Assessment of Preoperative Anxiety and Influencing Factors in Patients Undergoing Elective Surgery: An Observational Cross-Sectional Study.

Background and Objectives: Preoperative anxiety is a common emotional response before elective surgery that influences postoperative outcomes and can increase analgesic requirements. However, clinicians frequently overlook these concerns. This study aimed to quantify preoperative anxiety and evaluate its association with patient-related factors. Materials and Methods: Anxiety levels were evaluated in adult patients awaiting elective surgery using the Korean-translated version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory-Korean YZ form (STAI-KYZ). The patients were also surveyed regarding the subjective causes of preoperative anxiety. Results: The study found that a total of 55 adult patients had a well-balanced subject distribution. Both questionnaires showed high internal consistency (Cronbach's alpha values of 0.85 and 0.93). Significant correlations were observed in situational anxiety scores from the questionnaires, indicating differences between groups with high trait anxiety and those with normal anxiety levels (p < 0.05). Notably, female sex was the only patient-related factor that significantly affected the anxiety scores (p < 0.05). Furthermore, when considering additional patient factors stratified by sex, it became evident that younger females and females with prior general anesthesia experience displayed higher anxiety levels than their male counterparts. The most commonly reported subjective concern related to anesthesia was the fear of not regaining consciousness, followed by concerns about postoperative pain, intraoperative emergence, and other issues. Conclusions: This study confirms that being female is a significant risk factor for preoperative anxiety. Therefore, it is necessary to provide enhanced preoperative anxiolytic therapies, including preoperative patient education and other interventions, to individuals undergoing surgical procedures.

Ameliorative Effect of Ginsenoside Rg6 in Periodontal Tissue Inflammation and Recovering Damaged Alveolar Bone.

Periodontal disease is a chronic disease with a high prevalence, and in order to secure natural materials to prevent oral diseases, new materials that protect periodontal tissue from inflammation are being sought. Genes were identified using real-time quantitative polymerase chain reaction (RT-qPCR), and proteins were confirmed using Western blot. Dichlorodihydrofluorescein diacetate (DCF-DA) analysis was used, and the antibacterial effects were confirmed through Minimum Inhibitory Concentration (MIC) and Minimal Bactericidal Concentration (MBC) analysis. To confirm this effect in vivo, Sprague-Dawley rats, in which periodontitis was induced using ligation or Lipopolysaccharide of Porphyromonas gingivalis (PG-LPS), were used. In vitro experiments using human periodontal ligament (HPDL) cells stimulated with PG-LPS showed that Ginsenoside Rg6 (G-Rg6) had anti-inflammatory, antibacterial, antioxidant, and osteoblast differentiation properties. In vivo, G-Rg6 was effective in Sprague-Dawley rats in which periodontitis was induced using ligation or PG-LPS. Therefore, Ginsenoside Rg6 shows potential effectiveness in alleviating periodontitis.

Comparison of the performance of phase lag entropy and bispectral index for monitoring the depth of sedation under dexmedetomidine sedation: A prospective, observational, and non-inferiority trial.

STUDY OBJECTIVE: Although the performance of phase lag entropy (PLE), a new depth-of-sedation monitor based on the diversity of temporal patterns in the phase relationships in electroencephalogram (EEG) data, during propofol sedation has been proven through several studies, since different sedatives have different effects on EEG, we aimed to evaluate the performance of the PLE in comparison with the bispectral index (BIS) during dexmedetomidine sedation. DESIGN: A prospective, observational, and non-inferiority trial. SETTING: Tertiary university hospital operating room. PATIENTS: Forty-two patients aged 20-80 years who were scheduled to undergo elective surgery under spinal anesthesia and had American Society of Anesthesiologists (ASA) physical status I to III were enrolled in this study. INTERVENTIONS: Dexmedetomidine was administered with a loading dose of 0.5-1 µg/kg for 10 min, followed by a maintenance dose of 0.3-0.6 µg/kg/h. MEASUREMENTS: The depth of sedation was assessed using the modified observer's assessment of alertness/sedation (MOAA/S) scale; the data for PLE and BIS were collected; and vital signs, including blood pressure, heart rate, EKG, and pulse oximetry, were evaluated. MAIN RESULTS: 215,082 data points for the MOAA/S score and PLE and BIS values were analyzed. The baseline variabilities of PLE and BIS were 4.53% and 7.02%, respectively. The Spearman correlation coefficients of the MOAA/S score with PLE and BIS were 0.599 and 0.566, respectively. The prediction probabilities of the MOAA/S score with PLE and BIS were 0.647 and 0.636, respectively. When the MOAA/S score was 3 points, the mean (SD) values of PLE and BIS were 68.35 (15.68) and 75.85 (9.81), respectively, However, the mean (SD) values of PLE and BIS for an MOAA/S score of 1 point were 56.08 (12.49) and 68.29 (12.65), respectively. CONCLUSIONS: PLE shows potential as a hypnotic depth indicator during dexmedetomidine sedation, and its performance was not inferior to that of BIS.

