Current Status of Outsourced Food Service Operations According to the Type of Long-Term Care Institution and Plans for Improvement

This study aimed to explore the status of food service outsourcing behavior of long-term care institutions (LTCIs) through a cross-sectional survey using a questionnaire administered between July 16th and August 7th, 2020. The survey respondents were either dietitians or facility managers, who worked at 731 nursing homes, 477 group homes, and 673 day-care centers. Approximately 25.9% of nursing homes, 11.7% of group homes, and 33.1% of day-care centers used a managed-services company to operate their food service units.The main reason for outsourcing food service by nursing homes was related to the staffing of dietitians and cooks, whereas group homes and day-care centers outsourced food services due to factors relating to meal costs and the cooking process. Almost all the LTCIs entered into private contracts for outsourced food services. Only a few food service contracts included the types of meals, nutrition standards such as protein and calories per meal, and the parameter or ratio of food cost. Of the respondents, 84.5% from nursing homes, 87.5% from group homes, and 87.1% from day-care centers agreed that the quality of outsourced food services of the LTCIs should be regulated. Meals are essential for maintaining the health and functional status of LTCI users. As more LTCIs outsource their food services, we suggest the following: (1) Increasing the minimum dietitian staffing standards for LTCIs as per the Welfare of Senior Citizens Act and requiring at least one dietitian for every nursing home, (2) Making it mandatory to use a standard food service contract template when drafting food service contract, and (3) Developing realistic standards for food service operations considering the size and operation type of the LTCIs.

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study

Background@#The purpose of this study was to investigate the degree of sedation and the incidence of adverse effects resulting from various methods of administering the initial dose followed by continuous infusion of dexmedetomidine (DEX) for sedation in elderly patients undergoing spinal anesthesia. @*Methods@#In total, 72 patients aged over 65 years who were to be administered spinal anesthesia were randomly allocated into three groups. The initial doses were injected to the groups as follows: group DD, DEX 0.5 μg/kg for 10 min; group MD, midazolam 0.02 mg/kg; and group D, no initial dose. This was followed immediately by infusing a maintenance dose of DEX 0.5 μg/kg/h to all groups. @*Results@#The Bispectral index (BIS) in the D group was significantly higher than in the other two groups. There were no significant differences in the Ramsay sedation scale (RSS) among the groups. The RSS 3 level was reached in 10 min from the start of sedation in MD and DD groups and in 20 min from the start of sedation in D group. Neither bradycardia nor hypotension was observed in any of the groups. @*Conclusions@#Patients in all three groups reached the RSS 3 sedating-effect level. However, the group that received continuous infusion only without the initial dose showed higher BIS than the other two groups and reached the RSS 3 later. No adverse events were observed in any of the groups.

Anesthetic Management during Electroconvulsive Therapy / 이화의대지

Some patients with depression require electroconvulsive therapy performed undergeneral anesthesia. This requires rapid loss of consciousness, with minimal interferencefrom seizure activity, appropriate muscle relaxation status, prevention of hyperdynamicresponses to the electrical stimulus, and proper recovery of spontaneous ventilationand consciousness. The authors report the first case of electroconvulsive therapy performedwith the patient under general anesthesia at the Ewha Womans UniversityMedical Center, Korea.

Daily walnut intake improves metabolic syndrome status and increases circulating adiponectin levels: randomized controlled crossover trial

