Antibacterial effect of lidocaine in various clinical conditions

BACKGROUND: Infection, one of the complications associated with procedures, can cause fatal outcomes for patients. Although the local anesthetic agent we use is less susceptible to infection due to its antibacterial action, we performed this study to check the change in the antibacterial effect of lidocaine in various clinical conditions. METHODS: After exposing lidocaine to five contaminated environments, we checked on whether the bacteria could be cultured in blood agar plate (BAP) media. In each contaminated environment, lidocaine was exposed for 4 h (n = 9) and 8 h (n = 9), and the results were compared. Lidocaine was swabbed with chlorhexidine (group A), brought into contact with saliva (group B), skin (group C), an operating room floor and an outpatient room floor (group D), operating room air for 24 h (group A-a), and outpatient room air for 24 h (group A-b). After exposure, the culture was initiated. RESULTS: In 2 of 9 BAP media where lidocaine was exposed to saliva (group B) for 8 h, growth of a colony was observed. In gram staining, it was found to be Streptococcus viridans. No bacteria were found in any other groups. CONCLUSIONS: Though lidocaine has strong antibacterial activity, it has been found that long-term exposure to a contaminated environment reduces its antibacterial activity and that drug contamination can be heavily affected not only by environmental but also human effects. Therefore, the use of aseptic drugs is necessary, and stopping the reuse of the drug is a way to prevent complications, including infection.

Nineth Rib Syndrome after 10th Rib Resection

The 12th rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the 10th rib was not felt, and an image of the rib-cage confirmed that the left 10th rib was severed. When applying pressure from the legs to the 9th rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with 9th rib syndrome, and ultrasound-guided 9th and 10th intercostal nerve blocks were performed around the tips of the severed 10th rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the 9th rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left 10th rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining 10th rib to impinge on the 9th intercostal nerves, causing pain.

Successful Treatment of a Symptomatic Discal Cyst by Percutaneous C-arm Guided Aspiration

Although discal cysts are a rare cause of low back pain and radiculopathy. Currently, surgical excision is usually the first-line treatment for discal cysts. However, alternative treatment methods have been suggested, as in some cases symptoms have improved with interventional therapies. A 27-year-old man presented with an acute onset of severe pain, and was found to have a discal cyst after an open discectomy. The patient underwent cyst aspiration and steroid injection through the facet joint under C-arm guidance. After the procedure, the patient's pain improved to NRS 0-1. On outpatient physical examination 1 week, and 1 and 3 months later, no abnormal neurological symptoms were present, and pain did not persist; thus, follow-up observation was terminated. When a discal cyst is diagnosed, it is more appropriate to consider interventional management instead of surgery as a first-line treatment, while planning for surgical resection if the symptoms do not improve or accompanying neurologic deficits progress.

correlation between the first heart sound and cardiac output as measured by using digital esophageal stethoscope under anaesthesia

The use of an esophageal stethoscope is a basic heart sounds monitoring procedure performed in patients under general anesthesia. As the size of the first heart sound can express the left ventricle function, its correlation with cardiac output should be investigated. The aim of this study was to investigate the effects of cardiac output [CO] on the first heart sound [S1] amplitude. Six male beagles were chosen. The S1 was obtained with the newly developed esophageal stethoscope system. CO was measured using NICOM, a non-invasive CO measuring device. Ephedrine and beta blockers were administered to the subjects to compare changes in figures, and the change from using an inhalation anesthetic was also compared. The S1 amplitude displayed positive correlation with the change rate of CO [r = 0.935, p < 0.001]. The heart rate measured using the esophageal stethoscope and ECG showed considerably close figures through the Bland-Altman plot and showed a high positive correlation [r = 0.988, p < 0.001]. In beagles, the amplitude of S1 had a significant correlation with changes in CO in a variety of situations

Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia / 대한마취과학회지

BACKGROUND: As the number of elder patients grows, spinal anesthesia for such patients are increasing significantly. Any effort is needed to use the least anesthetic drug for maintaining the anesthesia while avoiding hazards of cardio-pulmonary complications. METHODS: American Society of Anesthesiologists physical status classification I and II, Forty five elderly patients (> or = 60 years) who received transurethral resection of the prostate or transurethral resection of the bladder tumor were allocated randomly into three treatment groups. The DMT 0.5 group was designed as with dexmedetomidine 0.5 microg/kg while the DMT 1.0 group has a 1 microg/kg intravenous injection over 10 min before anesthetic induction. The Control group was designed to get a normal saline. Each group was compared regarding the maximum sensory block level, extension of anesthesia, degree of motor block, level of sedation, VAS score and complications. RESULTS: There were no significant differences among the 3 treatment groups regarding the maximum level of sensory block and motor block. However, the duration of sensory block was significantly longer in DMT 1.0 group than in the control group (P = 0.045). Both DMT 1.0 group (median = 3, range = 2-6) and DMT 0.5 group (median = 3, range = 1-6) showed a mean value of 3-4 Ramsay sedation score, which resulted in more excessive sedation and significantly greater incidence of bradycardia compared to the control group. No complications such as hypotension, nausea, tremor, and hypoxia were found during this investigation. CONCLUSIONS: In elder patients, the DMT 1.0 group is effective in duration of sensory block and is superior in the aspect of prolonged duration of sensory block compared to the DMT 0.5 group.

