Nuevas técnicas para medir el nivel de actividad física en estudios epidemiológicos sobre enfermedades no transmisibles en Cuba / New techniques to measure physical activity levels in epidemiological studies about non-communicable diseases in Cuba

Introducción: Los estudios epidemiológicos sobre enfermedades no transmisibles en Cuba requieren técnicas que determinen el nivel de actividad física de manera práctica, válida, confiable y costo-efectiva. Objetivo: Caracterizar las técnicas que miden el nivel de actividad física de cuestionarios validados por sensores de movimiento y que resulten aplicables en la población cubana. Métodos: La búsqueda se efectuó a través de bases de datos PubMed, Cochrane, LILACS y SciELO. Las palabras utilizadas en la búsqueda fueron: actividad física, actividad física/técnicas de medición, actividad física/cuestionario, inactividad física y enfermedades no transmisibles. Se consultaron documentos que hubiesen sido publicados en el periodo 2014-2019. Análisis e integración de la información: Se identificaron 66 artículos, de los cuales se seleccionaron 36 que contribuyeron al resultado final. Se describieron las características más relevantes de cada técnica, así como también las semejanzas y diferencias entre ellas. Basado en los criterios de los autores referidos y el de los autores, se definió cuál sería la técnica apropiada a utilizar. Conclusiones: Se considera que los podómetros junto con la versión corta del Cuestionario Internacional de Actividad Física (IPAQ, siglas en inglés), son las técnicas que pueden utilizarse para medir el nivel de actividad física en la población cubana(AU)

Introduction: Epidemiological studies about non-communicable diseases in Cuba require techniques that determine physical activity levels in a practical, valid, reliable and cost-effective manner. Objective: Characterize the techniques that measure the level of physical activity of questionnaires validated by movement sensors and that are applicable in the Cuban population. Methods: A search was conducted in the databases PubMed, Cochrane, LILACS and SciELO, using the descriptors physical activity, physical activity / measurement techniques, physical activity / questionnaire, physical inactivity and non-communicable diseases. The documents consulted had been published in the period 2014-2019. Data analysis and integration: A total 66 articles were identified, of which 36 were selected that contributed to the final result. A description was performed of the most relevant characteristics of each technique, as well as the similarities and differences between them. Determination was made of the appropriate technique to be used, based on criteria issued by article authors and referred authors. Conclusions: Pedometers and the short International Physical Activity Questionnaire (IPAQ) were selected as the techniques to be used to measure physical activity levels in the Cuban population(AU)

Los cuestionarios como herramienta en la medición de la actividad física en personas con diabetes mellitus y obesidad en la población cubana / Questionnaires as a tool to measure physical activity in people with diabetes mellitus and obesity in the Cuban population

Introducción: Los cuestionarios son instrumentos estandarizados que se utilizan en la vigilancia global de la actividad física en las personas con diabetes mellitus y obesidad. Estos constituyen una técnica costo-efectiva más viable pero menos precisa en comparación con los métodos objetivos que se utilizan para medir la actividad física a nivel poblacional. Sin embargo, son la herramienta más empleada por los especialistas por su interacción directa con los pacientes que se incluyen en las investigaciones sobre la diabetes y la obesidad. Objetivos: Identificar los cuestionarios como una opción factible en Cuba para medir el nivel de actividad física en estudios epidemiológicos en personas con diabetes mellitus y obesidad. Métodos: Se realizó una revisión integradora de la bibliografía durante el periodo 2013-2020, a partir de los criterios de inclusión. La búsqueda se efectuó a través de PubMed, Cochrane, LILIACS y SciELO. Las palabras o criterios empleados fueron: actividad física, actividad física/cuestionarios, actividad física/técnicas de medición, enfermedades no transmisibles, diabetes mellitus y obesidad. Se identificaron 68 artículos, de los cuales fueron seleccionados 29 que contribuyeron al resultado final. Conclusiones: Las nuevas evidencias expuestas propician elementos sólidos para identificar los cuestionarios validados por sensores de movimiento como una opción factible que debe ser utilizada en Cuba para medir el nivel de actividad física en estudios epidemiológicos en personas con diabetes mellitus y obesidad(AU)

