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1.
Medicine (Baltimore) ; 98(50): e18233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852086

RESUMO

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN betweenThe success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.


Assuntos
Anestesia Epidural/instrumentação , Cateteres , Dor Lombar/terapia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Injeções Epidurais/métodos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
J Clin Med ; 8(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295896

RESUMO

Osteoarthritis (OA) is considered to be one of the most disabling diseases. The intra-articular opioid injection has been widely studied for its simplicity, safety, and efficacy in OA. In this study, however, we suggest a novel method of buprenorphine transdermal patch (BTDP) to painful knee joints of OA patients, instead of intra-articular opioid injection, and subsequently compared the knee application with conventional chest application. We retrospectively enrolled 213 patients with knee OA who did not respond to conventional therapy. The Numeric Rating Scale (NRS), adverse effects, and compliance were recorded before and after the application of the BTDP. All parameters were compared between the knee applied group and the chest applied group. After the BTDP application, the NRS score in the knee applied group was lower than that of the chest applied group (p = 0.007). NRS scores after buprenorphine patch decreased to 2.21 ± 0.77, and 2.55 ± 0.71 in the chest applied group and the knee applied group, respectively. The adverse effects were 19.32% in the knee applied group, and 64.00% in the chest applied group. The compliances were 82.95% and 37.60% in the knee applied group and chest applied group, respectively. This novel application of BTDP directly to the painful knee joint of knee OA patients led to a decrease in the NRS score, adverse effects, and an increase in compliance compared with the chest application method.

3.
Korean J Anesthesiol ; 71(5): 368-373, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29684988

RESUMO

BACKGROUND: Hypnosis monitors analyze small-amplitude electrical signals transmitted from the brain that could be exposed to the electromagnetic field that occurs around the body during electrocautery (ECT). We investigated the influence of ECT on hypnosis monitoring during anesthesia. METHODS: We simultaneously monitored BIS and uCON during 50 gynecologic oncology surgeries. During the episodes of ECT, we compared the absolute difference (a-Diff) between the baseline index and the most deviated index after ECT over either 30-60 s (ECT30-60) or more than 60 s (ECT > 60) between the monitors. We also investigated the bias and the limits of agreement between the monitors. RESULTS: Between the two monitors, the a-Diff of ECT30-60 was 1.4 ± 1.1 for the BIS, which was significantly greater than 0.6 ± 0.9 for the uCON (P = 0.003), and the a-Diff of ECT > 60 was 16.5 ± 8.2 for the BIS, which was also significantly greater than 1.4 ± 1.3 for uCON (P < 0.001). The intra-monitor index differences showed that the BIS during ECT > 60 was significantly greater than that during ECT30-60 (P < 0.001), but the uCON showed no significant difference between ECT30-60 and ECT > 60 (P = 0.056). The estimated bias between the monitors was 6.3 ± 9.8 and 95% limits agreement was -12.3 to 25.0. CONCLUSIONS: Prolonged ECT intervention might lead to spurious estimations of quantitative EEG indexes. Therefore, hypnosis should be clinically assessed in combination with scrutinized judgment of relevant clinical symptoms and signs for hypnosis.