Wire-reinforced endotracheal tube fire during tracheostomy: A case report / 대한마취과학회지

Every operation could have a fire emergency, especially in the case of a tracheostomy. When a flammable gas meets a source of heat, the danger of fire is remarkable. A tracheal tube filled with a high concentration of oxygen is also a great risk factor for fire. Intra-tracheal tube fire is a rare, yet critical emergency with catastrophic consequences. Thus, numerous precautions are taken during a tracheostomy like, use of a special tube to prevent laser damage, ballooning of the tube with normal saline instead of air, and dilution of FiO2 with helium or nitrogen. Since the first recorded cases on tube fires, most of the fires were initiated in the balloon and the tip. In the present case report, however, we came across a fire incidence, which originated from the wire.

Proposing a Scoring System for the Research Criteria of Complex Regional Pain Syndrome

This study evaluated the structure of complex regional pain syndrome (CRPS) population and suggested a weighted scoring system to balance on objective signs. One hundred sixty-eight consecutive patients were evaluated using the Budapest Research Criteria (BRC). By using multidimensional scaling and logistic regression analysis, we analyzed the degree of importance and relationships between objective findings. In addition, a receiver operating characteristic curve was constructed using a weighted score derived from the risk ratio as a diagnostic test. There were correlations between skin color change and edema, and between decreased range of motion and motor dysfunction when multidimensional scaling was applied. The trophic change was excluded by a logistic regression (95% CI; 0.80-11.850). The cutoff point based on weighted score derived from the risk ratios for determining CRPS was 7.88. At this point, the sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 95.3%, 96.3%, and 70.1%, respectively. We propose a weighted scoring system for the BRC using risk ratios of objective signs. Although a thorough systematic review would be required in the future, this study can contribute to reduction of the possible distortion of the feature of CRPS populations by the BRC.

Preemptive analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision / 대한마취과학회지

BACKGROUND: The transversus abdominis plane block is recently described peripheral block to providing analgesia to the anterior abdominal wall. The goal of this study is to evaluate the analgesic efficacy of the ultrasound-guided transversus abdominis plane block (US-TAP block) in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision. METHODS: Thirty-two patients undergoing gynecologic surgery were randomized to undergo standard care such as PCA, or to receive additional US-TAP block with standard care. After general anesthesia induction, a bilateral US-TAP block was performed using 0.375% ropivacaine 20 ml on each side. Postoperative demand of rescue analgesics in PACU and ward were recorded. Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit (PACU) and at 2, 6, 10, 24, 48 hr postoperatively to investigate pain, drowsiness, nausea and itch. RESULTS: The US-TAP block reduced pain intensity compared to standard care in the PACU (5.2 +/- 3.1 vs 8.4 +/- 1.3) and at 2, 24 postoperative hours (3.0 +/- 2.4 vs 5.2 +/- 2.4, 0.9 +/- 1.5 vs 2.2 +/- 1.9). Fentanyl requirements in PACU was reduced (20.3 +/- 20.9 vs 62.5 +/- 35.4 microg, P < 0.05). In ward, pethidine requirements was reduced (21.9 +/- 28.7 vs 56.3 +/- 34.8 mg, P < 0.05). CONCLUSIONS: The US-TAP block with standard care provide more effective analgesia after gynecologic surgery via a transverse lower abdominal skin incision.