Introduction: The questionnaires are standardized instruments, which are used in full monitoring of physical activity in people with diabetes mellitus and obesity. They are a more viable cost-effect technique, but less precise in comparison with the objective methods that are used to measure physical activity in the population level. However, they are the most used tool by the specialists due to its direct interaction with patients included in researches on diabetes and obesity. Objectives: Identify the questionnaires as a feasible option in Cuba to measure the level of physical activity in epidemiological studies in people with diabetes mellitus and obesity. Methods: An integrative review of the bibliography was carried out from the inclusion criteria during the period 2013-2020. The search was carried out through PubMed, Cochrane, LILACS and SciELO to answer the question of the review: What is the physical activity´s measurement technique that can be used in people with diabetes mellitus and obesity in the Cuban population, taking into account the new empirical evidence on the subject? Physical activity, physical activity / questionnaires, physical activity / measurement techniques, non-communicable diseases, diabetes mellitus and obesity; were the words or criteria used. 68 articles were identified, and 29 of them were selected so, they contributed to the final result. Conclusions: The new evidences presented provide solid elements to identify the questionnaires validated by motion sensors as a feasible option that should be used in Cuba to measure the level of physical activity in epidemiological studies of people with diabetes mellitus and obesity(AU)

Development and Application of Non-invasive Real-time Detection System for Viscoelasticity of Skin Tissue / 中国医疗器械杂志

To satisfy the daily demand of skin condition maintenance, make non-invasive real-time detection, and get proper quantitative evaluation of skin viscoelasticity parameters at the same time, a portable non-invasive detection system to acquire real-time skin tissue viscoelasticity is developed. The system relies mainly on a single-degree-of-freedom forced vibration model, with spring-damp-mass, and on dynamic micro indentation method. The experiment is conducted on two kinds of springs, and on pigskin tissues as well, the system's suitability, accuracy and stability are confirmed. The skin viscoelasticity detection in vivo is also carried out on 20 subjects with different ages, the differences of skin viscoelasticity in various parts of the body are investigated, and the correlations between age and skin viscoelasticity are clarified.

Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis / Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva para cirurgia de reparação do quadril em dois pacientes com estenose aórtica grave

BACKGROUND AND OBJECTIVES: Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm2 or a mean aortic valve gradient >30 mm Hg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair. CASE REPORT: Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2 mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions. CONCLUSION: Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.

JUSTIFICATIVA E OBJETIVOS: A estenose aórtica aumenta a morbidade e mortalidade no período perioperatório. A monitoração invasiva no perioperatório é recomendada para pacientes com área valvar <1,0 cm2 ou gradiente médio >30 mm Hg, além de ser importante evitar a hipotensão e arritmias. Relatamos o manejo anestésico com o uso de raquianestesia contínua e monitoração hemodinâmica minimamente invasiva em duas pacientes com estenose aórtica grave, submetidas à cirurgia de reparação do quadril. RELATO DE CASO: Duas pacientes com estenose aórtica grave foram programadas para cirurgia de reparação de fratura de quadril. Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva foi usada para o manejo anestésico de ambas as pacientes. A cirurgia foi realizada com sucesso após duas doses consecutivas de 2 mg de bupivacaína isobárica a 0,5% em uma das pacientes e quatro doses consecutivas na outra. As condições hemodinâmicas permaneceram estáveis durante a intervenção. Os sinais vitais e parâmetros hemodinâmicos permaneceram estáveis durante as duas intervenções. CONCLUSÃO: Nosso relato descreve o uso da raquianestesia contínua com monitoração hemodinâmica minimamente invasiva como uma alternativa válida para a anestesia geral ou peridural em duas pacientes com estenose aórtica grave, submetidas à cirurgia de membro inferior. Contudo, ensaios clínicos controlados são necessários para estabelecer que a técnica é segura e eficaz nesse tipo de pacientes.

Effects of pulse pressure alterations on cardiac output measurements derived from analysis of arterial pressure waveform

BACKGROUND: Changes in pulse pressure (PP) may alter the morphology of arterial pressure waveforms, thereby affecting the accuracy of cardiac output (CO) measurements derived from such waveforms. This study evaluated the influence of PP on the accuracy of FloTrac/Vigileo™ system-measured CO (APCO). Pulmonary artery catheter (PAC) measured stat mode CO (SCO) is used as a reference standard. METHODS: Hemodynamic variables were measured at various time points in 24 patients. APCO and SCO were compared using Bland-Altman analysis of the overall data pairs. The data pairs were divided into a low PP group and a high PP group, and subgroup analysis was conducted. RESULTS: The mean APCO (5.3 ± 1.7 L/min) was higher than the mean SCO (5.1 ± 1.6 L/min) for all data pairs (P < 0.001). The Bland-Altman analysis revealed an overall percentage error of 41.7% between the APCO and SCO, which exceeds a 30% limit of agreement. There was a significant relationship between PP and the difference between APCO and SCO (P = 0.031, R = 0.151). In subgroup analysis, APCO and SCO showed reasonable agreement in the low PP group, with a percentage error of 28.2%, but decreased agreement in the high PP group, with a percentage error of 43.2%. CONCLUSIONS: Changes in PP affect the accuracy of APCO measurements. An acceptable level of agreement between APCO and SCO was observed only in a low range of PP.