Verification of the performance of the Bispectral Index as a hypnotic depth indicator during dexmedetomidine sedation.

BACKGROUND: Differences in the effects of propofol and dexmedetomidine sedation on electroencephalogram patterns have been reported previously. However, the reliability of the Bispectral Index (BIS) value for assessing the sedation caused by dexmedetomidine remains debatable. The purpose of this study is to evaluate the correlation between the BIS value and the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale in patients sedated with dexmedetomidine. METHODS: Forty-two patients (age range, 20-80 years) who were scheduled for elective surgery under spinal anesthesia were enrolled in this study. Spinal anesthesia was performed using 0.5% bupivacaine, which was followed by dexmedetomidine infusion (loading dose, 0.5-1 µg/kg for 10 min; maintenance dose, 0.3-0.6 µg/kg/h). The MOAA/S score was used to evaluate the level of sedation, and the Vital Recorder program was used to collect data (vital signs and BIS values). RESULTS: A total of 215082 MOAA/S scores and BIS data pairs were analyzed. The baseline variability of the BIS value was 7.024%, and the decrease in the BIS value was associated with a decrease in the MOAA/S score. The correlation coefficient and prediction probability between the two measurements were 0.566 (P < 0.0001) and 0.636, respectively. The mean ± standard deviation values of the BIS were 87.22 ± 7.06, 75.85 ± 9.81, and 68.29 ± 12.65 when the MOAA/S scores were 5, 3, and 1, respectively. Furthermore, the cut-off BIS values in the receiver operating characteristic analysis at MOAA/S scores of 5, 3, and 1 were 82, 79, and 73, respectively. CONCLUSION: The BIS values were significantly correlated with the MOAA/S scores. Thus, the BIS along with the clinical sedation scale might prove useful in assessing the hypnotic depth of a patient during sedation with dexmedetomidine.

Decaying Post-Seismic Deformation Observed on the Korean Peninsula Following the 2011 Tohoku-Oki Earthquake.

We investigated decaying post-seismic deformation observed on the Korean Peninsula associated with the 2011 Mw 9.0 Tohoku-Oki earthquake using Global Navigation Satellite System (GNSS). The GNSS velocity vectors were estimated in five periods from 2005 to 2019. A co-seismic offset of the Korean Peninsula caused by the 2011 earthquake was inversely proportional to epicentral distances. According to the temporal variations of two components (magnitude and direction) of the GNSS velocity vector with the epicentral distance, the difference between the eastern and western regions for the two components becomes smaller over time. For approximately nine years after the 2011 event, the direction for the crustal movement in South Korea showed a recovery pattern returning to the pre-earthquake motion. In addition, the recovery patterns of the crustal movement were observed differently with the regional geologic structure (e.g., the crustal thickness) and each period. Our estimates of the decay in post-seismic deformation of the Korean Peninsula suggest that post-seismic relaxation will be complete within 5-20 years after the 2011 earthquake. The results suggest that the crustal movement on the Korean Peninsula is gradually recovering to its pre-earthquake motion.

Programmable DNA-Based Boolean Logic Microfluidic Processing Unit.

