Sang-Heon Park

Does intraocular pressure increase during laparoscopic surgeries? It depends on anesthetic drugs and the surgical position.

Background: Pneumoperitoneum in the pelvic laparoscopic surgery induces a rise in the intraocular pressure (IOP). This study investigated whether IOP changes were different depending on the surgical position (Trendelenburg vs. reverse Trendelenburg) and the anesthetic drugs (propofol vs. desflurane). Methods: A total of 100 patients scheduled for pelvic laparoscopy or laparoscopic cholecystectomy were enrolled. They were randomly allocated into the propofol group or the desflurane group. In the desflurane group, anesthesia was given with thiopental and desflurane. The propofol group was anesthetized with propofol. IOP, mean blood pressure, heart rate, and peak airway pressure were measured at the following time points: awake-supine position, induction of anesthesia, after position change, 5, 10, and 20 minutes after pneumoperitoneum. IOP was measured with the handheld tonometer (Tono-penXL). Results: In all the groups, IOP decreased after anesthesia was initiated (17±2 to 11±2 mm Hg). In laparoscopic cholecystectomy, a low IOP was maintained during the period of pneumoperitoneum, independent of anesthetic drugs. In pelvic laparoscopy, the head-down position produced a rise in IOP (11±2 to 14±3 mm Hg). Further, pneumoperitoneum in addition to the head-down position raised the IOP highly in the desflurane group, and the average IOP value was over the normal limit (22±4 mm Hg). In contrast, propofol kept IOP similar to the preoperative level during the whole period of pneumoperitoneum (18±3 mm Hg, P<0.001 vs. desflurane). Conclusions: Impact of anesthetics on IOP during laparoscopic surgery may change depending on the surgical position. For the laparoscopic surgery performed in the head-down position, propofol may be more helpful in preventing ocular hypertension.

A double bending lightwand can provide more successful endotracheal intubation in patients with a short thyromental distance: a prospective randomised study.

Background and objective This study assessed the efficacy of endotracheal intubation using a double bending lightwand in patients with an anticipated difficult airway because of a short thyromental distance. Methods On the basis of the shape of the lightwand used, 68 patients with a thyromental distance of less than 65 mm undergoing general anaesthesia were randomly allocated to one of two groups. In the conventional bending group (n = 34), the lightwand was bent at 6.5 cm from the distal end to 90° angle. In the double bending group (n = 34), the lightwand was bent 30° at 15 cm from its tip in addition to the conventional bending. The ease of insertion was assessed by the lightwand search time and success rate at the first attempt. Post-operative complications, if any, were noted. Results The success rate of intubation at the first attempt was higher for the double bending group (94 vs. 74%, P < 0.05). The search time was significantly shorter in the double bending group than the conventional bending group (10 ± 6 vs. 15 ± 8 s, P < 0.01). Mean blood pressure and heart rate increased after intubation in both groups (P < 0.05), but there were no significant differences between the groups. The incidence of post-operative sore throat and mucosal bleeding was not significantly different between the groups. Conclusion We conclude that the double bending lightwand is associated with a greater success rate of intubation in patients with an anticipated difficult airway because of a short thyromental distance.

Predicting the appropriate uncuffed endotracheal tube size for children: a radiograph-based formula versus two age-based formulas

STUDY OBJECTIVES To determine whether a radiograph-based formula using the tracheal diameter from a chest radiograph predicted the appropriate endotracheal tube (ETT) size in children, and to compare these results with those produced using age-based formulas. DESIGN Retrospective, observational study. SETTING Medical record review. MEASUREMENTS Data from 537 pediatric patients, aged 3 to 6 years, who underwent orotracheal intubation with an uncuffed ETT, were randomly divided into two datasets: one was used to derive a formula and the other was for validation. A radiograph-based formula was obtained by linear regression modeling between the tracheal diameter at the seventh cervical vertebra (C7) on chest radiography and the appropriate ETT size from the estimation dataset (n=268). The appropriate size was defined as the ETT size when air leak pressure was 10 to 30 cmH2O. The predictive ability of this equation was evaluated using the validation dataset (n=269). The primary outcome was the success rate of the prediction. MAIN RESULTS The following radiograph-based formula was obtained: ID = 3 + 0.3 × (tracheal diameter at C7). The success rate of the radiograph-based formula was 57%, which is higher than the 32% (P < 0.001) of the standard age-based formula (ID = 4 + age/4) or 43% (P = 0.002) of Penlingtons formula (ID = 4.5 + age/4). An underestimation of the actual tracheal size occurred in 65% of cases using the age-based formulas, but in only 19% with the radiograph-based formula (P < 0.001). CONCLUSIONS The radiograph-based formula may be useful for predicting the appropriate ETT size in children aged 3 to 6 years.