BACKGROUND/OBJECTIVES: Several previous studies have investigated whether regular walnut consumption positively changes heart-health-related parameters. The aim of this study was to investigate the effects of daily walnut intake on metabolic syndrome (MetS) status and other metabolic parameters among subjects with MetS. SUBJECTS/METHODS: This study was a two-arm, randomized, controlled crossover study with 16 weeks of each intervention (45 g of walnuts or iso-caloric white bread) with a 6 week washout period between interventions. Korean adults with MetS (n = 119) were randomly assigned to one of two sequences; 84 subjects completed the trial. At each clinic visit (at 0, 16, 22, and 38 weeks), MetS components, metabolic parameters including lipid profile, hemoglobin A1c (HbA1c), adiponectin, leptin, and apolipoprotein B, as well as anthropometric and bioimpedance data were obtained. RESULTS: Daily walnut consumption for 16 weeks improved MetS status, resulting in 28.6%-52.8% reversion rates for individual MetS components and 51.2% of participants with MetS at baseline reverted to a normal status after the walnut intervention. Significant improvements after walnut intake, compared to control intervention, in high-density lipoprotein cholesterol (HDL-C) (P = 0.028), fasting glucose (P = 0.013), HbA1c (P = 0.021), and adiponectin (P = 0.019) were observed after adjustment for gender, age, body mass index, and sequence using a linear mixed model. CONCLUSION: A dietary supplement of 45 g of walnuts for 16 weeks favorably changed MetS status by increasing the concentration of HDL-C and decreasing fasting glucose level. Furthermore, consuming walnuts on a daily basis changed HbA1c and circulating adiponectin levels among the subjects with MetS. This trial is registered at ClinicalTrials.gov as NCT03267901.

Optic nerve sheath diameter changes during gynecologic surgery in the Trendelenburg position: comparison of propofol-based total intravenous anesthesia and sevoflurane anesthesia

BACKGROUND: Elevated intracranial pressure (ICP), a disadvantage of laparoscopic or robotic surgery, is caused by the steep angle of the Trendelenburg position and the CO₂ pneumoperitoneum. Recently, sonographically measured optic nerve sheath diameter (ONSD) was suggested as a simple and non-invasive method for detecting increased ICP. This study aimed to explore the changes in ONSD in relation to different anesthetic agents used in gynecologic surgery.METHODS: Fifty patients were randomly allocated to two groups, sevoflurane (group SEV, n = 25) and propofol-based total intravenous anesthesia (TIVA) group (group TIVA, n = 25). The ONSD was measured at five time points (T0–T4): T0 was measured 5 min after induction of anesthesia in the supine position; T1, T2, and T3 were measured at 5, 15, and 30 min after CO₂ pneumoperitoneum induction in the Trendelenburg position; and T4 was measured at 5 min after discontinuation of CO₂ pneumoperitoneum in the supine position. Respiratory and hemodynamic variables were also recorded.RESULTS: The intra-group changes in mean ONSD in the Trendelenburg position were significantly increased in both groups. However, inter-group changes in mean ONSD were not significantly different at T0, T1, T2, T3, and T4. Heart rates in group TIVA were significantly lower than those in group SEV at points T1–T4.CONCLUSIONS: There was no significant difference in the ONSD between the two groups until 30 min into the gynecologic surgery with CO₂ pneumoperitoneum in the Trendelenburg position. This study suggests that there is no difference in the ONSD between the two anesthetic methods.

The Effect of Stellate Ganglion Block on Breast Cancer-Related Infectious Lymphedema / 한국호스피스완화의료학회지

Breast cancer related lymphedema (BCRL) is one of the most intractable complications after surgery. Patients suffer from physical impairment, as well as psychological depression. Moreover, a recent study revealed that cellulitis significantly increased the risk of BCRL, and cellulitis has been suggested as a risk factor of BCRL development. We describe a patient treated with stellate ganglion blocks (SGBs) without steroid for relief of symptoms and reduction of the arm circumference of breast cancer-related infectious lymphedema in a month. We measured the arm circumference at four locations; 10 cm and 5 cm above and below the elbow crease, numeric rating scale (NRS) score, lymphedema and breast cancer questionnaire (LBCQ) score on every visit to the pain clinic. A serial decrease of the arm circumference and pain score were observed after second injection. In the middle of the process, cellulitis recurred, we performed successive SGBs to treat infectious lymphedema. The patient was satisfied with the relieved pain and swelling, especially with improved shoulder range of motion as it contributes to better quality of life. This case describes the effects of SGB for infectious BCRL patients. SGB could be an alternative or ancillary treatment for infectious BCRL patients.

