Sang Hyun Kim

Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery

BACKGROUNDnRamosetron is a new selective 5-hydroxytryptamine type 3 (5-HT(3)) receptor antagonist that reportedly has more potent antiemetic effects compared with other 5-HT(3) receptor antagonists. The purpose of this study was to evaluate the efficacy of ramosetron for the prevention of postoperative nausea and vomiting (PONV) with that of ondansetron or placebo in high-risk patients undergoing gynaecological surgery.nnnMETHODSnIn this prospective, randomized, double-blinded, placebo-controlled study, 162 healthy patients who were undergoing gynaecological operation under general anaesthesia using sevoflurane were enrolled. Patients were divided into three groups: the ramosetron group (0.3 mg i.v.; n=54), the ondansetron group (8 mg i.v.; n=54), and the placebo group (normal saline i.v.; n=54). The treatments were given before the end of surgery. The incidence of PONV, severity of nausea, and the use of rescue antiemetic requirements during the first 24 h after surgery were evaluated.nnnRESULTSnThe incidence of nausea was lower in the ramosetron (50%) and ondansetron (44%) groups compared with the placebo group (69%) (P<0.05). In addition, the incidence of vomiting was lower in both the ramosetron (17%) and the ondansetron (20%) groups than in the placebo group (44%) during the first 24 h after surgery (P<0.05). The visual analogue scale score for nausea was also lower in the ramosetron and ondansetron groups compared with the placebo group (P<0.05). The proportion of patients requiring rescue antiemetics was significantly lower with ramosetron (15%) when compared with the placebo group (41%) during the 24 h after surgery (P<0.05). However, there were no significant differences in the incidence of nausea and vomiting, severity of nausea, and required rescue PONV between the ramosetron and the ondansetron groups.nnnCONCLUSIONSnRamosetron 0.3 mg i.v. was as effective as ondansetron 8 mg i.v. in decreasing the incidence of PONV and reducing nausea severity in female patients during the first 24 h after gynaecological surgery.

Comparison of the effects of vapocoolant spray and topical anesthetic cream on pain during needle electromyography in the medial gastrocnemius.

OBJECTIVEnTo compare the effects of a vapocoolant spray and an eutectic mixture of local anesthetics (EMLA) cream in reducing pain during needle electromyography examination.nnnDESIGNnRandomized controlled trial.nnnSETTINGnPhysical medicine and rehabilitation department of a university hospital.nnnPARTICIPANTSnAdults who underwent needle electromyography (N=99) were randomized to 1 of 2 experimental groups or the control group. Two patients dropped out during the study.nnnINTERVENTIONSnIn the experimental groups, vapocoolant spray or EMLA cream were applied before needle electromyography. In the control group, needle electromyography was performed without pretreatment.nnnMAIN OUTCOME MEASURESnIntensity of pain associated with needle electromyography was assessed using a 100-mm visual analog scale (VAS). Patient satisfaction and preference for repeated use were measured using a 5-point Likert scale.nnnRESULTSnVAS score for pain intensity was significantly lower in the spray group (31.9; 95% confidence interval [CI], 22.0-41.7) compared with the control group (52.9; 95% CI, 45.9-60.0; P=.002), whereas there was no significant difference between the EMLA cream group (42.4; 95% CI, 34.2-50.7) and the control group. Patient satisfaction and preference for repeated use were higher in the spray group than the EMLA group.nnnCONCLUSIONSnVapocoolant spray was more effective than EMLA cream in reducing pain during needle electromyography.

Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial.

