62 at pre-induction and 5.47+/-1.36, 1.11+/-0.33, 1.03+/-0.21 successively and in the DM group were 3.21+/-0.76 at pre-induction and 4.92+/-2.55, 0.80+/-0.18, 0.56+/-0.16 as the anesthesia progressed. CONCLUSIONS: These results suggest that the heart rate variability is significantly attenuated when anesthetics are administered, and that in the DM group heart rate variability is more prominently attenuated than in the control group. This result implies that diabetic patients have an underlying impairment of autonomic nervous system function and that this may lead to a further impairment of autonomic control, which has the potential to allow substantial intraoperative blood pressure liability during periods of surgical stress or blood loss.

Effects of Vasodilators on Coronary Vasospasm Induced by Endothelin in the Isolated Perfused Rat Heart / 대한마취과학회지

BACKGROUND: An endothelium derived vasoconstrictor peptide, endothelin, has been shown to be a potent coronary vascular constrictor. In the clinical settings of angina or myocardial ischemia, the endothelial injury of coronary artery can stimulate the endothelin production. In this study, the authors assessed the response to endothelin of the coronary artery in isolated rat heart and compared the relative effects of three vasodilators (nifedipine, adenosine, nitroprusside) on coronary vasospasm which was induced by endothelin. METHODS: The isolated rat heart preparations (Langendorff model) were obtained from fourty male Sprague-Dawley rats (350-400 gm). Preparations were perfusated with Krebs-Hanseleit solution of (mM): NaCl 115, NaHCO3 25, KCl 4.7, CaCl2 2H2O 2.5, MgCl2 6H2O 1.2, KH2PO4 1.2, glucose 10. The perfusate was maintained at 37oC and aerated with carbogen (oxygen 95% and carbon dioxide 5%). The coronary perfusion was maintained at 80 cmH20 pressure and Latex balloon was positioned in left ventricle. After the preparations were stabilized, endothelin (10(-9) M) was added to perfusate for 5 minutes and followed the perfusion without vasodilators (control, n = 10) or with vasodilators (nifedipine, adenosine and nitroprusside 10(-7) M to 10(-6) M, n = 10 each) for 45 minutes. The left ventricular developed pressure (LDP) and heart rate (HR) was recorded and the coronary effluent (VOL) was collected to measure the unit volume and the CPK isoenzyme (CK-MB). Effects of the interventions were assessed using analysis of variance. All values are presented as means +/- SE. RESULTS: VOL, HR and VDP were significantly reduced after infusion of 10(-9) M endothelin in 3 and 5 minutes. VOL was recovered efficiently after infusion of three vasodilators. Adenosine and nitroprusside groups showed superior recovery in the changes of rate pressure product (RPP) than in nifedipine group, which was significant reduced in VDP. CONCLUSIONS: These results suggest that in the situation of endothelin induced severe coronary vasospasm, adenosine and nitroprusside effectively reversed the coronary vasospasm without severe myocardial depression.

The Comparison of Antiemetic Effects of Metoclopramide, Granisetron and Ondansetron in Middle Ear Surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is a distressing adverse effect of anesthesia. This study was designed to evaluate antiemetic effects of metoclopramide, ondansetron and granisetron in middle ear surgery. METHODS: We compared the antiemetic activity of prophylactic administration of metoclopramide, ondansetron and granisetron in 103 patients undergoing middle ear surgery (tympanomastoidectomy and tympanoplasty). All Study drugs were given as a short intravenous infusion 30 minutes before the end of anesthesia. The incidence of PONV were assessed by direct questioning of patients at 6, 12, 24 and 48 hr after recovery from anesthesia. RESULTS: For the first 6 hr recovery period after surgery, the percentages of emesis in patients were 46.7%, 16%, 12% and 16% in the control, metoclopramide, ondansetron and granisetron groups respectively. After 6 hr, the percentage of emesis in patients significantly decreased in the control, ondansetron and granisetron groups when compared with the first 6 hr, but in the metoclopramide group there was no changes after 6 hr. CONCLUSIONS: The antiemetic drugs, metoclopramide, ondansetron and granisetron, were all effective in controling PONV in middle ear surgery.

A Retrospective Study of Efficacy of Autotransfusion in Spinal Surgery / 대한마취과학회지

BACKGROUND: To avoid complications of homologous transfusion, many methods are used in patients who undergo an operation, but the autologous transfusion is most popular. This retrospective study was done to evaluate the applicability of an autologous transfusion in an orthopedic spinal surgery. METHODS: The cases of 239 autologous transfusion and 85 homologous transfusions in patients who had spinal surgery due to spinal stenosis were reviewed, and the differences in homologous transfusion, postoperative drainage and complications in both groups were compared. Both groups were analysed and compared by the T-test and Mann-Whitmann rank sum test. RESULTS: In the homologous transfusion group, 4.6 +/- 2.7 units of RBC products were used in 85 patients. In the autologous transfusion group more than 2 techniques of preoperative deposit, intraoperative autotansfusion by cell saver, acute normovolemic hemodilution, and postoperative autotransfusion were used, and 3.6 +/- 2.4 units of RBC products were infused to 49 out of 239 patients (P < 0.001). A postoperative hematoma occured in 2 patients after a homologous transfusion but there were no cases in autologous transfusions. CONCLUSION: Consequently much of the homologous transfusion could be saved by using an autologous transfusion, and smaller amounts of postoperative drainge occured, so the author could confirm the benefit of autologous transfusion.

Comparison of the Effect of Epinephrine Concentration during Caudal Epidural Anesthesia / 대한마취과학회지

BACKGROUND: The advantages of addition of epinephrine to local anesthetics during caudal epidural anesthesia are core intense block, prolonged duration of anesthesia and reduction of systemic toxic effect of local anesthetics. The currently recommended concentration of epinephrine is 1 : 200,000, but absorbed epinephrines cause unwanted hemodynamic changes, so we attempted to ascertain the minimum effective concentrations of epinephrine during caudal epidural anesthesia. METHODS: Ninty patients classified ASA physical status I or II scheduled for perianal surgery were studied. These patients were divided into four groups who received 20 ml of 2% lidocaine with epinephrine concentrations of 1 : 100,000, 1 : 200,000, 1 : 400,000 or 1 : 800,000 respectively. Before and during anesthesia, patients' mean arterial pressure (MAP) and heart rate (HR) were measured. Caudal anesthesia was performed with patients in the jack-knife position. A 3 ml test dose was administered initially and then the remaining local anesthetics were injected slowly. The onset of analgesia, duration of analgesia, and other complications were observed. RESULTS: The onset of analgesia was slowest in the 1 : 800,000 group. The duration of analgesia was longest in the 1 : 100,000 group. There were no significant difference in MAP changes, but HR increased significantly in the 1 : 100,000 group compared to the 1 : 200,00 group. There were no systemic toxic symptoms for local anesthetics except that 1 patient, who was in the 1 : 100,000 group, had symptoms of palpitation and headache, considered to be the unwanted pharmacologic effects of epinephrine. CONCLUSION: We concluded that the 1 : 400,000 epinephrine concentration can be used during caudal epidural anesthesia.