Application of electronic chest radiograph scale measurement techniques in the prediction of placed length of peripherally inserted central venous catheters / 中国实用护理杂志

Objective To predict the length of peripherally inserted central venous catheters(PICC) with electronic chest radiograph scale measurement techniques, and observe its clinical effect. Methods A total of 185 breast cancer patients from October 2012 to December 2013 who were treated by PICC combined with MST guided by ultrasonic technology were as control group. A total of 192 breast cancer patients from January to November 2014 were as observation group. Control group adopted from the puncture point to right sternoclavicular joints impreaaion nip down again to the third floor of PICC in vitro measurement method. Observation group used to right sternoclavicular joints from the puncture point plus right sternoclavicular joints to subcarinal 1 vertebral body length, right sternoclavicular joints to subcarinal 1 vertebral body length measurement by electronic chest radiograph scale technology directly measured from the electronic chest radiographs. The accuracy rates and complications between the two measurement methods were compared. Results The accuracy rate in observation group was 97.92%(188/192), which was higher than that in control group (68.11%,126/185 ),and there was significant differencek,χ2=60.15, P<0.01. The complication rate in observation group was 6.77%(13/192), which was lower than that in control group (20.54%, 38/185) ,and there was significant difference,χ2=9.58, P<0.01. Conclusions The electronic chest radiograph scale measurement techniques could effectively improve the accuracy of PICC catheter placed, improve the quality of venipuncture, decrease the complications .

Construção e validação de um instrumento de avaliação do perfil desenvolvimental de crianças com Perturbação do Espectro do Autismo / Construction and validation of an developmental profile assessment tool for children with Autistic Spectrum Disorder

nos últimos anos a investigação tem dado particular relevância às alterações do Processamento Sensorial nas crianças com perturbações do espectro do autismo (PEA) e a literatura refere que entre 42% a 88% das crianças com PEA apresentam este tipo de disfunção. Nesta linha foi definido um projeto de investigação centrado na construção de uma escala que avalie a tradicional tríade que caracteriza as crianças com PEA (Interação, Comunicação e Comportamento e interesses repetitivos e estereotipados), enriquecida pela inclusão de um novo domínio: o Processamento Sensorial. Com a construção e validação desta escala pretendemos que pais e profissionais utilizem colaborativamente um instrumento de avaliação da intervenção que lhes permita monitorizar o processo de apoio e adequar as suas práticas. Neste artigo descrevemos os procedimentos e os resultados das sucessivas fases de construção do instrumento, desde as análises iniciais mais qualitativas até aos estudos centrados na análise quantitativa dos itens.

During the last few years, research has focused on changes in Sensory Processing in children with Autistic Spectrum Disorder (ASD). As a result, literature has shown that between 42% and 88% of children with ASD present this type of disorder. Based on these findings, a research project was designed centring on the construction of a tool to assess the traditional triad that characterizes children with ASD (Interaction, Communication and Behaviour and Repetitive and Stereotyped Interests), to which was added a new domain: Sensory Processing. By constructing and validating this assessment tool, the intention is for parents and professionals to collaboratively apply this intervention assessment instrument in order to monitor the support process and adapt their practices. In this paper, we describe procedures and results of the successive stages entailed in constructing this instrument, from the first primarily qualitative analyses up to the studies centred on the quantitative item analysis.

Accuracy of cardiac output measurements during off-pump coronary artery bypass grafting: according to the vessel anastomosis sites / 대한마취과학회지

BACKGROUND: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. METHODS: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. RESULTS: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. CONCLUSIONS: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.

The uncalibrated pulse contour cardiac output during off-pump coronary bypass surgery: performance in patients with a low cardiac output status and a reduced left ventricular function / 대한마취과학회지

