Jung Ah Lee

Comparison of an Intraoperative Infusion of Dexmedetomidine or Remifentanil on Perioperative Haemodynamics, Hypnosis and Sedation, and Postoperative Pain Control

This prospective, randomized, double-blind study compared the effects of dexmedetomidine and remifentanil on haemodynamic stability, sedation and postoperative pain control in the postanaesthetic care unit (PACU). Fifty consecutive patients scheduled for total laparoscopic hysterectomy were randomly assigned to receive infusions of either dexmedetomidine (1 μg/kg) i.v. over 10 min followed by 0.2-0.7 μg/kg per h continuous i.v. infusion or remifentanil (0.8-1.2 μg/kg) i.v. over 1 min followed by 0.05-0.1 μg/kg i.v. per min, starting at the end of surgery to the time in the PACU. Modified observers assessment of alertness scores were significantly lower in the dexmedetomidine group than in the remifentanil group at 0, 5 and 10 min after arrival in the PACU. Blood pressure and heart rate in the dexmedetomidine group were significantly lower than that recorded in the remifentanil group in the PACU. Dexmedetomidine, at the doses used in this study, had a significant advantage over remifentanil in terms of postoperative haemodynamic stability.

Comparison between Dexmedetomidine and Remifentanil for Controlled Hypotension and Recovery in Endoscopic Sinus Surgery

Objectives: We compared the efficacy of dexmedetomidine and remifentanil hydrochloride in intraoperative field conditions and recovery during endoscopic sinus surgery. Methods: Sixty-six patients (American Society of Anesthesiologists physical status I and II) scheduled for elective endoscopic sinus surgery were enrolled in this prospective, double-blinded, randomized study. The patients were randomly assigned to two groups. Propofol, 2 to 2.5 mg/kg, was administered to both groups to induce anesthesia, which was maintained with desflurane. One group received dexmedetomidine 1 μg/kg over 10 minutes at anesthesia induction, followed by 0.4 to 0.8 μg/kg per hour infusion during maintenance, whereas the other group received remifentanil 1 μg/kg over 1 minute at anesthesia induction, followed by 0.2 to 0.4 μg/kg per minute infusion during maintenance. Surgical conditions, hemodynamic parameters, intraoperative blood loss, time to extubation, sedation, and pain in the postanesthesia care unit (PACU) were recorded. Results: There were no significant differences between the two groups with respect to surgical field conditions, blood loss, or extubation time. The sedation score (Modified Observers Assessment of Alertness/Sedation) in the PACU was significantly lower in the dexmedetomidine group than in the remifentanil group (p < 0.001). No differences were found in total blood loss, surgical field conditions, hemodynamic parameters, time to extubation, or pain in the PACU when the two groups were compared (p > 0.05). Conclusions: Although remifentanil and dexmedetomidine both enabled hypotensive anesthesia and good intraoperative fields for endoscopic sinus surgery, recovery was faster with remifentanil than with dexmedetomidine in the immediate postoperative period.

Efficacy of Epidural Analgesia in Patients with Cancer Pain: A Retrospective Observational Study

Purpose Pain in terminal cancer patients may be refractory to systemic analgesics or associated with adverse drug reactions to analgesics. Epidural analgesia has been effectively used in such patients for pain control. However, this method does not provide pain relief to all patients. The efficacy and complications of continuous epidural analgesia were evaluated for expanding efficacy in terminal cancer patients. Materials and Methods The charts of patients who received epidural analgesia for over 5 years for the control of terminal cancer pain were reviewed retrospectively. Results Ninety-six patients received 127 epidural catheters. The mean duration for epidural catheterization was 31.5±55.6 (5-509) days. The dose of epidural morphine increased by 3.5% per day. The efficacy of epidural analgesia at 2 weeks follow up revealed improved pain control (n=56), as the morphine equivalent drug dose dropped from 213.4 mg/day to 94.1 mg/day (p<0.05) at 2 weeks follow up. Accordingly, after 2 weeks institution of epidural analgesia, there was a significant reduction in the proportion of patients with severe pain, from 78.1% to 19.6% (p<0.05). Conclusion Epidural analgesia was an effective pain control method in patients with terminal cancer pain, however, a systematized algorithm for the control of cancer-related pain in needed.

Intra-Operative Warming with a Forced-Air Warmer in Preventing Hypothermia after Tourniquet Deflation in Elderly Patients

This randomized, single-blind study aimed to explore the effects of intraoperative warming with a forced-air warmer in the prevention of hypothermia after tourniquet deflation in elderly patients undergoing unilateral total knee replacement arthroplasty under general anaesthesia. Patients were randomized to receive either intra-operative warming using a forced-air warmer with an upper body blanket (warming group; n = 12) or no intra-operative warming (non-warming group; n = 12). Oesophageal temperature was measured as core body temperature. At 30 min following tourniquet inflation, the core body temperature started to increase in the warming group whereas it continued to drop in the non-warming group. This difference was statistically significant. The final core body temperature after tourniquet deflation was significantly higher in the warming group (mean ± SD 36.1 ± 0.2 °C) than in the non-warming group (35.4 ± 0.3 °C). Intra-operative forced-air warming increased the core body temperature before tourniquet deflation and prevented subsequent hypothermia in elderly patients under general anaesthesia.

Hepatic ischemic preconditioning provides protection against distant renal ischemia and reperfusion injury in mice.