4.
Korean J Anesthesiol ; 66(5): 377-82, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24910730

RESUMO

BACKGROUND: We investigated the correction methods following wrong-settings of emulsion concentrations of propofol as a countermeasure against erroneous target-controlled infusions (TCI). METHODS: TCIs were started with targeting 4.0 µg/ml of effect-site concentration (Ceff) of propofol, and the emulsion concentrations were selected for 2.0% instead of 1.0% (FALSE1-2, n = 24), or 1.0% instead of 2.0% (FALSE2-1, n = 24). These wrong TCIs were corrected at 3 min after infusion start. During FALSE1-2, the deficit was filled up while injecting after equilibrium (n = 12), or while overriding (n = 12). During FALSE2-1, the overdose was evacuated while targeting Ceff (n = 12) or targeting plasma concentration (Cp) (n = 12). The gravimetrical measurements of TCI reproduced the Cp and Ceff using simulations. The reproduced Ceff at 3 min (Ceff-3min) and the time to be normalized within ± 5% of target Ceff (T±5%), were compared between the correction methods. RESULTS: During the wrong TCI, Ceff-3min was 1.98 ± 0.01 µg/ml in FALSE1-2, and 7.99 ± 0.05 µg/ml in FALSE2-1. In FALSE1-2, T±5% was significantly shorter when corrected while overriding (3.9 ± 0.25 min), than corrected after equilibrium (6.9 ± 0.05 min) (P < 0.001). In FALSE2-1, T±5% was significantly shorter during targeting Cp (3.6 ± 0.04 min) than targeting Ceff (6.7 ± 0.15 min) (P < 0.001). CONCLUSIONS: The correction methods, based on the pharmacokinetic and pharmacodynamic characteristics, could effectively and rapidly normalize the wrong TCI following erroneously selections of the emulsion concentration of propofol.

5.
Korean J Anesthesiol ; 66(4): 300-5, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24851166

RESUMO

BACKGROUND: The methods of arrangement of combined intravenous parallel infusions using anti-reflux valve (ARV), with and without anti-syphon valve (ASV) that could decrease occlusion alarm delay were investigated. METHODS: Occlusion challenge tests were mainly performed as bench experiments of four kinds of multiple parallel infusions (10 ml/h and 50 ml/h infusions), which were connected at the proximal or distal portion of ARV, with or without ASV. Alarm threshold was set to 1000 mmHg. Occlusion alarm delays and the compliances of the infusion systems were compared among groups. RESULTS: Without ASV, compared to 10 ml/h infusion alone distal to anti-reflux valve, 50 ml/h infusion distal to anti-reflux valve reduced the mean alarm delay from 416 ± 7 s to 81 ± 3 s (P < 0.001). Compared to 50 ml/h infusion alone, combined 10 ml/h and 50 ml/h infusion distal to ARV prolonged the alarm delay from 81 ± 3 s to 133 ± 6 s (P < 0.001). However, combined infusions distal to ARV with ASV significantly reduced the alarm delay from 133 ± 6 s to 74 ± 5 s (P < 0.001), and also reduced the compliance of the infusion system from 2.31 ± 0.12 to 1.20 ± 0.08 µl/mmHg (P < 0.001). CONCLUSIONS: The infusion setup of faster infusion rate, lower compliant system using ASV could effectively decrease occlusion alarm delay during multiple intravenous parallel infusions using ARV.

6.
J Anesth ; 28(2): 257-66, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23958914

RESUMO

Fentanyl-induced cough (FIC) is often observed after intravenous bolus administration of fentanyl during anesthesia induction. This meta-analysis assessed the efficacy of pharmacological and nonpharmacological interventions to reduce the incidence of FIC. We searched for randomized controlled trials comparing pharmacological or nonpharmacological interventions with controls to prevent FIC; we included 28 studies retrieved from Pub-Med, Embase, and Cochrane Library. Overall incidence of FIC was approximately 31 %. Lidocaine [odds ratio (OR) = 0.29, 95 % confidence interval (CI) 0.21­0.39], N-methyl-D-aspartate (NMDA) receptor antagonists (OR 0.09, 95 % CI 0.02­0.42), propofol (OR 0.07, 95 % CI 0.01­0.36), a2 agonists (OR 0.32, 95 % CI 0.21­0.48), b2 agonists (OR 0.10, 95 % CI 0.03­0.30), fentanyl priming (OR 0.33, 95 % CI 0.19­0.56), and slow injection of fentanyl (OR 0.25, 95 % CI 0.11­0.58)] were effective in decreasing the incidence of FIC, whereas atropine (OR 1.10, 95 % CI 0.58­2.11) and benzodiazepines (OR 2.04, 95 % CI 1.33­3.13) were not effective. This meta-analysis found that lidocaine, NMDA receptor antagonists, propofol, a2 agonists, b2 agonists, and priming dose of fentanyl were effective in preventing FIC, but atropine and benzodiazepines were not. Slow injection of fentanyl was effective in preventing FIC, but results depend on the speed of administration.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Tosse/induzido quimicamente , Tosse/prevenção & controle , Fentanila/efeitos adversos , Administração Intravenosa , Agonistas Adrenérgicos/uso terapêutico , Adulto , Anestésicos Intravenosos/administração & dosagem , Anestésicos Locais/uso terapêutico , Tosse/etiologia , Fentanila/administração & dosagem , Humanos , Lidocaína/uso terapêutico , Propofol/uso terapêutico , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores
7.
Korean J Anesthesiol ; 64(5): 407-13, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23741562

