How Do Gain-Loss Frames and Cultural Arguments Persuade? Designing Effective Messages to Weaken College Students' Binge-Drinking Intentions.

To design effective health messages, this study investigates the effects of gain-loss framing and relevant moderating effects in the context of college students' alcohol use. Specifically, based on an online experiment, we tested the moderation effects of message-sidedness and binge-drinking behaviors using a mediation model in which the association between gain-loss framing and behavioral intentions is mediated by attitudes toward binge-drinking. Four hundred thirty-four Korean college students participated in this study. Hayes' PROCESS Macro for SPSS was employed for the analysis. The results show that loss-framing significantly increased participants' unfavorable attitudes toward binge-drinking in the one-sided message condition. Moreover, attitudes toward binge-drinking were more significantly associated with behavioral intentions to binge-drink among heavy drinkers than among non-heavy drinkers. Our findings suggest important theoretical and practical implications for the development of message-framing strategies in health campaigns designed to prevent college students' binge-drinking in collectivistic societies where the cultural meaning of drinking extends beyond the individual realm to the larger social context.

Physicians' Perspectives on AI in Clinical Decision Support Systems: Interview Study of the CURATE.AI Personalized Dose Optimization Platform.

BACKGROUND: Physicians play a key role in integrating new clinical technology into care practices through user feedback and growth propositions to developers of the technology. As physicians are stakeholders involved through the technology iteration process, understanding their roles as users can provide nuanced insights into the workings of these technologies that are being explored. Therefore, understanding physicians' perceptions can be critical toward clinical validation, implementation, and downstream adoption. Given the increasing prevalence of clinical decision support systems (CDSSs), there remains a need to gain an in-depth understanding of physicians' perceptions and expectations toward their downstream implementation. This paper explores physicians' perceptions of integrating CURATE.AI, a novel artificial intelligence (AI)-based and clinical stage personalized dosing CDSSs, into clinical practice. OBJECTIVE: This study aims to understand physicians' perspectives of integrating CURATE.AI for clinical work and to gather insights on considerations of the implementation of AI-based CDSS tools. METHODS: A total of 12 participants completed semistructured interviews examining their knowledge, experience, attitudes, risks, and future course of the personalized combination therapy dosing platform, CURATE.AI. Interviews were audio recorded, transcribed verbatim, and coded manually. The data were thematically analyzed. RESULTS: Overall, 3 broad themes and 9 subthemes were identified through thematic analysis. The themes covered considerations that physicians perceived as significant across various stages of new technology development, including trial, clinical implementation, and mass adoption. CONCLUSIONS: The study laid out the various ways physicians interpreted an AI-based personalized dosing CDSS, CURATE.AI, for their clinical practice. The research pointed out that physicians' expectations during the different stages of technology exploration can be nuanced and layered with expectations of implementation that are relevant for technology developers and researchers.

Use of Internet Memes in PSAs: Roles of Perceived Emotion, Involvement with Memes, and Attitudes Toward the Issuing Organization in Perceived PSA Effectiveness.

To help solve the diabetes problem in Singapore, we developed humorous and fearful public service announcements (PSAs) based on popular Internet memes and investigated how the emotions derived from PSAs affect Singaporean millennials' perceptions of PSAs' effectiveness. In total, 416 people participated in the study through a Singaporean online survey company. Multivariable linear regression methods with SPSS were used to examine our hypotheses and research questions. According to the results, message manipulation significantly increased participants' perceived emotion (i.e. perceived humor and fear). Moreover, the results showed that perceived humor and fear were positively associated with perceived PSA effectiveness in both models, testing the humor effect and fear effect separately. As per the moderation analysis, the association between the perceived emotion (i.e. humor and fear) and the perceived PSA effectiveness is likely to increase when attitudes toward the organization are less positive. Moreover, the association between perceived fear and perceived PSA effectiveness is likely to increase when participants' involvement with memes is low. Our findings highlight important theoretical and practical implications for future studies investigating the effectiveness of Internet meme-based PSA messages regarding serious health issues.

The role of uncertainty and affect in decision-making on the adoption of AI-based contact-tracing technology during the COVID-19 pandemic.