BACKGROUND: We compared the continuous cardiac index measured by the FloTrac/Vigileo(TM) system (FCI) to that measured by a pulmonary artery catheter (CCI) with emphasis on the accuracy of the FCI in patients with a decreased left ventricular ejection fraction (LVEF) and a low cardiac output status during off-pump coronary bypass surgery (OPCAB). We also assessed the influence of several factors affecting the pulse contour, such as the mean arterial pressure (MAP), the systemic vascular resistance index (SVRI) and the use of norepinephrine. METHODS: Fifty patients who were undergoing OPCAB (30 patients with a LVEF > or = 40%, 20 patients with a LVEF < 40%) were enrolled. The FCI and CCI were measured and we performed a Bland-Altman analysis. Subgroup analyses were done according to the LVEF (< 40%), the CCI (< or = 2.4 L/min/m), the MAP (60-80 mmHg), the SVRI (1,600-2,600 dyne/s/cm5/m2) and the use of norepinephrine. RESULTS: The FCI was reliable at all the time points of measurement with an overall bias and limit of agreement of -0.07 and 0.67 L/min/m2, respectively, resulting in a percentage error of 26.9%. The percentage errors in the patients with a decreased LVEF and in a low cardiac output status were 28.2% and 22.3%, respectively. However, the percentage error in the 91 data pairs outside the normal range of the SVRI was 40.2%. CONCLUSIONS: The cardiac output measured by the FloTrac/Vigileo(TM) system was reliable even in patients with a decreased LVEF and in a low cardiac output status during OPCAB. Acceptable agreement was also noted during the period of heart displacement and grafting of the obtuse marginalis branch.

Avaliação da dor em neonatologia / Pain evaluation in neonatology

JUSTIFICATIVA E OBJETIVOS: O estudo da dor avançou muito nas últimas décadas tornando a avaliação e a intervenção uma preocupação crescente entre os profissionais de saúde. O objetivo da avaliação da dor deve ser o de proporcionar dados acurados, para determinar quais ações devem ser feitas para aliviá-la ou aboli-la e, ao mesmo tempo, avaliar a eficácia dessas ações. A finalidade desta revisão foi discutir os métodos utilizados na avaliação da dor em neonatologia, uma vez que estratégias de tratamento utilizadas sem uma avaliação sistemática da dor não são eficazes ou adequadas. CONTEUDO: Não existe nenhuma técnica amplamente aceita, de fácil realização e uniforme para a avaliação da dor em crianças, sobretudo em recém-nascidos e lactentes, que possa ser utilizada em todas as situações. Antes de se confiar na exatidão dos dados de avaliação, é necessário que os profissionais de saúde sintam-se seguros com os instrumentos usados na coleta de dados. Vários indicadores podem ser usados na avaliação, quantificação e qualificação do estímulo doloroso, e, quando analisados em conjunto, permitem a discriminação entre a dor e estímulos não-dolorosos. Ainda que seja desejável padronização objetiva para a medição da intensidade da dor, tal medida ainda não existe. A medição nessa faixa etária é feita por meio de parâmetros fisiológicos (freqüência cardíaca, freqüência respiratória, pressão arterial, etc.) e comportamentais (expressão facial, postura e vocalização ou verbalização), utilizando-se escalas de avaliação, cada uma com suas vantagens e limitações. CONCLUSÕES: A atual atenção para melhores métodos de medida e avaliação da dor contribuiu para aumentar a sensibilidade dos profissionais de saúde em relação à natureza das experiências dolorosas. A dor deve ser valorizada como o quinto sinal vital e avaliada de maneira sistematizada também nos recém-nascidos.

BACKGROUND AND OBJECTIVES: The study of pain has seen a great development in the last decades, making evaluation and intervention a growing concern among health professionals. The objective of pain evaluation should be to provide accurate data to determine the actions that should be taken to relieve or abolish it and, at the same time, to evaluate the efficacy of those actions. The objective of this review was to discuss the methods used to evaluate pain in neonatology, since treatment strategies used without systematic pain evaluation are not effective or adequate. CONTENTS: A widely accepted, easy to apply and uniform technique to evaluate pain in children, especially newborns and infants, that can be used in all situations does not exist. Before trusting the accuracy of the data, it is necessary that health professionals trust the instruments used to collect the data. Several indicators can be used to evaluate, quantify, and qualify the painful stimulus and, when analyzed as a set, allow the discrimination between pain and non-painful stimuli. Although the objective standardization of measuring pain severity is desirable, it does not exist. Measurement of pain in this age group is done by assessing physiological (heart rate, respiratory rate, blood pressure, and etc.) and behavioral (facial expression, posture, and vocalization or verbalization) parameters using evaluation scales, each one with its advantages and limitations. CONCLUSIONS: The current concern with better methods to measure and evaluate pain contributed to increase the sensitivity of health professionals regarding the nature of painful experiences. Pain should be valued as the fifth vital sign and evaluated in a systemized manner, including in newborns.

