The Effectiveness of Dexmedetomidine in Vacuum-Assisted Breast Biopsy Under Monitored Anesthesia Care / 고신대학교의과대학학술지

OBJECTIVES: Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB. METHODS: This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs. RESULTS: The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability. CONCLUSIONS: VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.

Neonatal anesthesia: how we manage our most vulnerable patients / 대한마취과학회지

Neonates undergoing surgery are at higher risk than older children for anesthesia-related adverse events. During the perioperative period, the maintenance of optimal hemodynamics in these patients is challenging and requires a thorough understanding of neonatal physiology and pharmacology. Data from animals and human cohort studies have shown relation of the currently used anesthetics may associate with neurotoxic brain injury that lead to later neurodevelopmental impairment in the developing brain. In this review, the unique neonatal physiologic and pharmacologic features and anesthesia-related neurotoxicity will be discussed.

Successful use of caudal anesthesia and light sevoflurane mask ventilation for inguinal hernia repair in an infant with multiple large intrapulmonary cysts / 대한마취과학회지

No abstract available.

Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy / 대한마취과학회지

BACKGROUND: The creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy. METHODS: Sixty patients undergoing laparoscopic colectomy were randomly allocated to one of the two groups: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5). RESULTS: In both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05). CONCLUSIONS: Respiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia.

General anesthesia versus sedation with dexmedetomidine for thoracic endovascular aortic repair in 38 patients in multicenter experiences: A retrospective study

BACKGROUND: Endovascular stent graft placement is a useful treatment option in lesions of the thoracic aorta. The aim of this study was to assess the possibility of sedation with dexmedetomidine compared with general anesthesia in patients undergoing thoracic endovascular aortic repair (TEVAR) in a multi-center clinical trial. METHODS: Data from 38 patients with thoracic aorta lesions treated by TEVAR between April 2010 and November 2013 were retrospectively collected at two hospitals. General anesthesia or sedation with dexmedetomidine was determined according to the hospital. Demographics, anesthetic recordings, and complications were reviewed. RESULTS: Stent graft placement was technically successful in all patients. There were no events during the anesthetic period. A total of 38 patients underwent TEVAR; 29 patients received general anesthesia, and 9 received sedation. Dexmedetomidine sedation (loading dose: 0.5-1.0 microg/kg for 10 min, maintenance: 0.2-0.8 microg/kg/h) was successfully performed without anesthesia-related complications or mortality. During the procedure, mean arterial pressure, heart rate, and saturation of peripheral oxygen were not statistically different between general anesthesia and dexmedetomidine sedation. CONCLUSIONS: In our study, TEVAR under sedation with dexmedetomidine was shown to be a feasible procedure that was well tolerated without specific complications.

Comparison of analgesic effects of programmed intermittent epidural bolus and continuous epidural infusion after total knee arthroplasty / 대한마취과학회지

No abstract available.

Comparison of analgesic effects of programmed intermittent epidural bolus and continuous epidural infusion after total knee arthroplasty / 대한마취과학회지

No abstract available.

Dexmedetomidine and remifentanil in the perioperative management of an adolescent undergoing resection of pheochromocytoma: A case report / 대한마취과학회지

A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.

Lumbar Plexopathy Caused by Metastatic Tumor, Which Was Mistaken for Postoperative Femoral Neuropathy

Surgical excision was performed on a 30-years old woman with a painful mass on her left thigh. The pathologic findings on the mass indicated fibromatosis. After the operation, she complained of allodynia and spontaneous pain at the operation site and ipsilateral lower leg. We treated her based on postoperative femoral neuropathy, but symptom was aggravated. We found a large liposarcoma in her left iliopsoas muscle which compressed the lumbar plexus. In conclusion, the cause of pain was lumbar plexopathy related to a mass in the left iliopsoas muscle. Prompt diagnosis of acute neuropathic pain after an operation is important and management must be based on exact causes.

