Secondary migration of a pre-existing central venous catheter due to a Swan-Ganz catheter insertion – A case report –

The entanglement of multiple central venous catheters is a rare and seriouscomplication. The Swan-Ganz catheter is a responsible for various cases.Case: A 66-year-old male patient was under general anesthesia for a coronary artery bypassgraft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a SwanGanz catheter was inserted into the left internal jugular vein. Chest radiograph after catheterplacement revealed that the Perm catheter had migrated to the left brachiocephalic vein.The surgeon attempted to reposition it manually, but postoperative radiograph showed thatit had rolled into a loop. On postoperative day 1, radiological intervention was performed tountangle the loop, which was successful.Conclusions: After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate thecondition.

Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea

Background@#The coronavirus disease 2019 (COVID-19) pandemic has caused significant changes. This study aimed to investigate the impact of COVID-19 on patients with chronic pain. @*Methods@#Patients with chronic pain from 23 university hospitals in South Korea participated in this study. The anonymous survey questionnaire consisted of 25 questions regarding the following: demographic data, diagnosis, hospital visit frequency, exercise duration, time outside, sleep duration, weight change, nervousness and anxiety, depression, interest or pleasure, fatigue, daily life difficulties, and self-harm thoughts. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was used to investigate the relationship between increased pain and patient factors. @*Results@#A total of 914 patients completed the survey, 35.9% of whom had decreased their number of visits to the hospital, mostly due to COVID-19. The pain level of 200 patients has worsened since the COVID-19 outbreak, which was more prominent in complex regional pain syndrome (CRPS). Noticeable post-COVID-19 changes such as exercise duration, time spent outside, sleep patterns, mood, and weight affected patients with chronic pain. Depression severity was more significant in patients with CRPS. The total PHQ-9 average score of patients with CRPS was 15.5, corresponding to major depressive orders. The patients’ decreased exercise duration, decreased sleep duration, and increased depression were significantly associated with increased pain. @*Conclusions@#COVID-19 has caused several changes in patients with chronic pain.During the pandemic, decreased exercise and sleep duration and increased depression were associated with patients’ increasing pain.

Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients

Background@#Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. @*Methods@#CRPS patients from 37 university hospitals in South Korea were surveyed.The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. @*Results@#A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. @*Conclusions@#Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients

Background@#Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. @*Methods@#CRPS patients from 37 university hospitals in South Korea were surveyed.The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. @*Results@#A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. @*Conclusions@#Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

Patients’ perception about opioids and addiction in South Korea

Background@#Chronic pain affects approximately 22% of the world’s population. Opioids can be useful in chronic pain management. However, some patients have negative perception of opioids. The purpose of this research was to evaluate patients’ perception about opioids and investigate problems associated with prescribing and taking opioids in South Korea. @*Methods@#Patients who visited a pain clinic in 14 university hospitals of South Korea from September through October 2018 were asked to complete anonymous questionnaires about taking opioids. @*Results@#Of the 368 patients that were surveyed (female 53.3%, male 46.7%), 56.8% were prescribed opioids. In the opioid group, 92.8% patients had heard of opioids from their doctor and 72.6% of them had a positive perception about opioids. The side effects associated with opioid use were constipation (35.4%), dizziness (24.6%), nausea and vomiting (17.4%), dysuria (6.2%), and addiction (2.0%). In the no opioid group, the primary sources of information about opioids were doctors (49.2%), mass media (30.8%), and the internet (16.2%). The main reasons why 39.0% patients did not take opioids were fear of addiction (57.7%) and side effects (38.5%). There were 71.5% and 60.9% patients in the opioid and no opioid group, respectively, who wished to take opioids when their numeric rating scale pain score was ≥ 7. @*Conclusions@#Perception of opioids among patients who take them was either neutral or positive. However, 39.0% patients who have not been prescribed opioids did not want an opioid prescription, citing fear of addiction and side effects as the primary reasons.