JUSTIFICATIVA Y OBJETIVOS: El estudio del dolor ha avanzado mucho en las últimas décadas haciendo con que la evaluación y la intervención sean una preocupación creciente entre los profesionales de la salud. El objetivo de la evaluación del dolor debe ser el de proporcionar datos precisos para determinar cuáles acciones deben ser toma de las para aliviarlo o eliminarlo y la mismo tiempo, evaluar la eficacia de esas acciones. La finalidad de esta revisión fue discutir los métodos utilizados en la evaluación del dolor en neonatología, cuando las estrategias de tratamiento utiliza de las sin una evaluación sistemática del dolor no son eficaces o adecua de las. CONTENIDO: No existe ninguna técnica ampliamente aceptada y fácilmente ejecutable y uniforme para la evaluación del dolor en niños, especialmente en los recién nacidos y lactantes que pueda ser utilizada en todas las situaciones. Antes de confiar en la exactitud de los datos de Evaluación, se hace necesario que los profesionales de la salud se sientan seguros con los instrumentos usados en la recolección del esos datos. Varios indicadores pueden ser usados en la evaluación, cuantificación y calificación del estímulo doloroso, y cuando se analizan en conjunto, permiten el desglose entre el dolor y los estímulos no dolorosos. Aunque sea deseable la estandarización objetiva para la medición de la intensidad del dolor, tal medida no existe todavía. La medición ene sea franja etaria es hecha por medio de parámetros fisiológicos (frecuencia cardíaca, frecuencia respiratoria, presión arterial, etc) y comportamentales (expresión facial, postura y vocalización o verbalización), utilizando escalas de evaluación, cada una con sus ventajas y limitaciones. CONCLUSIONES: La actual atención para mejores métodos de medida y evaluación del dolor aportó para aumentar la sensibilidad de los profesionales de salud con relación a la naturaleza de las experiencias dolorosas. El dolor debe ser entendido como...

Behavioral Effects of Different Concentrations of Formalin on Pain Test / 대한마취과학회지

BACKGROUND: The stimulus provided by a subcutaneous injection of formalin is tonic, moderate, continuous pain. We evaluated the effect of formalin at three concentrations, 1.5%, 2.5%, and 5% - 50nl to determine the relationship between formalin concentration and pain behaviors. METHODS: Male Sprague-Dawley rats (250 - 300 g body weight) were used. Following formalin (n = 8 each group) or saline (control group, n = 6) injection, flinching, licking, lifting, and favoring responses were recorded during the early (0 - 5 minutes after injection; phase 1) and late phases (20 - 60 minutes after injection, phase 2). Sham-injected rats (n = 4) underwent subcutaneous insertion of the needle, but no substance was injected. RESULTS: During both phases, flinching was more frequent in the 5% formalin group than in the control group (P < 0.05). As for the licking behavior, phase 1 of 2.5% and 5% formalin groups and phase 2 of all three groups showed longer durations than those in the control group, respectively (P < 0.05). As for the lifting behavior, phase 2 of the 2.5% and 5% group showed a longer duration than the control group (P < 0.05). There was no significant biphasic response of favoring in each group. CONCLUSIONS: Our findings indicate that the formalin concentration (2.5% or higher) plays an important role in inducing the biphasic response. Flinching and licking were the more spontaneous and robust biphasic parameters. In both phases, flinching was robust for 5% formalin.

Unilateral Cervical Sympathectomy Attenuates Hypertensive Responses Induced by Intracerebroventricular Administration of Choline in Rats / 대한마취과학회지

BACKGROUND: Brain acetylcholine is an important neurotransmitter in the control of blood pressure. Pharmacological activation of central cholinergic receptors by intracerebroventricular (ICV) administration of choline resulted in a marked pressure response in hypotensive experimental models, and the pressure response was associated with an increase in plasma vasopressin levels. The aim of this study was to determine whether a unilateral cervical sympathectomy affects the pressure response induced by ICV choline. METHODS: Rats were prepared with a cervical sympathectomy or with a sham operation and a 23 G cannula was implanted into the lateral cerebral ventricle. They were divided into three groups according to the pre-treated condition and the solution injected into the lateral cerebral ventricle; group 1 (ICV saline after sham operation), group 2 (ICV choline after sham operation), group 3 (ICV choline after cervical sympathectomy). Following the recovery period, pressure response was monitored for 50 min after injecting ICV choline or saline and plasma vasopressin levels were also assessed with an EIA kit at preinjection time, 10 min, and 50 min after ICV injection. RESULTS: The baseline systolic blood pressure was 120.6 +/- 3.9 mmHg in group 3 and 121.7 +/- 9.0 mmHg in group 2 and there was no significant difference. The pressure response to ICV choline became evident within 1 min and reached a maximum magnitude in 10 min in both groups. Compared to the sham operated rats (group 2), the pressure response to ICV choline was significantly attenuated in sympathectomized rats (p < 0.05). However, the plasma vasopressin levels were not significantly affected by ICV choline or a cervical sympathectomy. CONCLUSIONS: While the unilateral cervical sympathectomy itself did not have any effect on bloodpressure, it attenuated the pressure response to ICV choline. A unilateral cervical sympathectomy may attenuate the hypertensive response which is caused by an increased central cholinergic neurotransmission.

