Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study

Background@#The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. @*Methods@#This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. @*Results@#In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12–1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43–1.91; P < 0.001), respectively, compared to past non-users. @*Conclusion@#In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery.

Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study

Background@#The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. @*Methods@#This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. @*Results@#In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12–1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43–1.91; P < 0.001), respectively, compared to past non-users. @*Conclusion@#In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery.

Relationship Between Cognitive Function and Dysphagia After Stroke

OBJECTIVE: To investigate the characteristics of cognitive deficits in patients with post-stroke dysphagia, and to analyze the relationships between cognitive dysfunction and severity of dysphagia in supratentorial stroke. METHODS: A total of 55 patients with first-ever supratentorial lesion stroke were enrolled retrospectively, within 3 months of onset. We rated dysphagia from 0 (normal) to 4 (severe) using the dysphagia severity scale (DSS) through clinical examinations and videofluoroscopic swallowing studies (VFSS). The subjects were classified either as non-dysphagic (scale 0) or dysphagic (scale 1 to 4). We compared general characteristics, stroke severity and the functional scores of the two groups. We then performed comprehensive cognitive function tests and investigated the differences in cognitive performance between the two groups, and analyzed the correlation between cognitive test scores, DSS, and parameters of oral and pharyngeal phase. RESULTS: Fugl-Meyer motor assessment, the Berg Balance Scale, and the Korean version of the Modified Barthel Index showed significant differences between the two groups. Cognitive test scores for the dysphagia group were significantly lower than the non-dysphagia group. Significant correlations were shown between dysphagia severity and certain cognitive subtest scores: visual span backward (p=0.039), trail making tests A (p=0.042) and B (p=0.002), and Raven progressive matrices (p=0.002). The presence of dysphagia was also significantly correlated with cognitive subtests, in particular for visual attention and executive attention (odds ratio [OR]=1.009; 95% confidence interval [CI], 1.002–1.016; p=0.017). Parameters of premature loss were also significantly correlated with the same subtests (OR=1.009; 95% CI, 1.002–1.016; p=0.017). CONCLUSION: Our results suggest that cognitive function is associated with the presence and severity of post-stroke dysphagia. Above all, visual attention and executive functions may have meaningful influence on the oral phase of swallowing in stroke patients with supratentorial lesions.

Relationship of Vascular Factors on Electrophysiologic Severity of Diabetic Neuropathy

OBJECTIVE: To investigate the impact of vascular factors on the electrophysiologic severity of diabetic neuropathy (DPN). METHODS: Total 530 patients with type 2 diabetes were enrolled retrospectively. We rated severity of DPN from 1 (normal) to 4 (severe) based on electrophysiologic findings. We collected the data concerning vascular factors (including brachial-ankle pulse wave velocity [PWV], ankle brachial index, ultrasound of carotid artery, lipid profile from the blood test, and microalbuminuria [MU] within 24 hours urine), and metabolic factors of diabetes (such as glycated hemoglobin [HbA1c]). We analyzed the differences among the four subgroups using χ2 test and ANOVA, and ordinal logistic regression analysis was performed to investigate the relationship between significant variables and severity of DPN. RESULTS: The severity of DPN was significantly associated with duration of diabetes, HbA1c, existence of diabetic retinopathy and nephropathy, PWV, presence of plaque, low density lipoprotein-cholesterol and MU (p<0.05). Among these variables, HbA1c and presence of plaque were more significantly related with severity of DPN in logistic regression analysis (p<0.001), and presence of plaque showed the highest odds ratio (OR=2.52). CONCLUSION: Our results suggest that markers for vascular wall properties, such as PWV and presence of plaque, are significantly associated with the severity of DPN. The presence of plaque was more strongly associated with the severity of DPN than other variables.

Analysis of the Correlation Among Age, Disc Morphology, Positive Discography and Prognosis in Patients With Chronic Low Back Pain

OBJECTIVE: To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain. METHODS: A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows: no pain, dissimilar pain, similar pain, or concordant pain. Discs with similar or concordant pain were classified as positive. All the examined discs were assessed morphologically using axial computed tomography imaging. The grade of general degeneration and annular disruption of the discs were assessed according to the Dallas discogram description (DDD). Intradiscal injection of steroid was tried for patients with symptomatic disc identified during provocative discography and who did not consent to surgical operation. RESULTS: There was a higher correlation between general degeneration and age, as compared with annular disruption and age. Higher general degeneration and annular disruption grades had higher positive rates of discography. However, annular disruption alone was independently associated with positive discography. Age and grade of general degeneration did not affect the prognosis. CONCLUSION: The grade of general degeneration was associated with age, but it was not correlated with positive discography and prognosis. In addition, high grade of annular disruption correlated with positive discography.

