[The influence of remifentanil on intra- and postoperative drug cost].

BACKGROUND: Intraoperative use of remifentanil requires much more analgesics postoperatively. Moreover, remifentanil causes intraoperative hypotension and bradycardia. METHODS: The objectives are to compare intra- and post-operative drug cost between patients who received remifentanil (Group R, n = 72) and those who received fentanyl (Group F, n = 66) during laparoscopic cholecystectomy retrospectively. RESULTS: The baseline demographics were similar between the two groups. Intraoperative drug costs were 7,782 +/- 1,579 yen in Group R and 6,235 +/- 1,037 yen in Group E Postoperative drug costs were 364 +/- 521 yen in Group R and 146 +/- 153 yen in Group E Total drug costs were 8,167 +/- 1,607 yen in Group R and 6,381 +/- 1,042 yen in Group E These reached statistical significance (P < 0.01). Length of hospital stay (days) between the two groups were comparable. CONCLUSIONS: Remifentanil anesthesia requires much more intra- and post-operative drug cost than fentanyl anesthesia for laparoscopic cholecystectomy.

[Massive subcutaneous emphysema following percutaneous tracheostomy].

Although percutaneous dilatational tracheostomy (PDT) is fast becoming the method of choice for securing an airway in chronic ventilated patients in an intensive care unit (ICU). Subcutaneous emphysema is an unusual and sometimes lethal complication which may extend the length of stay in the ICU. We report a case of massive subcutaneous emphysema without tracheal wall laceration that occurred in the ICU after PDT. An 81-year-old woman was admitted to our ICU due to infective exacerbation of chronic obstructive airways disease. Her medical therapy included nebulized bronchodilators, steroids and empirical antibiotics. Within thirty-six hours of initial endotracheal intubation PDT was performed. Several hours following the procedure, the patient developed massive subcutaneous emphysema encompassing her entire body. No pneumothorax was identified on subsequent chest X-ray. Laryngoscopic and bronchoscopic examination showed no evidence of tracheal wall laceration. We discuss the etiology and management plan for this rare complication.

Calcium phosphate cement-based vertebroplasty compared with conservative treatment for osteoporotic compression fractures: a matched case-control study.

OBJECT: Few studies have been conducted to compare vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures (OVCFs). To investigate the effects of calcium phosphate cement (CPC)-based vertebroplasty on relief of pain and augmentation of the fractured vertebral body (VB), the authors compared the results of CPC-assisted vertebroplasty with those of conservative treatment alone. METHODS: Two groups of patients were examined: the vertebroplasty group (30 consecutive patients with primary OVCF) and the control group (30 patients matched for age, sex, interval from injury to treatment, and grade of the posterior wall defects of the fractured VB). Outcome measures included the visual analog scale (VAS) score of back pain and analgesic requirements, and the radiographically documented rate of the VB kyphosis. The follow-up duration was more than 12 months (mean 17 months). The mean VAS score at 12 months after injury was 0.67 cm in the vertebroplasty group and 1.97 cm in the control group, and the mean improvement rates in the VAS scores were 91.6 and 73.6%, respectively (p < 0.0001). The mean duration of analgesic requirement was 8.3 days in the vertebroplasty group and 62.2 days in the control group (p = 0.0005). The mean kyphosis rate at 12 months after injury was 72.9% in the vertebroplasty group and 58% in the control group, and the mean recovery rate of kyphosis was +8.4 and -21%, respectively (p < 0.0001). CONCLUSIONS: The authors conclude that CPC-assisted vertebroplasty provides better clinical and radiological results than conservative treatment for primary OVCF.

Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures: risk factor analysis for cement leakage.

OBJECT: The purpose of this study was to analyze the risk factors for leakage of calcium phosphate cement (CPC) after vertebroplasty for osteoporotic vertebral fractures and to determine whether the vertebral body (VB) leakage caused any changes in the therapeutic benefits. METHODS: Between August 2000 and April 2002, the authors performed 65 CPC-assisted vertebroplasty procedures in 55 patients with thoracic or lumbar osteoporotic vertebral fractures. Back and low-back pain were evaluated using the visual analog scale and the duration of analgesic medication requirement. Factors related to CPC leakage and the postoperative outcome were analyzed. There was a small amount of VB CPC leakage in 23 cases. In 10 of 23 cases, leakage into the epidural space was found. Although VB CPC leakage was independently associated with high initial age, female sex, high bone mineral density (BMD), short injury-surgery interval, and injection via the unipedicular route in the logistic regression analysis, there was no factor associated with CPC leakage into the epidural space. Cement leakage into the epidural space reduced the immediate therapeutic effects on fracture-related pain (p = 0.0128). All patients in whom cement leaked into the epidural space had improved by the 2-week follow-up examination. CONCLUSIONS: Advanced initial age, female sex, high BMD, a short interval from injury to surgery, and injection via the unipedicular route may increase the incidence of CPC leakage. Cement leakage into the epidural space attenuated only the immediate therapeutic effects of CPC-assisted vertebroplasty.

Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures.

OBJECT: Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). METHODS: Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B. CONCLUSIONS: Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.