Analysis of Fall Accidents of Dizzy Patients in a Tertiary Hospital in South Korea (2011-2015) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A fall refers to a sudden fall accident resulting in injury and hurt of the human body. In the hospital, fall accidents occur mainly in dizzy patients or elderly people, but can also occur even in young people who fail to adapt to the unfamiliar hospital environment. This study analyzed the incidence of fall accidents and its pattern in dizzy patients in a tertiary hospital in South Korea. SUBJECTS AND METHOD: This study was conducted using 477 fall accidents that occurred in a tertiary hospital in Korea from 2011 to 2015. Extensively investigated were related fall risk factors such as patient's sex, age, medical department, diagnosis, first witness, mental status, physical activity, patient risk factors, walking aids, medication use and treatment. RESULTS: Dizziness induced falls consisted of 20.5% of the total fall accidents. Sedative medications were frequently used in patients of dizziness induced falls (42.9%). Fall acidents were mainly detected by nurses 33%. The frequente sites of fall were the bed rooms (55%), the corridor (15%) or the bath rooms (8%). Types of physical damage were no damage (47%), abrasion or bruising (20%), laceration (10%), bath rooms (8%), fracture (3%), and head trauma (1%). In 532 treatments, observation was recommended for 68%, sterilization 15.2%, suture 4.7%, cast 1%, and surgery 1%. CONCLUSION: The study finds that the fall risk screening test and Multifactorial Fall Prevention Program should be performed for all high-risk patients of fall. About 20% of falls were associated with otologic dizziness, and otolaryngology doctors should pay attention to the fall problem and the medication related to dizziness, which may potentially increase the risk of falls.

The Effect of ATP-sensitive Potassium Channel on R-PIA Induced Mechanical Antiallodynia in a Peripheral Neuropathic Rat / 대한통증학회지

BACKGROUND: Nerve ligation injury may produce mechanical allodynia, but this can be reversed after an intrathecal administration of adenosine analogues. In many animal and human studies, ATP-sensitive potassium channel blockers have been known to reverse the antinociceptive effect of various drugs. This study was performed to evaluate the mechanical antiallodynic effects of spinal R-PIA (Adenosine A1 receptor agonist) and the reversal of these effects due to pretreatment with glibenclamide (ATP-sensitive potassium channel blocker). Thus, the relationship between the antiallodynic effects of R-PIA and ATP-sensitive potassium channel were investigated in a neuropathic model. METHODS: Male Sprague Dawley rats were prepared by tightly ligating the left lumbar 5th and 6th spinal nerves and implantation of a chronic lumbar intrathecal catheter for drug administration. The mechanical allodynia was measured by applying von Frey filaments ipsilateral to the lesioned hind paw. And the thresholds for paw withdrawal assessed. In study 1, either R-PIA (0.5, 1 and 2microgram) or saline were administered intrathecally for the examination of the antiallodynic effect of R-PIA. In study 2, glibenclamide (2, 5, 10 and 20 nM) was administered intrathecally 5 min prior to an R-PIA injection for investigation of the reversal of the antiallodynic effects of R-PIA. RESULTS: The antiallodynic effect of R-PIA was produced in a dose dependent manner. In study 1, the paw withdrawal threshold was significantly increased with 2microgram R-PIA (P < 0.05). In study 2, the paw withdrawal threshold with 2microgram R-PIA was significantly decreased almost dose dependently by intrathecal pretreatment of 5, 10 and 20 nM glibenclamide (P < 0.05). CONCLUSIONS: These results demonstrated that an intrathecal injection of ATP-sensitive potassium channel blockers prior to an intrathecal injection of adenosine A1 receptors agonist had an antagonistic effect on R-PIA induced antiallodynia. The results suggest that the mechanism of mechanical antiallodynia, as induced by an intrathecal injection of R-PIA, may involve the ATP-sensitive potassium channel at both the spinal and supraspinal level in a rat nerve ligation injury model.

Effects of Lidocaine on the Neuromuscular Block of Cisatracurium and Rocuronium / 대한마취과학회지

BACKGROUND: Lidocaine is a useful local anesthetic and antiarrhythmic agent perioperatively. It may augment a neuromuscular block from both nondepolarizing and depolarizing muscle relaxants. Cisatracurium of benzylisoquinoline derivatives and rocuronium of aminosteroid derivatives are new nondepolarizing muscle ralaxants. We investigated interactions of cisatracurium or rocuronium with lidocaine in vitro. METHODS: Institutional approvement was obtained. Eighty male Sprague Dawley rats (150 - 200 g) were divided into 8 groups (control, lidocaine 1, 10 and 100microgram of both cisatracurium and rocuronium groups). The animals were anesthetized with phentobarbital 40 mg/kg I.P.. The hemidiaphragm with the phrenic nerve was dissected and mounted within 5 minutes in a bath containing 100 ml Kreb's solution at room temperature. The phrenic nerve was stimulated at supramaximal intensity by a Grass S88 stimulator through an SIU5 isolation unit. A twitch height was measured by a precalibrated Grass FT88 force displacement transducer and recorded with a Grass 79 polygraph. After stabilization of the twitch response, cisatracurium (50microgram), and rocuronium (100microgram) were added to the Kreb's solutions. After 10 minutes, we measured twitch height, and saline 1 ml or lidocaine 1, 10 or 100microgram was added to the Kreb's solution. After 10 minutes, we again measured twitch responses. The data was analyzed by repeated measures of ANOVA. RESULTS: There were significant depressions in the twitch response of cisatracurium in lidocaine 10microgram and 100microgram groups compared with the control group and lidocaine 1microgram group. In addition, the lidocaine 100microgram group was significantly depressed compared with the lidocaine 10microgram group. There were no significant depressions of the twitch response of rocuronium in lidocaine 1microgram, 10microgram, and 100microgram groups compared with the control group. CONCLUSIONS: We concluded that lidocaine will increase the sensitivity to cisatracurium in the hemdiaphragm preparation of rats. Lidocaine will be able to cause recurarization. There was not a statistically significant change in the rocuronium group but it was clinically significant.