PurposeThis study was performed to examine whether applying triamcinolone acetonide paste as a lubricant to endotracheal tubes (ETTs) reduces the incidence and severity of postoperative sore throat (POST) more effectively than applying chlorhexidine gluconate jelly.MethodsThis was a randomized controlled clinical trial. Patients enrolled in the study were ages 20 to 70xa0yr, American Society of Anesthesiologists’ physical status I and II, and scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups, the chlorhexidine group and the triamcinolone group. Prior to endotracheal intubation, ETTs in the chlorhexidine group were lubricated with 0.1% chlorhexidine gluconate jelly, whereas the ETTs in the triamcinolone group were lubricated with 0.1% triamcinolone acetonide paste 0.5xa0mg. During the 24xa0hr after the operation, we recorded the incidence and severity of POST and the incidence of cough, hoarseness, dysphagia, nausea, and dry throat.ResultsOf the 150 patients initially enrolled, 143 patients were included in the study. The incidence of POST was significantly lower in the triamcinolone group compared with the chlorhexidine group (differencexa0=xa052.4%; 95% confidence interval, 36.8% to 64.2%; Pxa0<xa00.001). The severity score for the triamcinolone group was significantly lower than that for the chlorhexidine group. The frequencies of coughing, hoarseness, dysphagia, nausea, and dry throat were similar in the two groups for the first 24 hr after surgery.ConclusionsTriamcinolone acetonide paste applied along the length of the ETT resulted in clinically important and statistically significant decreases in the incidence and severity of POST compared with the application of chlorhexidine jelly. (ClinicalTrials.govxa0number, CT00908817).RésuméObjectifCette étude a été réalisée afin d’observer si la pâte de triamcinolone, appliquée pour lubrifier les sondes endotrachéales (SET), réduisait l’incidence et la gravité des maux de gorge postopératoires de façon plus efficace que la gelée de gluconate de chlorhexidine.MéthodeCette étude clinique randomisée contrôlée a recruté des patients ASA I-II (classification de l’American Society of Anesthesiologists) âgés de 20 à 70 ans et devant subir une cholécystectomie par laparoscopie non urgente. Les patients ont été randomisés en deux groupes. Dans le groupe chlorhexidine, les SET ont été lubrifiés avec de la gelée de gluconate de chlorhexidine à 0,1xa0%, alors que dans le groupe triamcinolone, les SET ont été lubrifiés avec 0,5xa0mg de pâte d’acétonide de triamcinolone à 0,1xa0% avant l’intubation endotrachéale. L’incidence et la gravité des maux de gorge postopératoires et l’incidence de toux, d’enrouement, de dysphagie, de nausée et de gorge sèche ont été enregistrées pendant les 24xa0h suivant l’opération.RésultatsParmi les 150 patients recrutés au début de l’étude, 143 ont été inclus. L’incidence des maux de gorge postopératoires était significativement plus basse dans le groupe triamcinolone que dans le groupe chlorhexidine (différencexa0=xa052,4xa0%, intervalle de confiance 95xa0%xa0: 36,8xa0% à 64,2xa0%, Pxa0<xa00,001). Le score de gravité était significativement plus bas dans le groupe triamcinolone que dans le groupe chlorhexidine. La fréquence de la toux, de l’enrouement, de la dysphagie, de la nausée et / ou de gorge sèche était semblable dans les deux groupes durant les premières 24xa0h après la chirurgie.ConclusionLa pâte d’acétonide de triamcinolone appliquée sur toute la longueur de la SET a entraîné des réductions importantes d’un point de vue clinique et statistiquement significatives de l’incidence et de la gravité des maux de gorge postopératoires par rapport à la gelée de chlorhexidine. (ClinicalTrials.gov numéro, NCT00908817).

Peripheral venous pressure as an alternative to central venous pressure in patients undergoing laparoscopic colorectal surgery

BACKGROUNDnPeripheral venous pressure (PVP) is strongly correlated with central venous pressure (CVP) during various surgeries. Laparoscopic surgery in the Trendelenburg position with pneumoperitoneum typically increases CVP. To determine whether PVP convincingly reflects changes in CVP, we evaluated the correlation between PVP and CVP in patients undergoing laparoscopic colorectal surgery.nnnMETHODSnBoth CVP and PVP were measured simultaneously at predetermined time intervals during elective laparoscopic colorectal surgery in 42 patients without cardiac disease. The pairs of venous pressure measurements were analysed for correlation, and the Bland-Altman plots of repeated measures were used to evaluate the agreement between CVP and PVP.nnnRESULTSnA total of 420 data pairs were obtained. The overall mean CVP was 11.3 (sd 4.5) mm Hg, which was significantly lower than the measured PVP of mean 12.1 (4.5) mm Hg (P=0.005). There was a strong positive correlation between overall CVP and PVP (correlation coefficient=0.96, P<0.0001). The mean bias (PVP-CVP) corrected for repeated measurements using random-effects modelling was 0.9 mm Hg [95% confidence interval (CI) 0.54-1.19 mm Hg] with 95% limits of agreement of -1.2 mm Hg (95% CI -1.75 to -0.62 mm Hg) to 2.9 mm Hg (95% CI 2.35-3.48 mm Hg).nnnCONCLUSIONSnPVP displays a strong correlation and agreement with CVP under the increased intrathoracic pressure of pneumoperitoneum in the Trendelenburg position and may be used as an alternative to CVP in patients without cardiac disease undergoing laparoscopic colorectal surgery.

