A low risk of nosocomial transmission of subclinical tuberculosis to neonates in a postpartum care center under COVID-19 control measures

We report the results of investigating and managing a tuberculosis (TB) exposure in a postpartum care center. Among the contacts exposed to a nursing assistant with subclinical TB, 5 of 44 neonates (11.4%) had positive tuberculin skin tests (TSTs) at 3 months of age, and all the TST-positive neonates received the Bacille Calmette-Guérin vaccination. Seven of 28 healthcare workers (25.0%) and 1 of 3 household contacts (33.3%) were positive in the initial or repeated interferon-gamma release assay. None of the contacts developed TB disease during the study period. Annual TB examinations of healthcare personnel at a postpartum care center under the Tuberculosis Prevention Act in South Korea enabled the early detection of subclinical TB, which reduced the risk of transmission to neonates under strict coronavirus disease 2019 prevention measures.

Early Ambulation Reduces the Incidence of Urinary Retention after Spinal Anesthesia for Benign Anorectal Surgery / 대한마취과학회지

BACKGROUND: It has been known that bed rest after spinal anesthesia for benign anorectal surgery helps to reduce the incidence of postdural puncture headache, but the bed rest position is thought to have a negative effect on urinary retention, as a result of anxiety, anal distention, bladder distention and pain-induced reflex inhibition of the urinary bladder detrusor muscle. We investigate the effect of early ambulation after spinal anesthesia on postdural puncture headache and on urinary retention compared with bed rest for 24 hours. METHODS: One hundred and fifty-three ASA Physical Status I patients received spinal anesthesia for scheduled benign anorectal surgery. We applied hyperbaric 0.5% tetracaine 6 mg (1.2 ml) using 25 gauge Quincke needles with the cutting bevel parallel to the dural fibers at the patients' sitting position. All patients were randomly divided into an early ambulation group or bed rest group. We investigated the incidence of urinary retention and headache. The duration of operation, the perioperative intravenous fluid volume, surgical technique and postoperative pain regimen were standardized. RESULTS: The incidence of urinary retention in the early ambulation group (16/75, 21.3%) was lower than that in bed rest group (32/78, 41.0%). There was no difference in any parameters between the two groups. CONCLUSIONS: To reduce the incidence of urinary retention, early ambulation after spinal anesthesia for benign anorectal surgery is recommended over bed rest with no increase in the incidence of postdural puncture headache.

A Comparison of the Effects of Isoflurane and Desflurane on Myocardial Contractility in Isolated Sprague-Dawley Hearts / 대한마취과학회지

BACKGROUND: Desflurane has some cardiovascular effects similar to isofl-urane. Desflurane has decreased systemic vascular resistance and demonstrated a myocardial depressant property in vivo animal stulies. The purpose of this study was to compare the myocardial and coronary effects of desflurane and isoflurane. METHODS: Cardiac effects were examinated in 24 rat hearts perfused with modified Krebs solution containing 1 MAC and 2 MAC desflurane or isoflurane for 10 min. at each concentration in a retrograde manner. Left ventricle pressure, heart rate and rate of change of ventricular pressure (dp/dt) were mea-sured, as were coronary flow and partial oxygen pressure. Oxygen delivery, myocardial oxygen consumption and percent oxygen extraction were calculated by each measurement. RESULTS: Heart rate, left ventricle pressure and dp/dt decreased each anesthetic similarly in a concentration-dependent manner. Heart rate decreased by 243.86 15.7 beats/min at 1 MAC and 219.14 15.8 beats/min at 2 MAC with isoflurane (control: 262.99 2.35 beats/min.) and by 250 23 beats/min at 1 MAC and 223.89 23 beats/min at 2MAC with desflurane (control 266.94 22.30 beats/min). Coronary flow increased by 13.72 0.99 ml/g/min at 1 MAC and 14.30 1.05 ml/g/min at 2 MAC with isoflurane (control :12.04 0.84 ml/g/min) and by 12.80 1.63 ml/g/min at 1 MAC and 13.71 1.46 ml/g/min at 2 MAC with desflurane (control 14.04 1.22 ml/g/min). Oxygen delivery increased proportionally with coronary flow. The increase in MVO2 was accompanied by a decrease in heart rate and pressure but there were no significant differences. Percent oxygen extraction decreased in a concentration dependent manner. CONCLUSIONS: This study shows that desflurane and isoflurane decreased heart rate, myocardial depression and coronary vasodilating effects, resulting in improved oxygen perfusion effects.

