The efficiency of IV PCA with remifentanil and ketorolac after laparoscopic-assisted vaginal hysterectomy / 대한마취과학회지

BACKGROUND: This randomized, double-blinded clinical study was designed to evaluate the efficiency and safety of remifentanil with ketorolac for IV PCA after laparoscopic-assisted vaginal hysterectomy. METHODS: Eighty patients were randomly allocated into four groups. Group R received IV PCA using only remifentanil at a basal rate of 0.025 microg/kg/min and a bolus of 0.375 microg/kg. Group RK1 received IV PCA using remifentanil at a basal rate of 0.015 microg/kg/min and a bolus of 0.225 microg/kg. Group RK2 received IV PCA using remifentanil at a basal rate of 0.0075 microg/kg/min and a bolus of 0.1125 microg/kg. Group F received IV PCA using fentanyl at a basal rate of 0.3 microg/kg/h and a bolus of 0.075 microg/kg. In addition, ketorolac at a basal rate of 0.04 mg/kg/h and a bolus of 0.01 mg/kg was added to Group RK1, RK2, and F. All PCA conditions had a lock out period of 15 minutes. Pulse rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and PONV score were recorded at 1, 3, 6, 12, and 24 hours after the operation. Total opioid use and the patients' number for rescue analgesic drug were also collected. RESULTS: The groups did not differ in PONV score and hemodynamic changes. The VAS in Group RK2 was high compared with the other groups. In addition, the sedation score was high in Group R. CONCLUSIONS: The additional ketorolac administration in remifentanil IV PCA had remifentanil sparing effects and reduced sedation among the side effects. Further studies will be needed to evaluate the precise and adequate dosage of ketorolac.

Comparison of ramosetron and ondansetron for preventing nausea and vomiting after middle ear surgery under general anesthesia with sevoflurane and remifentanil / 대한마취과학회지

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) after middle ear surgery. METHODS: Seventy patients of either sex, ASA 1-2, scheduled middle ear surgery (mastoidectomy and tympanoplasty) under general anesthesia with sevoflurane and remifentanil were included. Patients were randomly divided into two groups and received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) before the end of operation (n = 35 each). The incidence and severity of PONV, pain score (VAS), rescue antiemetic, rescue analgesic and side effects were assessed following 6 hr, 24 hr and 48 hr after surgery. RESULTS: The incidence of PONV showed no significant difference between groups at each time points after surgery. There were no difference in the severity of nausea, pain score, rescue antiemetic, analgesic drug usage and side effects between groups. CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in patients undergoing general anesthesia for middle ear surgery.

Allergic Reaction to a Latex Face Mask for Manual Ventilatory Support : A case report

The number of latex-induced allergic reactions, including anaphylaxis, has been increasing since latex induced contact urticaria was first reported in surgical patients by Nutter in 1979. Latex allergy is frequently seen in the healthcare industry, and is associated with systemic symptoms, hand eczema, and allergic contact dermatitis. Reactions range from contact urticaria, rhinitis and conjunctivitis, angioderma or bronchospasm to the recently recognized severe anaphylactic shock with cardiovascular collapse. We encountered a 55-year-old female patient who developed a severe anaphylactic reaction after manual vetilatory support using a facemask that contained latex. A subsequent allergy workup revealed a delayed-type hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients during the peri-anesthetic period. Two types of allergic reactions to natural rubber latex (NRL) and rubber products are now known to exist: type I (immediate-type) and type IV (delayed-type hypersensitivity [DTH]). Patients with NRL allergy should be provided with information on non-latex devices and latex avoidance in medical, dental, and occupational settings. In addition, we should pay more attention to the management of allergic reactions to latex in high risk groups.

