The effect of newly designed dual-channel elastomeric pump for intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomized, double-blind, prospective study.

BACKGROUND: A newly designed intravenous patient-controlled analgesia (PCA) device with a dual-channel elastomeric infusion pump has been recently introduced. One channel is a continuous line with a constant flow rate basal infusion, while the other channel has an adjustable flow rate and bolus function and is labeled as a selector-bolus channel. This study compared dual and single-channel intravenous PCA in terms of clinical effect and quality of recovery. METHODS: Eighty-four patients undergoing total laparoscopic hysterectomy were randomly allocated to a 1-channel group (n = 41) or a 2-channel group (n = 43). Only the selector-bolus channel was utilized, but the continuous channel was not utilized in the 1-channel group, but both channels were utilized in the 2-channel group. In the 1-channel group, 16 µg/kg of fentanyl, 2 mg/kg of ketorolac, and 12 mg of ondansetron with normal saline were administered to the selector-bolus channel and normal saline only in the continuous channel for blinding. In the 2-channel group, 16 µg/kg of fentanyl was administered to the selector-bolus channel, and ketorolac (2 mg/kg) and ondansetron (12 mg) were administered via the continuous channel. The quality of recovery was evaluated preoperatively and 24 h postoperatively using the Quality of Recovery-40 (QoR-40). Cumulative PCA consumption, postoperative pain rated using the numeric rating scale (NRS; during rest/cough), and postoperative nausea were evaluated 6, 12, 24, 36, and 48 h after surgery. Incidence of vomiting and use of antiemetics and rescue analgesics was measured. RESULTS: The 24-h postoperative QoR-40 score was higher in the 2-channel group than in the 1-channel group (P=0.031). The incidence of nausea at 12 h and 36 h was significantly higher in the 1-channel group (P=0.043 and 0.040, respectively), and antiemetic use was more frequent in the 1-channel group (P=0.049). Patient satisfaction was higher in the 2-channel group (P=0.036). No significant differences were observed in pain scores during resting/cough or cumulative PCA consumption. CONCLUSIONS: The 2-channel PCA showed better patient satisfaction with higher QoR-40 during the recovery compared with the 1-channel PCA. Better satisfaction was associated with lower nausea and reduced rescue antiemetics by maintaining the infusion of adjuvant analgesic agents and antiemetic agents constantly by utilizing dual channels. TRIAL REGISTRATION: Registered at ClinicalTrials.gov , NCT04082039 on 9 September 2019.

Concomitant ultrasound-guided intra-gestational sac methotrexate-potassium chloride and systemic methotrexate injection in the recurrent cesarean scar pregnancy.

Recurrent ectopic pregnancy of cesarean scar is very rare and its therapeutic management is still not established. We reported the first case of recurrent cesarean scar pregnancy that was successfully treated with concomitant intra-gestational sac methotrexate-potassium chloride injection and systemic methotrexate injection. This case study provides physicians with a safe and effective minimally invasive treatment option for recurrent cesarean scar pregnancy.

Vasomotor symptoms and the homeostatic model assessment of insulin-resistance in Korean postmenopausal women.

The aim of this cross-sectional study was to evaluate the association between vasomotor symptoms (VMS) and insulin resistance, which can be postulated by the homeostatic model assessment (HOMA) index. This study involved 1,547 Korean postmenopausal women (age, 45 to 65 years) attending a routine health check-up at a single institution in Korea from January 2010 to December 2012. A menopause rating scale questionnaire was used to assess the severity of VMS. The mean age of participants was 55.22±4.8 years and 885 (57.2%) reported VMS in some degree. The mean HOMA index was 1.79±0.96, and the HOMA index increased with an increase in severity of VMS (none, mild, moderate and severe) in logistic regression analysis (ß=0.068, t=2.665, P =0.008). Insulin resistance needs to be considered to understand the linkage between VMS and cardiometabolic disorders.

Vasomotor symptoms and metabolic syndrome in Korean postmenopausal women.

OBJECTIVE: This study aims to evaluate the association between vasomotor symptoms and risk of metabolic syndrome in Korean postmenopausal women. METHODS: We carried out a cross-sectional study of 1,906 Korean postmenopausal women (aged 45-65 y) who were attending a routine health checkup at an institution in Korea from January 2010 to December 2012. To assess vasomotor symptoms, we created a dichotomous variable (none or present) using Menopause Rating Scale results. Metabolic syndrome was defined by the updated criteria of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). RESULTS: In total, 1,906 women were included in the analysis; 1,105 (58.0%) women reported some degree of vasomotor symptoms. Women with vasomotor symptoms were younger and had shorter duration of menopause, higher body mass index, larger waist circumference, more adverse lipid profile, and higher prevalence of metabolic syndrome compared with women without vasomotor symptoms. On multivariate analysis, vasomotor symptoms were associated with metabolic syndrome after adjusting for confounding factors, including age, body mass index, homeostasis model assessment of insulin resistance, duration of menopause, alcohol consumption, current smoking, and physical exercise level (odds ratio, 1.8; 95% CI, 1.3-2.4; P < 0.001). CONCLUSIONS: The presence of vasomotor symptoms is associated with metabolic syndrome in Korean postmenopausal women. Lipid abnormalities and obesity seem to be important metabolic components associated with these symptoms. Vasomotor symptoms, if validated in longitudinal studies, may possibly serve as warning signs for identifying women at high risk for metabolic syndrome and cardiovascular disease.