Surgical Outcome of a Zero-profile Device Comparing with Stand-alone Cage and Anterior Cervical Plate with Iliac Bone Graft in the Anterior Cervical Discectomy and Fusion

OBJECTIVE: A Zero-profile device is a cervical stand-alone cage with integrated segmental fixation device. We characteristically evaluated the radiological changes as well as clinical outcomes in the application of Zero-profile devices compared with stand-alone cages and anterior cervical plates with iliac bone grafts for the cervical disease. METHODS: Retrospectively, total 60 patients at least more than one year follow-up were enrolled. Twenty patients were treated with Zero-profile devices (Group A), twenty patients with stand-alone cages (Group B) and twenty patients with anterior cervical plates and iliac bone grafts (Group C) for a single level cervical disease. The clinical outcomes were evaluated by Odom's criteria and Bazaz-Yoo dysphagia index. The radiologic parameters were by subsidence and the changes of the midpoint interbody height (IBH), the segmental kyphotic angle (SKA), the overall kyphotic angle (OKA) in index level. RESULTS: Although there was no significant clinical difference according to the Odom's criteria among them(p=0.766), post-operative dysphagia was significantly decreased in the Group A and B compared with the Group C (p=0.04). From the immediate postoperative to the last follow-up time, the mean change of IBH decrement and SKA increment were significant in the Group B compared with the Group A (p=0.025, p=0.033) and the Group C (p=0.001, p=0.000). The subsidence rate was not significant among all groups (p=0.338). CONCLUSION: This Zero-profile device is a valuable alternative to the anterior cervical discectomy and fusion with a low incidence of postoperative dysphagia and without segmental kyphotic change.

The Effect of Ephedrine and Crystalloid for Prevention of Hypotension During Spinal Anesthesia / 대한마취과학회지

This study was desinged for compare the efficacy of ephedrine infusion that of crystalloid administration in reducing the incidence of hypotension during spinal anesthesia. Sixty ASA 1 and 2 patients scheduled for transurethral prostatic resection and lower extremity surgery under spinal anesthesia were ramdomly allocated to receive either 15 ml/kg crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 12-14 mg of 0.4% tetracaine. Analgesic sensory level was T10 in both groups, Thirty patients in the crystalloid group received crystalloid solution (Ringer'lactate solution, 15 ml/kg) within 20 min prior to induction of spinal anesthesia. Thirty patients in the infusion group immediately after induction spinal anesthesia received ephedrine infusion at a rate 5 mg/ min for the first 2 min and then 1 mg/min for the next 18 min. Cardiovascular responses (systolic blood pressure and heart rate) and complications (hypotension, nausea and vomiting) after induction of spinal anesthesia were compared and results were as follows; 1) The incidence of hypotension was ll/30 (36%) in the crystalloid group and 3/30 (10%) in the infusion group (p<0.001). 2) Systolic blood pressure after induction of spinal anesthesia in the crystalloid group significantly decreased from 5 min to 20 min as compared to the infusion group (p<0.05). But, systolic blood pressure did not decrease siginificantly until 9 min after spinal anesthesia in the infusion group. 3) The mean heart rate after induction of spinal anesthesia in the crystalloid group significantly increased at 1 min as compared to infusion group; thereafter, there was no significant difference between the two groups. 4) The incidence of nausea and vomiting was 1/30 in the crystalloid group and 0/30 in the infusion group; The difference between the two groups was not significant. 5) Reactive hypertension or tachycardia did not occur in either group. Considering above results, we conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia.

The Effect of Hypothermia on the Duration of Vecuronium and Atracurium during Cardiac Surgery using Cardiopulmonary Bypass / 대한마취과학회지

The purpose of this study was to investigate the influence of hypothermia on the recovery time after either vecuronium or atracurium given by repeated bolus injection, and to determine the adequate time of administration of neuromuscular blockers during cardiopulmonary bypass. Two groups of 10 patients each were studied before(Tl), during(T2) and after(T3) hypothermia. Following an initial intravenous bolus dose of 2X ED95 of either vecuronium(Group I) or atracurium(Group II), repeated bolus dose of ED95 was injected whenever twitch tension had returned to 20% block of train-of-four response before bypass of control As a result, the action duration of vecuronium(from injection of loading dose to twitch tension=20%) was 29.5+/-5.5 mins, 103.1+/-12.0 mins and 70.8+/-9.9 mins before, during and after hypothermia, respectively. The eorresponding values for atracurium were 26.3+/-5.1 mins, 85.7+/-11.4 mins and 42.5+/-5.1 mins. We conclude that hypothermia increases significantly the duration of action of both muscle relaxants(P<0.001) and vecuronium is influenced by hypothermia more than atracurium. The rate of recovery of twitch height after hypothermia is more rapid in atracurium than vecuronium(P<0.001). Single bolus injection of ED95 of vecuronium administered just before cardiopulmonary bypass is suitable for maintaining the neuromuscular block throughout cardiopulmonary bypass.