RESUMO

BACKGROUND: The start-up behavior of syringe and syringe pump is known to be one of the causes of inaccurate intravenous infusion. This study evaluated the method of priming the infusion system (PRIMING), and its impact on the target-controlled infusion (TCI) of two remifentanil diluents. METHODS: PRIMING was performed using an evacuation of 2.0 ml to the atmosphere prior to TCI. Forty-eight TCI, using 50 µg/ml (Remi50) or 20 µg/ml (Remi20) of diluents, were performed targeting 4.0 ng/ml of effect-site concentration (Ceff), with PRIMING or not. The gravimetrical measurements of the delivered infusates reproduced actual Ceff. The bolus amount and time to reach 95% target were compared. RESULTS: Without PRIMING, Remi50 infused less bolus (43 ± 23 %) than Remi20 (19 ± 9 %) (P = 0.003), and showed more delayed increase of Ceff (11.2 ± 4.0 min) than Remi20 (7.4 ± 0.4 min) (P = 0.028). However, PRIMING significantly decreased the deficit of the bolus (2 ± 1%), as well as the delay of the increase of Ceff in Remi50 (1.2 ± 0.2 min) (both P < 0.001). In addition, with PRIMING, the start-up bolus showed minimal difference to the nominal bolus (1 and 2%), and Ceff were increased to 4.0 ± 0.1 ng/ml at the expected time of peak effect, irrespective of the diluents. CONCLUSIONS: Proper operation of the syringe pump used in the priming of the syringe may be helpful in reduction of the inaccuracy of TCI, particularly during the early phase of infusion, or the infusion of a more concentrated diluent.

8.
Korean J Pediatr ; 56(4): 165-75, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23646055

RESUMO

PURPOSE: There was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B). METHODS: A prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients. RESULTS: There was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1. CONCLUSION: Establishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required.

9.
Korean J Anesthesiol ; 64(3): 251-6, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23560192

RESUMO

BACKGROUND: We evaluated volumetric differences of syringe brand compatibilities, and investigated the impact of false brand settings on target-controlled infusion (TCI) and their methods of correction. METHODS: Gravimetric measurement of 10 ml bolus infusions was performed using BD Plastipak (BDP) and Terumo compatible syringes, while setting to 7 different kinds of brand compatibilities (BDP, Sherwood Monoject, BD Perfusion, Braun Perfusor, Braun Omnifix, Fresenius Injectomat, and Terumo). To investigate the performance of TCI using BDP with a false setting to Terumo (BDPTERUMO) and Terumo to BDP (TERUMOBDP), 24 TCI targeting 4.0 µg/ml of effect-site concentration (Ceff) of propofol were performed. Subsequently, another 24 TCI were evaluated for simple corrections of false settings at 30 min. We also investigated 24 TCI using active corrections (fill-up for BDPTERUMO, evacuation for TERUMOBDP) based on the pharmacokinetics of propofol. The Ceff at 30 min of TCI and time to normalize to ± 5% of target concentration (T±5%target) were compared. RESULTS: The Ceff of BDPTERUMO showed negative bias and 17.2% inaccuracy, and the Ceff of TERUMOBDP showed positive bias and 19.5% inaccuracy. The Ceff at 30 min showed no difference between the methods of correction in BDPTERUMO or TERUMOBDP. The T±5%target in both the active corrections was significantly shorter than that of each simple corrections (P < 0.001). CONCLUSIONS: False brand setting of syringe proportionally maintained different predicted concentrations as much as the volumetric differences of syringe brand. Based on the results, it is proposed that correction methods based on pharmacokinetics could effectively normalize the differences, without giving up the wrong TCI.