As molecular computing materials, information-encoded deoxyribonucleic acid (DNA) strands provide a logical computing process by cascaded and parallel chain reactions. However, the reactions in DNA-based combinational logic computing are mostly achieved through a manual process by adding desired DNA molecules in a single microtube or a substrate. For DNA-based Boolean logic, using microfluidic chips can afford automated operation, programmable control, and seamless combinational logic operation, similar to electronic microprocessors. In this paper, we present a programmable DNA-based microfluidic processing unit (MPU) chip that can be controlled via a personal computer for performing DNA calculations. To fabricate this DNA-based MPU, polydimethylsiloxane was cast using double-sided molding techniques for alignment between the microfluidics and valve switch. For a uniform surface, molds fabricated using a three-dimensional printer were spin-coated by a polymer. For programming control, the valve switch arms were operated by servo motors. In the MPU controlled via a personal computer or smartphone application, the molecules with two input DNAs and a logic template DNA were reacted for the basic AND and OR operations. Furthermore, the DNA molecules reacted in a cascading manner for combinational AND and OR operations. Finally, we demonstrated a 2-to-1 multiplexer and the XOR operation with a three-step cascade reaction using the simple DNA-based MPU, which can perform Boolean logic operations (AND, OR, and NOT). Through logic combination, this DNA-based Boolean logic MPU, which can be operated using programming language, is expected to facilitate the development of complex functional circuits such as arithmetic logical units and neuromorphic circuits.

The latest trend in neuromuscular monitoring: return of the electromyography.

To reduce the risk of residual neuromuscular blockade, neuromuscular monitoring must be performed. Acceleromyography (AMG)-based neuromuscular monitoring was regarded as "clinical gold standard" and widely applied. However, issues related to patient's posture and overestimation of train-of-four ratio associated with AMG-based neuromuscular monitoring have increased. Recently, electromyography (EMG)-based neuromuscular monitoring is receiving renewed attention, since it overcomes AMG's weaknesses. However, both AMG-based and EMG-based systems are useful when certain considerations are followed. Ultimately, to assure the patient's good outcomes, the choice of monitoring system is not as important as the monitoring itself, which should be always implemented in such patients.

Peripheral Nerve-Derived Stem Cell Spheroids Induce Functional Recovery and Repair after Spinal Cord Injury in Rodents.

Stem cell therapy is one of the most promising candidate treatments for spinal cord injury. Research has shown optimistic results for this therapy, but clinical limitations remain, including poor viability, engraftment, and differentiation. Here, we isolated novel peripheral nerve-derived stem cells (PNSCs) from adult peripheral nerves with similar characteristics to neural-crest stem cells. These PNSCs expressed neural-crest specific markers and showed multilineage differentiation potential into Schwann cells, neuroglia, neurons, and mesodermal cells. In addition, PNSCs showed therapeutic potential by releasing the neurotrophic factors, including glial cell-line-derived neurotrophic factor, insulin-like growth factor, nerve growth factor, and neurotrophin-3. PNSC abilities were also enhanced by their development into spheroids which secreted neurotrophic factors several times more than non-spheroid PNSCs and expressed several types of extra cellular matrix. These features suggest that the potential for these PNSC spheroids can overcome their limitations. In an animal spinal cord injury (SCI) model, these PNSC spheroids induced functional recovery and neuronal regeneration. These PNSC spheroids also reduced the neuropathic pain which accompanies SCI after remyelination. These PNSC spheroids may represent a new therapeutic approach for patients suffering from SCI.

Additional effect of magnesium sulfate and vitamin C in laparoscopic gynecologic surgery for postoperative pain management: a double-blind randomized controlled trial.

BACKGROUND: This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. METHODS: The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. RESULTS: Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 µg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 µg, P < 0.001, P = 0.003, respectively). CONCLUSIONS: Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.

Rogue cell-like chromosomal aberrations in peripheral blood lymphocytes of interventional radiologists: A case study.

We report two cases of interventional radiologists who had been exposed to radiation while performing fluoroscopically-guided interventional procedures (FGIPs), mainly transcatheter arterial chemoembolization, percutaneous catheter drainage, and percutaneous transhepatic biliary drainage procedures, for over 10 years. They had a unique multi-aberrant cell type with not only high numbers of dicentrics and/or centric rings but also excess acentric double minutes, similar to a rogue cell. As revealed in a self-administered questionnaire, they wore personal dosimeters and protective equipment at all times and used shielding devices during interventional fluoroscopy procedures. However, the exposed dose levels derived from cytogenetic dosimetry were much higher than the doses recorded on their personal dosimeters. A large number of unstable and stable chromosomal aberrations that were found in the peripheral blood lymphocytes of these interventional radiologists might be due to repeated and long-term exposure to ionizing radiation while performing FGIPs. Further investigations of chromosomal aberrations in interventional radiologists may improve the understanding of the long-term effects of radiation exposure on medical personnel.

