Validation of the Korean Version of the DN4 Diagnostic Questionnaire for Neuropathic Pain in Patients with Lumbar or Lumbar-Radicular Pain

PURPOSE: To evaluate the diagnostic value of the Korean version of the Douleur Neuropathique 4 (DN4) questionnaire and to validate this questionnaire in terms of psychometric properties in patients with chronic pain due to degenerative spinal disease. MATERIALS AND METHODS: The Korean version of the DN4 questionnaire, which was translated and linguistically validated by the MAPI Research Group, was tested on 83 patients with lumbar or lumbar-radicular pain. Test-retest reliability was evaluated in a subsample of 40 patients who completed two assessments with an interval of 2 weeks. Nociceptive pain and neuropathic component pain were diagnosed in 40 and 43 patients, respectively. RESULTS: The Cronbach's alpha coefficient of internal consistency was 0.819, and the test-retest intraclass correlation coefficient (3, 1) (95% confidence interval) was 0.813 (0.776-0.847) (n=40). The area under the receiver-operator characteristics curve was 0.953 (p<0.001), with 95% confidence interval between 0.869 and 0.990. The Korean version of the DN4 questionnaire showed a sensitivity of 100% and 87.1%, and a specificity of 88.2% and 94.1% at the cutoff value of 3/10 and 4/10, respectively, for discriminating neuropathic component pain. CONCLUSION: The present study demonstrated the good discriminatory power of DN4 between nociceptive pain and neuropathic component pain in patients with lumbar or lumbar-radicular pain.

Rescue of hemodynamic compromise in superior vena cava syndrome with transesophageal echocardiography / 대한마취과학회지

No abstract available.

Comparison of General and Spinal Anesthesia and Their Effect on Hemostasis using the Thromboelastography in Patients Undergoing Total Knee Arthroplasty: Preliminary report / 대한마취과학회지

BACKGOUND: General anesthesia was known to induce hypercoagulable status during major orthopedic surgery. This study was designed to analyze effects on hemostatic reponse in patients receiving general or spinal anesthesia for total knee arthroplasty, using the thromboelastography (TEG). METHODS: Among women that were scheduled to total knee arthroplasty without both no medical or surgical history and no chronic systemic disorder, ten patients were selected at each group (general or spinal anesthesia). TEG was measured at 4 times around the each surgery (before skin incision after induction, before bone manipulation, after bone manipulation, 1 hour after operation). RESULTS: There was no difference statistically between two groups in first and second measures of TEG. But, significantly different r time, k time, alpha angle, and maximum amplitude was noted between two groups after bone manipulation and 1 hour after operation (P < 0.05). Conculusions: After the release of tourniquet following bone procedures the patients receiving general anesthesia had relatively high hemostasis compared with the spinal anesthesia group. This phenomenon was also noted in 1 hour after operation.

10 Times Epidural Blood Patches for Spontaneous Intracranial Hypotension: A case report / 대한통증학회지

This report describes the successful treatment of spontaneous intracranial hypotension (SIH) with multiple cerebrospinal fluid (CSF) leaks using 10 applications of epidural blood patches (EBP). A forty year old female who suffered with a postural headache was diagnosed as having SIH. On the cisternography, multiple CSF leaks were noted at the thoracic and lumbar area. Her headache was not improved with conservative treatments such as bed rest, hydration and NSAIDS. So, she underwent treatment with EBPs. After 10 applications of site-directed EBPs, her headache was resolved gradually and completely without any complications.

A Treatment Experience of Focal Hyperhidrosis in Sacrococcygeal Region: A report of two cases / 대한통증학회지

Essential hyperhidrosis is a socially disabling and emotionally embarrassing condition. Localized excessive sweating in the sacrococcygeal region is a rare form of focal hyperhidrosis. Although numerous treatment options exist, including botulinum toxin and sympathetic neurolysis, there has been no generally accepted form of treatment. The following cases describe the successful reduction of excessive sweating in the sacrococcygeal region, without side effects, after local applications of topical glycopyrrolate and the use of fast drying clothes.