Objective: This study explores how negative affect, perceived net equity, and uncertainty influence the public's privacy decision-making regarding the adoption of contact-tracing technology based on artificial intelligence (AI) during the COVID-19 pandemic. Methods: Four hundred and eighteen adults in the US participated in the study via Amazon Mechanical Turk in August 2020. Statistical analyses were performed using the PROCESS macro. Indirect effects and their significance were estimated using bias-corrected bootstrap confidence intervals (CIs) with resampling set to n = 5000. Results: Perceived net equity was positively associated with low levels of perceived uncertainty regarding a COVID-19 contact-tracing application and intention to adopt it. Low levels of perceived uncertainty were positively associated with intentions to adopt such an application, thereby suggesting that a perceived level of uncertainty mediates the association between perceived net equity and adoption intentions. Anxieties regarding AI technology and COVID-19 risks both moderate the associations among perceived net equity, perceived level of uncertainty, and intentions to adopt the contact-tracing technology. Conclusions: Our findings highlight how the differing sources of emotion influence the associations among rational judgment, perceptions, and decision-making about new contact-tracing technology. Overall, the results suggest that both rational judgments and affective reactions to risks are important influencers of individuals' perceptions and privacy-related decision-making regarding a new health technology during the pandemic.

Relationship of Exposure to Contradictory Information and Information Insufficiency to Decision-Making About HPV Vaccination Among South Korean College Women.

In this study, we investigated how exposure to contradictory messages about the human papillomavirus (HPV) vaccine affects female South Korean college students' vaccination decisions. Specifically, we focused on the relationship between exposure to contradictory messages, current knowledge, and information insufficiency that may affect participants' confusion and decision-making about vaccination. A percentile bootstrap method and pairwise comparison tests in structural equation modeling were employed. Exposure to contradictory messages significantly and negatively affected current knowledge of the HPV vaccine. Although current knowledge significantly and negatively affected confusion around the vaccine, information insufficiency failed to predict it. The vaccine confusion significantly and positively affected decisional conflicts, which, in turn, decreased the behavioral intentions to vaccinate. Additionally, the results showed how the participants' altruistic orientations and perceived stigma moderated the associations among the variables. The findings have theoretical and practical implications for future research investigating the effects of vaccine-related information on young adult women's decision-making about vaccination, particularly in cultural contexts where the HPV vaccine uptake rates are low.

Privacy Management and Health Information Sharing via Contact Tracing during the COVID-19 Pandemic: A Hypothetical Study on AI-Based Technologies.

In this study, we extended and tested the privacy calculus framework in the context of a hypothetical AI-based contact-tracing technology for application during the COVID-19 pandemic that is based on the communication privacy management and contextual integrity theories. Specifically, we investigated how the perceived privacy risks and benefits of information disclosure affect the public's willingness to opt in and adopt contact-tracing technologies and how social and contextual factors influence their decision-making process. Four hundred eighteen adults in the United States participated in the study via Amazon Mechanical Turk in August 2020. A percentile bootstrap method with 5,000 resamples and bias-corrected 95% confidence intervals in structural equation modeling was used for data analysis. The participants' privacy concerns and perceived benefits significantly influenced their opt-in and adoption intentions, which suggests that the privacy calculus framework applies to the context of COVID-19 contact-tracing technologies. Perceived social, personal, and reciprocal benefits were identified as crucial mediators that link contextual variables to both opt-in and adoption intentions. Although this study was based on a hypothetical AI-based contact-tracing app, our findings provide meaningful theoretical and practical implications for future research investigating the public's technology adoption in contexts where tradeoffs between privacy risks and public health coexist.

Relationships of Family History-related Factors and Causal Beliefs to Cancer Risk Perception and Mammography Screening Adherence Among Medically Underserved Women.

This study examines how family history-related factors and causal beliefs affect underserved women's cancer risk perceptions and adherence to mammography. 1,010 patients at a primary care safety net clinic at a large urban hospital completed a survey in 2015. Of the 1,010 patients, 467 women 45 years of age or older were included in this analysis. The majority of participants were African American (68%). We built multivariable linear and logistic regression models to examine the dependent variables of cancer risk perception and mammography screening adherence. According to the results, those with a family history of cancer were significantly more likely to be adherent to mammography. Perceived importance of family health history also significantly predicted their mammography screening adherence. However, cancer risk perceptions did not predict underserved women's mammography adherence. Significant interaction effects on the associations 1) between family cancer history, cancer risk perceptions, and mammography screening adherence and 2) between race, behavioral causal beliefs, and risk perceptions were found. Findings suggest that implementing different strategies across racial groups and by cancer history may be necessary to promote regular mammography screening.

Uncertainty in the Process of Communicating Cancer-related Genetic Risk Information with Patients: A Scoping Review.

In the era of precision medicine, patients must manage the uncertainty caused by ambiguous genetic information. To aid health practitioners in effectively communicating genetic information, this study classified the types of uncertainty involved in these communication processes. A search of recent literature turned up 64 articles that measured and/or discussed patients' perceptions and/or feelings of uncertainty related to the communication process of cancer-related genetic information. In reviewing these papers, six types of uncertainty regarding cancer-related genetic information were identified: (1) uncertainty about understanding genetic information (n = 25; 39.1%); (2) uncertainty about future cancer risks (n = 34; 53.1%); (3) uncertainty about managing known genetic information or mutation status (n = 33; 51.6%); (4) uncertainty about the utility of genetic information (n = 5; 7.8%); (5) uncertainty about genetic test results before undergoing testing or receiving the results (n = 10; 15.6%); and (6) uncertainty about the impact of genetic results on family and life (n = 11; 17.2%). These six types of uncertainty serve as a helpful taxonomy for developing, validating, and utilizing future measures of uncertainty in the context of cancer-related genetic risk communication.

Relationships of health information orientation and cancer history on preferences for consent and control over biospecimens in a biobank: A race-stratified analysis.

In this study, we investigated how patients' self-reported health information efficacy, relationship with health providers, and cancer history are associated with their preferences for informed consent and need for control over biobank biospecimens. We recruited 358 women aged 40 and older (56% African American; 44% European American) and analyzed the data using multivariable regression models. Results show that African American participants' health information efficacy was significantly and negatively associated with their need for control over biospecimens and preference for a study-specific model. European American participants' dependency on doctors was a significant and negative predictor of their preference for a study-specific model. Several significant interaction effects, which varied across races, were found with regard to health information efficacy, personal cancer history, need for control, and preference for a study-specific model. The study findings suggest it is important to consider health information efficacy, relationship with providers, and need for control when developing large diverse biobanks.

Race, Trust in Doctors, Privacy Concerns, and Consent Preferences for Biobanks.

This study investigates how patients' privacy concerns about research uses of biospecimen and trust in doctors are associated with their preferences for informed consent and need for control over biospecimens in a biobank. Particularly, this study focuses on the perspectives of Communication Privacy Management theory, precision medicine, and racial health disparities. We recruited 358 women aged 40 and older stratified by race (56% African American and 44% European American). Multivariable linear regression models examined hypothesis and research questions. Individuals' privacy concerns and trust in doctors were significantly associated with their need for control. Although participants' privacy concerns were positively associated with their preference for study-specific model, trust in doctors had no effect on the preference. African American participants needed more control over their sample and were more likely to prefer study-specific model compared to European American participants. Significant interactions by race on the associations between trust and need for control and between privacy concerns and preference for study-specific model were found. These findings suggest that when developing large diverse biobanks for future studies it is important to consider privacy concerns, trust, and need for control with an understanding that there are differences in preferences by race.

Health communication roles in Latino, Pacific Islander, and Caucasian Families: A qualitative investigation.

Family communication about health is critical for the dissemination of information that may improve health management of all family members. Communication about health issues, attitudes, and behaviors in families is associated with life expectancy as well as quality of life for family members. This study addresses family communication about health by examining individual roles for family health communication and factors related to these roles, among families of three different racial/ethnic groups: Caucasians, Latinos, and Pacific Islanders. Data were collected from 60 participants recruited as 30 family dyads, 10 from each group, through qualitative semistructured interviews. Interviews were conducted with each participant separately and then together in a dyadic interview. Two coders independently coded interview transcripts using NVivo 11. Results identified the family health communication roles of collector, disseminator, health educator, and researcher. We also identified several factors related to these roles using the lens of family systems theory-the presence of chronic conditions in the family, previous experience, medical education, and family hierarchy. Findings demonstrate many similarities and relatively few differences in the family health communication roles and the related factors among the families of different race/ethnicity. Conclusions highlight implications for future research and intervention development.

Factors affecting breast cancer patients' need for genetic risk information: From information insufficiency to information need.

Information-seeking models typically focus on information-seeking behaviors based on individuals' interest in information, because their current level is perceived to be insufficient. In the context of genetic risk information (GRI), however, information insufficiency is difficult to measure and thus can limit understanding of information behavior in the context of GRI. We propose that an individual's need for information might be a more direct and conceptually clearer alternative to predicting their information-seeking behavior. To test this hypothesis, this study investigates the extent to which previously identified factors affecting interest in GRI are also predictors of need for GRI among women diagnosed with breast cancer at the age of 40 or younger (N = 1,069). As hypothesized, there was a positive association between interest in and need for GRI. Furthermore, hypothesized factors of numeracy, information orientation, and genetic knowledge were significant predictors of increased interest in and need for GRI. In contrast, hypothesized factors of genetic worry and genetic causal belief predicted increased interest in GRI only, while genetic self-efficacy predicted increased need for GRI only. As hypothesized, BRCA status significantly moderated associations between informational norm and both interest in and need for GRI. Collectively, the findings support inclusion of need for GRI in theoretical information-seeking models in the context of genomic risk.

Cross-Cultural Differences in the Influences of Spiritual and Religious Tendencies on Beliefs in Genetic Determinism and Family Health History Communication: A Teleological Approach.

Adopting a teleological approach, this study investigates how beliefs in genetic determinism, intentional spirituality, and religious tendencies are associated with family health history (FHH) communication among European American, Chinese, and Korean college students. The results indicate that intentional spirituality was negatively associated with beliefs in genetic determinism and FHH communication, while beliefs in genetic determinism were positively associated with FHH communication. Intrinsic and extrinsic religiosity and paranormal beliefs showed interesting dynamics with beliefs in genetic determinism and FHH communication. An interaction effect regarding cultural identity, beliefs in genetic determinism, and FHH communication was likewise found. The findings have meaningful implications for future studies about religious influences on health behaviors.

Cancer communication research in the era of genomics and precision medicine: a scoping review.

Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010-2017) on communication of cancer-related genetic and genomic testing (CGT) information. Searches in six databases revealed 9243 unique records; 513 papers were included. Most papers utilized an observational quantitative design; fewer utilized an experimental design. More attention has been paid to outcomes of CGT results disclosure than to decision making regarding CGT uptake or the process of results disclosure. Psychosocial outcomes were most common across studies. This literature has a strong focus on BRCA1/2, with few papers focused on Lynch syndrome or next-generation technologies. Women, Caucasians, older adults, and those of higher socioeconomic status were overrepresented. Research gaps identified include the need for studies on the process of CGT communication; examining behavioral, decision making, and communication outcomes; and inclusion of diverse populations. Addressing these gaps can help improve the use of genomics in cancer control and reduce disparities in access to and use of CGT.

Amitriptyline inhibits the MAPK/ERK and CREB pathways and proinflammatory cytokines through A3AR activation in rat neuropathic pain models / 대한마취과학회지

BACKGROUND: The pain-relief properties of tricyclic antidepressants can be attributed to several actions. Recent observations suggest that adenosine is involved in the antinociceptive effect of amitriptyline. The A3 adenosine receptor (A3AR) is the only adenosine subtype overexpressed in inflammatory and cancer cells. This study was performed to investigate the role of A3AR in the anti-nociceptive effect of amitriptyline. METHODS: Spinal nerve-ligated neuropathic pain was induced by ligating the L5 and L6 spinal nerves of male Sprague-Dawley rats. The neuropathic rats were randomly assigned to one of the following three groups (8 per group): a neuropathic pain with normal saline group, a neuropathic pain with amitriptyline group, and a neuropathic pain with amitriptyline and 3-ethyl-5-benzyl- 2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS) group. Amitriptyline or saline was administered intraperitoneally and 3-ethyl-5-benzyl-2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS-1191), an A3AR antagonist, was injected subcutaneously immediately before amitriptyline administration. The level of extracellular signal-regulated kinase P44/42 (ERK1/2), cyclic AMP response element-binding protein (CREB), and proinflammatory cytokines were assessed using immunoblotting or reverse-transciption polymerase chain reaction. RESULTS: Amitriptyline increased the mechanical withdrawal threshold of the neuropathic rats. The level of phospho-ERK1/2 and phospho-CREB proteins, and proinflammatory cytokines produced by spinal nerve ligation were significantly reduced by amitriptyline administration. However, the use of MRS-1191 before amitriptyline administration not only reduced the threshold of mechanical allodynia, but also increased the signaling protein and proinflammatory cytokine levels, which were reduced by amitriptyline. CONCLUSIONS: The results of this study suggest that the anti-nociceptive effect of amitriptyline involves the suppression of ERK1/2 and CREB signaling proteins, and A3AR activation also affects the alleviation of the inflammatory response.

Amitriptyline inhibits the MAPK/ERK and CREB pathways and proinflammatory cytokines through A3AR activation in rat neuropathic pain models / 대한마취과학회지

BACKGROUND@#The pain-relief properties of tricyclic antidepressants can be attributed to several actions. Recent observations suggest that adenosine is involved in the antinociceptive effect of amitriptyline. The A3 adenosine receptor (A3AR) is the only adenosine subtype overexpressed in inflammatory and cancer cells. This study was performed to investigate the role of A3AR in the anti-nociceptive effect of amitriptyline.@*METHODS@#Spinal nerve-ligated neuropathic pain was induced by ligating the L5 and L6 spinal nerves of male Sprague-Dawley rats. The neuropathic rats were randomly assigned to one of the following three groups (8 per group): a neuropathic pain with normal saline group, a neuropathic pain with amitriptyline group, and a neuropathic pain with amitriptyline and 3-ethyl-5-benzyl- 2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS) group. Amitriptyline or saline was administered intraperitoneally and 3-ethyl-5-benzyl-2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS-1191), an A3AR antagonist, was injected subcutaneously immediately before amitriptyline administration. The level of extracellular signal-regulated kinase P44/42 (ERK1/2), cyclic AMP response element-binding protein (CREB), and proinflammatory cytokines were assessed using immunoblotting or reverse-transciption polymerase chain reaction.@*RESULTS@#Amitriptyline increased the mechanical withdrawal threshold of the neuropathic rats. The level of phospho-ERK1/2 and phospho-CREB proteins, and proinflammatory cytokines produced by spinal nerve ligation were significantly reduced by amitriptyline administration. However, the use of MRS-1191 before amitriptyline administration not only reduced the threshold of mechanical allodynia, but also increased the signaling protein and proinflammatory cytokine levels, which were reduced by amitriptyline.@*CONCLUSIONS@#The results of this study suggest that the anti-nociceptive effect of amitriptyline involves the suppression of ERK1/2 and CREB signaling proteins, and A3AR activation also affects the alleviation of the inflammatory response.

Gendered Cultural Identities: The Influences of Family and Privacy Boundaries, Subjective Norms, and Stigma Beliefs on Family Health History Communication.

This study investigates the effects of cultural norms on family health history (FHH) communication in the American, Chinese, and Korean cultures. More particularly, this study focuses on perceived family boundaries, subjective norms, stigma beliefs, and privacy boundaries, including age and gender, that affect people's FHH communication. For data analyses, hierarchical multiple regression and logistic regression methods were employed. The results indicate that participants' subjective norms, stigma beliefs, and perceived family/privacy boundaries were positively associated with current FHH communication. Age- and gender-related privacy boundaries were negatively related to perceived privacy boundaries, however. Finally, the results show that gendered cultural identities have three-way interaction effects on two associations: (1) between perceived family boundaries and perceived privacy boundaries and (2) between perceived privacy boundaries and current FHH communication. The findings have meaningful implications for future cross-cultural studies on the roles of family systems, subjective norms, and stigma beliefs in FHH communication.

The Effects of Remifentanil on Expression of High Mobility Group Box 1 in Septic Rats

High mobility group box 1 (HMGB1) is a pivotal mediator of sepsis progression. Remifentanil, an opioid agonist, has demonstrated anti-inflammatory effects in septic mice. However, it is not yet known whether remifentanil affects the expression of HMGB1. We investigated the effects of remifentanil on HMGB1 expression and the underlying mechanism in septic rats. Forty-eight male Sprague-Dawley rats were randomly divided into 3 groups; a sham group, a cecal ligation and puncture (CLP) group, and a CLP with remifentanil treatment (Remi) group. The rat model of CLP was used to examine plasma concentrations of proinflammatory cytokines, tissue HMGB1 mRNA and the activity of nuclear factor (NF)-κB in the liver, lungs, kidneys, and ileum. Pathologic changes and immunohistochemical staining of NF-κB in the liver, lungs, and kidneys tissue were observed. We found that remifentanil treatment suppressed the level of serum interleukin (IL)-6 and tumor necrosis factor (TNF)-α 6 hours after CLP, and serum HMGB1 24 hours after CLP. HMGB1 mRNA levels and the activity of NF-κB in multiple organs decreased by remifentanil treatment 24 hours after CLP. Remifentanil treatment also attenuated nuclear expression of NF-κB in immunohistochemical staining and mitigated pathologic changes in multiple organs. Altogether, these results suggested that remifentanil inhibited expression of HMGB1 in vital organs and release of HMGB1 into plasma. The mechanism was related to the inhibitory effect of remifentanil on the release of proinflammatory cytokines and activation of NF-κB.

The Effects of Experienced Uncertainty and Patients' Assessments of Cancer-Related Information-Seeking Experiences on Fatalistic Beliefs and Trust in Physicians.

Using the 2013 HINTS 4 Cycle 2 data representing a general population sample, this study investigates the effects of patients' experiences of uncertainty about prostate cancer during doctor-patient communication, as well as patients' positive assessments of their cancer-related information-seeking experiences, on their fatalistic beliefs regarding cancer and their trust in physicians. Our tests show significant differences in trust in physicians among men who do and do not experience uncertainty about the prostate-specific antigen (PSA) test during doctor-patient communication. The analysis also indicates that individuals with experiences of uncertainty about the PSA test are more likely than those without such experiences of uncertainty to place their trust in doctors. However, no apparent difference or association exists when there are uncertainties relating to treatment choices regarding slow-growing cancer or treatment side effects. Nevertheless, as hypothesized, individuals who positively evaluate their cancer-related information-seeking experiences are less likely to have fatalistic beliefs about cancer. Furthermore, patients' positive assessments are highly predictive of their levels of trust in their physicians. Additionally, tests of interaction effects show that individuals' levels of education moderate the association between uncertainty experiences about the PSA test and both cancer fatalism and trust in physicians. Further implications and limitations of the study are discussed.

Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control

We aimed to compare fentanyl, remifentanil and dexmedetomidine with respect to hemodynamic stability, postoperative pain control and achievement of sedation at the postanesthetic care unit (PACU). In this randomized double-blind study, 90 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive fentanyl (1.0 µg/kg) over 1 minute followed by a 0.4 µg/kg/hr infusion (FK group, n = 30), or remifentanil (1.0 µg/kg) over 1 minute followed by a 0.08 µg/kg/min infusion (RK group, n = 30), or dexmedetomidine (1 µg/kg) over 10 minutes followed by a 0.5 µg/kg/hr infusion (DK group, n = 30) initiating at the end of main procedures of the operation to the time in the PACU. A single dose of intravenous ketorolac (30 mg) was given to all patients at the end of surgery. We respectively evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs and the perioperative side effects to compare the efficacy of fentanyl, remifentanil and dexmedetomidine. Compared with other groups, the modified OAA/S scores were significantly lower in DK group at 0, 5 and 10 minutes after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different from other groups. The blood pressure and heart rate in the DK group were significantly lower than those of other groups at the PACU (P < 0.05). DK group, at sedative doses, had the better postoperative hemodynamic stability than RK group or FK group and demonstrated a similar effect of pain control as RK group and FK group with patient awareness during sedation in the PACU. (World Health Organization registry, KCT0001524).