Influence of Facial Flushing on Pre- or Type 2 Diabetes Risk according to Alcohol Consumption in Korean Male.

BACKGROUND: This study aims to examine the association between alcohol consumption and the risk of pre- or type 2 diabetes mellitus (T2DM) by alcohol-induced flushing response in Korean male adults, particularly based on their body mass index (BMI). METHODS: This study selected 1,030 (158 non-drinkers, 364 flushers, and 508 non-flushers) male adults who had medical checkups. A logistic regression analysis was used to compare the association between alcohol consumption and the risk of pre- or T2DM. RESULTS: In both the normal-weight group (BMI <23 kg/m2) and the overweight group (BMI ≥23 kg/m2 and <25 kg/ m2), the flushers had a higher risk of pre- or T2DM (odds ratio, 95% confidence interval) when consuming more than 8 drinks of alcohol per week than the non-drinkers (normal-weight group: 3.43, 1.06-11.07; overweight group: 4.94, 1.56-15.67). But in the non-flushers among the normal-weight group and the overweight group, there was no significant difference compared to non-drinkers regarding the risk of pre- or T2DM. Obese flushers had a significantly higher risk of pre- or T2DM when consuming more than 4 drinks of alcohol per week than the non-drinkers (>4 and ≤8 drinks: 2.64, 1.10-6.36; >8 drinks: 2.42, 1.11-5.27). However, obese non-flushers had only a significant higher risk of pre- or T2DM when consuming more than 8 drinks of alcohol per week than the non-drinkers (2.72, 1.39-5.30). CONCLUSION: These results suggest that obese flushers have an increased risk of developing pre- or T2DM even with less alcohol consumption.

A Smart Recommender Based on Hybrid Learning Methods for Personal Well-Being Services.

The main focus of the paper is to propose a smart recommender system based on the methods of hybrid learning for personal well-being services, called a smart recommender system of hybrid learning (SRHL). The essential health factor is considered to be personal lifestyle, with the help of a critical examination of various disciplines. Integrating the recommender system effectively contributes to the prevention of disease, and it also leads to a reduction in treatment cost, which contributes to an improvement in the quality of life. At the same time, there exist various challenges within the recommender system, mainly cold start and scalability. To effectively address the inefficiencies, we propose combined hybrid methods in regard to machine learning. The primary aim of this learning method is to integrate the most effective and efficient learning algorithms to examine how combined hybrid filtering can help to improve the cold star problem efficiently in the provision of personalized well-being in regard to health food service. These methods include: (1) switching among content-based and collaborative filtering; (2) identifying the user context with the integration of dynamic filtering; and (3) learning the profiles with the help of processing and screening of reflecting feedback loops. The experimental results were evaluated by using three absolute error measures, providing comparable results with other studies relative to machine learning domains. The effects of using the hybrid learning method are gathered with the help of the experimental results. Our experiments also show that the hybrid method improves accuracy by 14.61% of the average error predicted in the recommender systems in comparison to the collaborative methods, which mainly focus on the computation of similar entities.

Thyroid cancer among female workers in Korea, 2007-2015.

BACKGROUND: Prevalence of thyroid cancer has been increasing rapidly worldwide, especially among women. There has been a debate as to whether such an increase represents consequences of over-diagnosis or a true increase. To find the occupational risk of Korean female workers in different industry sectors, we analyzed the data of Korean female workers. METHODS: National Female Worker Cohort data that contain information on total female workers were used for our analysis of prevalence of thyroid cancer (C73 according to KCD-5, 6 code) derived from National Health Insurance data. By combining industrial codes from National Health Insurance Service and those from Korea Workers' Compensation and Welfare Service, the classification of industrial codes became to consist of the total of thirty three representing both non-office (NO) and office (O) categories. Both an internal comparison among female workers within the cohort and an external comparison to compare female workers with Korean general female population were carried out. RESULTS: Among 149,258 female workers, 2,641 cases of thyroid cancers were identified. Differences in prevalence of thyroid cancer between female workers (40.5%) and general Korean female population (32.6%) were observed; however, the differences in prevalence of thyroid cancer between NO workers and O workers were not apparent. An analysis involving workers in Financial and insurance activities sector revealed that, standardized prevalence rate (SPR) of both NO (2.96, 95% CI = 2.01-4.20) and O workers (3.68, 95% CI = 3.10-4.33) increased significantly and that an AOR (adjusted odds ratio) increased marginally (1.38, 95% CI = 0.97-1.96). Further, when stratified in respect to the duration of employment, an AOR of female workers having been employed for more than 8 years showed a significant increase (1.63, 95% CI = 1.07-2.49). CONCLUSIONS: Female workers had a higher risk of thyroid cancer than general female population but the difference between NO workers and O workers was not found to be significant in most industrial sectors. Further studies using data with information regarding specific occupational exposures are needed.