Educating restaurant owners and cooks to lower their own sodium intake is a potential strategy for reducing the sodium contents of restaurant foods: a small-scale pilot study in South Korea

BACKGROUND/OBJECTIVES: This study was conducted to evaluate the feasibility of a sodium reduction program at local restaurants through nutrition education and examination of the health of restaurant owners and cooks. SUBJECTS/METHODS: The study was a single-arm pilot intervention using a pre-post design in one business district with densely populated restaurants in Seoul, South Korea. The intervention focused on improving nutrition behaviors and psychosocial factors through education, health examination, and counseling of restaurant personnel. Forty-eight restaurant owners and cooks completed the baseline survey and participated in the intervention. Forty participants completed the post-intervention survey. RESULTS: The overweight and obesity prevalences were 25.6% and 39.5%, respectively, and 74.4% of participants had elevated blood pressure. After health examination, counseling, and nutrition education, several nutrition behaviors related to sodium intake showed improvement. In addition, those who consumed less salt in their baseline diet (measured with urine dipsticks) were more likely to agree that providing healthy foods to their customers is necessary. This study demonstrated the potential to reduce the sodium contents of restaurant foods by improving restaurant owners' and cooks' psychological factors and their own health behaviors. CONCLUSIONS: This small pilot study demonstrated that working with restaurant owners and cooks to improve their own health and sodium intake may have an effect on participation in restaurant-based sodium reduction initiatives. Future intervention studies with a larger sample size and comparison group can focus on improving the health and perceptions of restaurant personnel in order to increase the feasibility and efficacy of restaurant-based sodium reduction programs and policies.

Effect of intraoperative infusion of ketamine on remifentanil-induced hyperalgesia / 대한마취과학회지

BACKGROUND: Opioid induced hyperalgesia (OIH) is related with high opioid dosage, a long duration of opioid administration, and abrupt discontinuation of infused opioids in anesthetic settings. Ketamine is known to attenuate OIH efficiently, but methods of administration and methods to quantify and assess a decrease in OIH vary. We demonstrated the existence of remifentanil-induced hyperalgesia and investigated the ability of ketamine to attenuate OIH. METHODS: Seventy-five patients undergoing laparoscopic gynecologic surgery under remifentanil-based anesthesia were assigned to one of the following groups: (1) group RL (remifentanil 0.05 microg/kg/min), (2) group RH (remifentanil 0.3 microg/kg/min), or (3) group KRH (remifentanil 0.3 microg/kg/min + ketamine 0.5 mg/kg bolus with 5 microg/kg/min infusion intraoperatively). Desflurane was administered for maintenance of anesthesia to target bispectral index scores (40-60) and hemodynamic parameters (heart rate and blood pressure < +/- 20% of baseline values). All parameters related to OIH and its attenuation induced by ketamine were investigated. RESULTS: There was no significant difference among the three groups related to demographic and anesthetic parameters except the end-tidal concentration of desflurane. Additional analgesic consumption, numerical rating scale scores at 6 and 24 h, and cumulative fentanyl dose were significantly higher in group RH than in the other two groups. The value difference of the Touch-Test sensory evaluation was significantly higher negative in group RH than in the other two groups. CONCLUSIONS: Remifentanil-induced hyperalgesia is significantly attenuated by intraoperative bolus and infusion of ketamine. Ketamine also decreased tactile sensitization, as measured by Touch-Test sensory evaluation.

Hypertensive crisis during percutaneous radiofrequency ablation of a metastatic adrenal tumor under general anesthesia: A case report

Radiofrequency ablation (RFA) has been used as an alternative method of surgical treatment to treat neoplasms of variable body organs. In considerable proportion of RFA cases, anesthesiologists are asked to conduct general anesthesia. RFA has been known to be a safe and effective treatment, however injury to adjacent normal tissue during RFA develops serious complications. In particular, unintended injury to normal adrenal tissue of adrenal tumors can cause severe complications such as hypertensive crisis due to excessive secretion of catecholamine. However, serious complications of primary or metastatic adrenal tumors have been rarely reported due to RFA. We report a case of hypertensive crisis with associated tachycardia and ventricular arrhythmia during RFA of hepatocellular carcinoma metastatic to the adrenal gland.