10.
J Anesth ; 27(5): 742-9, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23519582

RESUMO

Rocuronium is reported to be associated with injection pain or withdrawal movement (IPWM). This meta-analysis assessed the efficacy of different pharmacological treatments used to decrease the incidence of the rocuronium-induced IPWM. We searched the Cochrane Library, Embase and PubMed for randomized controlled trials comparing a pharmacological drug with a placebo to prevent the rocuronium-induced IPWM and found 37 studies with 5,595 patients. Overall incidence of rocuronium-induced IPWM was 74%. Pretreatment with opioids [risk ratio (RR) 0.16; 95% confidence interval (95% CI) 0.09-0.29], lidocaine (0.47; 0.35-0.64), and ketamine (0.41; 0.22-0.77) were effective in decreasing IPWM. Lidocaine pretreatment with venous occlusion (0.40; 0.32-0.49) and opioids pretreatment with venous occlusion (0.77; 0.61-0.96) were also effective. Mixing sodium bicarbonate (NaHCO3) with rocuronium (0.15; 0.06-0.34) was also efficacious in reducing IPWM. Indirect comparison shows that the RR of NaHCO3 admixture and pretreatment with opioids were lower than that of the other four interventions (pretreatments of ketamine or lidocaine, and lidocaine or opioids with venous occlusion). This meta-analysis suggests that opioids, lidocaine, ketamine, and NaHCO3 are effective in decreasing rocuronium-induced IPWM. Considering the efficacy and convenience, pretreatment with opioids without venous occlusion is recommended for reducing rocuronium-induced IPWM.


Assuntos
Analgésicos/uso terapêutico , Androstanóis/efeitos adversos , Dor/induzido quimicamente , Dor/prevenção & controle , Humanos , Injeções Intravenosas , Dor/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Rocurônio
11.
J Anesth ; 27(2): 199-204, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22983593

RESUMO

PURPOSE: The purpose of this study was to determine the intubation time needed to facilitate tracheal intubation (Time(EI)) with a low dose of rocuronium (0.3 mg/kg) during propofol induction, and to determine whether this time was reduced by the administration of atropine. METHODS: Forty-six children, aged 3-10 years, were randomly assigned to receive either saline (control group) or atropine 10 µg/kg (atropine group). Anesthesia was induced with alfentanil 10 µg/kg, propofol 2.5 mg/kg, and rocuronium 0.3 mg/kg. Each Time(EI) at which tracheal intubation was attempted was predetermined according to the up-and-down method. The values of Time(EI) that provided excellent intubation conditions in 50 and 95 % of patients were defined as Time(EI)50 and Time(EI)95, respectively. RESULTS: Time(EI)50 ± SD was 160 ± 26.2 and 150 ± 13.7 s in the control and atropine groups, respectively. Using isotonic regression, Time(EI)95 in the control and atropine groups was 199 s (95 % CI 198.8-200.7 s) and 171 s (95 % CI 171.3-172.1 s), respectively. Time(EI)95 was significantly higher in the control group than in the atropine group (P < 0.001). HR was significantly higher in the atropine group than in the control group during the study period. CONCLUSIONS: This study demonstrated that the Time(EI)95 of a low dose of rocuronium (0.3 mg/kg) required for excellent tracheal intubation was 199 s during i.v. anesthesia induction using propofol and alfentanil in children. Also, i.v. atropine (10 µg/kg) before anesthesia induction was able to reduce Time(EI)95 by 28 s.


