Effects of cranial electrotherapy stimulation on preoperative anxiety and blood pressure during anesthetic induction in patients with essential hypertension.

OBJECTIVE: Cranial electrotherapy stimulation (CES) is a non-invasive treatment that improves symptoms such as anxiety and pain. The purpose of this study was to analyze the effect of CES pretreatment on levels of preoperative anxiety, pain, and hemodynamic responses-especially changes in blood pressure-during anesthetic induction in patients with essential hypertension. METHODS: Eighty patients undergoing general anesthesia were randomly assigned to receive either no pretreatment (control group, n = 40) or CES pretreatment (CES group, n = 40). Anxiety scores, systolic and diastolic blood pressures, mean arterial pressure, and heart rate were measured in the general ward the evening before surgery, as well as in the preoperative holding area, operating room, and after intubation. Withdrawal responses to rocuronium injection were also measured. RESULTS: Anxiety scores in the operating room were significantly lower in the CES group. Withdrawal responses to rocuronium injection were also significantly lower in the CES group. There were no significant differences in hemodynamic values between the two groups. CONCLUSIONS: CES pretreatment reduces both preoperative anxiety levels and withdrawal responses to rocuronium injection. However, it does not have a significant effect on hemodynamic responses.

Relationship between the muscle relaxation effect and body muscle mass measured using bioelectrical impedance analysis: A nonrandomized controlled trial.

OBJECTIVE: The dose of neuromuscular blocking drugs is commonly based on body weight, but using muscle mass might be more effective. This study investigated the relationship between the effect of neuromuscular blocking drugs and muscle mass measured using bioelectrical impedance analysis. METHODS: Patients who were scheduled for elective surgery using a muscle relaxant were screened for inclusion in this study. Under intravenous anaesthesia, 12 mg or 9 mg of rocuronium was administered to males and females, respectively; and the maximal relaxation effect of T1 was measured using a TOF-Watch-SX® acceleromyograph. RESULTS: This study enrolled 40 patients; 20 males and 20 females. For both sexes, the maximal relaxation effect of T1 did not correlate with the body weight-based dose of neuromuscular blocking drugs (males, r2 = 0.12; females, r2 = 0.26). Instead, it correlated with the dose based on bioelectrical impedance analysis-measured muscle mass when injected with the same dose of rocuronium (males, r2 = 0.78, female, r2 = 0.82). CONCLUSIONS: This study showed that the muscle relaxation effect of rocuronium was correlated with muscle mass and did not correlate with body weight when using the same dose. Therefore, a muscle mass-based dose of neuromuscular blocking drugs is recommended.

C-reactive protein and N-terminal pro-brain natriuretic peptide discrepancy: a differentiation of adenoviral pharyngoconjunctival fever from Kawasaki disease.

PURPOSE: To differentiate adenoviral pharyngoconjunctival fever (PCF) from acute Kawasaki disease (KD) using laboratory tests before results of virus-real time polymerase chain reaction and ophthalmologic examination are obtained. METHODS: Baseline patient characteristics and laboratory measurements were compared between 40 patients with adenovirus infection and 123 patients with KD. RESULTS: The patients with adenovirus infection were generally older than those with KD (median: 3.9 years vs. 2 years, P=0.000). White blood cell and, platelet count, and aspartate aminotransferase, alanine aminotransferase, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels showed significant differences between the 2 groups, but the C-reactive protein (CRP) levels did not (6.8±3.0 mg/dL vs. 8.3±5.8 mg/dL, P=0.126). In the adenovirus infection group, the CRP levels were <1, <3, <10, and ≥10 mg/dL in 2 (5%), 3 (7.5%), 30 (75%), and 5 patients (12.5%), respectively. The cutoff NT-proBNP level was 265 pg/mL. Discrepancy was defined as CRP and NT-proBNP levels of ≥3 or <3 mg/dL, and <265 or ≥265 pg/mL, respectively. Among the 35 patients with adenovirus infection whose CRP levels were ≥3 mg/dL, 29 (82.9%) showed a discrepancy. Conversely, of the 103 patients with KD whose CRP levels were ≥3 mg/dL, 83 (80.6%) showed no discrepancy. Between the groups, a significant difference in discrepancy rate was observed (P=0.000). None of the patients with adenovirus infection had CRP and NT-proBNP levels of <3 mg/dL and ≥265 pg/mL, respectively. CONCLUSION: With a sensitivity of 82.9% and a specificity of 80.6%, CRP and NT-proBNP levels may differentiate between adenoviral PCF and acute KD.

Dysarthria induced by irinotecan in a patient with colorectal cancer.

PURPOSE: Successful management and subsequent prevention of a rare adverse drug reaction (ADR) associated with irinotecan chemotherapy are reported. SUMMARY: A 49-year-old man with meta-static colon cancer undergoing treatment with i.v. irinotecan (180 mg/m(2) to be infused over 120 minutes) as part of a multidrug chemotherapy regimen developed dysarthria about 90 minutes into irinotecan infusions on two occasions. In both instances, the dysarthric symptoms (numbness of the tongue and difficult speech) resolved after the discontinuation of irinotecan and administration of hydration therapy. Brain imaging studies showed no functional or structural abnormalities; several concomitantly administered medications, including metoclopramide, palonosetron, and other components of the chemotherapy regimen, were deemed unlikely to have played a causal or contributory role in the episodes of dysarthria. Application of the ADR probability scale of Naranjo et al. in this case yielded a score of 9, indicating a definite ADR caused by irinotecan. For subsequently administered chemotherapy cycles, the duration of the patient's irinotecan infusions was increased (to 180 minutes for cycles 3-5 and to 240 minutes for cycles 6-12). Dysarthria did not recur and, with the exception of transient tongue twisting during two of the 180-minute infusions, he completed the full course of irinotecan therapy without a recurrence of dysarthric symptoms. CONCLUSION: Irinotecan-induced dysarthria in a man being treated for colon cancer resolved with the discontinuation of irinotecan. With increases in the duration of infusion, the man received additional irinotecan treatments with no recurrence of dysarthria.