Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis / 대한마취과학회지

Background@#The costoclavicular brachial plexus block (CCB) is a recently established technique that uses the infraclavicular approach and is performed just below the clavicle. This meta-analysis aimed to determine whether CCB can reduce the incidence of hemidiaphragmatic paralysis (HDP), which is a major adverse event related to brachial plexus block (BPB), while yielding comparable block performance as other BPB techniques. @*Methods@#We searched electronic databases to identify relevant studies that compared the incidence of HDP between CCB and other BPB techniques. The primary outcome was the incidence of HDP following CCB and other BPB techniques. The secondary outcomes were pulmonary function test results, other adverse events, and block performance parameters such as onset and performance time. @*Results@#We included six randomized controlled trials that included 414 patients. Compared with the other BPB group, the CCB group had a significantly lower incidence of HDP (relative ratio: 0.21, 95% CI [0.12, 0.36], P < 0.001) and higher peak expiratory flow rate (mean difference: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015). There were no significant between-group differences with respect to other adverse events and block performance parameters. @*Conclusions@#Compared with other BPB techniques, CCB involves a lower incidence of HDP with comparable onset and performance time.

Standard digit-based versus 90° rotation technique for supraglottic airway device insertion: a meta-analysis of randomized controlled trials / 대한마취과학회지

Background@#Prompt insertion and placement of supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of insertion success rate, insertion time, and postoperative complications. @*Methods@#A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digit-based techniques for insertion of SGA devices in anesthetized patients were included. @*Results@#The first-attempt (risk ratio [RR]: 1.16, 95% CI [1.09, 1.25], P < 0.001) and overall success rates (RR: 1.06, 95% CI [1.03, 1.09], P < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference: −4.42 s, 95% CI [−6.70, −2.15 s], P < 0.001). The incidences of postoperative sore throat (RR: 0.63, 95% CI [0.49, 0.83], P < 0.001) and blood staining (RR: 0.28, 95% CI [0.20, 0.39], P < 0.001) were lower in the 90° rotation group. @*Conclusions@#The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases postoperative complications as compared with that of the standard digit-based technique in anesthetized patients.

Effects of Tianeptine on The Activity of Glutamate Transporter EAAT3 Expressed in Xenopus Oocytes / 생물치료정신의학

Objectives@#: Tianeptine is an antidepressant that has drawn attention recently. Unlike traditional monoaminergic antidepressants, tianeptine is known to affect glutamate neurotransmission like ketamine. However, there has been paucity of studies investigating the role of tianeptine on glutamate transporters, especially excitatory amino acid transporter type 3 (EAAT3). @*Methods@#: After expression of EAAT3 by intracellular injection of EAAT3 mRNA, we investigated the effect of tianeptine on the activity of EAAT3, by measuring membrane current in response to L-glutamate administration using Xenopus oocyte expression system and two-electrode voltage clamps.. @*Results@#: Tianeptine (1mM for 72h) significantly reduced Vmax (6.9±0.6 vs. 4.8±0.3mC, n=14-22, p<0.05) without changing Km (27.0±7.6 vs. 23.3±4.9mM, n=14-22, p=0.72). @*Conclusion@#: When tianeptine was exposed for 72h, it decreased the activity of EAAT3 in a concentration-dependent manner (1-100mM). Our results suggest that tianeptine decreases EAAT3 activity by reducing the available number or turnover rate of EAAT3.

Anesthetic considerations for urologic surgeries / 대한마취과학회지

Urologic surgeries are widely performed, and the cases have increased owing to the fact that the elderly population is growing. The narrow and limited surgical space is a challenge in performing most urologic surgeries. Additionally, the elderly population is exposed to the risk of perioperative complications; therefore, a comprehensive understanding and approach are required to provide optimized anesthesia during surgery. We have searched the literature on anesthesia for urologic surgeries and summarized the anesthetic considerations for urologic surgeries.

Effects of tranexamic acid on the activity of glutamate transporter EAAT3

Background@#Tranexamic acid (TXA) is the most widely used hemostatic agent in surgical patients. However, when used in a high dose, it could cause a seizure in the postoperative period. The exact effector mechanism behind the seizure triggering remains unknown. Therefore, the authors investigated the effects of TXA on the activity of glutamate transporter type 3 (excitatory amino acid transporter 3; EAAT3), which is the main neuronal glutamate transporter type. @*Methods@#EAAT3 was expressed in Xenopus laevis oocytes through mRNA injection. Oocytes were incubated with diluted tranexamic acid for 72 h. Two-electrode voltage clamping was used to measure membrane currents before, during, and after applying 30 M L-glutamate. Responses were quantified by integrating the current traces and reported in microcoulombs (C). Results were presented as mean  SEM. @*Results@#TXA (30 to 1,000 M) significantly decreased EAAT3 activity. Our kinetic study showed that Vmax was significantly decreased in the TXA group compared with the control group (1.1  0.1 vs. 1.4  0.1 C, n = 18–23, P = 0.043), but the Km did not significantly change (12.7  3.9 M for TXA vs. 12.8  3.8 for control, n = 18–23, P = 0.986). @*Conclusions@#Our results suggest that TXA attenuates EAAT3 activity, which may explain its proconvulsant effect.