The Effects of Small Intravenous Doses of Midazolam on Explicit Recall and the Bispectral Index after Fetal Expulsion in a Cesarean Section under General Anesthesia / 대한마취과학회지

BACKGROUND: Explicit recall in a cesarean section under general anaesthesia can be a terrifying experience and may cause psychological sequelae. Administering low doses of midazolam, we investigated the changes of the bispectral index (BIS) and the occurrence of explicit recall of specific events after fetal expulsion in a cesarean section under general anesthesia. METHODS: The investigation was carried out on 30 ASA 1 or 2 parturients who underwent a cesarean section under general anesthesia. Anesthesia was maintained with 50% N2O in oxygen and 0.75% of isflurane. We randomly allocated parturients into a control group (n = 10), group A (n = 10), and B (n = 10). Neither midazolam nor any other drugs except oxytocin were administered in the control group. In the group A and B, midazolam 0.02 and 0.03 mg/kg respectively, were injected immediately after umbilical cord clamping. An isolated forearm test were done to all the parturients at 5, 10, and 20 minutes after fetal expulsion. We assessed the changes of the BIS at 1, 2, 3, 4, 5, 10, 15, and 20 minutes after fetal expulsion, at discontinuance of isoflurane administration and extubation. The wav file, "clench your left or right hand" was binaurally played, simultaneously with the isolated forearm test. The wav file, "one, two, three, four, five" was also binaurally played 15 minutes after fetal expulsion. We interviewed all the parturients the next day and assessed the occurrence of explicit recall. RESULTS: The BIS values after fetal expulsion in the control group and group A was maintanied above 60 and group B, below 60 (P < 0.05). The lowest median BIS value was 54.5 in the group A, 36.4 in the group B (P < 0.05). There were two parturients in the control group and in the group A, respectively, who showed explicit recall. The results of the isolated forearm test were negative for all groups. The extubation times and PAR scores failed to show significant differences among the three groups. CONCLUSIONS: The authors confirmed the occurrence of explicit recall for specific events after fetal expulsion. The BIS values after fetal expulsion could be maintained below 60 until the end of surgery,and explicit recall could be prevented when we injected midazolam 0.03 mg/kg immediately after fetal expulsion.

The Effect of Simultaneous and Alternative Cardioplegia Delivery on Right Ventricular Preservation in Patients Undergoing Right Coronary Artery Bypass Graft Surgery / 대한마취과학회지

BACKGROUND: Most surgeons prefer delivering cardioplegia alternatively via the aortic root and coronary sinus in patients undergoing coronary artery bypass graft surgery (CABG). Recently, some surgeons have delivered cardioplegia via the grafted vessel to the obstructed right coronary artery in order to preserve right ventricular function whenever retrograde cardioplegia is delivered. Thus, we have compared the effect on right ventricular preservation between the aforementioned two methods after cardiopulmonary bypass in patients undergoing a right CABG. METHODS: Twenty-eight patients undergoing an elective CABG with significant right coronary artery obstructive disease were allocated into 2 groups. In the alternative cardioplegia delivery group (A-group), cold blood cardioplegia was delivered via the aortic root and coronary sinus alternatively. In the simultaneous cardioplegia delivery group (S-group), cold blood cardioplegia was delivered via the coronary sinus and grafted vessel to the obstructed right coronary artery simultaneously. Hemodynamic measurements were obtained pre-bypass, at pericardial closure and at sternal closure. Data recorded included right ventricular ejection fraction, right ventricular volume index and right and left ventricular hemodynamics. RESULTS: There was no significant difference in the right ventricular ejection fraction between the two groups at pre-bypass, pericardial closure and sternal closure. In both groups, the right ventricular ejection fraction and cardiac index were not decreased, and the left ventricular ejection fraction was higher at pericardial closure than pre-bypass. However, in both groups, there was a decrease in the right andleft ventricular stroke work index and right ventricular stroke volume index at sternal closure. CONCLUSIONS: We have concluded that simultaneous cardioplegia delivery via the coronary sinus and grafted vessel to the obstructed right coronary artery was not superior to the alternative cardioplegia delivery via the aortic root and coronary sinus for preservation of right ventricular function in patients undergoing a right CABG.

