Efficacy of dexamethasone added to ramosetron for preventing postoperative nausea and vomiting in highly susceptible patients following spine surgery / 대한마취과학회지

BACKGROUND: Opioid-based patient controlled analgesia (PCA) provides adequate pain control following spinal surgeries at the expense of increased risk of postoperative nausea and vomiting (PONV). We evaluated the efficacy of dexamethasone added to ramosetron, which is a newly developed five-hydroxytryptamine receptor 3 antagonist with a higher receptor affinity and longer action duration compared to its congeners, on preventing PONV in highly susceptible patients receiving opioid-based IV PCA after spinal surgery. METHODS: One hundred nonsmoking female patients undergoing spinal surgery were randomly allocated to either a ramosetron group (group R) or a ramosetron plus dexamethasone group (group RD)., Normal saline (1 ml) or 5 mg of dexamethasone was injected before anesthetic induction, while at the end of the surgery, ramosetron (0.3 mg) was administered to all patients and fentanyl-based IV PCA was continued for 48 hrs. The incidence and severity of PONV, pain score and the amount of rescue antiemetics were assessed for 48 hours after surgery. RESULTS: The number of patients with moderate to severe nausea (20 vs. 10, P = 0.029), and overall incidence of vomiting (13 vs. 5, P = 0.037) were significantly lower in the group RD than in the group R, respectively. Rescue antiemetic was used less in the RD group without significance. CONCLUSIONS: Combination of ramosetron and dexamethasone significantly reduced the incidence of moderate to severe nausea and vomiting compared to ramosetron alone in highly susceptible patients receiving opioid-based IV PCA after surgery.

Effect of ketamine pretreatment for anaesthesia in patients undergoing percutaneous transluminal balloon angioplasty with continuous remifentanil infusion / 대한마취과학회지

BACKGROUND: An appropriate level of sedation and pharmacological assist are essential during percutaneous transluminal balloon angioplasty (PTA). Ketamine provides good analgesia while preserving airway patency, ventilation, and cardiovascular stability with an opioid sparing effect suggesting that it would be ideal in combination with remifentanil and midazolam in spontaneously breathing patients. We evaluated the effect of a small dose of ketamine added to midazolam and remifentanil on analgesia/sedation for PTA procedures. METHODS: Sixty-four patients receiving PTA were enrolled. The Control group received midazolam 1.0 mg i.v. and continuous infusion of remifentanil 0.05 microg/kg/min. The Ketamine group received, in addition, an intravenous bolus of 0.5 mg/kg ketamine. Patients' haemodynamic data were monitored before remifentanil infusion, 5 min after remifentanil infusion, at 1, 3, 5, 30 min after incision, and at admission to the recovery room. Verbal numerical rating scales (VNRS) and sedation [OAA/S (Observer's Assessment of Alertness/Sedation)] scores were also recorded. RESULTS: The VNRS values at 1, 3, and 5 min after incision and OAA/S scores at 5 min after remifentanil infusion, and 1, 3, and 5 min after incision were lower in the Ketamine group than in the Control group. In the Control group, the VNRS value at 1 min after incision significantly increased and OAA/S values at 3, 5, and 30 min after incision significantly decreased compared to baseline values, while there were no significant changes in the ketamine group. CONCLUSIONS: A small dose of ketamine as an adjunct sedative to the combination of midazolam and remifentanil produced a better quality of sedation and analgesia than without ketamine and provided stable respiration without cardiopulmonary deterioration.

The effect of milrinone on the intraoperative hemodynamics during off-pump coronary bypass surgery in patients with an elevated echocardiographic index of the ventricular filling pressure / 대한마취과학회지

BACKGROUND: Hemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB) is mainly attributed to impaired filling and diastolic dysfunction. An elevated ratio of the mitral velocity to the early-diastolic velocity of the mitral annulus (E/e' > 15) is a relatively new indicator of diastolic function, and this was reported to be associated with impaired hemodynamics during OPCAB. We investigated the efficacy of milrinone on the perioperative hemodynamics and short term outcomes of patients with an E/e' > 15 and who underwent OPCAB. METHODS: The patients were randomly allocated into either group C (control, n = 31) or group M (n = 31) and they were treated with the same amount of either normal saline or milrinone (0.5 microg/kg/min) without bolus loading after completion of internal mammary artery harvest until the end of operation. Hemodynamic measurements were recorded after the induction of anesthesia (T1), 5 min after starting each distal anastomosis of the left anterior descending artery (T2), left circumflex artery (T3) and right coronary artery (T4), and 5 min after sternum closure (T5). RESULTS: The mixed venous oxygen saturation (SvO2) was lower through T2-T4 compared to the baseline value in both groups, while the degree of the decrease was significantly less in group M than that in group C. The other hemodynamic variables, the operative data and the postoperative outcomes were similar between the two groups. CONCLUSIONS: Intraoperative infusion of milrinone did not significantly improve the perioperative hemodynamics and the subsequent short term outcomes for the patients with preexisting diastolic dysfunction as represented by an elevated E/e' value, although it reduced the degree of decrease of the SvO2 during OPCAB.

Pseudoaneurysm in the inferior epigastric artery and scrotal hematoma following removal of a femoral vein catheter: A case report / 대한마취과학회지

We report a rare case of pseudoaneurysm of the inferior epigastric artery and inguinal hematoma extending to the scrotum following the removal of a femoral venous catheter in a 24-year-old male patient undergoing two consecutive neurosurgical procedures.

