Chang-Po Kuo

A comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery.

BACKGROUND: In this study, we compared the effects of 3% hypertonic saline (HTS) and 20% mannitol on brain relaxation during supratentorial brain tumor surgery, intensive care unit (ICU) stays, and hospital days. METHODS: This prospective, randomized, and double-blind study included patients who were selected for elective craniotomy for supratentorial brain tumors. Patients received either 160 mL of 3% HTS (HTS group, n = 122) or 150 mL of 20% mannitol infusion (M group, n = 116) for 5 minutes at the start of scalp incision. The Pco2 in arterial blood was maintained within 35 to 40 mm Hg, arterial blood pressure was controlled within baseline values ±20%, and positive fluid balance was maintained intraoperatively at a rate of 2 mL/kg/h. Outcome measures included fluid input, urine output, arterial blood gases, serum sodium concentration, ICU stays, and hospital days. Surgeons assessed the condition of the brain as “tight,” “adequate,” or “soft” immediately after opening the dura. RESULTS: Brain relaxation conditions in the HTS group (soft/adequate/tight, n = 58/43/21) were better than those observed in the M group (soft/adequate/tight, n = 39/42/35; P = 0.02). The levels of serum sodium were higher in the HTS group compared with the M group over time (P < 0.001). The average urine output in the M group (707 mL) was higher than it was in the HTS group (596 mL) (P < 0.001). There were no significant differences in fluid input, ICU stays, and hospital days between the 2 groups. CONCLUSIONS: Our results suggest that HTS provided better brain relaxation than did mannitol during elective supratentorial brain tumor surgery, whereas it did not affect ICU stays or hospital days.

Pre‐medication with intravenous clonidine suppresses fentanyl‐induced cough

Background:  A reflex cough is often observed after an intravenous bolus of fentanyl. This study was conducted to determine whether pre‐treatment with intravenous clonidine could effectively attenuate fentanyl‐induced cough.

The Effectiveness of Benzydamine Hydrochloride Spraying on the Endotracheal Tube Cuff or Oral Mucosa for Postoperative Sore Throat

BACKGROUND:The etiology of postoperative sore throat (POST) is considered to be the result of laryngoscopy, intubation damage, or inflated cuff compression of the tracheal mucosa. In this study, we compared the effectiveness in alleviating POST using different approaches to benzydamine hydrochloride (BH) administration by spraying the endotracheal tube (ET) cuff or the oropharyngeal cavity, or both. METHODS:Three hundred eighty patients were included in this prospective and double-blind study, which was randomized into 4 groups: group A, oropharyngeal cavity spray of BH, and distilled water on the ET cuff; group B, both the oropharyngeal cavity and the ET cuff received BH spray; group C, the ET cuff received BH spray, and the oropharyngeal cavity received distilled water; and group D, distilled water sprayed on both the ET tube and into the oropharyngeal cavity. The patients were examined for sore throat (none, mild, moderate, severe) at 0, 2, 4, and 24 hours postextubation. RESULTS:The incidence of POST was 23.2%, 13.8%, 14.7%, and 40.4% in groups A, B, C, and D, respectively. POST occurred significantly less frequently in groups B and C compared with group D (odds ratio: 0.36; 95% confidence interval: 0.21–0.60; P < 0.05). However, there was no significant difference between groups A and D (odds ratio: 0.62; 95% confidence interval: 0.38–1.01). Moreover, there was no significant interaction between spraying BH over the oropharyngeal cavity and the ET cuff on the incidence of POST (P = 0.088). The severity of POST was significantly more intense in group D compared with groups B and C (P < 0.001). Group B had a significantly higher incidence of local numbness, burning, and/or stinging sensation compared with patients in group D (P < 0.05). CONCLUSIONS:This study indicates that spraying BH on the ET cuff decreases the incidence and severity of POST without increased BH-related adverse effects.

Neuroprotective effect of curcumin in an experimental rat model of subarachnoid hemorrhage.

BACKGROUND Subarachnoid hemorrhage (SAH) causes a high mortality rate and morbidity. It was suggested that oxidant stress plays an important role in neuronal injury after SAH. Therefore, we assessed the effect of curcumin on reducing cerebral vasospasm and neurologic injury in a SAH model in rat. METHODS A double-hemorrhage model was used to induce SAH in rats. Groups of animals were treated with intraperitoneal injection of 20 mg/kg curcumin (curcumin group, n = 24) or dimethyl sulfoxide (vehicle group, n = 33), normal saline (SAH group, n = 34) or normal saline (sham group, n = 22), 3 h after SAH induction and daily for 6 days. Glutamate was measured before SAH induction and once daily for 7 days. Glutamate transporter-1, wall thickness and the perimeter of the basilar artery, neurologic scores, neuronal degeneration, malondialdehyde, superoxide dismutase, and catalase activities were assessed. RESULTS Changes of glutamate levels were lower in the curcumin group versus the SAH and vehicle groups, especially on day 1 (56 folds attenuation vs. vehicle). Correspondingly, glutamate transporter-1 was preserved after SAH in curcumin-treated rats. In the hippocampus and the cortex, malondialdehyde was attenuated (30% and 50%, respectively). Superoxide dismutase (35% and 64%) and catalase (34% and 38%) activities were increased in the curcumin rats compared with the SAH rats. Mortality rate (relative risk: 0.59), wall thickness (30%) and perimeter (31%) of the basilar artery, neuron degeneration scores (39%), and neurologic scores (31%) were improved in curcumin-treated rats. CONCLUSIONS Curcumin in multiple doses is effective against glutamate neurotoxicity and oxidative stress and improves the mortality rate in rats with SAH.

The Effects of Collateral Meridian Therapy for Knee Osteoarthritis Pain Management: A Pilot Study

OBJECTIVE The purpose of this preliminary study was to examine whether collateral meridian (CM) therapy was feasible in treating knee osteoarthritis (OA) pain. METHODS Twenty-eight patients with knee OA and knee pain were randomly allocated to 2 groups. The CM group patients received CM therapy, whereas the control patients received placebo treatment for knee pain relief. Patients in the CM group received 2 CM treatments weekly for 3 weeks. The outcome measures were pain intensity on a visual analog scale, and knee function was determined using the Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS In the CM group, the posttreatment visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were lower than those of the control group; a significant reduction in pain intensity (P = .02, P = .01, respectively) and improvement in knee function (P = .04, P = .03, respectively) were shown in the CM group at the second and third week. CONCLUSION Collateral meridian therapy may be feasible and effective for knee OA pain relief and knee function recovery. Therefore, additional randomized control trials are warranted.

Do Anesthetic Techniques Affect Operating Room Efficiency? Comparison of Target-Controlled Infusion of Propofol and Desflurane Anesthesia in Breast Cancer Surgery

Background: Anesthetic techniques may contribute to the reduction of operating room (OR) costs by decreasing anesthesia-controlled time. Anesthesia induction and emergence have to be time-optimized without neglecting patient care. The purpose of this study was to compare total intravenous anesthesia (TIVA group) and desflurane anesthesia (desflurane group) with respect to OR efficiency and the incidence of postoperative nausea and vomiting (PONV) in breast cancer surgery. Design: Retrospective clinical study. Methods: Information from the anesthesia database of the Tri-Service General Hospital for January 2010 to December 2011 was retrieved for patients who underwent breast cancer surgery. Three hundred and sixteen patients were included in the TIVA group (n = 196) or the desflurane group (n = 120). Emergence from anesthesia, OR time, and PONV were compared. Results: Emergence time was significantly shorter in the TIVA group than in the desflurane group (4.5±4.6 min vs. 10.4±6.4 min; P ＜ 0.01). There were no significant differences in postanesthesia recovery (PAR) discharge time between the groups. However, the total OR stay time was significantly shorter in the TIVA group than in the desflurane group (167±34 min vs. 173 ± 33 min; P ＜ 0.05). Increased PONV (30.9% vs. 12.2%; P ＜ 0.01) and antiemetic usage (19 vs. 5; P ＜ 0.05) were reported in the desflurane group compared with the TIVA group. Conclusion: TIVA provided faster emergence, increased OR efficiency, and decreased PONV compared with desflurane anesthesia in breast cancer surgery.

Cerebrospinal fluid rhinorrhea after thermometer insertion through the nose.

Cerebrospinal fluid (CSF) rhinorrhea is a rare clinical condition. Most leaks either are caused by traumatic head injury or are a complication of surgical procedures on the base of the skull. CSF rhinorrhea from nasal tube placement has been reported previously. We report a case of nasal thermometer placement during anesthesia complicated by a CSF leakage. We reemphasize that any material—including thermometers, nasogastric tubes, and endotracheal tubes—should be directed posteriorly after introduction into the external naris.

A Surgical Patient with Idiopathic Thrombocytopenic Purpura Presenting with both Acute Ischemic Stroke and Acute Myocardial Infarction-A Case Report

Idiopathic thrombocytopenic purpura (ITP) in adults is associated with minor or serious bleeding complications but rarely with thrombotic events. We report a case involving a 61-year-old woman with ITP who had both acute right parietotemporal lobe infarction and acute myocardial infarction (MI) at the same time as severe thrombocytopenia (4000/μL). This case reminds us that ITP, ischemic stroke, and MI are not mutually exclusive while severe thrombocytopenia.

Successful Cardiopulmonary Resuscitation in a Morbidly Obese Patient with Airway Obstruction 10 Days after Tracheostomy

Tracheostomy is often performed in patients requiring prolonged ventilatory support. Tracheostomy tube obstruction caused either by blood clots, mucous plugs, tube malposition and tissue granulation can lead to life-threatening complications. The risk of such complications is markedly increased in morbidly obese individuals. Here we report an incident in an 81-year-old, morbidly obese, male patient who sustained airway obstruction which resulted in cardiac arrest 10 days after tracheostomy. A 17-cm 10-ng blood clot in a tracheobronchial configuration was found to cause the obstruction. It was removed and the patient recovered after resuscitation. The etiology of the obstruction, specific management, and recommendations are discussed.