Jeong Han Lee

Comparison of the effects of acetaminophen to ketorolac when added to lidocaine for intravenous regional anesthesia

Background This study was done to evaluate the effect on pain relief when acetaminophen was added to lidocaine for intravenous regional anesthesia (IVRA). Methods Sixty patients undergoing hand or forearm surgery received IVRA were assigned to three groups: Group C received 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml (n = 20), Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml (n = 20) and Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketorolac 10 mg made up to a total volume of 40 ml (n = 20). Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed. Results Sensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C (P < 0.001). Conclusions The addition of acetaminophen to lidocaine for IVRA shortens the onset time of sensory block and delays tourniquet pain onset time, but not with ketorolac. Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.

Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation

Background This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. Methods A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. Results The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). Conclusions In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.

Does dexmedetomidine reduce postoperative pain after laparoscopic cholecystectomy with multimodal analgesia

Background Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We evaluated the analgesic effect of perioperative dexmedetomidine infusion during laparoscopic cholecystectomy with multimodal analgesia. Methods Forty-two patients aged 20 to 60 years old were allocated randomly into one of 2 groups (n = 21, in each). All patients underwent laparoscopic cholecystectomy under multimodal analgesia. The patients in group P received dexmedetomidine 1 µg/kg during 10 min before induction and then 0.5 µg/kg/h continuously until the removal of the gall bladder while the patients in the group C received saline by the same methods as group P. Total analgesic consumption and VAS score were recorded for the first 24 hr. Results There were no significant differences in VAS scores between group P and group C during 24 hr after laparoscopic cholecystectomy. VAS scores of group P were lower than that of group C during the 1st hr after operation. The amount of ketorolac required during the 24 hr after the operation was significantly less in group P compared to group C. Conclusions The administration of dexmedetomidine during laparoscopic cholecystectomy with multimodal analgesia has minimal benefits on the reduction of the postoperative pain score. The amount of ketorolac requirements during 24 hr after the operation showed significant difference. Dexmedetomidine might be helpful for the postoperative pain after laparoscopic cholecystectomy with multimodal analgesia.

Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia

Background Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia. Methods One hundred twenty patients aged 20 to 65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the group N received normal saline 1 hour before induction and after the resection of gall bladder. The patients in the group S1 received dexamethasone 8 mg 1 hour before induction and normal saline after the resection of gall bladder. The patients in the group S2 received normal saline 1 hour before induction and dexamethasone 8 mg after the resection of gall bladder. Results VAS scores of group S1 and S2 were lower than that of group N during 48 hours after laparoscopic cholecystectomy. There were no significant differences of VAS scores between the group S1 and the group S2. The analgesic consumption of group S1 and S2 were significantly lower than that of group N. Conclusions A single dose of dexamethasone (8 mg) intravenously given 1 hour before induction or during operation was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. The analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during surgery was not significantly different.

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.

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine

Background Similar to lipid emulsion propofol, microemulsion propofol also causes a high incidence of pain during intravenous injection. Various methods have been used to minimize the incidence and severity of pain on injection of lipid emulsion propofol. In this study, we investigated the effect of a lidocaine mixture on pain induced by microemulsion propofol injection, and sought to determine the optimal dose of lidocaine that could reduce pain on injecting a propofol-lidocaine mixture. Methods One hundred sixty (n = 160) patients of American Society of Anesthesiologists physical status class I or II were randomly allocated to four groups: Group A, control; Group B, 20 mg lidocaine; Group C, 30 mg lidocaine; Group D, 40 mg lidocaine. In each patient, pain on microemulsion propofol solution injection was graded as none, mild, moderate, or severe. Results The incidence of pain in groups A, B, C, and D was 97.5%, 80%, 65%, and 50%, respectively. Increasing the lidocaine dose significantly reduced pain (P < 0.05). One patient in Group D (2.5%) had moderate to severe pain, which was significantly lower than groups B (42.5%) and C (32.5%) (P < 0.05). Conclusions The lidocaine and propofol mixture is effective in alleviating pain associated with microemulsion propofol injection. Within this dose range and in this patients population, increasing lidocaine dosage significantly reduced pain during injection of microemulsion propofol.

Comparison of surgical conditions during propofol or desflurane anesthesia for endoscopic sinus surgery.

Background Reduction of intraoperative bleeding is necessary to achieve the ideal surgical field for the endoscopic sinus surgery (ESS). Intraoperative intra nasal bleeding is influenced by various anesthetics. This study compared surgical field condition between propofol/remifentanil (PR) based anesthesia and desflurane/remifentanil (DR) based anesthesia. Methods American Society of Anesthesiologists physical status class I or II patients undergoing ESS were randomly assigned to group PR (n = 36) or group DR (n = 32). The extent of the preoperative surgical lesion was classified as high (> 12) and low (≤ 12) Lund-Mackay (LM) scores according to the computed tomography findings. The target mean blood pressure was maintained at 70-80 mmHg. Only one surgeon was involved in rating the visibility of the surgical field on a numeric rating scale (NRS) every 10 minutes. Results There was a different surgical field grade from PR to DR. The mean (SD) surgical field score of NRS for the PR and DR was 2.3 (0.57) and 2.7 (0.67), respectively (P = 0.006). Especially in the high-LM score patients, the mean (SD) of surgical field score for the PR and DR was 2.4 (0.67) and 3.0 (0.63), respectively (P = 0.012). Conclusions In the high-LM score patients, PR based anesthesia resulted in better surgical field condition for ESS than DR based anesthesia. In ESS, PR based anesthesia is considered to be helpful.

THE EFFECTS OF HEMODILUTION ON ACUTE INFLAMMATORY RESPONSES IN A BLEOMYCIN-INDUCED LUNG INJURY MODEL

Acute normovolemic hemodilution (ANH) can be used in acute lung injury (ALI) patients who refuse blood transfusions. To investigate the effects of hemodilution on the acute inflammatory response in lung injury, the authors studied the effects of ANH in a rat model of bleomycin-induced lung injury. Bleomycin (10 mg/kg) was used to induce lung injury in 2 groups of rats. The treatment groups included a lung injury group with hemodilution (HI), a lung injury group without hemodilution (NHI), and a control group. Hemodilution was performed by removing blood and substituting the same amount of hydroxyethyl starch solution targeted to 7.0 g/dL via the right and left internal jugular veins. At day 3 after bleomycin instillation, systemic hemoglobin concentration was 9.5 ± 1.1 g/dL. Tumor necrosis factor-α, interleukin-1β, and interleukin-6 levels measured in the bronchoalveolar lavage fluid (BALF), blood, and lung tissue were not significantly different between the HI and NHI groups 3 days after lung injury. Microscopic findings showed fibrosis and inflammation in the HI and NHI groups 28 days after lung injury, but no significant differences were found between the 2 groups. Hemodilution after bleomycin administration did not further affect the acute inflammatory response or lung injury.

Inter-arm arterial pressure difference caused by prone position in the thoracic outlet syndrome patient -A case report-

Thoracic outlet syndrome has neurologic symptoms caused by compression of brachial plexus, blood vessel symptoms are caused by compression of the artery or vein. The authors report a case of sudden decrease in blood pressure of the left arm after turning the patient from supine position to prone position. They confirmed that the patient had thoracic outlet syndrome after performing computed tomography.

The effect of dexmedetomidine on propofol injection pain

Propofol causes pain during vascular injection. Dexmedetomidine, an α2-adrenoceptor agonist, has an analgesic effect as well as a sedative effect. Several studies have examined whether the analgesic effect of dexmedetomidine can reduce pain associated with propofol injection [1], but these studies were not helpful in clarifying the appropriate dosage of dexmedetomidine for minimizing hemodynamic changes from the drug while maximizing the reduction of propofol injection pain. In this study, we evaluated the efficacy of dexmedetomidine in reducing pain and hemodynamic changes during propofol injection. The study was approved by the Institutional Review Board of our hospital, and informed consent was obtained from the subject patients after sufficient explanation regarding general anesthesia and our study. One hundred sixty American Society of Anesthesiologists physical status 1 or 2 patients (20 to 60 years old) who were scheduled for elective surgery were enrolled. They were randomly divided into four groups; group 1 (propofol 120 mg and normal saline, n = 40), group 2 (propofol 120 mg and dexmedetomidine 0.25 μg/kg, n = 40), group 3 (propofol 120 mg and dexmedetomidine 0.5 μg/kg, n = 40), and group 4 (propofol 120 mg and dexmedetomidine 0.75 μg/kg, n = 40). The volume of the drug mixture 1% propofol (long-chain triglyceride) and saline or dexmedetomidine was 15 ml in all patients. Injection pain was graded using a 4-point scale. A 20 gauge catheter was mounted on the dorsal hand or wrist area. The drug mixture was injected for 25 seconds through the catheter in order to induce anesthesia. From the start of the injection until the loss of consciousness, each patient was asked, “Does it hurt?” every 5 seconds to measure the degree of pain. The pain was evaluated as 0 when there was no discomfort in the injection area (no pain), 1 when the patient simply answered “Yes” without any change in behavior (slight), 2 when there was a change in behavior or voluntary complaint of pain (intermediate), and 3 when the patient made a loud sound, grimaced, withdrew his or her arm, or shed tears (severe). SAS 9.2 (SAS Institute Inc., Cary, NC, USA) was used to perform a one way ANOVA for age, height, weight, and hemodynamic changes. The degree of pain was analyzed with a χ 2 -test, and the results were considered statistically significant