Analysis of Statistical Methods and Errors in the Articles Published in the Korean Journal of Pain

BACKGROUND: Statistical analysis is essential in regard to obtaining objective reliability for medical research. However, medical researchers do not have enough statistical knowledge to properly analyze their study data. To help understand and potentially alleviate this problem, we have analyzed the statistical methods and errors of articles published in the Korean Journal of Pain (KJP), with the intention to improve the statistical quality of the journal. METHODS: All the articles, except case reports and editorials, published from 2004 to 2008 in the KJP were reviewed. The types of applied statistical methods and errors in the articles were evaluated. RESULTS: One hundred and thirty-nine original articles were reviewed. Inferential statistics and descriptive statistics were used in 119 papers and 20 papers, respectively. Only 20.9% of the papers were free from statistical errors. The most commonly adopted statistical method was the t-test (21.0%) followed by the chi-square test (15.9%). Errors of omission were encountered 101 times in 70 papers. Among the errors of omission, "no statistics used even though statistical methods were required" was the most common (40.6%). The errors of commission were encountered 165 times in 86 papers, among which "parametric inference for nonparametric data" was the most common (33.9%). CONCLUSION: We found various types of statistical errors in the articles published in the KJP. This suggests that meticulous attention should be given not only in the applying statistical procedures but also in the reviewing process to improve the value of the article.

Pregnancy in Woman with Spinal Cord Stimulator for Complex Regional Pain Syndrome: A Case Report and Review of the Literature

Spinal cord stimulation (SCS) is used to manage chronic pain syndromes and it is accepted a cost-effective therapy. Child-bearing women who had SCS become or choose to become pregnant despite these policies pregnancy is a relative contraindication. A 32-year-old woman had SCS as a treatment for the CRPS I of the left lower extremity. During various check up tests, we happen to find out that her serum beta-hCG was positive and confirmed pregnancy. SCS is not recommended in pregnancy because the effects of SCS on pregnancy and nursing mothers had not been confirmed. However, many female patients suffering from chronic pain may expect future pregnancy and we think that they must be informed about the possibility of pregnancy and the effects of SCS device implantation in the course of pregnancy. First of all, a good outcome requires a multidisciplinary team approach, including obstetrics, neonatology, pain medicine and anesthesia, as was used from an early pregnancy. Unfortunately, she had a misabortrion after 6 weeks.

The Effect of Inhalation Induction with Sevoflurane on Postoperative Emotional Changes in Children / 대한마취과학회지

BACKGROUND: This study was designed to determine whether sevoflurane induction without painful procedures, such as intravenous catheter (IVC) insertion, has any emotional benefit compared with intravenous induction using a prepared IVC. METHODS: Children undergoing outpatient surgery were randomized to 2 groups: inhalation induction with sevoflurane (sevoflurane group, n = 24) or intravenous induction with thiopental sodium (control group, n = 21). In the sevoflurane group an IVC was inserted after chidren had been anesthetized by sevoflurane inhalation, while in the control group, an IVC was placed in the preoperative holding area. Total time and the number of IVC insertion attempts were recorded in both groups. Anesthesia times, agitation scores and the views of medical staff on technique benefits were also noted. Patients and parents were interviewed the following day. RESULTS: Time required for IVC insertion was significantly greater in the control group. No statistically significant differences were found in terms of; the number of attempts required for IVC insertion, anesthesia induction times, extubation times, recovery times, or agitation scores. Though interviews with patients and parents produced similar results in both groups, medical staff satisfaction levels were significantly higher in the sevoflurane group. CONCLUSION: Inhalation induction with sevoflurane had no beneficial effect on postoperative emotional changes. However, this method provides benefit to both children and medical staff because it avoids stressful, time-wasting, painful experiences.

The Effects of Additional Alfentanil for Sedation during the Endoscopic Retrograde Cholangiopancreatography / 대한마취과학회지

BACKGROUND: Propofol can be used as a sedative. And, opioids are also frequently used to relieve pain or to induce sedation during monitored anesthetic care. The objectives of this study were to evaluate the effects of additional alfentanil for sedation. METHODS: Forty-four patients scheduled for ERCP (endoscopic retrograde pancreatocholangiography) were allocated to one of two groups (group 1: propofol without alfentanil, group 2: propofol with alfentanil). In group 2, we mixed propofol with 1,000microgram alfentanil, and administered propofol using a target controlled infusion (TCI). During ERCP, we checked oxygen saturation, systolic blood pressure, heart rate, complications (hypoxemia, agitation, bradycardia, tachycardia). After the procedure, we also checked recovery characteristics; complications (nausea/vomiting, itching, urinary retention, soar throat), and satisfaction scores by using the VAS system (0-100 mm, 0 mm: no satisfaction at all, 100 mm: perfect satisfaction). RESULTS: There were no significant differences between the two groups in terms of the recovery characteristics, incidence of complications and the satisfaction score of endoscopist or patients. And the total amounts of propofol used were not significantly different. Only SPO2, systolic blood pressure and heart rate showed slight differences, but these were not clinically significant. CONCLUSIONS: We concluded that the sedation using propofol mixed with 1,000microgram alfentanil has no merit compared with plain propofol.