A Comparison of the Bronchodilatory Effect of Halothane, Isoflurane and Desflurane in Isolated Rat Fourth Order Bronchi / 대한마취과학회지

BACKGROUND: Volatile anesthetics are potent bronchodilators of airway smooth muscle. Bronchodilation is occured by depressing reflex neural pathways innervating airway smooth muscle and by acting directly on the smooth muscle cell. We studied the direct relaxation effect and their potency of halothane, isoflurane and desflurane on isolated rat distal bronchial segment of fourth order precontracted with acetylcholine. METHODS: Isolated Sprague-Dawley rat bronchial rings were suspended in tissue bath with modified- Krebs's solution. Based on the dose-response curve, the ED50 of acetylcholine (ACh) was calculated for fourth bronchial segment and administered to each tissue bath, after which the stabilized response was recorded. After then each bronchial segment with intact epithelium was exposed to increasing concentration of halothane, isoflurane and desflurane (1.0, 1.5 and 2.0 MAC)and the relaxant responses were recorded by polygraph. RESULTS: Halothane, isoflurane and desflurane produced concentration-dependent bronchodilation (P<0.05 for either anesthetics; 22 4%, 18 6%, 24 5% for halothane, isoflurane and desflurane at 1.5 MAC, 32 6%, 27 7%, 38 5% for halothane, isoflurane and desflurane at 2.0 MAC). Overall, desflurane had a significantly greater relaxing effect as compared with halothane, isoflurane at 1.5 MAC and 2.0 MAC during ACh-mediated contraction. CONCLUSION: The mechanism of halothane, isoflurane and desflurane-mediated bronchodilation is not known, but may be due to an epithelium dependent effect. The potency of relaxing the ACh precontracted isolated rat bronchial smooth muscle is desflurane, halothane, isoflurane in ordered.

A Comparison of the Bronchodilatory Effect of Halothane, Isoflurane and Desflurane in Isolated Rat Fourth Order Bronchi / 대한마취과학회지

BACKGROUND: Volatile anesthetics are potent bronchodilators of airway smooth muscle. Bronchodilation is occured by depressing reflex neural pathways innervating airway smooth muscle and by acting directly on the smooth muscle cell. We studied the direct relaxation effect and their potency of halothane, isoflurane and desflurane on isolated rat distal bronchial segment of fourth order precontracted with acetylcholine. METHODS: Isolated Sprague-Dawley rat bronchial rings were suspended in tissue bath with modified- Krebs's solution. Based on the dose-response curve, the ED50 of acetylcholine (ACh) was calculated for fourth bronchial segment and administered to each tissue bath, after which the stabilized response was recorded. After then each bronchial segment with intact epithelium was exposed to increasing concentration of halothane, isoflurane and desflurane (1.0, 1.5 and 2.0 MAC)and the relaxant responses were recorded by polygraph. RESULTS: Halothane, isoflurane and desflurane produced concentration-dependent bronchodilation (P<0.05 for either anesthetics; 22 4%, 18 6%, 24 5% for halothane, isoflurane and desflurane at 1.5 MAC, 32 6%, 27 7%, 38 5% for halothane, isoflurane and desflurane at 2.0 MAC). Overall, desflurane had a significantly greater relaxing effect as compared with halothane, isoflurane at 1.5 MAC and 2.0 MAC during ACh-mediated contraction. CONCLUSION: The mechanism of halothane, isoflurane and desflurane-mediated bronchodilation is not known, but may be due to an epithelium dependent effect. The potency of relaxing the ACh precontracted isolated rat bronchial smooth muscle is desflurane, halothane, isoflurane in ordered.