Changes of Pulmonary Artery Pressure during Liver Transplantation / 대한마취과학회지

BACKGROUND: Pulmonary hypertension (PH) associated with end stage liver disease is rare but the risk of hemodynamic deterioration during liver transplantation may be high. This study was done to characterize the pulmonary hemodynamics during liver transplantation and to seek the relationship between pulmonary artery pressure (PAP) and other hemodynamic variables. METHODS: One hundred patients undergoing liver transplantation were chosen and we divided patients into normal and PH groups (mean pulmonary artery pressure [MPAP] > 25 mmHg). Hemodynamic data was collected throughout the surgery. Studied variables between groups were analyzed with an unpaired t-test. The relationship between MPAP and other hemodynamic variables was analyzed with a linear regression test. Survival analysis was performed by cumulative survival analysis (Logrank test). RESULTS: Incidence of PH during liver transplantation was 34%, and true PH (pulmonary vascular resistance index [PVRI] > 150 dyne.sec/cm5/m2, MPAP > 25 mmHg) was 7%. MPAP, systemic vascular resistance index, cardiac index, right ventricular ejection fraction, maximum elastance, central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), and right ventricular end-diastolic volume index were significantly higher in the PH group. In the PH group, right ventricular function curve was abnormal. MPAP correlated significantly with PAOP, and CVP (P < 0.01). One year survival rate showed no significant difference between groups (Logrank test P = 0.49). CONCLUSIONS: Episodes of increased pulmonary artery pressure during liver transplantation was not infrequent. PAP was more dependent on preloads. In patients with high PAP, RV diastolic dysfunction was usually observed. Early mortality rate after liver transplantation was not associated with PH.

Role of Perfusion Pressure in Major Organ Blood Flow during Cardiopulmonary Bypass in Canines / 대한마취과학회지

BACKGROUND: There has been no report about the effects of blood pressure (BP) on the change of blood flow (BF) to major organs when pump flow is maintained during cardiopulmonary bypass (CPB). We evaluated the changes of the BF and oxygen consumption of major organs when BP was controlled by vasopressors or vasodilators during CPB. METHODS: Carotid, femoral, hepatic and renal arteries and veins were exposed and arteries were cannulated for pressure monitoring, except the hepatic artery and arteries on the opposite side were exposed for the measurement of BF in 7 dogs. Temperature was lowered to 30oC after initiation of CPB and phenylephrine or sodium nitroprusside was infused to increase or decrease BP about 30% under the same pump flow. BP and BF were measured before CPB, before the infusion of drugs and when BP was changed by vasoactive drugs. Blood gas analyses were performed from the artery and each vein while the BF was measured. RESULTS: The change of BP didn't affect carotid and renal BF. However, hepatic BF decreased about 50% when BP was reduced and femoral BF changed in the opposite way of BP change. Oxygen consumption of each organ wasn't influenced by BP. CONCLSIONS: When pump flow was constantly maintained, changes in BP redistributed BF to major organs but didn't affect oxygen consumption. The brain and kidney have the ability of autoregulation of BF unlike the liver or legs. Hepatic BF was dependent on perfusion pressure and a decrease in BP by vasodilators during CPB may be not good for the liver.

The Effect of Epidural Anesthesia on Coagulation Following Vascular Surgery in Patients with Arteriosclerosis Obliterance / 대한마취과학회지

BACKGROUND: The purpose of this study was to examine the relationship of epidural anesthesia with coagulation status and surgery outcome following lower extremity revascularization. METHODS: Twenty patients with arteriosclerosis obliterance (ASO) scheduled for lower extremity vascular reconstruction were randomized to receive either general anesthesia or combined general-epidural anesthesia. An additional 20 randomly selected patients without atherosclerotic vascular disease undergoing lower abdominal or lower extremity surgery served as controls for coagulation status. In the group with general anesthesia, anesthesia was induced by administration of pentothal sodium and succinylcholine and maintained with N2O-O2, isoflurane and vecuronium. In the group with combined anesthesia, epidural anesthesia was performed at the level of L2-3 or L3-4 epidural space using 2% lidocaine, followed by general anesthesia same as general group. Postoperative pain control was followed by on-demand oral or intravenous narcotics in the general group and followed by epidural 0.125% bupivacaine and morphine in the combined group. The coagulation status was monitored using thrombelastography (TEG) and standard coagulation tests. RESULTS: The ASO patients were hypercoagulable compared to the control patients before operation and on the first postoperative day. The hypercoagulability was attenuated postoperatively in the combined group. In the ASO-general group, postoperative MA, alpha and TEG index were 69.5 +/- 6.1 mm, 53.3 +/- 7.5 degree and 1.18 1.29 respectively, but in the ASO-combined anesthesia group, they were 58.0 +/- 6.2 mm, 38.0 +/- 4.0 degree and - 0.38 +/- 1.20 respectively (P < 0.05). The rates of postoperative complications did not significantly differ between the two groups. CONCLUSIONS: In patients with arteriosclerosis obliterance undergoing arterial reconstructive surgery, thrombelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and epidural anesthesia is associated with beneficial effects on coagulation status.