The effect of intravenous low dose ketamine for reducing postoperative sore throat

Background This study was performed to evaluate the effectiveness of intravenous low dose ketamine for reducing the incidence and severity of postoperative sore throat (POST). Methods This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 70 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the ketamine group received an intravenous injection of 0.5 mg/kg of ketamine just before induction, followed by 10 µg/kg/min throughout the operation. Patients in the control group received intravenous saline instead of ketamine. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. Results No significant differences in the incidence and severity of POST during the 24 h after the operation were found between the two groups (21/31 in the ketamine group vs. 26/34 in the control group, P = 0.398). Conclusions Intravenous injection of low dose ketamine was not effective for reducing POST.

A comparison of sufentanil and fentanyl for patient- controlled epidural analgesia in arthroplasty

Background The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated. Methods Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 µg/ml) or sufentanil (group S1: sufentanil 0.5 µg/ml, group S2: sufentanil 0.75 µg/ml, and group S3: sufentanil 1.0 µg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery. Results Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. Conclusions The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 µg/ml). Therefore, 0.5 µg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.

The effects of epidural magnesium on postoperative pain management in patients with patient-controlled epidural analgesia after a thoracotomy

BACKGROUNDnMagnesium presents analgesic effects by blocking the non-competitive N-methyl-D-aspartate receptor in the spinal cord. The purpose of this study was to evaluate the effects of epidural magnesium on cumulative dose of ropivacaine in patients with patient-controlled epidural analgesia (PCEA) after a thoracotomy.nnnMETHODSnIn a randomized, prospective, double-blind trial, we enrolled 40 patients undergoing PCEA after a thoracotomy. Control group (n = 20) received an initial dose of 0.375% ropivacaine 0.1 ml/kg, and following demand doses of 0.2% ropivacaine 2 ml with 15 min lockout interval on the patient demand. Magnesium group (n = 20) additionally received MgSO4 100 mg in the initial dose and 4 mg in the demand doses. Cumulative dose of ropivacaine, the resting and coughing visual analog scale (VAS) score were measured at 3, 6, 12, 24, and 48 hours after surgery.nnnRESULTSnMagnesium group showed lower cumulative dose of ropivacaine than control group at 12, 24, and 48 hours after the surgery (P<0.05), but not at 3 and 6 hours (P < 0.05). The VAS score was not different between 2 groups (P < 0.05).nnnCONCLUSIONSnEpidural magnesium may be useful as an adjuvant to ropivacaine after a thoracotomy. However, because magnesium showed no beneficial effect at the early period after the surgery, more investigation about proper initial dose is required.

Thyroid surgery under monitored anesthesia care (MAC)

BACKGROUNDnThyroid surgery is usually performed under general anesthesia, but thyroid surgery under monitored anesthesia care (MAC) has become re-introduced. We report our experiences of 40 cases of thyroid surgery under MAC.nnnMETHODSnForty patients were enrolled in this study. Bilateral superficial cervical plexus block (BSCPB) was performed by using 1% mepivacaine with 1 : 200,000 epinephrine. After BSCPB, patients were sedated with propofol and fentanyl. Postoperative pain, sore throat, hoarseness, and postoperative nausea and vomiting (PONV) were assessed.nnnRESULTSnMean postoperative pain VAS were 1.3, 1.2, 1.0, 0.8 and postoperative sore throat VAS 1.4, 1.4, 1.1, 0.9 at PACU (post-anesthesia care unit) and postoperative 3, 6, 12 h, respectively. The incidence of hoarseness was 25, 5, 2.5%, and 0% and PONV were 0, 5, 10%, and 7.5% at PACU and postoperative 3, 6, 12 h, respectively.nnnCONCLUSIONSnThyroid surgery under MAC may be a suitable alternative to general anesthesia.

Effect of electrical stimulation for dysphagia caused by vascular dementia

administered 5LOi to GP and observed no difference in brain Ab levels when compared to vehicle controls. Following administration of 5LOi to Tg4510 mice, there was a reduction in LTB4/CysLT, but no effect on gliosis, synaptic markers or p-tau/tau levels. Conclusions: Taken together, our results suggest that 3-week 5LOi treatment decreases brain Ab X-42 levels in amyloid models, without any effect on de novo generation of Ab and without a detectable reduction in LTB4/CysLT. The lack of LTB4/CysLT lowering in the amyloid models is a confound that may be due to localized effects surrounding the plaque. On the contrary, a significant decrease in LTB4/CysLT was observed following 5LOi administration to Tg4510 mice, without a significant effect on tau/synaptic markers suggesting that 5LOi may target only Ab-related pathology.