Effect of coenzyme Q10 on spinal cord ischemia-reperfusion injury

OBJECT Spinal cord ischemia remains a serious complication of thoracoabdominal aortic aneurysm surgery. Coenzyme Q10, a potent antioxidant, has been reported to exert a neuroprotective effect. In the present study, we evaluated the effect of coenzyme Q10 pretreatment on spinal cord ischemia-reperfusion injury. METHODS Male Sprague-Dawley rats were treated with either 300 mg/kg coenzyme Q10 (CoQ10 group, n = 12) or saline (control and sham groups, n = 12 for each group) for 5 days before ischemia. Spinal cord ischemia was induced in the control and CoQ10 groups. Neurological function was assessed using the Basso-Beattie-Bresnahan (BBB) motor rating scale until 7 days after reperfusion, and then the spinal cord was harvested for histopathological examinations and an evaluation of malondialdehyde level. RESULTS On post-reperfusion Day 1, the CoQ10 group showed higher BBB scores compared with those in the control group, although the difference was not significant. However, on Day 2, the CoQ10 group showed a significantly higher BBB score than the control group (14.0 [10.3-15.0] vs 8.0 [5.0-9.8], median [IQR], respectively; p = 0.021), and this trend was maintained until Day 7 (17.5 [16.0-18.0] vs 9.0 [6.5-12.8], respectively; p < 0.001). Compared with the control group, the CoQ10 group had more normal motor neurons (p = 0.003), fewer apoptotic changes (p = 0.003) and a lower level of tissue malondialdehyde (p = 0.024). CONCLUSIONS Pretreatment with 300 mg/kg coenzyme Q10 resulted in significantly improved neurological function and preservation of more normal motor neurons.

Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration: a prospective randomised study.

Context Muscle relaxants used to facilitate tracheal intubation have disadvantages. Objective This study was designed to evaluate the dose requirements for remifentanil combined with thiopental for optimal lightwand intubation without muscle relaxants. Design Prospective randomised controlled study. Setting A tertiary care teaching hospital. Patients Ninety-six patients requiring general anaesthesia for elective surgery. Interventions Patients received remifentanil 1, 2, or 3 &mgr;g kg−1 (group R1, R2, R3, each n = 32) as a slow bolus infusion over 60 s, followed by thiopental 5 mg kg−1. Ninety seconds after remifentanil administration, lightwand intubation was attempted and intubation time was recorded. Intubating conditions were considered excellent if there was no patient movement or cough, good if coughing occurred once or twice after intubation and poor if persistent movement or cough occurred after intubation. Excellent or good intubating conditions were regarded as clinically acceptable. The duration of apnoea was recorded. Main outcome measures Intubating conditions and the duration of apnoea. Results Lightwand intubation was successful at the first attempt in all patients except for two in group R1. The intubating conditions were more acceptable in groups R2 and R3 than in group R1 (97 and 100 vs. 63%, P < 0.01). Intubation time was shorter in group R3 than in group R1 (22 ± 8 vs. 33 ± 18 s, P < 0.01). There was no significant difference in intubation time and conditions between groups R2 and R3. The mean duration of apnoea was prolonged in group R3 compared with group R2 (10.2 ± 2.1 vs. 4.6 ± 1.6 min, P < 0.01). Conclusion Our results suggest that remifentanil 2 or 3 &mgr;g kg−1 combined with thiopental 5 mg kg−1 provides acceptable conditions for lightwand intubation without muscle relaxants. Spontaneous ventilation returns more rapidly following remifentanil 2 &mgr;g kg−1 than with remifentanil 3 &mgr;g kg−1.

Cardiopulmonary resuscitation with assisted extracorporeal life support during cardiac arrest caused by drug-eluting stent thrombosis: a case report.

Discontinuation of dual antiplatelet therapy within 12 months after drug-eluting stent (DES) implantation increases the possibility of stent thrombosis. We now report the case of a 66-year-old man who suffered a cardiac arrest due to stent thrombosis after an elective laparoscopic anterior resection. Ten month ago, he underwent DES implantation and then had been taking dual antiplatelet therapy. Nine days prior to the surgery, he discontinued dual antiplatelet therapy. Forty minutes after intensive care unit admission, cardiac arrest occurred. However, his cardiac rhythm did not restore in spite of resuscitation, so immediately veno-arterial extracorporeal membrane oxygenation (ECMO) was implanted. Four days after the surgery, he was weaned from ECMO support, recovered completely, with no cardiopulmonary or neurological sequelae.

Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services

Variability in rapid response system (RRS) characteristics based on the admitted wards is unknown. We aimed to compare differences in the clinical characteristics of RRS activation between patients admitted to medical versus surgical services. We reviewed patients admitted to the hospital who were detected by the RRS from October 2012 to February 2014 at a tertiary care academic hospital. We compared the triggers for RRS activation, interventions performed, and outcomes of the 2 patient groups. The RRS was activated for 460 patients, and the activation rate was almost 2.3 times higher for surgical services than that for medical services (70% vs. 30%). The triggers for RRS activation significantly differed between patient groups (P = 0.001). They included abnormal values for the respiratory rate (23.2%) and blood gas analysis (20.3%), and low blood pressure (18.8%) in the medical group; and low blood pressure (32.0%), low oxygen saturation (20.8%), and an abnormal heart rate (17.7%) in the surgical group. Patients were more likely classified as do not resuscitate or required intensive care unit admission in the medical group compared to those in the surgical group (65.3% vs. 54.7%, P = 0.045). In multivariate analysis, whether the patient belongs to medical services was found to be an independent predictor of mortality after adjusting for the modified early warning score, Charlson comorbidity index, and intervention performed by the RRS team. Our data suggest that RRS triggers, interventions, and outcomes greatly differ between patient groups. Further research is needed to evaluate the efficacy of an RRS approach tailored to specific patient groups.

Transcultural adaptation and validation of familial satisfaction in the intensive care unit in Korea: preliminary study

Lately, in North America, questionnaires have been developed and validated, which were to assess family needs and satisfaction with care in the intensive care unit. One of the most widely used one is FS-ICU-24 survey.