The Role of Family Behaviors in Determining Income Distribution: The Case of South Korea.

In this article, we examined what has contributed to the worsening income inequality and poverty between 1996 and 2011 in South Korea. We used a rank-preserving exchange method and a conditional reweighting method to assess the roles of family behaviors-including female labor force participation and family structure-characteristics of household heads, and men's earnings. The results showed that the change in men's earnings was a dominant factor in accounting for the increasing income inequality and poverty. The change in age and education among household heads also contributed significantly to the worsening income distribution. The change in family structure mainly affected the income disparity among lower-income families and increased poverty. The rise in women's labor force participation improved the income distribution but not considerably. The distributional roles of family have not worked to prevent or reverse the worsening income distribution in the past few decades in South Korea.

Effects of topical dexamethasone in postoperative sore throat.

BACKGROUND: Postoperative sore throat (POST) is a complication that undermines patient satisfaction and increases discomfort in the postoperative period. The present study examined the effects of dexamethasone gargle and endotracheal tube cuff soaking on the incidence and severity of POST. METHODS: Ninety patients undergoing laparoscopic cholecystectomy were randomly allocated into three groups: 0.9% normal saline gargling and tube soaking (group C), 0.05% dexamethasone solution gargling and 0.9% normal saline tube soaking (group G), 0.9% normal saline gargling and 0.05% dexamethasone tube soaking (group S). The incidence and severity of POST were then assessed and recorded at 24 hours after surgery. RESULTS: The total incidence of POST was significantly different among the groups (P < 0.05), and group S exhibited a significantly lower incidence of POST than group C (P < 0.0167). In addition, the POST intensity of group G and group S was less severe than those of group C (Both P < 0.0167). CONCLUSIONS: Among patients undergoing laparoscopic cholecystectomy, those who gargled with 0.05% dexamethasone solution exhibited lower severity of POST than the control group, and those whose endotracheal tube cuff was soaked in the dexamethasone solution before intubation exhibited significantly lower incidence and severity of POST than the control group.

Engineered extracellular microenvironment with a tunable mechanical property for controlling cell behavior and cardiomyogenic fate of cardiac stem cells.

Endogenous cardiac stem cells (CSCs) are known to play a certain role in the myocardial homeostasis of the adult heart. The extracellular matrix (ECM) surrounding CSCs provides mechanical signals to regulate a variety of cell behaviors, yet the impact in the adult heart of these mechanical properties of ECM on CSC renewal and fate decisions is mostly unknown. To elucidate CSC mechanoresponses at the individual cell and myocardial level, we used the sol-to-gel transitional gelatin-poly(ethylene glycol)-tyramine (GPT) hydrogel with a tunable mechanical property to construct a three-dimensional (3D) matrix for culturing native myocardium and CSCs. The elastic modulus of the GPT hydrogel was controlled by adjusting cross-linking density using hydrogen peroxide. The GPT hydrogel showed an ability to transduce integrin-mediated signals into the myocardium and to permit myocardial homeostatic processes in vitro, including CSC migration and proliferation into the hydrogel from the myocardium. Decreasing the elastic modulus of the hydrogel resulted in upregulation of phosphorylated integrin-mediated signaling molecules in CSCs, which were associated with significant increases in cell spreading, migration, and proliferation of CSCs in a modulus-dependent manner. However, increasing the elastic modulus of hydrogel induced the arrest of cell growth but led to upregulation of cardiomyocyte-associated mRNAs in CSCs. This work demonstrates that tunable 3D-engineered microenvironments created by GPT hydrogel are able to control CSC behavior and to direct cardiomyogenic fate. Our system may also be appropriate for studying the mechanoresponse of CSCs in a 3D context as well as for developing therapeutic strategies for in situ myocardial regeneration. STATEMENT OF SIGNIFICANCE: The extracellular matrix (ECM) provides a physical framework of myocardial niches in which endogenous cardiac stem cells (CSCs) reside, renew, differentiate, and replace cardiac cells. Interactions between ECM and CSCs might be critical for the maintenance of myocardial homeostasis in the adult heart. Yet most studies done so far have used irrelevant cell types and have been performed at the individual cell level, none able to reflect the in vivo situation. By the use of a chemically defined hydrogel to create a tunable 3D microenvironment, we succeeded in controlling CSC behavior at the myocardial and individual cell level and directing the cardiomyogenic fate. Our work may provide insight into the design of biomaterials for in situ myocardial regeneration as well as for tissue engineering.