Novel alternative for submental intubation - A case report -

Background@#Submental intubation is commonly used during general anesthesia for maxillofacial surgeries as it provides a safe unrestricted surgical access compared to tracheostomy. During submental intubation, soft tissues and blood clots can become lodged in the endotracheal tube. To overcome this problem, we used a laparoscopic trocar.Case: A 52-year-old man with maxillofacial injury was scheduled to undergo an open reduction and internal fixation. We performed submental intubation using laparoscopic trocar, which created sufficient space for the insertion of the endotracheal tube. Unlike conventional methods, our method did not require any blunt dissection and caused significantly less soft tissue damage and required significantly less time. @*Conclusions@#Submental intubation with laparoscopic trocar is a one-step method and is quick and easy-to-perform technique with less complications.

A survey of patients’ perspectives of steroid injection (ppyeojusa) in Korea

BACKGROUND: Steroid injections are commonly used in pain clinics to relieve pain and treat inflammation. In Korea, these steroid injections are well known as ‘ppyeojusa’, which means to inject into the bone in Korean. Some patients often have a negative perception of this treatment method due to inaccurate information about the treatment and side effects of steroids. The purpose of this study is to investigate patients’ perception and knowledge of ppyeojusa. METHODS: A questionnaire about ppyeojusa was completed by patients who visited one of the pain clinics in nine university hospitals, from August 1 to September 10, 2017. RESULTS: Three-hundred seventy-four patients completed the survey. Eighty-five percent of patients had had ppyeojusa, and 74% of the respondents had heard of ppyeojusa from the mass media, friends or relatives. Only 39% of the patients answered that this injection was safe without side effects if properly spaced. Of the patients surveyed, 21% responded that ppyeojusa are “injections into the bone”; while 15% responded that ppyeojusa are “terrible injections that melted ‘the bone if used a lot’”. Half of the patients did not know what the active constituent is in ppyeojusa. If steroid injections are advised by the pain specialists, 89% of the patients would consent. CONCLUSIONS: Most pain clinic patients have heard of ppyeojusa. Most patients obtained information about ppyeojusa from mass media, rather than their physicians. Therefore, it is likely that most patients have inaccurate knowledge.

Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients

BACKGROUND: Spinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires. METHODS: Anonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed. RESULTS: Between June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01). CONCLUSIONS: These results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.

The effect of pre-anesthetic administration of dexmedetomidine on the consumption of opioids in postoperative gynecologic patients

BACKGROUND: This study was designed to assess whether pre-anesthetic administration of dexmedetomidine reduces the postoperative consumption of opioids, in patients receiving patient-controlled fentanyl after gynecological laparotomy. METHODS: This was a prospective, randomized, double-blind, controlled study. Ten minutes before induction of anesthesia, 36 patients scheduled for elective gynecological laparotomy were assigned to receive either normal saline (group N) or dexmedetomidine 1 µg/kg (group D). A patient-controlled analgesia (PCA) device was used to administer fentanyl for the postoperative 24 h period. Cumulative fentanyl consumption and pain score were assessed at postoperative 30 min, 6 h and 24 h. Patient's satisfaction for pain control and other side effects (nausea, sedation score) were recorded for all corresponding time points. RESULTS: There was no significant difference between the groups in cumulative fentanyl consumption (Group N: 11.1 ± 3.2 µg/kg, Group D: 10.3 ± 2.9 µg/kg, P value: 0.706). The incidence of side-effects did not differ between the groups. Both groups showed similar blood pressure after anesthesia induction. However, 10 min after anesthesia induction, the heart rates in group D were significantly lower than group N (P = 0.0002). CONCLUSIONS: In patients undergoing gynecological laparotomy, the pre-anesthetic administration of single loading dose dexmedetomidine (1 µg/kg) given 10 min before anesthesia induction did not reduce the PCA consumption of postoperative fentanyl or the pain score.