Central Venous Pressure and Its Effect on Blood Loss during Hepatic Lobectomy / 대한마취과학회지

BACKGROUND: Some studies reported that lowering central venous pressure (LCVP) during liver resection could significantly reduce the intra-operative blood loss, however it is still controversial concerning LCVP induced renal dysfunction, hypovolemia, hemodynamic instability. This study evaluated the association of low central venous pressure with blood loss during liver resection comparing the control group. METHODS: A total 62 patients aged 20 to 70 underwent hepatectomy by the same group of surgeon were randomized into group L (CVP 10 mmHg, n = 32) during dissection and lobectomy period. Data such as age, sex, concurrent disease, liver resection site (right or left), pre-, intra- and postoperative day 3 hemoglobin, blood urea nitrogen, creatinine, bleeding time, prothrombin time, activated partitial thromboplastin time, intraoperative blood loss, urine output, transfusion volume, length of hospital stay were collected and compared between the two groups and t-test was used for comparison of results. RESULTS: The difference of total blood loss between two groups was 193.6 +/- 432.2 ml (group L; 589.1 +/- 380.8 ml, group C; 782.7 +/- 316.7 ml), however statistically insignificant (P value = 0.1243). Additionally, there were no significant differences in other data including the length of hospital stay. CONCLUSIONS: Our results suggest maintaining CVP under 10 mmHg is not effective in reducing blood loss during liver resection.

Acute Heart Failure Induced by a beta-blocker after the Local Infiltration of Epinephrine: A case report / 대한마취과학회지

Topical epinephrine can cause severe hypertension, ventricular tachycardia, myocardial ischemia, cardiac arrest or pulmonary edema. The increased blood pressure and left ventricular afterload, as well as decreased left ventricular compliance caused by epinephrine may also decrease the cardiac output. If a beta blocker is used in these situations, the resulting decreased contractility and inability to increase the heart rate may further compromise the cardiopulmonary function. A 26 year-old man developed tachycardia and hypertension following the local infiltration of epinephrine 2 ml (1:10,000) around the nasal mucosa and an intramucosal injection of epinephrine 7.2 ml (1:100,000). He was treated with intravenous esmolol 10 mg. He showed a decreasing heart rate and blood pressure, depressed ST segments and inverted T waves. At the same time, the pulsation of the femoral arteries was not palpable. Cardiac massage was started. He was treated with intravenous atropine 0.5 mg and epinephrine 5microgram. He recovered from circulatory failure after this treatment and his ECG showed a normal sinus rhythm.

Comparison of Maintenance and Emergence of Anesthesia in Total Intravenous Anesthesia with Propofol and Remifentanil for Thyroidectomy and Mastectomy / 대한마취과학회지

BACKGROUND: This study investigated the effect of type of surgery on consumption of propofol and remifentanil and recovery index. METHODS: Fifty female patients (ASA physical status 1, 2) scheduled for thyroidectomy (Group I) or mastectomy (Group II) received total intravenous anesthesia (TIVA) with propofol and remifentanil. The anesthesia was maintained with target-controlled infusion (TCI) of propofol and remifentanil under bispectral index (BIS) monitoring. The effect site concentration of propofol was controlled for maintaining BIS values within the range of 45-50. The effect site concentration of remifentanil was controlled for maintaining blood pressure and heart rate within 20% of baseline values. Blood pressure, heart rate, BIS, effect site concentration of propofol and remifentanil were measured before induction, during induction, at the beginning of operation, at the end of operation, and during recovery. The time from discontinuation of propofol to eye opening and regaining of orientation, total amount of propofol and remifentanil used, and the amount of drug per body weight kilogram per hour were investigated. RESULTS: There were no significant differences between Group I and II on the amount of remifentanil used. Although the amount of propofol consumed per body weight kilogram per hour was larger in Group II, there were no significant differences of recovery index between Group I and II. CONCLUSIONS: There were no significant differences in the amount of propofol and remifentanil consumed and recovery index in thyroidectomy and mastectomy under TIVA. The larger amount of propofol consumed per body weight per hour in Group II was thought as a result of shorter operation time than Group I.

A Study on the Relationship of Internet Addiction and Depression in College students / 한국역학회지

OBJECTIVES: To investigate the relationship of internet addiction and depression, and evaluate other possible related factors. METHODS: Data was based on the questionnaires from 300 college students in Seoul. Gender, age, major, family income, academic performance, people they live with, location, and main use of internet were included. We used Young`s Internet Addiction Test and Beck Depression Inventory(BDI) to measure the depression and addiction degree. RESULTS: In logistic regression analysis, it was found that gender, depression degree and main use of internet were significant variables. There were 136 males, 144 females in this study, and the risk of being addicted to internet were 10.9 times(CI:2.67~44.68) higher in male than female. People with moderate depression (Beck`s Depression Inventory(BDI) Score>20) also had higher risk(11.4 times, CI:2.03~63.95) to be addicted in internet than normal group. Lastly, in case of internet use, people who use internet for games and chatting were 6.38(CI:1.38~29.63) and 4.84 times(CI:1.30~18.06) risky compare to the group with web surfing. CONCLUSION: The result of this study suggests that there is noticeable relationship of internet addiction and depression. However we do not have evidence of exact relation between them, therefore more studies should be done.