We previously demonstrated that there are acute and delayed phases of renal protection against renal ischemia and reperfusion (IR) injury with renal ischemic preconditioning (IPC). This study assessed whether hepatic IPC could also reduce distant renal IR injury through the blood stream-mediated supply of reactive oxygen species (ROS). Male C57BL/6 mice were randomly divided into four groups: group I, sham operated including right nephrectomy; group II (IR), left renal ischemia for 30 min and reperfusion injury; group III (IPC-IR), hepatic ischemia for 10 min followed by 10 min of reperfusion before left renal IR injury; group IV (MPG - IPC + IR), pretreated with 100 mg/kg N-(2-mercaptopropionyl)-glycine (MPG) 15 min before hepatic IPC and left renal IR injury. Renal function, histopathologic findings, proinflammatory cytokines, and cytoprotective proteins were evaluated 15 min or 24 hr after reperfusion. Hepatic IPC attenuated the expression of proinflammatory cytokines, tumor necrosis factor α, intercellular adhesion molecule 1, and induced inducible nitric-oxide synthase, and the phosphorylation of Akt in the murine kidney. Renal function was better preserved in mice with hepatic IPC (group III) than groups II or IV. Hepatic IPC protects against distant renal IR injury through the blood stream-delivery of hepatic IPC-induced ROS, by inducing cytoprotective proteins, and by inhibiting inflammatory reactions.

The Effect of Ketamine with Remifentanil for Improving the Quality of Anaesthesia and Recovery in Paediatric Patients Undergoing Middle-Ear Ventilation Tube Insertion

This prospective randomized study evaluated the effects of ketamine with remifentanil to improve the quality of anaesthesia and postoperative recovery, following brief procedures, in 60 paediatric patients undergoing middle-ear ventilation tube insertion (MEVTI). Patients were randomly assigned to either ketamine 2 mg/kg intravenous [i.v.] bolus plus normal saline by i.v. infusion (K group, n = 30) or ketamine 2 mg/kg i.v. bolus, plus remifentanil 0.15 μg/kg per min i.v. infusion (KR group, n = 30). Parameters that were assessed included intraoperative patient movement, surgeon satisfaction, anaesthesia time, total ketamine dose, postoperative recovery time, agitation and side-effects. Intraoperative patient movement scores were significantly lower, and surgeon satisfaction scores were significantly higher, in the KR group than in the K group. Time to recovery was significantly shorter in the KR group than in the K group. In conclusion, remifentanil was a good adjuvant to ketamine, improving the quality of anaesthesia and postoperative recovery in children undergoing MEVTI.

Severe hypotension and water intoxication developed after an accidental oxytocin overdose in a morbidly obese patient undergoing cesarean section -A case report-

We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.

Acute compartment syndrome of the forearm and hand in a patient of spine surgery -A case report-

A 38-year-old woman underwent a 4-hour operation in the prone position for a laminectomy at C4-7 and posterior cervical decompressive fusion at C7-T1 under general anesthesia. After undraping at the end of surgery, considerable swelling with many blisters of the left forearm and hand was observed. The chest roll at the left side had moved cephalad into the axilla and compressed the axillary structures. An emergency fasciotomy to decompress the compartments of the forearm and dorsal surface of the hand was performed. In the post anesthesia care unit, the radial pulse of the left hand was palpable and the level of oxygen saturation was normal. Forearm and hand edema subsided gradually over several days and the patient was discharged with full function of her left arm. This compartment syndrome suggests careful attention should be paid to the position of the chest roll when the prone position is established for a long duration.

Rumpel-Leede phenomenon associated with noninvasive blood pressure monitoring -A case report-

We report a case of Rumpel-Leede (RL) phenomenon, - acute dermis capillary rupture, secondary to noninvasive blood pressure (NIBP) monitoring in a patient with type 2 diabetes mellitus (DM) and hypertension. The first most likely cause is vascular fragility in microangiopathy as a result of DM and chronic steroid use. The second is the increased venous pressure during cycling of the blood pressure cuff in a hypertensive state. Anesthesiologists need to be aware that acute dermal capillary rupture, although rare, can occur in patients with long-standing DM, hypertension and chronic steroid use.

Aminophylline Partially Prevents the Decrease of Body Temperature during Laparoscopic Abdominal Surgery

Aminophylline can elicit thermogenesis in rats or increase metabolic rate during cold stress in lambs. We tested the hypothesis that aminophylline would reduce the change in core body temperature during laparoscopic abdominal surgery requiring pneumoperitoneum. Fifty patients were randomly divided into an aminophylline group (n=25) and a saline control group (n=25). Esophageal temperature, index finger temperature, and hemodynamic variables, such as mean blood pressure and heart rate, were measured every 15 min during sevoflurane anesthesia. In the aminophylline group, esophageal temperatures at T45 (36.1±0.38 vs. 35.7±0.29, P=0.024), T60 (36.0±0.39 vs. 35.6±0.28, P=0.053), T75 (35.9±0.34 vs. 35.5±0.28, P=0.025), T90 (35.8±0.35 vs. 35.3±0.33, P=0.011), and T105 (35.8±0.36 vs. 35.1±0.53, P=0.017) and index finger temperatures at T15 (35.8±0.46 vs. 34.9±0.33, P<0.001), T30 (35.7±0.36 vs. 35.0±0.58, P=0.029), T45 (35.8±0.34 vs. 35.2±0.42, P=0.020), T60 (35.7±0.33 vs. 34.9±0.47, P=0.010), T75 (35.6±0.36 vs. 34.8±0.67, P=0.028), T90 (35.4±0.55 vs. 34.4±0.89, P=0.042), and T105 (34.9±0.53 vs. 33.9±0.85, P=0.024) were significantly higher than in the saline control group. Aminophylline is effective in maintaining the core temperature through a thermogenic effect, despite reduced peripheral thermoregulatory vasoconstriction. Graphical Abstract