Relating factors to wearing personal radiation protectors among healthcare professionals.

BACKGROUND: With increasing use of medical radiologic procedures, wearing proper protector should be emphasized to reduce occupational radiation exposures. This research describes the rates of lead apron wearing for radiation protection and assessed occupational factors related to wearing rates for various types of healthcare professionals. METHODS: We conducted a self-administered questionnaire survey through a website, on-site visits, fax, and mail. Of the 13,489 participants, 8858 workers who could not completely separate themselves from radiological procedure areas. Their general characteristics (sex and age), work history (job title, duration of employment, and hospital type), and practices (frequency of radiation procedures, ability to completely separate from radiation, and frequency of wearing protective lead aprons) were examined. RESULTS: The mean rate of lead apron wearing during radiologic procedures was 48.0 %. The rate was different according to sex (male: 52.9 %, female: 39.6 %), hospital type (general hospital: 63.0 %, hospital: 51.3 %, clinic: 35.6 %, dental hospital/clinic: 13.3 %, public health center: 22.8 %), and job title (radiologic technologist: 50.3 %, doctor: 70.3 %, dentist/dental hygienist: 15.0 %, nurse/nursing assistant: 64.5 %) (p < 0.001). By logistic regression analysis stratified by job title, use of lead aprons by radiologic technologists and nurses/nursing assistants was associated with hospital type and exposure frequency score. For doctors, apron wearing was associated with employment duration. For dentists/dental hygienists, apron wearing was associated with the exposure frequency score. CONCLUSIONS: To improve working environments for healthcare professionals exposed to radiation, it is necessary to consider related factors, such as job title, duration of employment, and hospital type, when utilizing a planning and management system to prevent radiation-related health problems.

Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery.

BACKGROUND: Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. METHODS: Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. RESULTS: The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. CONCLUSIONS: The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.

The combination of sugammadex and neostigmine can reduce the dosage of sugammadex during recovery from the moderate neuromuscular blockade.

BACKGROUND: Sugammadex is a novel neuromuscular reversal agent, but its associated hypersensitivity reaction and high cost have been obstacles to its widespread use. In the interest of reducing the necessary dosage of sugammadex, the reversal time of the combined use of sugammadex and neostigmine from moderate neuromuscular blockade were investigated. METHODS: The patients enrolled ranged in age from 18 to 65 years old with American Society of Anesthesiologists class 1 or 2. The subjects were randomly assigned into one of the four groups (Group S2, S1, SN, and N; n = 30 per group). The reversal agents of each groups were as follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1 mg/kg + neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg, N - neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg. The time to recovery of the train-of-four (TOF) ratio was checked in each group. RESULTS: The time to 90% recovery of TOF ratio was 182.6 ± 88.9, 371.1 ± 210.4, 204.3 ± 103.2, 953.2 ± 379.7 sec in group S2, S1, SN and N, respectively. Group SN showed a significantly shorter recovery time than did group S1 and N (P < 0.001). However, statistically significant differences between the S2 and SN groups were not be observed (P = 0.291). No hypersensitivity reactions occurred in all groups. CONCLUSIONS: For the reversal from rocuronium-induced moderate neuromuscular blockade, the combined use of sugammadex and neostigmine may be helpful to decrease the recovery time and can also reduce the required dosage of sugammadex. However, the increased incidence of systemic muscarinic side effects must be considered.