Opioid-induced hyperalgesia

Perioperative opioid-induced hyperalgesia (OIH) can be defined as the "increased perception of pain after opioid-based anesthesia and surgery" since hyperalgesia is defined as "increased pain from a stimulus that normally provokes pain." OIH has been identified mainly after remifentanil-based anesthesia in surgical patients given the high dose and rapid withdrawal used. The mechanisms of OIH have been postulated mainly by the cellular-level adaptation in internalization of the receptors and downregulation of intracellular coupling, upregulation of spinal dynorphins, and activation of N-methyl-D-aspartate receptors have been postulated as well. The clinical aspects of OIH with various causes, especially remifentanil, have been investigated. Pros and cons related to remifentanil-induced hyperalgesia have been suggested. The dose and duration of remifentanil used in surgery and anesthesia can be the appropriate factors for OIH, including the way of setting for the control groups of those studies, and the methods for evaluating the pain. Opioids remain one of the most powerful pain killers for acute pain management. Opioids are sometimes necessary for perioperative analgesia, but OIH can be an unavoidable risk. Ongoing interest in OIH and the development of anesthesia optimized for its prevention will increase the quality of perioperative life.

The Pentax airway scope versus the Macintosh laryngoscope: Comparison of hemodynamic responses and concentrations of plasma norepinephrine to tracheal intubation / 대한마취과학회지

BACKGROUND: The Pentax Airway Scope (AWS) is a video laryngoscope designed to facilitate tracheal intubation with a high-resolution image. The Pentax AWS has been reported to cause less hemodynamic stress than the Macintosh laryngoscope. The aims of this study are to investigate the differences in hemodynamic responses and norepinephrine concentrations to tracheal intubation between procedures using he Pentax AWS and the Macintosh laryngoscope. METHODS: Forty patients (American Society of Anesthesiologists class I-II, age range: 18-60 years) were randomly assigned to be intubated with either the Pentax AWS or the Macintosh laryngoscope while under general anesthesia. Routine monitoring, including invasive arterial blood pressure and bispectral index, were applied. Thiopental (4 mg/kg), fentanyl (1 microg/kg), midazolam (0.05 mg/kg), and rocuronium (0.6 mg/kg) were administered for anesthetic induction. Systolic, diastolic, and mean blood pressures and heart rates were recorded pre-intubation, immediately post-intubation (T0), and over the following 10 minutes at one minute intervals (T1, T2, T3, T4, T5em leaderT10). Patient blood was sampled for norepinephrine concentrations pre-intubation (baseline) and post-intubation (T1). Evidence of sore throat was evaluated 30 min and 24 hr after extubation. Data were transformed to % basal and expressed as mean +/- SD. RESULTS: The systolic, diastolic, and mean blood pressure, and heart rate at T0 and T4 were significantly different between the two groups. There was no significant difference in plasma norepinephrine between the two groups. The difference in incidence of sore throat was not significant between the two groups. CONCLUSIONS: Pentax-AWS for tracheal intubation has greater hemodynamic stability than the Macintosh blade laryngoscope.

Opioid-induced hyperalgesia is a paradox for perioperative physician / 대한마취과학회지

No abstract available.