Sedation with Dexmedetomidine during Tracheostomy in Severe Tracheal Stenotic Patients / 대한구급학회지

In patients with severely compromised airways, a tracheostomy is usually performed under local anesthesia. Dexmedetomidine can be a better choice of sedative for such patients because it causes minimal respiratory depression. We report two cases of patients with severe stenosis of the airways who underwent sedation with dexmedetomidine during tracheostomy under local anesthesia. In the first case, recurrent laryngeal cancer caused laryngeal stenosis, and the narrowest laryngeal width was less than 3 mm. In the second case, the tracheostomy opening site was narrowed to a diameter of 3.4 mm in a patient with a history of total laryngectomy. For both patients, sedation was induced by dexmedetomidine infusion and the tracheostomy was performed successfully under local anesthesia without any events. Dexmedetomidine seems to be an effective and safe sedative for tracheostomies in patients with critical airways. The management and implications of sedation with dexmedetomidine in the patients with severe stenotic airways are discussed.

Massive bleeding despite tourniquet inflation in total knee replacement patient with a femoro-popliteal artery bypass graft / 대한마취과학회지

No abstract available.

Comparison of two types of combined spinal-epidural sets in terms of catheter positioning: reinforced catheter vs. non-reinforced catheter

BACKGROUND: The purpose of this study is to examine the usefulness of a combined spinal-epidural set with reinforced catheter (CombiSpeed(R), Ace Medical, Seoul, Korea) as compared with the non-reinforced catheter (PORTEX(R), Smiths medical, Brisbane, Australia) in terms of catheter positioning and clinical aspects of anesthesia. METHODS: One hundred and two patients scheduled for regional anesthesia were enrolled in this study. They were allocated randomly either into group A (CombiSpeed(R)) or group P (PORTEX(R)). Vital signs and the levels of sensory and motor block were measured every 5 minutes. Ease of insertion and the removal of the catheter were assessed, so was the incidence of venous cannulation and paresthesia during epidural catheter insertions. After the placement of epidural catheter, we checked the location of catheter by radiography and measured in a clockwise angle from the midline to catheter tip (angle X). In laboratory, tensile strength of the two products was measured by using tonometry. RESULTS: There were no significant differences between groups in intra-operative vital sign, block level and ease of catheter insertion and removal. No difference was observed in angle X between the groups (group A: 93.6 +/- 129.5degrees, group P: 124.5 +/- 127.7degrees, P = 0.22). There were no complications such as paresthesia or venous cannulation during catheter insertion. The tensile strength was higher in group A (group A: 1.70 +/- 0.05 kg, group P: 1.30 +/- 0.03 kg, P < 0.05). CONCLUSIONS: CombiSpeed(R) is as useful as PORTEX(R) in terms of ease for catheter placement, positioning of catheter tip and clinical aspects of anesthesia.

General anesthesia versus monitored anesthetic care with dexmedetomidine for closed reduction of nasal bone fracture / 대한마취과학회지

BACKGROUND: Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures. METHODS: Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups. RESULTS: Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV. CONCLUSIONS: MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.

A detection of unexpected blood antibody at the time of transfusion was needed, during the operation: A case report / 대한마취과학회지

To avoid the occurrence of fatal complications of blood transfusion, several tests are implemented before transfusion. The tests include ABO typing, Rh typing, cross-matching test and blood antibody screening test, and in usual they are completed before transfusion. However in the case of repetitive operations done via brief distance, reexamination for blood antibody tends to be omitted. After 2 previous operations, 30 years old male patient showed positive blood antibody screening during the third operation. Although antibody screening test performed before the first operation, no unexpected blood antibody was detected. During the third operation, after the decision to start transfusion was made, it took two hours to find appropriate blood. There was no significant deterioration of patient's condition but the loss of time could lead to critical consequences. We present this case to make anesthesiologists and surgeons aware of possibility of unexpected blood antibody detection after transfusion.

Erratum: Comparison of two types of combined spinal-epidural sets in terms of catheter positioning: reinforced catheter vs. non-reinforced catheter

We found an error in our published article.

The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting / 대한마취과학회지

BACKGROUND: 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone. METHODS: Among the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups. RESULTS: The frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups. CONCLUSIONS: There were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.