Monitored anesthesia care in and outside the operating room / 대한마취과학회지

Monitored anesthesia care (MAC) is an anesthesia technique combining local anesthesia with parenteral drugs for sedation and analgesia. The use of MAC is increasing for a variety of diagnostic and therapeutic procedures in and outside of the operating room due to the rapid postoperative recovery with the use of relatively small amounts of sedatives and analgesics compared to general anesthesia. The purposes of MAC are providing patients with safe sedation, comfort, pain control and satisfaction. Preoperative evaluation for patients with MAC is similar to those of general or regional anesthesia in that patients should be comprehensively assessed. Additionally, patient cooperation with comprehension of the procedure is an essential component during MAC. In addition to local anesthesia by operators or anesthesiologists, systemic sedatives and analgesics are administered to provide patients with comfort during procedures performed with MAC. The discretion and judgment of an experienced anesthesiologist are required for the safety and efficacy profiles because the airway of the patients is not secured. The infusion of sedatives and analgesics should be individualized during MAC. Many procedures in and outside of the operating room, including eye surgery, otolaryngologic surgery, cardiovascular procedures, pain procedures, and endoscopy are performed with MAC to increase patient and operator satisfaction.

Association between Abacus Training and Improvement in Response Inhibition: A Case-control Study

OBJECTIVE: The abacus, first used in Asian countries more than 800 years ago, enables efficient arithmetic calculation via visuo-spatial configuration. We investigated whether abacus-trained children performed better on cognitive tasks and demonstrated higher levels of arithmetic abilities compared to those without such training. METHODS: We recruited 75 elementary school children (43 abacus-trained and 32 not so trained). Attention, memory, and arithmetic abilities were measured, and we compared the abacus with the control group. RESULTS: Children who had learned to use an abacus committed fewer commission errors and showed better arithmetic ability than did controls. We found no significant differences between children with and without abacus training in other areas of attention. CONCLUSION: We speculate that abacus training improves response inhibition via neuroanatomical alterations of the areas that regulate such functions. Further studies are needed to confirm the association between abacus training and better response inhibition.

Preoperative increased heart rate is related to the blood pressure decrease during spinal anesthesia for cesarean delivery

BACKGROUND: Hypotension is a very common side effect of spinal anesthesia for cesarean delivery. If we can predict the degree of blood pressure decrease after spinal anesthesia, hypotension will be treated better. Tachycardia may reflect the effective circulatory volume deficit. We studied if preoperative heart rate can predict the degree of hypotension after spinal anesthesia. METHODS: Fifty-two parturients for elective cesarean delivery were enrolled and the gestation periods of all parturient were over 37 weeks. In the supine position, noninvasive blood pressure (BP) and heart rate (HR) were measured as baseline values. After change to the right decubitus position, spinal anesthesia was done. Hyperbaric bupivacaine 8 mg and fentanyl 15 microg were injected intrathecally through 26G spinal needle. After return to the wedged supine position, BP and HR were measured every minute until anesthetic level was fixed. If mean BP decreased below 70% value of baseline, ephedrine 5 mg was injected intravenously. The lowest mean BP, hypotension (<80% of baseline) and total ephedrine requirement were recorded. Retrospective analysis was done after grouping by baseline heart rate (below 80 vs. over 80 beats/min). RESULTS: The patients who had more rapid heart rate before anesthesia, tended to have more decrease of mean BP during spinal anesthesia (P < 0.001, R = 0.45). In retrospective group analysis, the incidence of hypotension was lower in low HR group (46% vs. 83%, P = 0.014). CONCLUSIONS: If preoperative heart rate is over 80 beats/min, careful management is required to prevent hypotension during spinal anesthesia for cesarean delivery.

Effect of propofol on oxidative stress-attenuated glutamate transporter EAAT4 activity

BACKGROUND: Propofol (2, 6-diisopropylphenol) has been known to have neuroprotective effects. Excitatory amino acid transporter 4 (EAAT4) is a glutamate transporter predominantly expressed in the cerebellar Purkinje cells, which is vulnerable to ischemic injury. Thus, we hypothesized that propofol reverses reduced EAAT4 activity which was induced by oxidative stress and investigated the effects of propofol on EAAT4 under oxidative stress induced by tert-butyl hydroperoside (t-BHP). METHODS: EAAT4 was expressed in Xenopus oocytes by injection of its mRNA. By using two-electrode voltage clamping, membrane currents were recorded before, during, and after application of L-aspartate (3 microM) in the presence or absence of t-BHP and propofol. RESULTS: L-aspartate induced an inward current in EAAT4 expressing oocytes. Exposure of these oocytes to t-BHP (1-20 mM) for 10 min dose-dependently decreased EAAT4 activity (1 +/- 0.01 microC for control; 0.88 +/- 0.05 microC for 1 mM; 0.83 +/- 0.03 microC for 2mM; 0.65 +/- 0.04 microC for 3 mM; 0.51 +/- 0.07 microC for 5 mM; 0.45 +/- 0.03 f microC for 10 mM and 0.24 +/- 0.06 microC for 20 mM). IC50 for t-BTH was 6.05 mM and further study was performed with 10 mM t-BTH. Propofol (3-10 microM) dose-dependently reversed this t-BHP-attenuated EAAT4 activity. CONCLUSIONS: Oxidative stress by t-BHP decreased EAAT4 activity and 3-10 microM propofol restored oxidative stress-reduced EAAT4 activity.

