Jeong-Hwa Seo

Efficacy of butylscopolamine for the treatment of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study

BACKGROUND Catheter-related bladder discomfort (CRBD) secondary to intraoperative catheterization of urinary bladder is one of the most distressing symptoms during recovery from anaesthesia. Butylscopolamine, a peripheral antimuscarinic agent, is effective for relieving the pain, which is because of smooth muscle contraction. The aim of this study was to assess the efficacy and safety profiles of butylscopolamine in treating CRBD after urological surgeries. METHODS Adult male patients undergoing urological surgery requiring urinary bladder catheterization intraoperatively were enrolled. Induction and maintenance of anaesthesia were standardized. Patients were randomized into two groups after complaining of CRBD in the post-anaesthesia care unit. The control group (n=29) received normal saline and the butylscopolamine group (n=28) was administered butylscopolamine 20 mg i.v. The severity of CRBD, postoperative pain, and adverse effects were assessed at baseline, 20 min, 1, 2, and 6 h after administration of the study drug. RESULTS The severity of CRBD observed in the butylscopolamine group was significantly lower than that of the control group at 1, 2, and 6 h after administration of the study drug [59 (12), 50 (16), 40 (21) in the control group vs 41 (22), 32 (25), 23 (18) in the butylscopolamine group, P<0.01]. Rescue analgesics were required less in the butylscopolamine group than in the control group (P=0.001). Adverse events were comparable between the two groups. CONCLUSION Butylscopolamine 20 mg administered i.v. after complaining CRBD during recovery reduced both the severity of CRBD and the need for rescue analgesics without adverse effects in patients undergoing urologic surgeries.

Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery

Objective To investigate the incidence and risk factors for emergence agitation in the postanaesthetic care unit (PACU), in adult patients undergoing urological surgery. Methods Medical records were retrospectively reviewed. Preoperative, intraoperative and postoperative variables were evaluated. Emergence agitation was defined as a Riker sedation–agitation score ≥5. Logistic regression analysis was used to determine independent risk factors for emergence agitation. Results Emergence agitation was observed in 48/488 (9.8%) patients. Chronic lung disease (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.03, 7.17), duration of surgery (OR 1.01, 95% CI 1.00, 1.01), history of social drinking (OR 2.48, 95% CI 1.25, 4.93), postoperative pain score (OR 1.32, 95% CI 1.14, 1.53), voiding urgency (OR 2.20, 95% CI 1.01, 4.77) and presence of gastric tube (OR 2.85, 95% CI 1.07, 7.54) were independent risk factors for emergence agitation. Conclusions Adequate postoperative pain management and prevention of catheter-related bladder discomfort may be helpful in reducing the incidence of emergence agitation in urology patients.

Influence of a modified propofol equilibration rate constant (ke0) on the effect‐site concentration at loss and recovery of consciousness with the Marsh model

This study compared the predicted effect‐site concentration of propofol at loss and recovery of consciousness when using target‐controlled infusion devices with the same pharmacokinetic model (Marsh) but a different plasma effect‐site equilibration rate constant (ke0), the DiprifusorTM (ke0 0.26 min−1) and Base Primea™ (ke0 1.21 min−1). We studied 60 female patients undergoing minor gynaecological surgery under general anaesthesia. Although the total dose of propofol and time until loss of consciousness were comparable, the effect‐site concentration at loss of consciousness was significantly lower with the Diprifusor than with the Base Primea (1.2 (0.3) μg.ml−1 vs 4.5 (0.9) μg.ml−1, respectively, p < 0.001). The effect‐site concentration at recovery of consciousness was significantly higher with the Diprifusor than with the Base Primea (1.8 (0.4) μg.ml−1 vs 1.5 (0.2) μg.ml−1, respectively, p = 0.01). In conclusion, the effect‐site concentration of propofol differs depending on the ke0, despite the use of the same pharmacokinetic model. Therefore, the ke0 should be considered when predicting loss and recovery of consciousness based on the effect‐site concentration of propofol.

Uppermost blood levels of the right and left atria in the supine position : Implication for measuring central venous pressure and pulmonary artery wedge pressure

Background: To eliminate the influence of hydrostatic pressure, proper transducer positions for central venous pressure and pulmonary artery wedge pressure are at the uppermost blood levels of right atrium (RA) and left atrium (LA). This study was performed to investigate accurate reference levels of central venous pressure and pulmonary artery wedge pressure in the supine position. Methods: Chest computed tomography images of 96 patients without history of cardiothoracic surgery, heart disease, or cardiothoracic anatomical abnormality were retrospectively reviewed. The anteroposterior (AP) diameter of the thorax and the vertical distances from the skin on the back to the most anterior portion of RA (RA height) and LA (LA height) were measured. Their ratios were abbreviated, respectively, as RA height/AP diameter and LA height/AP diameter. Data are expressed as mean ± SD (range). Results: There was a significant difference [4.6 ± 1.0 (1.6–6.4) cm; P < 0.001] between RA and LA heights. AP diameter was positively correlated with RA and LA heights (R 2 = 0.839 and 0.700, respectively; P < 0.001). There was also a significant difference between RA height/AP diameter [0.83 ± 0.03 (0.71–0.91)] and LA height/AP diameter [0.62 ± 0.04 (0.52–0.72)] (P < 0.001). Conclusion: In the supine position, a central venous pressure transducer should be positioned approximately 4.6 cm higher than a pulmonary artery wedge pressure transducer. The external reference level for central venous pressure seems to be at approximately four fifths of the AP diameter of the thorax from the back, and that for pulmonary artery wedge pressure seems to be at approximately three fifths of the AP diameter.

Combined treatment with celecoxib and sevoflurane after global cerebral ischaemia has no additive neuroprotective effects in rats

BACKGROUND The purpose of this study was to investigate whether combined administration of celecoxib and sevoflurane after ischaemia produces additive neuroprotection against transient global cerebral ischaemia in rats. METHODS Cerebral ischaemia was induced by bilateral common carotid artery occlusion with haemorrhagic hypotension for 8 min. After ischaemia, no drugs were administered in the sham (n=4) and control (n=10) groups. In the celecoxib group (n=10), celecoxib 2 mg kg(-1) was administered after reperfusion. In the sevoflurane group (n=10), after reperfusion, sevoflurane 2.4% was inhaled two times for 5 min each at an interval of 10 min to achieve postconditioning. In the celecoxib+sevoflurane group (n=10), administration of celecoxib 2 mg kg(-1) and the sevoflurane postconditioning were performed simultaneously. Necrotic or apoptotic cells were examined in the hippocampus 7 days after ischaemia. Serum levels of proinflammatory cytokines including tumour necrosis factor-α and interleukin-1β were measured 2 h, and 3 and 7 days after ischaemia. RESULTS Necrotic or apoptotic cells were observed more frequently in the control group than in the celecoxib or sevoflurane groups 7 days after ischaemia (P<0.05). Cytokine levels were higher in the control group when compared with the celecoxib or sevoflurane groups 2 h after ischaemia (P<0.05). However, the histological outcomes and cytokine levels were similar in all three groups treated with celecoxib or sevoflurane. CONCLUSIONS Combined treatment with celecoxib and sevoflurane after global cerebral ischaemia has no additive neuroprotective effects in rats.

A novel supraclavicular approach to the right subclavian vein based on three-dimensional computed tomography.

BACKGROUND: We used three-dimensional (3-D) computed tomography to develop a novel supraclavicular approach to the subclavian vein that minimizes the distance from insertion site to the vein. METHODS: Forty-five adult patients with normal body build were retrospectively included in the 3-D computed tomography investigation. Assuming that the clavisternomastoid angle was the skin entry point, and that the subclavian vein on the first rib was a target, the optimal angle of approach was measured on the simulated 3-D images. A 3-D video was developed from these images to explain the approach. In a pilot study, we prospectively tested this approach in 60 adult patients with normal body build requiring central venous catheterization. The number of attempts, success rate, and complications were noted. RESULTS: The optimal angle of approach was 10.6° ± 5.3° medially and 35.4° ± 12.5° posteriorly from the skin entry point. The estimated depth of the subclavian vein was 13.7 ± 3.1 mm. During the pilot study, the first trial with a finder needle was successful in 87% of patients and the overall success rate of catheterizations was 100% without complications. CONCLUSIONS: The proposed supraclavicular approach to the subclavian vein is a simple method of central venous catheterization. The pilot study suggests the method is reasonably safe. The video explaining the approach graphically is available in the supplementary material.

Randomized, clinical trial on the preventive effects of butylscopolamine on early postoperative catheter-related bladder discomfort

BACKGROUND Postoperative catheter-related bladder discomfort (CRBD) can be a distressing complication for patients in whom a urinary catheter was inserted during an operation. Our randomized, dual-center, clinical trial investigated the effects of butylscopolamine on the prevention of postoperative CRBD in patients undergoing various operations. METHODS Adult male patients undergoing elective operations requiring intraoperative urinary catheterization under general anesthesia were enrolled. They were assigned randomly to 2 groups: The butylscopolamine group (n = 49) received 20 mg of butylscopolamine intravenously immediately before the end of the operation; no medication was given for prevention of CRBD in the control group (n = 50). The presence and severity of CRBD were assessed at 1, 2, and 6 hours postoperatively. Adverse effects of butylscopolamine were also examined. RESULTS The overall incidence of CRBD was less in the butylscopolamine group than in the control group (31% vs 66%, respectively; P = .001). The incidence of CRBD at 1, 2, and 6 hours postoperatively was also less in the butylscopolamine group (P = .006, .04, and .048, respectively). In addition, the average severity of CRBD for 6 hours postoperatively was significantly less in the butylscopolamine group than in the control group (median, 0 [interquartile range, 0-17] vs 22 [interquartile range, 0-47], respectively; P = .002). Adverse effects were comparable between the 2 groups. CONCLUSION Intravenous administration of butylscopolamine at the end of an operation decreases effectively the incidence and severity of early postoperative CRBD without adverse effects.

A randomised controlled trial comparing incentive spirometry with the Acapella® device for physiotherapy after thoracoscopic lung resection surgery†

Lung resection surgery has been associated with numerous postoperative complications. Seventy‐eight patients scheduled for elective video‐assisted thoracoscopic lung resection were randomly assigned to receive standard postoperative care with incentive spirometry or standard care plus positive vibratory expiratory pressure treatment using the Acapella® device. There was no significant difference between incentive spirometry and the Acapella device in the primary outcome, forced expiratory volume in 1 s, on the third postoperative day, mean (SD) 53% (16%) vs 59% (18%) respectively, p = 0.113. Patients treated with both devices simultaneously found incentive spirometry to be less comfortable compared with the Acapella device, using a numeric rating scale from 1 to 5 with lower scores indicating higher comfort, median (IQR [range]) 3 (2–3 [2–4]) vs 1 (1–2 [1–3]) respectively, p < 0.001. In addition, 37/39 patients (95%) stated a clear preference for the Acapella device. Postoperative treatment with the Acapella device did not improve pulmonary function after thoracoscopic lung resection surgery compared with incentive spirometry, but it may be more comfortable to use.

Comparison of Needle Insertion and Guidewire Placement Techniques During Internal Jugular Vein Catheterization: The Thin-Wall Introducer Needle Technique Versus the Cannula-Over-Needle Technique.

Objectives:For needle insertion and guidewire placement during central venous catheterization, a thin-wall introducer needle technique and a cannula-over-needle technique have been used. This study compared these two techniques regarding the success rates and complications during internal jugular vein catheterization. Design:Prospective, randomized, controlled study. Setting:A university-affiliated hospital. Patients:Two hundred sixty-six patients scheduled for thoracic surgery, gynecologic surgery, or major abdominal surgery, who required central venous catheterization. Interventions:Patients were randomly assigned to either the thin-wall introducer needle group (n = 134) or the cannula-over-needle group (n = 132). Central venous catheterization was performed on the right internal jugular vein under assistance with real-time ultrasonography. Needle insertion and guidewire placement were performed using a thin-wall introducer needle technique in the thin-wall introducer needle group and a cannula-over-needle technique in the cannula-over-needle group. Measurements and Main Results:The guidewire placement on the first skin puncture was regarded as a successful guidewire insertion on the first attempt. The number of puncture attempts for internal jugular vein catheterization was recorded. Internal jugular vein was assessed by ultrasonography to identify complications. The rate of successful guidewire insertion on the first attempt was higher in the thin-wall introducer needle group compared with the cannula-over-needle group (87.3% vs 77.3%; p = 0.037). There were fewer puncture attempts in the thin-wall introducer needle group than in the cannula-over-needle group (1.1 ± 0.4 vs 1.3 ± 0.6; p = 0.026). There was no significant difference in complications of internal jugular vein catheterization between the two groups. Conclusions:The thin-wall introducer needle technique showed a superior success rate for first attempt of needle and guidewire insertion and required fewer puncture attempts during internal jugular vein catheterization.

Randomised trial comparing forced-air warming to the upper or lower body to prevent hypothermia during thoracoscopic surgery in the lateral decubitus position

Background: In the supine position, forced‐air warming is more effective on the lower body than on the upper body to prevent intraoperative hypothermia. However, it is unknown in the lateral decubitus position. We thus compared forced‐air warming on the upper and lower bodies in the lateral position. Methods: Patients (n=123) were randomised to receive forced‐air warming on the upper body or lower body during thoracoscopic surgery in the lateral position. We measured the nasopharyngeal temperature at 0, 30, 60, 90, and 120 min after lateral positioning during surgery and the infrared tympanic membrane temperature at 0, 30, 60, 90, and 120 min after surgery. Patients received both upper and lower body warming at a temperature of <35.5°C. The primary outcome was the incidence of intraoperative hypothermia with a temperature of <36.0°C. Results: Intraoperative hypothermia was less frequent with the upper body warming than with the lower body warming {21/62 vs 35/61, risk ratio [95% confidence interval (CI)] 0.6 (0.4–0.9), P=0.011}. The intraoperative temperature was higher with the upper body warming than with the lower body warming at 30 (P=0.002), 60 (P<0.001), and 90 (P<0.001) min after lateral positioning, and the postoperative temperature was higher at 0 (P<0.001) and 30 (P=0.001) min after surgery. Fewer patients received both upper and lower body warming in the upper body warming group than in the lower body warming group during surgery (1 vs 7, P=0.032). Conclusions: Forced‐air warming was more effective on the upper body than on the lower body to prevent hypothermia during thoracoscopic surgery in the lateral decubitus position. Clinical trial registration: NCT02993666.