Plasma concentrations of nociceptin/orphanin FQ: comparison of levels after general and neuraxial anesthesia for arthroscopic knee surgery / 대한마취과학회지

BACKGROUND: Nociceptin/orphanin FQ (N/OFQ) is an endogenous opioid heptadecapeptide. Preclinically, the pharmacologic action of N/OFQ has been characterized for the treatment of pain in non-human primates. Clinically, the pharmacologic action of N/OFQ is unclear, and concentrations have only been measured under certain clinical conditions. The aims of this study were to measure the plasma concentrations of N/OFQ in different postoperative pain states and to identify the potential relationship between postoperative pain states and N/OFQ plasma concentrations. METHODS: Two groups of 14 patients scheduled for knee arthroscopy were included in this study. Postoperative pain in the first group (IV group) was controlled by intravenous patient-controlled analgesia (IV-PCA). Postoperative pain in the second group (ES group) was controlled by epidural patient-controlled analgesia (E-PCA) or the remnant analgesic effects of spinal anesthesia. Plasma concentrations of N/OFQ were measured by enzyme-linked immunosorbent assay. Numerical rating scale (NRS) scores were recorded for all patients. Differences between the two groups with regards to plasma concentrations of N/OFQ and NRS scores were evaluated by the Mann-Whitney U-test. RESULTS: Plasma concentrations of N/OFQ (mean +/- SD) were 70.4 +/- 128.0 pg/ml in the IV group and 19.2 +/- 43.4 pg/ml in the ES group. NRS scores (mean +/- SD) were 3.1 +/- 1.9 in the IV group and 0.5 +/- 1.1 in the ES group. The differences in plasma N/OFQ concentrations between groups were not significant (P = 0.06). NRS scores were significantly lower in the ES group as compared with the IV group (P = 0.0019). CONCLUSIONS: Plasma concentrations of N/OFQ increase in acute postoperative pain states, but are not correlated with the level of postoperative pain.

Functional activity of the cannabinoid 1 receptor is not affected by opioid antagonists in the rat brain / 대한마취과학회지

BACKGROUND: WIN55212-2 is a synthetic cannabinoid agonist and selective to cannabinoid 1 (CB1) receptors, which are distributed mainly in the central nervous system. Opioid receptors and CB1 receptors have several similarities in terms of their intracellular signal transduction mechanisms, distributions, and pharmacological action. Several studies have therefore sought to describe the functional interactions between opioids and cannabinoids at the cellular and behavioral levels. The present study investigated agonist-stimulated [35S]GTPgammaS binding by WIN55212-2 in rat brain membranes and determined the antagonism by selective opioid antagonists at the level of receptor-ligand interaction and intracellular signal transduction. METHODS: Sprague-Dawley rats (male, n = 20) were euthanized for the preparation of brain membranes. In agonist-stimulated [35S]GTPgammaS binding by WIN55212-2, the values of EC50 and maximum stimulation (% over basal) were determined in the absence or presence of the micro, kappa and delta opioid receptor antagonists naloxone (20 nM), norbinaltorphimine (3 nM), and naltrindole (3 nM), respectively. Ke values for opioid antagonist inhibition in the absence or presence of each opioid receptor antagonist were calculated using the following equation: [nanomolar antagonist] / (dose ratio of EC50 - 1). RESULTS: In WIN55212-2-stimulated [35S]GTPgammaS binding in the rat brain membranes, the values of EC50 and maximum stimulation (% over basal) were 154 +/- 39.5 nM and 27.6 +/- 5.3% over basal, respectively. Addition of selective opioid antagonists did not produce a significant rightward shift in the WIN55212-2 concentration-response curve, and Ke values were not applicable. CONCLUSIONS: Our results suggest that the functional activity of WIN55212-2-stimulated [35S]GTPgammaS binding was not affected by opioid antagonists in the rat brain membranes. Although the exact mechanism remains unclear, our results may partially elucidate their actions.

Effects of Co-Administration of Intrathecal Nociceptin/Orphanin FQ and Opioid Antagonists on Formalin-Induced Pain in Rats