Preemptive Analgesia of Local Infiltration with Bupivacaine for Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Laparoscopic cholecystectomy is of benefit to reduce postoperative pain but many patients suffer from considerable pain after the surgery. The aim of this study was to investigate whether the preoperative infiltration of bupivacaine at the trocar site reduced the intensity of the postoperative pain or not. METHODS: Sixty patients who underwent elective laparoscopic cholecystectomy were selected. In a randomozed study, patients were divided into three groups. General anesthesia was induced with pentothal and succinylcholine, and maintained with vecuronium and isoflurane. After induction, the preincisional group (n = 20) received 0.25% bupivaciane 20 ml infiltration before skin incision and the postoperative group (n = 20) was given 0.25% bupivacaine 20 ml after peritoneal closure. The control group (n = 20) did not receive bupivacaine at any time. The first time of demand for analgesics and the amount of analgesics given during postoperative 48 hours were checked and recorded. The degree of postoperative pain was assessed hourly by visual analogue scale (VAS) score until 9 hours and checked once more at 24 hours postoperatively. RESULTS: The first times of demand for analgesics were significantly delayed in the preoperative group (12.1+/-6.0 hours) as compared with the control (2.9+/-1.6 hours) and postoperative groups (6.2+/-3.9 hours). The demand for analgesics until 9-hour postoperation by the preincisional group (10.5+/-14.7) was significantly less than that of the control (42.0 20.4) and postoperative groups (31.5+/-22.8). The VAS score of the preoperative group was lower than that of the control or postoperative groups during the postoperative 24 hours. CONCLUSIONS: Local infiltration of 0.25% bupivacaine into the trocar site preincisionally could reduce the early postoperative pain after laparoscopic cholecystectomy.

Preemptive Analgesia of Butorphanol for Hysterectomy / 대한마취과학회지

BACKGROUND: It is necessary to reduce hyperexcitable sensations induced by painful stimulus by preventing central sensitization, so called preemptive analgesia. We observed the effect of butorphanol on postoperative pain after hysterectomy so as to direct analgesic action based on elucidation of the preemptive effect. METHODS: We selected thirty-six patients undergoing elective total abdominal hysterectomy, ASA Physical Status I or II, and employed a double-blind cross-over design. Patients were randomly allocated to one of both groups, receiving intravenous butorphanol 2 mg, either preincisionally or postoperatively. Anesthesia was induced with thiopental and maintained with isoflurane. Patients received meperidine on request for postoperative pain. Patients checked the VAS of spontaneous incisional pain and movement-associated pain by themselves.The time of first demand for postoperative meperidine and the amount of postoperative meperidine for the first 6 hours and 6 to 48 hours were recorded. RESULTS: At 5 hours after surgery, the postoperative VAS score of the preincisional group was lower than that of the postoperative group, and at 24 hours after surgery, the former was also lower than the latter. The first time of demand for postoperative meperidine was earlier in the postoperative group than in the preincisional group. The amount of meperidine for the postoperative first 6 hours was less in the preincisional group than in the postoperative group. CONCLUSIONS: Preincisional intravenous butorphanol reduced the intensity of spontaneous incisional pain and movement-associated pain, regarded as a preemptive effect of butorpahnol, in the early postoperative period.

The Effect of Desflurane on Myocardial Contractility and Coronary Flow in Isolated Rat Hearts / 대한마취과학회지

Background: Desflurane, a fluorinated methyl-ethyl ether, has some advantageous properties including low blood solubility, stability in soda lime, and resistance to biodegradation. Desflurane in vivo has demonstrated myocardial depressant property. The purpose of this study was to test the direct effects of desflurane on myocardial contractile function and coronary flow in the isolated heart. Methods: Twelve isolated rat hearts were continuously perfused with modified Krebs solution containing 6, 9 and 12 vol% of desflurane for 10 min at each concentration. Systolic left ventricular pressure and rate of change of ventricular pressure (dp/dt) were measured. Heart rate and coronary flow were also measured. To differentiate direct vasodilatory effect of desflurane from an indirect metabolic effect due to autoregulation of coronary flow, oxygen delivery, myocardial oxygen consumption and percent oxygen extraction were calculated. Results: Heart rate (control 266+/-22 beats/min) decreased to 250+/-23 beats/min at 6 vol%, 236+/-26 beats/min at 9 vol% and 223+/-22 beats/min at 12 vol% of desflurane. Systolic left ventricular pressure and dp/dt decreased in a concentration-dependent manner. In spite of decrement of myocardial oxygen consumption, coronary flow (control 12.0+/-1.2 ml/min) increased to 12.8+/-1.6 ml/min at 6 vol%, 12.9+/-1.6 ml/min at 9 vol% and 13.7+/-1.4 ml/min at 12 vol% of desflurane. Oxygen delivery increased proportionally with coronary flow. Percent oxygen extraction decreased in a concentration-dependent manner. Conclusion: These results suggest that desflurane has a direct myocardial depressing and coronary vasodilating effect in a concentration-dependent manner.