Assuntos
Androstanóis , Atropina , Intubação Intratraqueal/métodos , Antagonistas Muscarínicos , Fármacos Neuromusculares não Despolarizantes , Anestesia , Pressão Arterial/fisiologia , Débito Cardíaco/efeitos dos fármacos , Criança , Pré-Escolar , Tosse/etiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Rocurônio , Fatores de Tempo , Tonsilectomia
12.
Korean J Anesthesiol ; 65(6): 544-51, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24427461

RESUMO

BACKGROUND: Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia. METHODS: Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 µg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated. RESULTS: VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups. CONCLUSIONS: The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.

13.
Korean J Anesthesiol ; 63(1): 30-5, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22870362

RESUMO

BACKGROUND: This study evaluates the effectiveness of the target-controlled infusion (TCI) of remifentanil through stepwise increases in the effect-site concentration (C(eff)) in preventing coughs. METHODS: In a preliminary study, we randomly selected 140 patients to receive remifentanil through two-step increases in C(eff) (1.0 ng/ml to 4.0 ng/ml: Group R(1-4); 2.0 ng/ml to 4.0 ng/ml: Group R(2-4)). Based on the results of the preliminary study, we employed another sample of 140 patients and implemented a three-step increase in TCI (1.0 ng/ml to 2.0 ng/ml to 4.0 ng/ml: Group R(1-2-4)). We then compared this treatment with direct targeting based on 4.0 ng/ml TCI (Group R(4)). We recorded the episodes of coughs, rating them as mild (1-2), moderate (3-4), or severe (5 or more). RESULTS: In Group R(1-4), one patient (1.5%) coughed during the first step, and five (7.3%) coughed during the second step. In Group R(2-4), nine (13.2%) coughed during the first step, but none coughed during the next step. Only one patient had a mild cough during the three-step increase in TCI, that is, patients in Group R(1-2-4) were significantly less likely to cough than those in Group R(4) (P < 0.001). CONCLUSIONS: Stepwise increases in the TCI of remifentanil reduced the incidence of remifentanil-induced coughing, and the three-step increase in TCI nearly eliminated remifentanil-induced coughing.

14.
Korean J Anesthesiol ; 62(4): 309-16, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22558495

RESUMO

BACKGROUND: We investigated how one pharmacokinetic (PK) model differed in prediction of plasma (C(p)) and effect-site concentration (C(eff)) using a reproducing simulation of target-controlled infusion (TCI) with another PK model of propofol. METHODS: Sixty female patients were randomly assigned to TCI using Marsh PK (Group M) and TCI using Schnider PK (Group S) targeting 6.0 µg/ml of C(p) of propofol for induction of anesthesia, and loss of responsiveness (LOR) was evaluated. Total and separate cross-simulation were investigated using the 2 hr TCI data (Marsh TCI and Schnider TCI), and we investigated the reproduced predicted concentrations (MARSH(SCH) and SCHNIDER(MAR)) using the other model. The correlation of the difference with covariates, and the influence of the PK parameters on the difference of prediction were investigated. RESULTS: Group M had a shorter time to LOR compared to Group S (P < 0.001), but C(eff) at LOR was not different between groups. Reproduced simulations showed different time courses of C(p). MARSH(SCH) predicted a higher concentration during the early phase, whereas SCHNIDER(MAR) was maintained at a higher concentration. Volume and clearance of the central compartment were relevant to the difference of prediction, respectively. Body weight correlated well with differences in prediction between models (R(sqr) = 0.9821, P < 0.001). CONCLUSIONS: We compared two PK models to determine the different infusion behaviors during TCI, which resulted from the different parameter sets for each PK model.