PURPOSE: Nociceptin/orphanin FQ (N/OFQ) as an endogeneous hexadecapeptide is known to exert antinociceptive effects spinally. The aims of this study were to demonstrate the antinociceptive effects of i.t. N/OFQ and to investigate the possible interaction between N/OFQ and endogenous opioid systems using selective opioid receptor antagonists in rat formalin tests. MATERIALS AND METHODS: I.t. N/OFQ was injected in different doses (1-10 nmol) via a lumbar catheter prior to a 50 microL injection of 5% formalin into the right hindpaw of rats. Flinching responses were measured from 0-10 min (phase I, an initial acute state) and 11-60 min (phase II, a prolonged tonic state). To observe which opioid receptors are involved in the anti-nociceptive effect of i.t. N/OFQ in the rat-formalin tests, naltrindole (5-20 nmol), beta-funaltrexamine (1-10 nmol), and norbinaltorphimine (10 nmol), selective delta-, micro- and kappa-opioid receptor antagonists, respectively, were administered intrathecally 5 min after i.t. N/OFQ. RESULTS: I.t. N/OFQ attenuated the formalin-induced flinching responses in a dose-dependent manner in both phases I and II. I.t. administration of naltrindole and beta-funaltrexamine dose-dependently reversed the N/OFQ-induced attenuation of flinching responses in both phases; however, norbinaltorphimine did not. CONCLUSION: I.t. N/OFQ exerted an antinociceptive effect in both phases of the rat-formalin test through the nociceptin opioid peptide receptor. In addition, the results suggested that delta- and micro-opioid receptors, but not kappa-opioid receptors, are involved in the antinociceptive effects of N/OFQ in the spinal cord of rats.

Effects of clonidine on the activity of the rat glutamate transporter EAAT3 expressed in Xenopus oocytes / 대한마취과학회지

BACKGROUND: Clonidine has been shown to be a potent neuroprotectant by acting at alpha2 receptors on glutamatergic neurons to inhibit the release of glutamate. The aim of this study is to investigate the effects of clonidine on the activity of EAAT3 that can regulate extracellular glutamate. METHODS: EAAT3 was expressed in the Xenopus oocytes. Using a two-electrode voltage clamp, membrane currents were recorded after application of 30 microM L-glutamate both in the presence and absence of various concentrations of clonidine. To determine the effects of clonidine on the Km and Vmax of EAAT3 and the reversibility of clonidine effects, membrane currents were recorded after the application of various concentrations of L-glutamate both in the presence and absence of 1.50 x 10(-7) M clonidine. RESULTS: Clonidine reduced the EAAT3 responses to L-glutamate in a concentration-dependent manner. This inhibition was statistically significant at higher concentrations than at the clinically relevant range. Clonidine at 1.50 x 10(-7) M reduced the Vmax, but did not affect the Km of EAAT3 for L-glutamate. CONCLUSIONS: These results suggest that the direct inhibition of EAAT3 activity is not related to the sedation effect of clonidine and that the clonidine-induced reduction of EAAT3 activity provides additional data for the possible involvement of glutamatergic hyperactivity in the proconvulsant effect of clonidine.

Preoxygenation in pediatric patients

BACKGROUND: Preoxygenation with tidal volume breathing for 3 min is a standard technique using 100% oxygen for prevention of hypoxia during the induction of general anesthesia. The measurement of end tidal oxygen concentration is useful in preoxygenation monitoring. The aim of the study was to determine the effects of preoxygenation in pediatric patients during 3 min with tidal volume breathing. METHODS: Sixty patients who were scheduled for general surgery were divided into 0-6 yr old children (Group I, n = 20), 7-15 yr old children (Group II, n = 20) and adults (Group III, n = 20). Patients with an inflatable mask connected to an anesthesia machine breathed 100% oxygen spontaneously for 3 min with tidal volume in all three groups. End tidal oxygen concentration, end tidal carbon dioxide concentration and respiratory rate were measured simultaneously for 3 min. RESULTS: Group I and II showed significantly higher end tidal oxygen concentrations than Group III from 10 sec to 160 sec with 3 min tidal volume breathing (P < 0.05). The mean time required for end tidal oxygen concentration of 90% was 85.5 +/- 18.5 sec for Group I, 101.5 +/- 21.5 sec for Group II and 148.0 +/- 24.0 sec for Group III. Therefore, Group I and II showed a significantly shorter time than Group III (P < 0.05). CONCLUSIONS: Pediatric patients showed a significantly shorter time to obtain the required preoxygenation.