Postoperative nausea and vomiting after endoscopic thyroidectomy: total intravenous vs. balanced anesthesia / 대한마취과학회지

BACKGROUND: Endoscopic thyroidectomy was recently introduced and has been rapidly accepted by surgeons and patients. The present study was conducted to estimate and compare the incidences of postoperative nausea and vomiting (PONV) after endoscopic thyroidectomy using two different anesthetic methods: sevoflurane based balanced anesthesia; total intravenous anesthesia (TIVA). METHODS: Ninety nine female patients that were scheduled to undergo elective endoscopic thyroidectomy under general anesthesia were enrolled. These patients were randomly allocated to receive sevoflurane based balanced anesthesia (BA group) or propofol-remifentanil anesthesia (TIVA group). PONV was evaluated using a 4-point Likert scale, and pain using a visual analogue scale (VAS; range 0 to 100) for 0-2, 2-6, and 6-24 hours postoperatively. At 24 hours postoperatively, overall patient satisfaction regarding PONV and pain were recorded. RESULTS: The incidence of PONV was 14.6% in the TIVA group and 51.3% in the BA group. The incidence of nausea at 0-2 and 2-6 hours postoperatively was lower in the TIVA group than in the BA group (4.2% vs. 35.9%, 6.3% vs. 23.1%, respectively), but no between-group difference was observed at 6-24 hours postoperatively (8.3% vs. 5.1%). Antiemetic usage at 0-2 and 2-6 hours was lower in the TIVA than the BA group (4.2% vs. 38.5%, 6.3% vs. 23.1%), but no between-group difference was observed for 6-24 hours (6.3% vs. 7.7%). There were no differences in pain or in patient satisfaction. CONCLUSIONS: After endoscopic thyroidectomy, total intravenous anesthesia with propofol-remifentanil is associated with less PONV during the early postoperative period (0-6 hours) than sevoflurane based balanced anesthesia.

Comparison of the effectiveness of lidocaine and salbutamol on coughing provoked by intravenous remifentanil during anesthesia induction / 대한마취과학회지

BACKGROUND: Coughing is a side effect of opioids that is rarely studied. Here, we evaluated the incidence of remifentanil induced coughing during anesthesia induction in an attempt to identify its risk factors and to examine the preventive effects of lidocaine and salbutamol. METHODS: A total of 237 patients scheduled to undergo general anesthesia were allocated randomly into three groups. Group C received no medication, while Group L received 2% lidocaine at 0.5 mg/kg intravenously 1 minute prior to remifentanil infusion and Group S inhaled one metered aerosol puff of salbutamol 15 minutes prior to entering the operating room. Remifentanil was infused at 5 ng/ml by target controlled infusion and coughing was measured for five minutes and graded as none, mild, moderate, or severe based on the number of coughs. RESULTS: The incidences of coughing were 30.4%, 25.3%, and 35.4% in Groups C, L, and S, respectively. The incidences, onset times, and severity of coughing did not differ significantly among groups. In addition, multivariate analysis showed that non-smoking and a lower body weight were risk factors of remifentanil-induced coughing (odds ratio, 8.13; P = 0.024, 1.11, and 0.004, respectively). CONCLUSIONS: The incidence of remifentanil-induced coughing was 30%. A total of 0.5 mg/kg lidocaine and 1 metered aerosol puff of salbutamol did not prevent coughing. Non-smoking and low body weight were found to be risk factors of remifentanil-induced coughing.

Sudden Sensorineural Hearing Loss after General Anesthesia: A case report / 대한마취과학회지

Sudden hearing loss is a rare complication after general anesthesia.The variety of etiologies and the difficulty in treatment must be a challenge to anesthesiologists.In this patient who was otherwise normal in her right ear, sudden sensorineural hearing loss occurred immediately after general anesthesia.The possible causes of her sensorinerual hearing loss we supposed are the inner ear dysfunction by drilling noise or the pressure change of middle ear cavity or the microvascular circulatory deficiency related to head-rotated position.After steroid, prostaglandin injection and stellate ganglion block therapy, remarkable improvement of hearing was observed.