Effect of ulinastatin on the rocuronium-induced neuromuscular blockade / 대한마취과학회지

BACKGROUND: Ulinastatin is a glycoprotein derived from human urine and a serine protease inhibitor found in human urine and blood. Ulinastatin increases both liver blood flow and urine output. Rocuronium is eliminated mainly through the liver and partly through the kidney, hepatic elimination of rocuronium might be enhanced by ulinastatin. We examined the effect of ulinastatin on the neuromuscular block caused by rocuronium. METHODS: Forty four adult patients were randomly divided into two groups of 22 patients each, i.e. the study group and the control group. In the study group, a bolus dose of ulinastatin 5,000 U/kg was administered 2 min before the injection of rocuronium 0.6 mg/kg. In the control group, normal saline was administered instead of ulinastatin. For the monitoring of both onset and recovery from neuromuscular blockade, train-of-four (TOF) and post-tetanic count were used with TOF-Watch Sx. All patients underwent general anesthesia with total intravenous anesthesia (TIVA) of remifentanil and propofol, using the effect site target infusion system. RESULTS: In the study group, the onset of neuromuscular block was significantly slower than in the control group (P < 0.05). The recovery time from the rocuronium injection to the return of PTC was also significantly shorter in the study group than in the control group (P < 0.05). Similarly, times to the return of T1, T2, T3, and T4 (i.e. the first, second, third, and fourth response of TOF) were significantly shorter in the study group than in the control group (P < 0.05). CONCLUSIONS: Ulinastatin significantly delays the onset of neuromuscular block and accelerates the recovery from the block caused by rocuronium.

Acute spontaneous spinal epidural hematoma: A report of two cases

A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoagulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with an immediate laminectomy and decompression. If the neurologic symptom improves within 12 hours, a conservative treatment is effective; however few cases have been reported. We report this case with a review of the relevant literature.

Anesthetic management of a neonate with Antley-Bixler syndrome: A case report

Antley-Bixler syndrome is a congenital anomaly of multiple bones and cartilage, and this was first reported by Antley and Bixler in 1975. It is characterized by craniosynostosis, midface hypoplasia with choanal stenosis and atresia, radiohumeral synostosis and femoral bowing. This is sometimes accompanied by cardiac, renal, gastrointestinal and genital malformations. The risk of respiratory distress is high in the infants with this syndrome, and this is most commonly caused by choanal stenosis and atresia. Careful anesthetic management is needed for these infants because of the potential risk of a difficult airway and respiratory complications. We report here on our experience with the anesthetic management of a neonate with Antley-Bixler syndrome and we review the relevant literature.

Comparison among the effect of ondansetron, lidocaine and combination of ondansetron and lidocaine on microemulsion propofol injection pain

BACKGROUND: The pain caused by injection of propofol is known to be related to the concentration of aqueous free propofol. Microemulsion propofol can cause a serious pain because it has 7 times higher concentration of aqueous free propofol. We used ondansetron, lidocaine, ondansetron lidocaine as pretreatment to compare the effect for injection pain of microemulsion propofol. METHODS: 75 patients, ASA physical status I or II were enrolled. We randomly allocated into Group L (n = 25) received 2% lidocaine 40 mg, group O (n = 25) received ondansetron 4 mg and group M (n = 25) received ondansetron 4 mg plus 2% lidocaine 40 mg as pretreatment. After instituting standard monitoring, the venous drainage was occluded using a pneumatic tourniquet at 25 cm proximal to venous line. The patients were pretreated over a period of 15 seconds with one of the pretreatment drug. After releasing the tourniquet, microemulsion propofol was injected. We asked the patient about degree of injection pain until loss of consciousness, by using 0-100 point pain intensity numerical rating scale (PI-NRS). In the recovery room, we asked the patient whether they recall injection pain. RESULTS: There were significant differences in the group L and the group M compared with group O on PI-NRS (P < 0.05). The incidence of injection pain was significantly lower in group L and group M than group O. CONCLUSIONS: Pretreatment of lidocaine and lidocaine + ondansetron is more effective than ondansetron alone for reducing pain on injection of microemulsion propofol.