Résumé
Background@#This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. @*Methods@#The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. @*Results@#Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 μg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 μg, P < 0.001, P = 0.003, respectively). @*Conclusions@#Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.
Résumé
Background@#Higher levels of anxiety increase the risks of surgery, including morbidity and mortality. The objectives of this study were to measure anxiety and depression during the preoperative period and to identify the degree of knowledge and concerns of older patients and their family protectors regarding anesthesia, and the causes of these concerns. @*Methods@#We administered a questionnaire to older patients scheduled to undergo surgery and their family protectors one day prior to the surgery. The questionnaire included tools for quantifying anxiety and depression (Anxiety-Visual Analogue Scale, the Amsterdam Preoperative Anxiety and Information Scale, State-Trait Anxiety Inventory Korean YZ Form, and Short Form Geriatric Depression Scale). We also asked about the concrete causes of anxiety using pre-created forms. @*Results@#There were 140 older patients and family protectors who participated in the study. The majority of older patients (n = 114, 81.4%) undergoing surgery and their family protectors (n = 114, 81.4%) indicated that they were anxious. Most of the older patients and their family protectors responded that they had insufficient knowledge about anesthesia, and they were mostly worried about failure to awaken following surgery, and postoperative pain. Older patients with higher anxiety scores showed higher depression scores. There were significant differences in depression scores depending on the presence of cohabitating family members. @*Conclusions@#It is important to remember that older patients with higher depression scores have higher anxiety during the preoperative period.
Résumé
Background@#Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. @*Methods@#We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. @*Results@#The mean age of patients with VCP was 51.28 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. @*Conclusions@#We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.
Résumé
BACKGROUND: This study evaluated the effect of vitamin C on post-laparoscopic shoulder pain (PLSP) in patients undergoing benign gynecological surgery during the first 72 h. METHODS: Sixty patients (aged 20 to 60 years, with American Society of Anesthesiologists physical status classification I or II) scheduled for elective laparoscopic hysterectomy were enrolled in this study. The vitamin C group (Group C) received 500 mg of vitamin C in 50 ml of isotonic saline infusion intravenously twice a day from the day of surgery to the third day after surgery. Patients in the saline group (Group S) received the same volume of isotonic saline over the same period. Post-operative analgesic consumption, pain scores of the incision site and the shoulder, and the incidence of PLSP were all evaluated at 1, 6, 24, 48, and 72 h following surgery. RESULTS: Cumulative post-operative fentanyl consumption was significantly less in Group C at 24 and 48 h after surgery (P = 0.002, P = 0.012, respectively). The pain intensity of PLSP was also significantly lower in Group C 24 h after the operation (P = 0.002). Additionally, the incidence of PLSP was significantly lower in Group C 24 and 48 h after the operation (P = 0.002, P = 0.035, respectively). CONCLUSIONS: Perioperative intravenous administration of vitamin C (500 mg, twice a day) reduced post-operative analgesic consumption and significantly lowered the pain intensity and incidence of PLSP.