Effect of flumazenil on recovery from anesthesia and the bispectral index after sevoflurane/fentanyl general anesthesia in unpremedicated patients / 대한마취과학회지

BACKGROUND: Benzodiazepines have a hypnotic/sedative effect through the inhibitory action of gamma-aminobutyric acid type A receptor. Flumazenil antagonizes these effects via competitive inhibition, so it has been used to reverse the effect of benzodiazepines. Recently, flumazenil has been reported to expedite recovery from propofol/remifentanil and sevoflurane/remifentanil anesthesia without benzodiazepines. Endogenous benzodiazepine ligands (endozepines) were isolated in several tissues of individuals who had not received benzodiazepines. METHODS: Forty-five healthy unpremedicated patients were randomly allocated to either flumazenil or a control groups. Each patient received either a single dose of 0.3 mg of flumazenil (n = 24) or placebo (n = 21). After drug administration, various recovery parameters and bispectral index (BIS) values in the flumazenil and control groups were compared. RESULTS: Mean time to spontaneous respiration, eye opening on verbal command, hand squeezing on verbal command, extubation and time to date of birth recollection were significantly shorter in the flumazenil group than in the control group (P = 0.004, 0.007, 0.005, 0.042, and 0.016, respectively). The BIS value was significantly higher in flumazenil group than in the control group beginning 6 min after flumazenil administration. CONCLUSIONS: Administration of a single dose of 0.3 mg of flumazenil to healthy, unpremedicated patients at the end of sevoflurane/fentanyl anesthesia without benzodiazepines resulted in earlier emergence from anesthesia and an increase in the BIS value. This may indicate that flumazenil could have an antagonistic effect on sevoflurane or an analeptic effect through endozepine-dependent mechanisms.

Myocardial bridge detected by changes in ECG before induction: A case report

Myocardial bridge, in which some of the epicardial coronary arterial segments are embedded in the muscle, has clinical significance because serious cardiac diseases such as angina, cardiac ischemia, myocardial infarction, and sudden cardiac death can occur. However, anesthetic management for the perioperative period for patients with myocardial bridge has remained controversial. We present a case of anesthetic management for total gastrectomy in a previously healthy 56-year-old male patient, who exhibited T-wave inversion and ST-segment depression in ECG monitoring on arrival to the operating room. While delaying the operation for further study, he was diagnosed as having myocardial bridge on a 3D-coronary CT. After confirmation of the normal coronary angiography, the patient underwent total gastrectomy uneventfully. There is no substitute for vigilance regarding the anesthesiologist.

Effect-site target-controlled infusion of propofol: comparison of Schnider and modified Marsh models

BACKGROUND: We investigated effect-site concentrations of propofol, changes in blood pressure and heart rate, time to loss of consciousness, time to loss of eyelid reflex and awakening time during anesthesia using effect-site target-controlled infusion, to compare the differences between Schnider and modified Marsh model. METHODS: Forty American Society of Anesthesiologists (ASA) physical status I or II patients between the ages of 18 and 55 years old and who were scheduled for elective surgery under general anesthesia were enrolled in this study. The patients were randomized into two groups: one group using modified Marsh model (Group 1) and the other group using Schnider model (Group 2). Effect-site concentrations of propofol, blood pressure, heart rate and BIS at each anesthetic stage were recorded. Time to loss of consciousness, time to loss of eyelid reflex and awakening time were measured. RESULTS: Group 1 showed shorter time to loss of consciousness and eyelid reflex at the lower effect-site concentration of propofol than Group 2 (P < 0.05). The effect-site concentrations of Group 1 were higher than those of Group 2 at eye opening and extubation (P < 0.05). CONCLUSIONS: Induction of anesthesia is achieved at lower effect-site concentration of propofol and more rapidly in the modified Marsh model than in the Schnider model. However the effect-site concentrations of propofol for awakening are higher in the modified Marsh model than in the Schnider model.