Jin Yun Kim

The clinical effectiveness of the streamlined liner of pharyngeal airway (SLIPA™) compared with the laryngeal mask airway ProSeal™ during general anesthesia

Background The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA), a new supraglottic airway device (SGA), with the laryngeal mask airway ProSeal™ (PLMA) during general anesthesia. Methods Sixty patients were randomly allocated to two groups; a PLMA group (n = 30) or a SLIPA group (n = 30). Ease of use, first insertion success rate, hemodynamic responses to insertion, ventilatory efficiency and positioning confirmed by fiberoptic bronchoscopy were assessed. Lung mechanics data were collected with side stream spirometry at 10 minutes after insertion. We also compared the incidence of blood stain, incidence and severity of postoperative sore throat and other complications. Results First attempt success rates were 93.3% and 73.3%, and mean insertion time was 7.3 sec and 10.5 sec in PLMA and SLIPA. There was a significant rise in all of hemodynamic response from the pre-insertion value at one minute following insertion of SLIPA. But, insertion of PLMA was no significant rise in hemodynamic response. There was no statistically significant difference in the mean maximum sealing pressure, gas leakage, lung mechanics data, gastric distension, postoperative sore throat and other complication between the two groups. Blood stain were noted on the surface of the device in 40% (n = 12) in the SLIPA vs. 6.7% (n = 2) in the PLMA. Conclusions The SLIPA is a useful alternative to the PLMA and have comparable efficacy and complication rates. If we acquire the skill to use, SLIPA may be considered as primary SGA devices during surgery under general anesthesia.

The Effect of Intraperitoneal Ropivacaine on Pain after Laparoscopic Colectomy: A Prospective Randomized Controlled Trial

BACKGROUND Although laparoscopic procedures are becoming more common, postoperative pain remains a major factor causing delayed patient recovery. There have been several trials to reduce pain by instilling local anesthetics into the peritoneal cavity, but there has been no study on prolonged (∼300 min) or intensive surgery. We investigated the analgesic effect of intraperitoneal ropivacaine instillation after laparoscopic colectomy. MATERIALS AND METHODS Sixty patients were randomized to three groups. Twenty patients in each group received 50 mL of appropriate solutions after the formation of a pneumoperitoneum. The solution was normal saline (control) in group C and 1 mg/kg of ropivacaine in each of groups I and D. In group D, ropivacaine was sprayed again before the elimination of the pneumoperitoneum. Patients reported their postoperative pain using a subjective visual analogue scale. Fentanyl use for pain relief and frequency of pushing a button (FPB) for a bolus of patient controlled analgesia were evaluated, and scales of recovery rates were obtained. RESULTS The immediate postoperative pain score was lower in groups I and D than in group C. In groups I and D, FPB measures and fentanyl use were both less than in group C. The time taken to resume a regular diet was shorter in group D than in group C. CONCLUSIONS The intraperitoneal instillation of ropivacaine was effective in reducing postoperative pain and in shortening the recovery course after laparoscopic colectomy. The additional instillation of ropivacaine at the end of the surgery proved even more effective.

Ultrasound-Guided Infraorbital Nerve Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia - A Case Report -

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.

Antihyperalgesic effects of ginseng total saponins in a rat model of incisional pain

BACKGROUND The aim of this study was to assess whether intraperitoneal administration of ginseng total saponins (GTS) has antihyperalgesic effects in a rat model of incisional pain. The proinflammatory responses and reversal of the antihyperalgesic effect of GTS by N-methyl-d-aspartate (NMDA) or naloxone were also evaluated. MATERIALS AND METHODS Rats were injected intraperitoneally with 0.9% saline vehicle or various doses of GTS before or after a plantar incision. Paw withdrawal in response to application of the von Frey filament with the lowest bending force marked the mechanical withdrawal threshold (MWT). Blood samples were collected for the assessment of serum interleukin (IL)-1β and IL-6 levels. The IL levels were measured using an enzyme-linked immunosorbent assay kit. Rats were injected intraperitoneally with NMDA or naloxone before the GTS injection to assess the reversal of the antihyperalgesic effect of GTS. RESULTS The MWT measured 2 h after the plantar incision increased significantly after the postincision administration of 50, 100, or 200 mg/kg of GTS compared with the MWT at 2 h after plantar incision. The MWT also increased significantly after the preincision injection of 100 or 200 mg/kg of GTS compared with the MWT of the vehicle control. Administration of GTS suppressed the postincision rise in serum IL-1β levels and NMDA inhibited the increase in the MWT compared with GTS alone. CONCLUSIONS Intraperitoneal administration of GTS before or after surgery induces antihyperalgesic effects in a rat model of incisional pain. The effects on mechanical hyperalgesia may be associated with anti-inflammatory cytokines and NMDA signaling.

Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial

BackgroundPostoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Palonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared palonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery.MethodsNinety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral aprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual analogue scale [VAS] nausea score <4 and no use of rescue therapy) 0–48 h after surgery. Nausea severity (0–10) and use of rescue therapy were monitored for 0–48 h. The secondary efficacy end points were the effect of aprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and use of rescue analgesics.ResultsAprepitant was non-inferior to palonosetron in terms of complete response 0–48 hours after surgery (74% vs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than that with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg aprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were required in the aprepitant group.ConclusionsPalonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they bind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management in humans.