15.
Korean J Anesthesiol ; 61(2): 133-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21927683

RESUMO

BACKGROUND: A decrease in core body temperature caused by heat distribution depends on the anesthetic agent used. The purpose of this study is to investigate the effects of sevoflurane and propofol on core temperature during laparoscopic major abdominal surgery requiring pneumoperitoneum of more than 90 min. METHODS: Fifty adult patients undergoing laparoscopic major abdominal surgery were randomly assigned to either a sevoflurane group (n = 25) or a propofol group (n = 25). In the sevoflurane group, anesthesia was induced with propofol 2 mg/kg, remifentanil 1.0 µg/kg, and maintained with 0.8-2.0 vol% sevoflurane and 0.1-0.2 µg/kg/min remifentanil. In the propofol group, anesthesia was induced with the effect-site concentration of propofol of 5.0 µg/ml and remifentanil 4 ng/ml, and maintained with the effect-site concentration of propofol of 2-3.5 µg/ml and remifentanil 3-5 ng/ml. Core body temperature was measured with an esophageal stethoscope with a temperature sensor after the start of the pneumoperitoneum (baseline) and at 15-min intervals until completion of surgery. RESULTS: During the study period, core temperature was comparable between the two groups. When compared with baseline values, core temperatures in both groups were significantly decreased 45 min after pneumoperitoneum. CONCLUSIONS: This study demonstrated that in patients undergoing prolonged laparoscopic surgery, a decrease in core body temperature during sevoflurane-remifentanil anesthesia was not different than propofol-remifentanil anesthesia, and the incidence of hypothermia of the two groups did not differ.

16.
Korean J Anesthesiol ; 60(6): 393-7, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21738840

RESUMO

BACKGROUND: Target-controlled infusion (TCI) of propofol and remifentanil can provide satisfactory intubating conditions without a neuromuscular blocking agent. We compared the effect-site concentration of remifentanil required for intubation with the lightwand and the Macintosh laryngoscope during propofol TCI without a neuromuscular blocking agent in adult patients. METHODS: Forty-nine patients were randomly assigned to the lightwand group (n = 25) or the direct laryngoscope group (n = 24). Anesthesia was induced by propofol TCI with an effect-site concentration of 5.4 µg/ml. Two minutes after start of propofol TCI, remifentanil was administered at the predetermined effect-site concentration. The effect-site concentration of remifentanil was determined using Dixon's up-and-down method (0.5 ng/ml as a step size). The first patient in each group was tested at 4.5 ng/ml of remifentanil. Tracheal intubation was performed 2 min after the start of remifentanil TCI. Acceptable intubation was defined as an excellent or good intubating conditions. RESULTS: Using a modified Dixon's up and down method, the EC50 ± SD of remifentanil in the lightwand and laryngoscope groups was 4.75 ± 0.71 ng/ml and 5.08 ± 0.52 ng/ml, respectively; there was no statistically significant difference between the groups (P = 0.373). CONCLUSIONS: The effect-site concentration of remifentanil for acceptable intubation with the lightwand and Macintosh laryngoscope in 50% of adults did not differ during propofol TCI without a neuromuscular blocking agent.

17.
J Anesth ; 25(2): 195-9, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21327806

RESUMO

PURPOSE: The purpose of this study was to investigate the effect of ketamine on intubating conditions for tracheal intubation during anesthesia induction with sevoflurane and alfentanil in pediatric patients. METHODS: After obtaining parental consents, 50 children, aged 3-10 years, were randomly allocated into two groups to receive either i.v. ketamine 0.5 mg/kg (ketamine group, n = 25) or i.v. saline 5 ml (control saline group, n = 25). One minute after injection of the study drug (ketamine or saline), anesthesia was induced with 5% sevoflurane, followed by injection of alfentanil 10 µg/kg 1 min later. The trachea was intubated 4 min after inhalational induction of anesthesia. Acceptable intubation was defined as excellent or good intubating conditions. Mean arterial pressure (MAP) and heart rate (HR) were recorded during the induction period. RESULTS: The percentage of patients with acceptable intubating conditions was higher in the ketamine group (87%) than in the control group (52%) (P = 0.0129). MAP before intubation was significantly lower in the control group than in the ketamine group (P = 0.001). CONCLUSION: This study demonstrated that administration of ketamine 0.5 mg/kg could improve intubating conditions for tracheal intubation without neuromuscular blockade and preserve hemodynamic stability during sevoflurane inhalation induction with alfentanil in children.