Intravenous anesthesia using laryngeal mask airway without muscle relaxants during tracheostomy in a patient with quadriplegia: A case report / 대한마취과학회지

Quadriplegia is a serious or complete loss of motor function of all four limbs that is commonly caused by spinal cord injuries secondary to damage to the cervical spine. In this situation, there is a higher risk of pneumonia due to paralysis of the respiratory muscles. Tracheostomy is preferred over endotracheal intubation for the effective elimination of sticky bronchial secretion. The safest technique for a tracheostomy is to carry it out under general anesthesia with endotracheal intubation. However, endotracheal intubation may be difficult and cause other complications in patients with laryngotracheal stenosis caused by repeated tracheostomy and a limitation of neck movement as a result of the fixation of the cervical vertebral bodies due to the cervical spine fracture. We report a case of a tracheostomy performed sucessfully under intravenous anesthesia using a laryngeal mask airway without muscle relaxants in a patient with quadriplegia caused by a cervical spine injury.

Sevoflurane for the Management of Refractory Status Epilepticus : A case report / 대한마취과학회지

Refractory status epilepticus is defined as seizure activity that continues after treatment with conventional anticonvulsants. An 8-month-old male had an operation for repair of small bowel perforation, and he suffered a febrile seizure that developed into refractory status epilepticus. Febrile seizure is the most common etiology for children with status epilepticus. We report here on a case of a patient with refractory status epilepticus, and he was managed with sevoflurane, an inhalational anesthetic. The patient was given an inspired concentration of 0.6-2 vol% sevoflurane for 15 days. After stopping of sevoflurane inhalation, he continued to experience intermittent convulsive status epilepticus that was successfully managed with using conventional anticonvulsants.

Predictors of Quitting Smoking: Results of worksite smoking cessation campaign of a steel manufacturing industry / 대한산업의학회지

OBJECTIVES: We evaluated demographic, socioeconomic, smoking-related, other health behavior, and disease factors associated with smoking cessation. METHODS: This study included 5,493 male employees in a steel manufacturing industry, who smoked at health examination underwent in 1998. Quitters were defined as those who had stopped smoking at least one month prior to re-examination in 1999. The information on related factors was collected by self-administered questionnare. RESULTS: At 12 months of follow-up, 1,955 patients (35.6 %) had quit smoking. The quit rate was higher in middle-aged, white collar, and high rank personnels. The quit rate increased with decreasing amount of cigarette, decreasing duration of smoking, and increasing age of starting smoking. There were higher quit rates among smokers who drank less or exercise. However, the existence of disease did not affect the quit rate. CONCLUSION: This study showed that many demographic, socioeconomic, smoking-related and other health behaviors associated with smoking cessation. These results could be of use in the other worksite smoking cessation campaigns to enhance the quit rate.

The Incidence of Hypoxia Following the Use of Hypnotics and Analgesics during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.

Effects of Change in Obestiy and Life Style Factors on Blood Pressure and Serum Cholesterol - 3-year Follow-up among Workers in a Steel Manufacturing Industry - / 예방의학회지

OBJECTIVES: We investigated the effects of changes in obesity and life style factors, such as cigarette smoking, alcohol drinking, and exercise, on the changes in blood pressure and serum cholesterol among Korean men. METHODS: This study included 7,205 healthy male employees in the steel manufacturing industry. Each subject underwent health examination in 1994 and was re-examined in 1997. The study subjects were classified into four categories, according to changes in body mass index (BMI) (loss; stable; mild gain; severe gain), cigarette smoking (quitter; non-smoker; smoker continued; smoker started), alcohol drinking (quitter; non-drinker; drinker continued; drinker started) and exercise (more exercise; continuous regular exercise; continuous irregular or no exercise; less exercise), respectively. We evaluated the relationship between the categories of change in those independent variables and the changes in blood pressure and serum cholesterol, adjusted for BMI in 1994 and age by analysis of variance. RESULTS: The change in systolic blood pressure was positively associated with the changes in BMI (p<0.001) and drinking (p=0.001), but negatively with smoking (p=0.004), compared to the first category of each independent variables. The systolic blood pressure was significantly less increased in the continuous smoking group than quitter or non-smoker. The changes in diastolic blood pressure and serum cholesterol appeared to have statistically significant linear relationships only with the change in BMI. The change in exercise showed a marginal significance with diastolic blood pressure (p=0.088). CONCLUSIONS: These prospective data emphasize the importance of obesity as a determinant of the changes in blood pressure and serum cholesterol. In addition, the changes in smoking and drinking habits can affect systolic blood pressure.