Association between Long Working Hours and Suicidal Ideation / 대한산업의학회지

OBJECTIVES: This study was conducted to investigate the relationship between long working hours and suicidal ideation. METHODS: Data based on the fourth Korea National Health and Nutrition Health and Nutrition Examination Survey_(2007~2009) pertaining to a total of 4,539 full-time workers were analyzed. Working hours were divided into four groups (60 hours/week). The relationship between working hours and suicidal ideation was then analyzed after adjusting for general and occupational characteristics using a multivariate logistic regression model. RESULTS: Working 40-51 hours/week showed the lowest suicidal ideation(9.5%), whereas working 52~59 hours/week, over 60 hours/week and less than 40 hours/week showed suicidal ideations of 14.8%, 15.7% and 17.2% respectively. Even after adjusting for general and occupational characteristics, employees working 40~51 hours/week had the lowest suicidal ideation. Working 52~59 hour/week, over 60 hours/week and less than 40 hours/week showed an odds ratios of 1.413(p-value: 0.058), 1.380(p-value: 0.020) and 1.164(p-value: 0.358) respectively. CONCLUSIONS: The results suggest that working long hours, especially over 60 hours per week, is related to suicidal ideation.

Effect of Remifentanil and Fentanyl on Bispectral Index and Hemodynamics during Propofol TCI / 대한마취과학회지

BACKGROUND: Remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short lasting pharmacokinetics. It is likely to make it a very useful opioid for clinical practice. The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to compare sedative and cardiovascular effects of remifentanil and fentanyl during target controlled infusion (TCI) of propofol by monitoring BIS and hemodynamics. METHODS: Fifty-two patients undergoing total abdominal hysterectomy were randomly assigned to remifentanil group and fentanyl group with 26 cases in each group. Anesthesia was induced with propofol (4microgram/ml) and either remifentanil (0.5microgram/kg) or fentanyl (1.5microgram/kg) and was maintained with inhalation of 50% nitrous oxide and 50% oxygen mixture and a continuous infusion of either remifentanil (0.2microgram/kg/min) or fentanyl (0.03microgram/kg/min). Depth of anesthesia, hemodynamic changes and adverse reactions were observed. RESULTS: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly lesser than that in the fentanyl group (P<0.05). During intubation, skin incision, maintenance of anesthesia and extubation, remifentanil group shows lesser fluctuation of hemodynamic value than those in the fentanyl group (P<0.05). BIS was significantly decreased both groups during infusion of propofol, but no difference was found between the two groups. There was no significant difference between the two groups in the aspect of adverse reactions. CONCLUSIONS: Remifentanil with propofol TCI based anesthetic can prevent the fluctuation of heart rate and mean arterial pressure during the operation especially, during intubation.

Comparison of Neonatal Effects during General Anesthesia Using Sevoflurane and Spinal Anesthesia for Elective Cesarean Section / 대한마취과학회지

BACKGROUND: The study was designed to compare neonatal outcome biochemically and clinically. We examined the administration of sevoflurane below 1.0% with 50% oxygen and 50% nitrous oxide and spinal anesthesia during elective cesarean section. METHODS: The study examined 60 parturients, who were planned after 36 weeks gestation, ASA I-II, at term undergoing elective cesarean section, and who were allocated to receive 1.0% sevoflurane with 50% oxygen and 50% nitrous oxide (n = 30), and spinal anesthesia (n = 30). General anesthesia was induced with thiopental 5 mg/kg followed by succinylcholine 1.0 mg/kg to facilitate tracheal intubation. Parturients received sevoflurane given in a 50 : 50 oxygen and nitrous oxide mixture, using 0.5-1.0% progressive incremental dosing up to 1.5-2.0 MAC. Spinal anesthesia involving a spinal injection of 8 mg hyperbaric (plain) bupivacaine 0.5% with 20microgram fentanyl was added. A systolic blood pressure of less than 90 mmHg or a reduction in the systolic pressure of greater than 20% from baseline was considered as hypotension and treated with a bolus of 5 mg of intravenous ephedrine. We studied neonatal data including umbilical artery gas analysis results and Apgar scores at 1 and 5 min. RESULTS: Comparing the general and the spinal anesthetic groups, no significant differences could be detected in neonatal outcome biochemically or clinically. CONCLUSIONS: Anesthesia type does not seem to influence the biochemical or clinical results of the neonates delivered by elective cesarean section. We believe that both general anesthesia with sevoflurane and spinal anesthesia could be performed in elective term cesarean sections without risk to neonates.

The Efficacy of Continuous Epidural Blockade with Ketamine and Local Anesthetics on Acute Herpes Zoster Pain: A case report / 대한마취과학회지

The pain associated with acute herpes zoster is neuropathic. In this case report, we describe acute herpes zoster patients with severe pain, allodynia, and hyperesthesia over the T1 to T8 dermatomes. Patients received continuous epidural administration of ketamine at a dose of 20 mg with 0.125% bupivacaine at a dose of 110 ml for 2 days. Their acute herpes zoster pain was controlled without any sign of side effects. This case report, epidural blocks with ketamine, an antagonist of the N-methyl-D-aspartic acid receptor and bupivacaine effectively in treated acute herpes zoster pain, when applied soon after the onset of the acute phase of the disease.