Comparison of Clinical Characteristics in Controlled Ventilation and Spontaneous Breathing during Vital Capacity Inhalation Induction with Sevoflurane / 대한마취과학회지

BACKGROUND: Although controlled ventilation can shorten the induction time during vital capacity inhalation induction (VCII) with sevoflurane, it may associated with decrease in blood pressure and hyperventilation-related hyperdynamic responses such as hypertension and tachycardia. This study was designed to compare the clinical effects between controlled ventilation (CV) within acceptable ranges of PETCO2 and spontaneous breathing (SB) during VCII. METHODS: 100 patients were randomly allocated to the one of two groups. After the loss of consciousness during VCII with sevoflurane, controlled ventilation was applied in CV group within acceptable ranges of PETCO2 and spontaneous breathing was maintained in SB group. Alfentanil 4 mcg/kg was given i.v. 2 minutes prior to intubation. PETCO2, mean arterial pressure (MAP), heart rate (HR), SPO2, and BIS were measured at 1, 2 and 3 minute after the loss of consciousness (LOC). Clinical side effects were evaluated. RESULTS: MAP and HR were significantly decreased and increased in CV group compare to the baseline values at 1 minute after LOC. There were statistical differences of MAP and HR between two groups at 1 and 2 minutes after LOC. 46 of 50 (92%) showed delayed expiration with holding their breath > 20 s in SB group. No differences of other clinical side effects except hypotension between two groups. CONCLUSIONS: We conclude that spontaneous breathing provides a stable hemodynamic status and relatively acceptable ventilation profile compare to controlled ventilation during VCII.

A Comparative Study of Nonpulsatile and Pulsatile Perfusion on Hemodynamics and Renal Function Centered on the patients undergoing coronary artery bypass grafting with cardiopulmonary bypass / 대한마취과학회지

BACKGROUND: It has been widely believed that pulsatile flow was better than nonpulsatile flow. However it remains uncertain whether pulsatile perfusion has shown substantive clinical improvement compared to standard, nonpulsatile perfusion. The purpose of this study was to compare nonpulsatile perfusion with pulsatile perfusion on hemodynamic and renal function during and after cardiopulmonary bypass (CPB) in the patients undergoing coronary artery bypass grafting (CABG). METHODS: Twenty patients undergoing CABG were divided into two groups, nonpulsatile perfusion group (NP) and pulsatile perfusion group (PP). Hemodynamic data was measured at preinduction, postinduction, immediately after aorta cross clamping (ACC on), and 60 minutes after the start of CPB (CPB 60'). Hemodynamic variables included mean arterial pressure (MAP), peripheral vascular resistance (PVR), plasma catecholamine (epinephrine, norepinephrine), and dosage of the vasodilator (sodium nitroprusside). Renal parameters were urine output, and serum BUN and creatinine. They were measured at preCPB, during CPB, postCPB, and POD 1. RESULTS: MAP was significantly higher in NP at CPB 60'. At CPB 60, PVR returned to preinduction level in NP, but was still decreased in PP. The dosage of vasodilator (sodium nitroprusside) infusionwas significantly higher in NP than in PP. In both groups, plasma epinephrines were increased significantly during CPB but there was no difference between the groups. Plasma norepinephrine was significantly higher in NP than in PP during CPB. At postCPB, urine output was higher than preCPB only in PP. At POD 1, serum BUN increased to the preCPB level in NP but was still decreased in PP. After CPB, serum creatinine was decreased significantly in PP. There was no significant difference in renal parameters between both groups. Conclusion: It was suggested that pulsatile perfusion, compared with nonpulsatile perfusion, can attenuate hemodynamic changes by decreasing release of plasma norepinephrine, peripheral vascular resistance, mean arterial pressure and dosage of vasodilator during cardiopulmonary bypass. Pulsatile perfusion didn't show substantive clinical difference of renal outcome in patients without preoperative renal dysfunction.