Assuntos
Anestésicos Inalatórios/farmacologia , Intubação Intratraqueal , Ketamina/farmacologia , Éteres Metílicos/farmacologia , Bloqueio Neuromuscular , Pressão Sanguínea/efeitos dos fármacos , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Sevoflurano
18.
Virol J ; 7: 201, 2010 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-20738861

RESUMO

We investigated the prevalence of human papillomavirus (HPV) infection and the distribution of high-risk HPV genotypes among 2,308 high-risk Korean women to predict how much the current prophylactic HPV vaccines might affect the prevention of cervical cancer in Korea. HPV DNA was detected in 939 women (40.7%) but only one-third of women were positive for HPV-16 and/or HPV-18, the genotypes used for developing the HPV vaccines. Thus, the development of area-specific HPV vaccines based on dominant HPV genotypes in our country is needed for preventing HPV infection and the development of premalignant lesions in the cervix of Korean women.


Assuntos
Papillomaviridae/classificação , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Adolescente , Adulto , Fatores Etários , Grupo com Ancestrais do Continente Asiático , Estudos Transversais , DNA Viral/genética , DNA Viral/isolamento & purificação , Feminino , Genótipo , Humanos , Coreia (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Vacinas contra Papillomavirus/imunologia , Prevalência , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
19.
Korean J Anesthesiol ; 58(3): 231-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20498770

RESUMO

BACKGROUND: The plasma effect-site equilibrium rate constant (k(e0)) of propofol has been reported in various pharmacodynamic studies; however, it is not desirable to apply k(e0) for the link with pharmacokinetic models that were separately investigated. Thus, we titrated k(e0) for the pharmacokinetic model, which is known as the multiple covariates adjusted model of propofol. METHODS: Ninety female patients scheduled for gynecologic surgery were randomly assigned to three groups targeting different plasma concentrations of 5.4, 8.1, and 10.8 microg/ml. Target-controlled infusions (TCI) were provided by a computer-assisted continuous infusion system. Time to loss of responsiveness (LOR) was measured by a blind investigator; effect-site concentrations (C(e)) for LOR were then calculated with simulation of TCI using different k(e0)s. We determined the k(e0) minimizing total discrepancy (TD) between the inputted and calculated k(e0) from the t(1/2)k(e0)s for a given probability of LOR of the C(e), and also obtained the k(e0) for the minimal TD between the median C(e), which were compared to the known k(e0). RESULTS: K(e0)s from these two methods were 0.3692 and 0.3788/min. C(e)s for LOR with these k(e0)s were significantly different from those with Schnider's k(e0). CONCLUSIONS: We proposed a method for titration of the k(e0) of propofol. The k(e0)s of propofol was lower than Schnider's k(e0). An adequate k(e0) for the specific pharmacokinetic model and a certain population would be useful for prediction of an accurate C(e), and could be used for calculation of accurate dosing during targeting of the effect site.

20.
Korean J Anesthesiol ; 56(4): 462-465, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30625773

RESUMO

A mixture of local anesthetic and epinephrine provides hemostasis for ear microsurgery. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced catecholamine-induced cardiovascular crisis, with severe hypertension, tachycardia, and acute pulmonary edema, after subcutaneous infiltration with a 2% lidocaine and 1:200,000 epinephrine solution. The patient recovered without any apparent sequelae after intensive care, including diuretics, steroids, and nitroglycerin for the hypertension and pulmonary edema, and a vasopressor for the subsequent hypotension.

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