General anesthesia for laparoscopic cholecystectomy in a patient with Kennedy's disease: A case report / 대한마취과학회지

Kennedy's disease is a rare lower motor neuron disease affecting the limbs and bulbar musculature. Regional anesthesia is generally the recommended anesthetic technique in patients with Kennedy's disease because of bulbar involvement and airway clearing disturbance. We administered general anesthesia in a patient with Kennedy's disease who was undergoing a laparoscopic cholecystectomy. We closely monitored the degree of neuromuscular blockade throughout the operation and injected atracurium on demand. There was no exacerbation of neurologic signs or symptoms postoperatively. Therefore, we report the successful administration of general anesthesia for laparoscopic cholecystectomy in a patient with Kennedy's disease.

Comparison of Ramosetron and Ondansetron for Preventing Nausea and Vomiting after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: Sixty patients undergoing total abdominal hysterectomy or myomectomy, ASA physical status I or II, aged 30-65 yr, received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) at the end of surgery (n = 30 each). A standard general inhalational anesthesia and postoperative IV patient-controlled analgesia were used. At postoperative 3, 24 and 48 hours, we assessed pain score (VAS), incidence of PONV, rescue drug consumption, adverse events associated with study medications and overall satisfaction scores. RESULTS: The incidence of PONV showed no difference between groups at each time points after surgery (overall incidence; 59% in group R, 69% in group O). There was no difference in the severity of nausea, pain score and analgesic drug usage. However, the consumption of rescue drug in the ramosetron group was markedly less than that of ondansetron group at postoperative 3 hrs (none vs. 8 patients). No clinically serious adverse events were observed in either of the groups. Overall satisfaction scores were also comparable in both groups (6.5 +/- 3.0 vs. 6.2 +/- 2.7). CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in women undergoing general anesthesia for gynecologic surgery. Severity of PONV seems significantly less with ramosetron than with ondansetron in the early postoperative period.

Could Modified Thromboelastogram Assess Platelet Inhibition by Aspirin in off Pump Coronary Artery Bypass Surgical Patients and Healthy Volunteers? / 대한마취과학회지

BACKGROUND: Thromboelastogram (TEG) is regarded as a method by which coagulation can be measured during surgery. Off pump coronary artery bypass (OPCAB) surgical patients are routinely placed on aspirin. But conventional TEG could not detect platelet dysfunction by antiplatelet agent. We used modified TEG (addition of heparin and platelet agonists) to determine whether this modified TEG could assess the platelet dysfunction by aspirin in OPCAB surgical patients and healthy volunteers. METHODS: After institutional review board approval and consent, platelet function of 10 OPCAB patients (group 1) and 10 healthy subjects (group 2: before aspirin, group 3: after aspirin) were measured using modified TEG. In each group, TEG parameters (R, K time and MA) were analyzed using paired t-test and one way ANOVA was used to determine the difference between groups. RESULTS: In group 1 (OPCAB patients) and group 2 (healthy subjects, before aspirin), the R and K time were increased significantly with the addition of heparin and then decreased subsequently with the platelet agonists (ADP or collagen) in the presence of anticoagulation (heparin). MA showed a decrease in both groups. This compares with no significant difference in all parameters in group 3 (healthy subjects, after aspirin) with the addition of heparin, ADP and collagen. There were no significant differences in each TEG parameter between groups. CONCLUSIONS: This study suggested that aspirin medication obliterated the effect of anticoagulation and platelet agonists in modified TEG. However modified TEG does not provide a comprehensive and sensitive reflection of platelet inhibition by aspirin. TEG should be supplemented by other methods of platelet function assessment.

Relationship Between Pain Threshold and Postoperative Morphine Requirement / 대한마취과학회지

BACKGROUND: Variability in pain sensitivity is a well known phenomenon. The variability also extends to experimental stimuli and postoperative opioid requirement. But the report of the relationship between pain threshold and postoperative opioid requirement is very rare. METHODS: We investigated prospectively the association between pressure pain threshold and postoperative morphine requirement. We estimated pressure pain threshold by using pressure algometer and adopted PCA to treat postoperative pain. RESULTS: In this study the relationship between pain threshold and postoperative opioid requirement was significant. But the correlation was weak negative (Pearson r = -0.273, P < 0.05). CONCLUSIONS: Considering other associated factors which affect postoperative pain, although correlation between pain threshold and postoperative opioid requirement was significant but we concluded that clinical relevance of pain threshold is uncertain.