Implant installation after guided bone regeneration: comparison between immediate and delayed group

The Effects of Intravenous Injection of Atropine on Airway Pressure, Respiratory Compliance and Resistance in Normal Subjects during General Anesthesia / 대한마취과학회지

Atropine, an anticholinergic agent, has bronchodilating effects, so it had been used to treat bronchospasm. But, bronchodilating effects in normal man is controversial. In this study, after anesthetizing patients who did not have any respiratory disease, intravenous injection of atropine to the subjects was done, and then we monitored airway pressures to see the changes in respiratory mechanics indirectly. ASA physical status class 1 or 2 patients were studied. Without premedication, intravenous injection of fentanyl 3 mcg/kg, midazolam 0.1 mg/kg, thiopental 3 mg/kg and vecuronium 0.15 mg/kg was done consecutively. Ventilation was controlled by face mask with O2-N2O(50%)-isoflurane( < 0.5 vo1.%) for 5 minutes with closed circuit anesthetic machine(Physio-Flex) and then intubation was done. After intubation anesthesia was maintained with O2-N2O(50%)-isoflurane( < 0.5 voL%) and ventilation was controlled with tidal volume 9 ml/kg, respiratory rate 11/min and inspiratory tlow rate was maintained constantly for each subject. When airway pressure was stabilized, atropine 0.015 mg/kg was injected intravenously. Thereafter, for 20 minutes peak airway pressure(P), plateau pressure(P(peak)), mean airway pressure(P(plateau)), mean arterial pressure and heart rate were monitored every minute interval. And we calculated dynamic compliance, static compliance and resistance of total respiratory system. Atropine produced significant decrease in P(peak) and increase in dynamic compliance but did not produce significant changes in P(plateau) P(mean) , and static compliance and resistance. In CONCLUSION, atropine has bronchodilating effect in normal subjects anesthetized with isoflurane of low concentration.

The Effects of Intravenous Administration of Ketamine on Airway Pressure, Respiratory Resistance and Compliance in Normal Subjects during General Anesthesia / 대한마취과학회지

A dissociative anesthetic agent, ketamine has bronchodilating property and its bronchodilating effects in asthmatic patients have been apparent since earlier clinical studies. In this study, after anesthetizing patients who did not have any respiratory disease, we administered ketamine to the patients intravenously, and then monitored airway pressure to see the changes in respiratory mechanics indirectly. ASA physical status class 1 and 2 surgical patients who didn't have any respiratory disease were studied. Without premedication, fentanyl 3 mcg/kg, midazolam 0.1 mg/kg, thiopental 3 mg/kg and vecuronium 0.15 mg/kg were injected intravenously consecutively. Ventilation was controlled by face mask with O2-N2O(50%)-isoflurane(<0.5 vo1.%) for 5 minutes with closed circuit anesthetic machine(Physio-Flex). After intubation, anesthesia was maintained with O2-N2O(50%)-isoflurane(<0.5 vol.%) and controlled ventilation was done with tidal volume 9 ml/kg, respiratory rate 11/min and inspiratory flow was constant for each subject. When airway pressure was stabilized, ketamine 4 mg/kg was administered intravenously, Thereafter, for 20 minutes P(peak), P(plateau), P(mean), mean arterial pressure and heart rate were monitored every minute interval. Dynamic compliance, static compliance and resistance of the total respiratory system were calculated by inspiratory pressure method. The result is that ketamine does not produce significant changes in airway pressure, resistance and compliance of total respiratory system. In conclusion, ketamine does not have bronchodilating effect in normal pntients anesthetized with isoflurane of low concentration.

The Clinical Study of the Method on the Stabilization of the Hemodynamic Response to Tripod Pin Fixation / 대한마취과학회지

We have observed that the tripod pin fixation for craniotomy is frequently accompanied by tachycardia and arterial hypertension, despite an apparently uate depth of general anesthesia beforehand. The method on the stabilization of the hemodynamic response to tripod pin fixation was studied in 73 adult normotensive patients. They were divided into four groups' 1) a control group (C group), 2) a group of bupivacaine loeal infiltration (B group), 3) a group receiving fentanyl 2 mg/kg intravenously (F group), and 4) a group receiving thiopental sodium 3 mg/kg intravenously (T group). Before the tripod pin fixation, we measured systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). After the tripod pin fixation we observed those parameters one minute interval till 7 minutes. B group and F group showed the significant stability of SBP, DBP and MAP in comparision to C group and T group. In the B group, all the parameters returned to pre-pin fixation level rapidly compared to F group. In conclusion, to prevent hemodynamic response to tripod pin fixation, bupivacaine local infilteration method is most effective in this study.

Effect of calcium ion on fMLP-stimulated neutrophils chemotaxis / 대한면역학회지

No abstract available.