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1.
Sci Rep ; 9(1): 9737, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31278306

RESUMO

Mandibular setback surgery (MSS) for skeletal class III patients can result in a relative reduction of pharyngeal airway space (PAS). Consequently, there is a possibility of the decline of sleep quality after surgery. We investigated changes in sleep quality measured by overnight polysomnography (PSG) and the three-dimensional (3D) volumes of PAS following MSS with or without Le Fort I osteotomy (LF I) in class III patients (N = 53). Overnight PSG and cone beam computed tomography were conducted at preoperative stage (T0) and postoperative 3 months (T1). Measurements of PAS volumes were performed, and the subjective symptoms of sleep were evaluated by self-questionnaires. There were significant increases in respiratory disturbance index (RDI) and total respiratory effort-related arousal (RERA) index during T0-T1. The 3D volumes of PAS showed significant decreases in the oropharyngeal airway, hypopharyngeal airway, and total airway spaces. No significant changes were observed in subjective symptoms of sleep. MSS with or without LF I for class III patients could worsen sleep quality by increasing sleep parameters such as the RDI and RERA in PSG, and reduce volumes of PAS at postoperative 3 months. Although subjective symptoms may not show significant changes, objective sleep quality in PSG might decrease after MSS.

2.
Medicine (Baltimore) ; 98(15): e15084, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985662

RESUMO

Sphenopalatine ganglion block (SPGB) is a technique developed in the 1990s for the management of head and neck pain patients. Recently, transnasal sphenopalatine ganglion block (TN-SPGB) has been widely used for these patients; however, no objective methods exist for validating the success of TN-SPGB. In this study, we measured the changes in facial temperature before and 30 minutes after TN-SPGB by using digital infrared thermal imaging (DITI) to validate its success.The medical records of patients, who underwent TN-SPGB and facial DITI between January 2016 and December 2017, were reviewed. TN-SPGB and facial DITI were performed 36 times in 32 patients. The changes in facial temperatures measured at the forehead (V1), maxillary area (V2), and mandibular area (V3) by using DITI before and 30 minutes after TN-SPGB were recorded and compared. The temperatures on the ipsilateral and contralateral sides of these areas were also compared. The comparison between pain relief group and pain maintenance group was analyzed.After TN-SPGB, the temperature decreased significantly on both sides of V1 (P = .0208, 0.0181). No significant differences were observed between the ipsilateral and contralateral sides (P > .05). There was no correlation between changes in temperature and changes in pain score in the pain regions after the procedure (P > .05).The temperature decreased significantly in V1 area at 30 minutes after TN-SPGB compared with the temperature before TN-SPGB. Based on these results, we propose using DITI to measure temperature changes as an objective method for verifying the success of TN-SPGB.


Assuntos
Temperatura Corporal , Bloqueio do Gânglio Esfenopalatino , Face , Feminino , Humanos , Raios Infravermelhos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/fisiopatologia , Manejo da Dor , Estudos Retrospectivos , Termografia , Resultado do Tratamento
3.
BMC Anesthesiol ; 19(1): 4, 2019 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611202

RESUMO

BACKGROUND: Insertion under laryngoscopic guidance has been used to achieve ideal positioning of the laryngeal mask airway (LMA). However, to date, the efficacy of this technique has been evaluated only using fiberoptic evaluation, and the results have been conflicting. Other reliable tests to evaluate the efficacy of this technique have not been established. Recently, it has been suggested that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal leak pressure (OPLP). The aim of this study was to assess the efficacy of LMA insertion under laryngoscopic guidance using OPLP as an indicator. METHODS: After approved by the institutional ethics committee, a prospective comparison of 100 patients divided into 2 groups (50 with blind technique and 50 with the laryngoscope technique) were evaluated. An LMA (LarySeal™, Flexicare medical Ltd., UK) was inserted using the blind approach in the blind insertion group and using laryngoscopy in the laryngoscope-guided insertion group. The OPLP, fiberoptic position score, whether the first attempt at LMA insertion was successful, time taken for insertion, ease of LMA insertion, and adverse airway events were recorded. RESULTS: Data were presented as mean ± standard deviation. The OPLP was higher in the laryngoscope-guided insertion group than in the blind insertion group (21.4 ± 8.6 cmH2O vs. 18.1 ± 6.1 cmH2O, p = 0.031). The fiberoptic position score, rate of success in the first attempt, ease of insertion, and pharyngolaryngeal adverse events were similar between both groups. The time taken for insertion of the LMA was significantly longer in the laryngoscope-guided insertion group, compared to blind insertion group (35.9 ± 9.5 s vs. 28.7 ± 9.5 s, p < 0.0001). CONCLUSION: Laryngoscope-guided insertion of LMA improves the airway seal pressure compared to blind insertion. Our result suggests that it may be a useful technique for LMA insertion. TRIAL REGISTRATION: cris.nih.go.kr , identifier: KCT0001945 (2016-06-17).


Assuntos
Intubação Intratraqueal/métodos , Máscaras Laríngeas , Laringoscópios , Laringoscopia/métodos , Idoso , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
Acta Ophthalmol ; 97(4): e533-e539, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30565886

RESUMO

PURPOSE: To compare MultiColor fundus imaging (MC) and colour fundus photography (CFP) for the evaluation of epiretinal membrane (ERM). METHODS: In this retrospective study, 192 eyes (181 patients) that underwent vitrectomy for ERM were imaged using Spectralis optical coherence tomography (for MC) and AFC-210 digital camera (for CFP) 1 week before vitrectomy. Two investigators independently determined the rate of delineability and ERM area for each modality. RESULTS: The intergrader agreement rates for delineability were very high for both image modalities. The rate of delineability of ERM (%) was higher for MC than for CFP, for both investigators [70.8% versus 52.6% and 73.4% versus 53.6% (both p -)]. Epiretinal membrane (ERM) area measurement showed high agreement between investigators for MC (p = 0.466) but differed significantly between the investigators for CFP (p -). The ERM area determined on MC was significantly wider than that on CFP for both investigators (p - for investigator 1 and p - for investigator 2). CONCLUSION: The ERM area is more clearly detectable and widely demarcated in MC than in CFP images. MultiColor imaging (MC) may be more sensitive and accurate for early detection of ERM and ERM area measurement.


Assuntos
Membrana Epirretiniana/diagnóstico , Angiofluoresceinografia/métodos , Fotografação/métodos , Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Idoso , Estudos Transversais , Membrana Epirretiniana/cirurgia , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Vitrectomia
5.
Clin Interv Aging ; 13: 1769-1777, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30271132

RESUMO

Purpose: Among inhalational anesthetics, desflurane is widely believed to provoke upper airway irritation including coughing and laryngospasm. Remifentanil has been generally used to prevent cough due to its unique pharmacodynamics. However, there was no study that compared optimal remifentanil effect-site concentration (Ce) to prevent emergence cough according to the type of inhalational agent in elderly female patients. Thus, we investigated the Ce of remifentanil for preventing cough during emergence from sevoflurane and desflurane anesthesia in elderly female patients. Methods: Forty-three female patients between 60 and 75 years of age undergoing laparoscopic cholecystectomy were randomly allocated to sevoflurane group (n=22) or desflurane group (n=21). The optimal remifentanil Ce using target-controlled infusion for 50% of patients (EC50) and 95% of patients (EC95) was assessed by Dixon's up-and-down method or isotonic regression method with a bootstrapping approach. Results: By Dixon's up-and-down method, the EC50 of remifentanil in sevoflurane group (2.08±0.47 ng/mL) was comparable with that in desflurane group (2.25±0.40 ng/mL) (P=0.385). The EC50 (83% CIs) and EC95 (95% CIs) by isotonic regression also did not show significant difference between two groups [2.06 (1.45-2.23) and 2.46 (2.35-2.48) ng/mL in sevoflurane group and 2.14 (1.45-2.56) and 2.88 (2.47-2.98) ng/mL in desflurane group, respectively]. Conclusion: There was no difference in the remifentanil Ce to prevent emergence cough between sevoflurane and desflurane anesthesia. Therefore, the clinicians may not need to adjust the remifentanil Ce to prevent emergence cough according to inhalational agents in elderly female patients.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Tosse/prevenção & controle , Desflurano/efeitos adversos , Remifentanil/administração & dosagem , Sevoflurano/efeitos adversos , Idoso , Período de Recuperação da Anestesia , Colecistectomia Laparoscópica , Tosse/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
6.
PLoS One ; 13(10): e0204586, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30286208

RESUMO

PURPOSE: We aimed to develop a model of chronic kidney disease (CKD) progression for predicting the probability and time to progression from various CKD stages to renal replacement therapy (RRT), using 6 months of clinical data variables routinely measured at healthcare centers. METHODS: Data were derived from the electronic medical records of Ajou University Hospital, Suwon, South Korea from October 1997 to September 2012. We included patients who were diagnosed with CKD (estimated glomerular filtration rate [eGFR] < 60 mL·min-1·1.73 m-2 for ≥ 3 months) and followed up for at least 6 months. The study population was randomly divided into training and test sets. RESULTS: We identified 4,509 patients who met reasonable diagnostic criteria. Patients were randomly divided into 2 groups, and after excluding patients with missing data, the training and test sets included 1,625 and 1,618 patients, respectively. The integral mean was the most powerful explanatory (R2 = 0.404) variable among the 8 modified values. Ten variables (age, sex, diabetes mellitus[DM], polycystic kidney disease[PKD], serum albumin, serum hemoglobin, serum phosphorus, serum potassium, eGFR (calculated by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), and urinary protein) were included in the final risk prediction model for CKD stage 3 (R2 = 0.330). Ten variables (age, sex, DM, GN, PKD, serum hemoglobin, serum blood urea nitrogen[BUN], serum calcium, eGFR(calculated by Modification of Diet in Renal Disease[MDRD]), and urinary protein) were included in the final risk prediction model for CKD stage 4 (R2 = 0.386). Four variables (serum hemoglobin, serum BUN, eGFR(calculated by MDRD) and urinary protein) were included in the final risk prediction model for CKD stage 5 (R2 = 0.321). CONCLUSION: We created a prediction model according to CKD stages by using integral means. Based on the results of the Brier score (BS) and Harrel's C statistics, we consider that our model has significant explanatory power to predict the probability and interval time to the initiation of RRT.


Assuntos
Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Prognóstico , Distribuição Aleatória , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Tempo , Adulto Jovem
7.
Clin Interv Aging ; 13: 1053-1060, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29881261

RESUMO

Background: Remifentanil infusion during emergence lowers cough. Effect-site concentration (Ce) of remifentanil using target-controlled infusion (TCI) has been evaluated in previous studies. Recent studies revealed the existence of sex-related differences in remifentanil Ce in young and elderly patients. Thus, there was the need to re-evaluate the effect of age in single sex. We investigated the remifentanil Ce for suppressing emergence cough in young and elderly male patients and evaluated the age-related differences. Patients and methods: In total, 25 young (ages between 20 and 50 years) and 24 elderly (ages between 65 and 75 years) male patients undergoing laparoscopic cholecystectomy were enrolled. Anesthesia was implemented with remifentanil using TCI and sevoflurane. The remifentanil Ce for suppressing emergence cough was estimated for each group using Dixon's up-and-down method and isotonic regression method with a bootstrapping approach. Results: The remifentanil Ce for suppressing emergence cough in 50% (EC50) and 95% (EC95) of the patients was comparable between the young and elderly patients. Isotonic regression demonstrated that the EC50 (83% confidence interval [CI]) of remifentanil was 2.56 (2.39-2.75) ng/mL in the young patients and 2.15 (1.92-2.5) ng/mL in the elderly patients. The EC95 (95% CI) of remifentanil was 3.33 (2.94-3.46) ng/mL in the young patients and 3.41 (3.18-3.48) ng/mL in the elderly patients. Dixon's up-and-down method also demonstrated that the EC50 was comparable between the two groups (2.69±0.32 ng/mL vs 2.39±0.38 ng/mL, P=0.132). Conclusion: The remifentanil Ce for suppressing emergence cough following extubation during general anesthesia was comparable between young and elderly male patients. It indicates that age-related differences in remifentanil requirement for suppressing emergence cough did not exist in male sex.


Assuntos
Analgésicos Opioides/farmacologia , Anestésicos/efeitos adversos , Colecistectomia Laparoscópica , Tosse/tratamento farmacológico , Piperidinas/farmacologia , Adulto , Fatores Etários , Idoso , Extubação , Analgésicos Opioides/administração & dosagem , Anestesia Geral , Humanos , Masculino , Éteres Metílicos , Pessoa de Meia-Idade , Piperidinas/administração & dosagem , Remifentanil , Sevoflurano , Adulto Jovem
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