Jeoung Hyuk Lee

How much are patients willing to pay for prevention of postoperative nausea and vomiting

BACKGROUND Postoperative nausea and vomiting (PONV) remains a common complication of anesthesia. We tried to assess the amount patients were willing to pay for a hypothetical antiemetic that would completely prevent PONV. METHODS Trained residents interviewed 86 patients, who were scheduled to undergo general anesthesia, and questionnaires were completed. RESULTS Patients were willing to pay a median of 30,000 won for an antiemetic that would completely prevent PONV. The amounts patients were willing to pay correlated with age, previous history of PONV, and patient income. CONCLUSIONS Patients assigned a value for avoidance of PONV. It is suggested that more efforts to prevent PONV would be helpful for the increase in patient satisfaction.

Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects.

Background We purposed to systemically review studies investigating the prophylactic effect of both pharmacological and non-pharmacological modalities against rocuronium induced withdrawal movement (RIWM) in the Korean population. Methods Literature search was performed using MEDLINE, EMBASE, CENTRAL, Koreamed, KMBASE, KISS and RISS up to March 2014. Randomized controlled trials (RCTs) comparing pharmacological and non-pharmacological interventions with placebo aimed for the Korean population were included. Outcome measures were the incidence and severity of RIWM. We conducted subgroup analyses according to each intervention method. Results Data were analyzed from 41 RCTs totaling 4,742 subjects. The overall incidence of RIWM was about 80% (range 56-100%). Incidence and severity of RIWM were significantly reduced with lidocaine (risk ratio [RR] 0.60, 95% CI 0.49-0.74; standardized mean difference [SMD] -0.74, 95% CI -1.05 to -0.44), opioids (RR 0.28, 95% CI 0.18-0.44; SMD -1.71, 95% CI -2.09 to -1.34) and hypnotics (RR 0.36, 95% CI 0.25-0.52; SMD -2.20, 95% CI -2.62 to -1.79). Regardless of tourniquet use, lidocaine showed a prophylactic effect against incidence and severity of RIWM: tourniquet (RR 0.36, 95% CI 0.21-0.62; SMD -1.51, 95% CI -2.15 to -0.86); non-tourniquet (RR 0.58, 95% CI 0.47-0.71; SMD -0.74, 95% CI -1.05 to -0.44). Dilution and slow injection of rocuronium decreased incidence and severity of RIWM: dilution (RR 0.47, 95% CI 0.39-0.56; SMD -1.64, 95% CI -2.47 to -0.81); slow injection (RR 0.34, 95% CI 0.17-0.70; SMD -2.13, 95% CI -2.74 to -1.51). Conclusions The greater part of pharmacological and non-pharmacological interventions showed prophylactic effect against the incidence and severity of RIWM in the Korean population.

The use of 3 sugammadex out of 5 reversal of during recovery of rocuronium-induced neuromuscular blockade in a patient with post-tonsillectomy hemorrhage: a case report

Post-tonsillectomy hemorrhage (PTH) is the most frequent complication of tonsillectomy, and occasionally results in a lethal outcome. A 21-year-old man (height 180 cm, weight 95 kg) was scheduled for a bilateral tonsillectomy and uvulopalatopharyngoplasty for treatment of obstructive sleep apnea. He required 5 rounds of general anesthesia due to recurrent PTH. The anesthesiologist used sugammadex a total of 3 times to achieve the successful reversal of the deep neuromuscular blockade (NMB) induced by rocuronium. After sugammadex 2 mg/kg was administered, the NMB was reversed in 2 minutes each time. Re-administration of rocuronium within a short time interval after sugammadex may result in unpredictable effects of neuromuscular blocking agents. Sugammadex made it possible to perform a rapid, complete reverse when the residual block was maintained by an incomplete reversal of anticholinesterase.

Emergence cerebral oxygen desaturation without hemodynamic compromise in pediatric patients

Background The regional cerebral oxygen saturation (rSO2) decreases significantly during ordinary anesthetic recovery in pediatric patients anesthetized with sevoflurane or desflurane. The present study examined the relationship between rSO2 and the clinical parameters associated with the degree of anesthetic recovery. Methods Twelve pediatric patients with American Society of Anesthesiologists physical status 1 were assigned randomly to receive anesthesia with sevoflurane or desflurane. All children underwent general anesthesia for minor surgery. After surgery, the rSO2, the age-adjusted MAC fraction of anesthetic concentration (FE), and the bispectral index (BIS) were recorded over a 10-minute period. The correlations between rSO2 and candidate predictors, such as FE, BIS, anesthetic, and duration of anesthesia, were analyzed. Results All children recovered uneventfully. The lowest observed rSO2 reached 63% and the maximum decrease in rSO2 was 24%. The mean blood pressure and heart rate were maintained within clinical ranges. The decrease in rSO2 correlated positively with the FE (r = 0.25, P = 0.00) and the duration of anesthesia (r = 0.24, P = 0.01), and inversely with the use of sevoflurane (r = -0.30, P = 0.00). Conclusions Despite normal parameters, cerebral desaturation occurred during the emergence of ordinary general anesthesia even without hemodynamic compromise or arterial desaturation. Cerebral desaturation might be associated with the degree of anesthetic recovery and the use of sevoflurane.

Hypocapnia Attenuates, and Nitrous Oxide Disturbs the Cerebral Oximetric Response to the Rapid Introduction of Desflurane

The aim of this study was to develop a nonlinear mixed-effects model for the increase in cerebral oximetry (rSO2) during the rapid introduction of desflurane, and to determine the effect of hypocapnia and N2O on the model. Twelve American Society of Anesthesiologist physical status class 1 and 2 subjects were allocated randomly into an Air and N2O group. After inducing anesthesia, desflurane was then increased abruptly from 4.0 to 12.0%. The PETCO2, PETDESF and rSO2 were recorded at 12 predetermined periods for the following 10 min. The maximum increase in rSO2 reached +24-25% during normocapnia. The increase in rSO2 could be fitted to a four parameter logistic equation as a function of the logarithm of PETDESF. Hypocapnia reduced the maximum response of rSO2, shifted the EC50 to the right, and increased the slope in the Air group. N2O shifted the EC50 to the right, and reduced the slope leaving the maximum rSO2 unchanged. The N2O-effects disappeared during hypocapnia. The cerebrovascular reactivity of rSO2 to CO2 is still preserved during the rapid introduction of desflurane. N2O slows the response of rSO2. Hypocapnia overwhelms all the effects of N2O.

Effectiveness of 100 beats per minute music on cardiopulmonary resuscitation compression rate education: A manikin study

Introduction Recent cardiopulmonary resuscitation (CPR) guidelines emphasize the importance of high-quality chest compression. The aim of this study is to determine the effect of education using music on the chest compression rate. Methods This randomised, open-labeled study enrolled 81 medical students. They were randomly divided into three groups. After they were educated in CPR according to the American Heart Association 2010 guidelines, they performed 100 chest compressions using a mannequin capable of collecting each compression depth and speed. After that, the control group received a verbal feedback about their own results. The metronome group was also notified of their own results, and listened to the metronome sound at 100 beats per minute (bpm). The music group listened to the music (about 100 bpm). Twenty-four hours after their CPR education, chest compressions were performed again with the method identical to the first evaluation. The results were compared using multivariate analysis of variances. Result Compression rate (bpm): There was a significant difference between the control (mean, 110.4; 95% CI: 104.4, 116.5) and metronome group (mean, 98.5; 95% CI: 91.6, 105.4) after education (p=0.01). There was a significant difference between control and music group (mean, 98.2; 95% CI: 94.6, 101.8) after education (p<0.001) There were no differences between the music and metronome group before or after education (p=0.50, p=0.94). However, the variance of music group was significantly less than the metronome group (p=0.01). Compression depth (inches): there was no difference between the groups according to the CPR education method. (Control: 1.8±0.3; Metronome group: 1.6±0.2; Music group: 1.7±0.3 p=0.09) Conclusion Both education method of using music and metronome are more effective than conventional method. However the effect of using music may be better than using metronome.

The effect of hand dominance on neuromuscular monitoring at the adductor pollicis muscle

Background Neuromuscular blockade of the adductor pollicis muscle may be influenced by hand dominance resulting in conflicting results of several studies. The current study examined whether hand dominance could influence the measurements of neuromuscular blockade with acceleromyography at the adductor pollicis. Methods The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in both hands in 31 patients after induction of anesthesia. Onset, maximum effect, and offset of rocuronium were measured and compared in both hands. The train-of-four (TOF) ratios to 0.9 were recorded in all patients. Results In total, 27 patients were right-handed and 4 patients were left-handed. The mean supramaximal threshold or initial TOF ratio was not different between dominant and nondominant hands. No statistically significant differences were found between 716 paired TOF ratios in both hands. A correlation was seen between the dominant and nondominant hand (Nondominant = 0.931·Dominant + 1.714, R = 0.929). The analysis by the Bland-Altman plot showed an excellent agreement with a bias of 1.6% and limits of agreement of -21.2 to 24.5%. Conclusions Dominant and nondominant hands can be used interchangeably for neuromuscular monitoring at the adductor pollicis.

How should we monitor pediatric patients with Duchenne muscular dystrophy? -A case report-

Duchenne muscular dystrophy is a hereditary disorder characterized by progressive muscle weakness and contracture, and special care during anesthesia is needed in these patients. Because inhalational anesthetics and succinylcholine can cause fatal results, intravenous anesthetics are commonly used. However, monitorings for the pediatric population are not otherwise specified. We report our experience of a 6 year-old boy that underwent muscle biopsy suspicious of muscle dystrophy under general anesthesia. The patient received midazolam, fentanyl, propofol and a small dose of rocuronium. He was monitored with bispectral index (BIS), acceleromyography (TOF). At the end of surgery, recovery of TOF ratio to 90% was evaluated, followed by injection of pyridostigmine and glycopyrrolate. When reversal of neuromuscular block was confirmed quantitatively and clinically, the patient was extubated and he experienced no complication.

Pulmonary edema during hysteroscopic surgery - Three cases report -

Hysteroscopic surgery has become a routine gynecologic procedure. The advantages are associated with more accurate removal of lesion, its short operating time, rapid post-operative recovery and low morbidity. However, there are potentially serious complications which can be occured during and following hysteroscopic surgery. The complications are uterine perforation, fluid overload and electrolyte disturbance due to intravasation and absorption of uterine distention media, hemorrhage and, rarely, gas or air embolism. We experienced pulmonary edema during hysteroscopic surgery in three consecutive patients. Therefore, we report these cases of fluid overload with uterine distention media resulting acute pulmonary edema during hysteroscopic surgery.

Factors affecting difficult lightwand intubation: a prospective double-blind trial

BACKGROUND Unanticipated difficulties during tracheal intubation are related to perioperative morbidity and mortality, but the success of direct laryngoscopic intubation depends largely on clinicians experience and the upper airway anatomy. The lightwand was introduced as alternative intubation technique, but the indicators of difficult lightwand intubation (DLWI) have not been identified. Accordingly authors conducted this study to identify subject factors that affect DLWI, and to compare these with those of difficult laryngoscopic intubation. METHODS Seventy-three healthy subjects requiring tracheal intubation for elective surgery were enrolled. Anatomic factors, such as, body mass index (BMI), Mallampati classification (MC), inter-incisor gap, thyromental distance, neck circumference, extent of head and neck motion, and Cormack-Lehane grade (CL) were determined and evaluated in terms of their abilities to predict DLWI, which was described using intubation time and number of intubation attempts. Multiple regression analyses were performed to identify predictors using a variable selection technique. RESULTS Only MC and BMI were found to predict DLWI. The weighted sum of time and number of attempts (r2 = 0.854, P = 0.000) was found to be better predictor of DLWI than their product (r2 = 0.734, P = 0.000). Cormack-Lehane grade was not found to be significantly related to DLWI (P = 0.093). CONCLUSIONS Of the anatomic factors examined, only Mallampati classification and body mass index were found to predict difficult lightwand intubation.