Pneumomediastinum and pneumothorax after orthognathic surgery -A case report-

The occurrences of pneumomediastinum and pneumothorax after oral and/or maxillofacial surgery are rare, but both are potentially life-threatening complications. Most of the cases that present pneumomediastinum and pneumothorax in the oral and/or maxillofacial surgery result from air dissecting down the fascial planes of the neck. We report a case of a 23-year-old male patient who underwent bilateral sagittal split ramus osteotomy under general anesthesia and developed pneumomediastinum and pneumothorax without any traumatic introduction of air through the cervical fascia three days postoperatively. The possible causes and its prevention are discussed with a review of the relevant literature.

Severe intraoperative hyponatremia associated with the absorption of irrigation fluid during hysteroscopic myomectomy: a case report

A case of severe hyponatremia with accompanying pulmonary edema and cardiovascular instability during a hysteroscopic myomectomy with general anesthesia is presented. The patients sodium value decreased to 87 mmol/L. She was managed with aggressive maneuvers, including an infusion of 3% hypertonic saline. The patients serum sodium increased to 113 mmol/L at the end of the operation, and it was increased up to 138 mmol/L at 48 hours. The patient recovered completely without neurologic sequelae.

Ramosetron, midazolam, and combination of ramosetron and midazolam for prevention of postoperative nausea and vomiting: A prospective, randomized, double-blind study

Objective To compare the efficacy of ramosetron, midazolam, and the combination of ramosetron and midazolam in the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing thyroidectomy. Methods Patients were randomized to receive 0.3 mg ramosetron (Group R), 75 µg/kg midazolam (Group M) or 0.3 mg ramosetron combined with 75 µg/kg midazolam (Group RM) before the induction of anaesthesia. PONV, use of rescue antiemetics, pain severity and fentanyl consumption were assessed for 24 h after thyroidectomy. Results A total of 100 patients were enrolled; 94 patients completed the study. The severity of nausea was statistically significantly reduced at 0–2 h in Group RM compared with Groups R and M, and at 2–6 h in Group RM compared with Group M. The incidence of retching and vomiting was significantly lower at 0–2 h, 2–6 h, 6–12 h in Group RM than in Group M, and lower in Group R than Group M at 6–12 h. The requirement for rescue antiemetics was significantly lower at 0–2 h in group RM than in group M. Conclusion The combination therapy of ramosetron and midazolam provided superior antiemetic efficacy compared with midazolam single therapy, but did not show any significant additional benefits compared with ramosetron single therapy.

The antiemetic effect of midazolam or/and ondansetron added to intravenous patient controlled analgesia in patients of pelviscopic surgery

Background We made a comparative study on the antiemetic effect of midazolam and ondansetron added to intravenous patient-controlled analgesia (PCA) using fentanyl with gynecologic patients undergoing pelviscopic surgery. Methods The PCA using 20 µg/kg of fentanyl was started in all groups postoperatively. A dose of 16 mg of ondansetron was added to the PCA of group O (n = 30). A dose of 5 mg of midazolam was added to the PCA of group M (n = 30). While 16 mg of ondansetron and 5 mg of midazolam were added to the PCA of group MO (n = 30). Total volume of the PCA was 60 ml, and the PCA system was programmed to deliver 0.5 ml/h of continuous doses and a 0.5 ml bolus on demand, with a 15 minutes lockout interval. The incidence of postoperative nausea and vomiting (PONV), sedation score, visual analog scale (VAS) for pain, and rescue drug dose for PONV were investigated at the postanesthesia care unit (PACU), 6 hours, and 24 hours after recovery. Results The incidence of PONV in group MO was significantly lower than in group O at PACU, 24 hours after recovery (P < 0.05). The sedation score and VAS pain score showed no differences among all groups. Conclusions Midazolam added to PCA using fentanyl proved more effective than ondansetron in preventing PONV without adverse effects.

Effects of pneumoperitoneal pressure and position changes on respiratory mechanics during laparoscopic colectomy

Background This study was designed to assess the effects of pneumoperitoneal pressure (PP) and positional changes on the respiratory mechanics during laparoscopy assisted colectomy. Methods Peak inspiratory pressure, plateau pressure, lung compliance, and airway resistance were recorded in PP of 10 mmHg and 15 mmHg, with the position change in 5 steps: head-down at 20°, head-down at 10°, neutral position, head-up at 10° and head-up at 20°. Results When the patient was placed head-down, the position change accentuated the effects of pneumoperitoneum on respiratory mechanics. However, when the patient was placed in a head-up position during pneumoperitoneum the results showed no pattern. In the 20° head-up position with the PP being 10 mmHg, the compliance increased from 30.6 to 32.6 ml/cmH2O compared with neutral position (P = 0.002). However with the PP being 15 mmHg, the compliance had not changed compared with neutral position (P = 0.989). In 20° head-down position with the PP of 10 mmHg, the compliance was measured as 24.2 ml/cmH2O. This was higher than that for patients in the 10° head-down position with a PP of 15 mmHg, which was recorded as 21.2 ml/cmH2O. Also in the airway resistance, the patient in the 20° head-down position with the PP of 10 mmHg showed 15.8 cmH2O/L/sec, while the patient in the 10° head-down position with the PP of 15 mmHg showed 16.2 cmH2O/L/sec of airway resistance. These results were not statistically significant but still suggested that the head-down position accentuated the effects of pneumoperitoneum on respiratory mechanics. Conclusions Our results suggest that respiratory mechanics are affected by the patient position and the level of PP - the latter having greater effect.