Ki Hyuk Hong

The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting

Background 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone. Methods Among the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups. Results The frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups. Conclusions There were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.

A comparative evaluation of humidifier with heated wire breathing circuit under general anesthesia

BACKGROUND Dry and cold anesthetic gas deteriorates patients respiratory function and body heat balance. We examined whether a humidifier with heated wire circuit might maintain core temperature and humidity of inspired gas in patient undergoing general anesthesia. METHODS We enrolled forty ASA physical status I, II patients under general anesthesia for this study. We allocated the patients randomly into two groups with (experimental group) or without (control group) Humitube(R) anesthesia circuit, which delivered heated and humidified inspired anesthetic gases. We recorded the temperatures and humidity of the inspired gases throughout the surgery. RESULTS The temperatures and relative humidity of the inspired gases in experimental group were significantly greater compared to control group (36.2 +/- 0.9degrees C, 89.5 +/- 4.8% vs. 30.4 +/- 1.8degrees C, 37.9 +/- 5.9%, P < 0.05) during anesthesia. The core temperatures in experimental group were significantly greater compared to control group (36.1 +/- 0.3degrees C vs. 35.7 +/- 0.1degrees C, P < 0.05) during anesthesia. CONCLUSIONS A humidifier with heated wire system for anesthesia breathing circuit is helpful to maintain core temperature and adequate humidity.

A detection of unexpected blood antibody at the time of transfusion was needed, during the operation -A case report-

To avoid the occurrence of fatal complications of blood transfusion, several tests are implemented before transfusion. The tests include ABO typing, Rh typing, cross-matching test and blood antibody screening test, and in usual they are completed before transfusion. However in the case of repetitive operations done via brief distance, reexamination for blood antibody tends to be omitted. After 2 previous operations, 30 years old male patient showed positive blood antibody screening during the third operation. Although antibody screening test performed before the first operation, no unexpected blood antibody was detected. During the third operation, after the decision to start transfusion was made, it took two hours to find appropriate blood. There was no significant deterioration of patients condition but the loss of time could lead to critical consequences. We present this case to make anesthesiologists and surgeons aware of possibility of unexpected blood antibody detection after transfusion.

Subdural hemorrhage after scoliosis correction surgery - A case report -

An 11-year-old boy underwent thoracolumbar surgery to correct a deformity caused by congenital kyphoscoliosis from the 6th thoracic vertebra to the 2nd lumbar vertebra. During a screw insertion, some tore and cerebro-spinal fluid (CSF) leaked. After CSF leakage, the amplitude of the motor evoked potential in the left lower extremity was reduced by 90% compared to baseline value, but there was no nerve damage at the surgical site. His post-surgical mental status did not recover completely. Brain computed tomography revealed a subdural hemorrhage in the inter-hemispheric fissure, with both tentorium and right frontotemporooccipital and diffuse brain edema. On the 4th postoperative day, mental status recovered to near alertness, but upper motor strength was grade II, right lower motor strength was grade II and left lower motor strength was grade I. Right hemifacial palsy was also noted. At 2.5 months after surgery, right facial palsy remained, but motor function recovered to near normal levels with conservative care.