Reliability of Noninvasive Measurement of Cardiac Output Using Partial CO2 Rebreathing: A Comparison with Thermodilution Method / 대한마취과학회지

BACKGROUND: A noninvasive method for estimating cardiac output was tested in dogs. The technique is based on a differential CO2 Fick equation applied during normal ventilation and 50 seconds of partial rebreathing using additional dead space. We compared the cardiac output measured by the CO2 rebreathing method vs. the thermodilution technique. METHODS: Seven mongrel-dogs (24.6 +/- 0.4 kg) were studied, anesthesia was induced and maintained with a pentobarbital 25 mg/kg IV bolus injection followed by an infusion of 5 mg/kg/h. Mechanical ventilation was accomplished with a Servo 900C ventilator with FiO2 0.6 to maintain normocarbia. A fiberoptic pulmonary artery catheter was introduced via an external jugular vein for continuous monitoring of the cardiac output by the thermodilution method. Also cardiac output was measured by using partial CO2 rebreathing method. A continuous infusion of 0.5% bupivacaine was started at 0.5 mg/kg/min via the venous infusion port of the pulmonary catheter. Bupivacaine was infused continuously until mean arterial pressure decreased to 60 mmHg or less for at least 5 seconds. RESULTS: The total measured cardiac outputs (n = 72) were distributed over the range of 1.03-7.72 L/min by thermodilution method and 1.6-7.3 L/min by CO2 rebreathing. The correlation coefficients between both cardiac outputs was 0.6, the mean difference was 0.27 +/- 0.81 L/min. CONCLUSIONS: The cardiac output measured by CO2 rebreathing method was well correlated with cardiac output by thermodilution method.

Evaluation of Coagulation Function in Hip Replacement Arthroplasty Using Thromboelastography / 대한마취과학회지

BACKGROUND: Hip replacement arthroplasty is highly traumatic and may be associated with serious perioperative cardiorespiratory and vascular complications. Bone traumatization induces activation of the hemostatic system. A method of assessment of hemostatic function with whole blood is thromboelastography (TEG), which is a sensitive indicator of platelet interreaction with protein coagulation cascade. The authors investigated the effect of bone cement on blood coagulation during hip arthroplasty by TEG. METHODS: Sixty patients scheduled for hip replacement arthroplasty were randomly allocated to either a noncemented group (n = 35) or cemented group (n = 25). All the patients were operated on under general anesthesia. Collected 0.36 ml blood samples were measured by TEG from 210 seconds to 270 seconds after sampling. TEG parameters were measured at preoperation, before and after bone cement insertion (before and after reaming in the noncemented group), at postoperative 6, 24 hours in both groups. RESULTS: There were no significant changes of r, k, alpha angle, MA and Ly60 irrespective of the use of bone cement. Also, in the cemented group, there were no significant changes in TEG measurements between before and after bone cement insertion. However, there were increase in MA and alpha angle at postoperative 6 hours compared with preoperation irrespective of the use of bone cement. CONCLUSIONS: This study reveals that there are no differences between fixation with and without bone cement in the activation of the cascade systems by hip replacement arthroplasty.

Arterial Blood Lactate Concentrations as a Prognostic Predictor in Critically Ill Patients: in Comparison with APACHE II Scores / 대한마취과학회지

BACKGROUND: Disordered lactate metabolism which is due to tissue hypoxia and hypoperfusion is frequently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ failure. The present study was designed to evaluate the prognostic value of blood lactate as a determinant of mortality in comparison with the APACHE II score. METHODS: 29 adult ICU patients participated in this study. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE II scores were collected on the first and last days of ICU stay. These data were compared between survivor and non-survivor groups. RESULTS: On the day of admission, blood lactate concentrations and APACHE II scores of non-survivors were 48.5 +/- 27.0 mg/dl and 18.5 +/- 5.9, while those of survivors were 23.7 +/- 12.9 mg/dl and 6.7 3.1. On the day of discharge, arterial blood lactate concentrations and APACHE II scores of non-survivors were 143.2 +/- 54.0 mg/dl and 28.2 +/- 6.0, while those of survivors were 14.9 +/- 7.1 mg/dl and 4.7 +/- 2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concentration and APACHE II score. Furthermore, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients with an initial arterial blood lactate concentration higher than 40 mg/dl. CONCLUSIONS: The result shows that arterial blood lactate concentration can serve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients.