Effects of Female Hormones and the Menstrual Cycle on Postoperative Pain / 대한마취과학회지

BACKGOUND: This study was designed to examine the effects of female hormones and the menstrual cycle on postoperative pain. METHODS: Ninety women who underwent gynecologic surgery involving a lower abdominal incision were asked for information regarding their menstrual cycles, and blood samples were obtained to determine the progesterone and estrogen levels of the patients at the time of surgery. Patient controlled analgesia was applied to control postoperative pain and an estimate of the consumption of analgesic drugs by the patients was made. Analgesic consumption and pain scores were recorded at 2, 24, and 48 hours after operation. RESULTS: There was no relationship observed between the concentration of progesterone and estrogen and the consumption of analgesic drugs. However, patients that were in the luteal phase at the time of surgery consumed a significantly lower amount of analgesic drugs during the 2-24 hours following surgery than patients that were in the follicular phase (19.4 +/- 6.5 ml vs 24.6 +/- 11.0 ml, P < 0.05), Theree was, no significant difference in pain scores between two menstrual phases. CONCLUSIONS: This study demonstrates that there is less postoperative pain experienced by patients that are in the luteal phase of their menstrual cycle at the time of surgery than in patients that were in the follicular phase of their menstrual cycle, however, the results of this study did not reveal a relationship between the blood concentration of female hormones and postoperative pain.

Preoperative Assessment of Coagulation Profiles Using a Thromboelastography in Patients with Chronic Renal Failure / 대한마취과학회지

BACKGROUND: Patients with chronic renal failure traditionally have been recognized as being at risk for perioperative bleeding diathesis. However, there has been a few reports that chronic renal failure patients showed a hypercoagulability. The purpose of this study was to assess blood coagulation profiles in patients with chronic renal failure using a thromboelastography. METHODS: Thirty patients (ASA physical status, 2 and 3) with chronic renal failure (experimental group), were scheduled to get presenting for an arteriovenous fistula formation, and 30 patients with normal renal function (control group) were randomly selected. Blood sampling for a thromboelastography was performed prior to induction of anesthesia. A thromboelastography was analyzed by measuring R time, K time, maximum amplitude (MA), alpha degree, and TEG index. Laboratory tests including serum blood urea nitrogen, creatinine, hematologic data (hemoglobin, hematocrit, platelet count), and coagulation data (PT, PT-INR, aPTT, BT) were also measured in all patients preoperatively. RESULTS: In the thromboelastographic indices, K time was significantly decreased and MA, alpha angle, and TEG index were significantly increased in patients with chronic renal failure (experimental group) compared with the control group (P<0.05). However, there were no significant differences of PT, PT-INR, aPTT, BT between the groups. CONCLUSIONS: Thromboelastographic data demonstrates a hypercoagulable state in patients with chronic renal failure. This finding suggests that traditional concern for bleeding diathesis in patients with chronic renal failure may require reassessment.