Anesthetic Management of Small Bowel Transplantation for Infant Who Had Done Small Bowel Resection Operation: A case report / 대한마취과학회지

Small bowel transplantation is becoming the treatment of choice for short-gut syndrome. Improvements in surgical techniques, immunosuppressants, and anesthetic management of patients have allowed this procedure to become the standard of treatment for patients who are unable to continue total parenteral nutrition (TPN) therapy due to TPN-associated complications. We experienced small bowel transplantation in a 10-month-old male infant who had small bowel resection for small bowel volvulus and has suffered from complications such as recurrent sepsis, disseminated intravascular coagulation (DIC) due to long-term TPN. We report our experience with a brief review of the relevant literature.

Effects of Epidural Naloxone on Pruritus Induced by Hydromorphone Epidural Patient-Controlled Analgesia / 대한통증학회지

BACKGROUND: Opioid delivered by epidural patient-controlled analgesia (PCA) is effective in relieving pain after surgery, but it is associated with side effects, such as nausea, vomiting, pruritus, respiratory depression, and urinary retention. The purpose of this study was to compare hydromorphone related side effects and the quality of analgesia when naloxone was added to epidural PCA regimen. METHODS: Fifty-two thoracotomy patients with PCA were allocated blindly into two groups. Patients in group H (n = 26) received continuous epidural hydromorphone (16microgram/ml) in 0.1% bupivacaine; patients in group N (n = 26) received an epidural infusion containing naloxone (2 microgram/ml) and hydromorphone (16microgram/ml) in 0.1% bupivacaine. The basal rate of PCA was 4 ml/hr and the demand dose was 1.5 ml with a lockout time of 15 min. Pain intensity, sedation, pruritus, nausea and vomiting, respiratory depression were checked at 6, 12, 24 hours postoperatively. RESULTS: The Visual Analog Scale (VAS) scores were significantly lower in group H than in group N. There were no significant differences in the overall incidence of pruritus, nausea and sedation between the two groups. CONCLUSIONS: Continuous epidural infusion of naloxone combined with hydromorpho-ne is not effective in reducing the incidence and severity of pruritus induced by epidural hydromorphone.

Risk Factors of Postoperative Nausea and Vomiting: Development of Korean Risk Model / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) along with postoperative pain is one of the most frequently encountered complaints after the surgery. The goal of this study is to elucidate the probable high risks factors of PONV by making 24 hr-observations on 4008 patients undergone general anesthesia. METHODS: PONV scores (0: no PONV; 1, nausea; 2, retching; 3, vomiting) and characteristics of patient, surgery, anesthesia were recorded by patient interview and chart review at post anesthesia care unit and at ward 24 hours after operation. Risk factors of PONV were investigated by Odds ratio and P value. Multiple regression analysis was performed to produce the provability of PONV. RESULTS: Incidence of PONV was 26.1% at PACU and 22.9% at ward. Total incidence of PONV during 24 hrs was 39.3. High risk factors of PONV were as follows in decreasing order: 1) female, 2) history of PONV or motion sickness, 3) nonsmoker, 4) operative time of longer than 60 minutes and 5) patient controlled analgesia. P (probability of PONV) = 1/1 + e-Z Z = -1.928 + 0.899 (Gender) + 0.664 (Hx) + 0.558 (OP-duration) + 0.261 (Smoking Status) + 0.184 (Postop-opioid). CONCLUSIONS: We could identify 5 risk factors and developed a Korean PONV risk model enabling to predict the probability of PONV by this study of 4008 patients.

Mental Change with Seizure after Propofol-N2O Anesthesia for Thoracoscopic Sympathectomy: A case report / 대한마취과학회지

We experienced a case of postoperative mental change with seizure after propofol-N2O anesthesia for thoracoscopic sympathectomy. A 23-year-old male patient was anesthetized with N2O-O2-propofol, and postoperative pain control was achieved with intravenous morphine. Bilateral electrocauterization of the upper dorsal sympathetic chain at the T2 and T3 level was performed with thoracoscopy. Thoracoscopy was done with carbon dioxide insufflation. In the postoperative recovery room, the patient experienced seizure, fever and a mental change. He was transferred to the intensive care unit and treated with acyclovir, mannitol, diphenylhydantoin and dexamethasone. Fourteen days after the operation, the patient was discharged with a clear mentality.