So Jin Park

Comparison of ramosetron's and ondansetron's preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy

Background This study compared the preventive effects of ramosetron and ondansetron on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing abdominal hysterectomy. Methods In a prospective, randomized, double-blinded study, a total of 120 highly susceptible women (nonsmokers, those receiving opioid-based IV patient-controlled analgesia [PCA]) undergoing abdominal hysterectomy were included in the study. Patients were divided into 2 groups and each group received either 0.3 mg of ramosetron or 4 mg of ondansetron, IV. All patients received fentanyl-based IV PCA during the 48 h postoperative periods. The incidences of PONV and side effects of 5-HT3 antagonists (headache and dizziness) were assessed at 3 intervals (<2 h, 2-24 h and 24-48 h) postoperatively. Results Patients in the ramosetron group showed a significantly higher ratio of complete response and lower incidence of nausea during the 24-48 h interval after surgery compared with those the ondansetron group. Conclusions Ramosetron (0.3 mg) is more effective in preventing delayed PONV in highly susceptible women undergoing abdominal hysterectomy compared with ondansetron (4 mg).

The influence of age and gender on remifentanil EC50 for preventing rocuronium induced withdrawal movements

Background Rocuronium-induced withdrawal movements can be harmful to patients during the induction period. Remifentanil has been reported to reduce these movements effectively. In this study, we determined the EC50 of remifentanil for the prevention of rocuronium induced withdrawal movements in male, female, old and child group. Methods We included patients scheduled for general anesthesia and assigned them into 4 groups depending on their age and gender: male group (20-60 yr), female group (20-60 yr), old group (>65 yr) and child group (6-12 yr). Remifentanil was administered by target controlled infusion. Propofol 2 mg/kg was then administered after equilibration between the effect and plasma concentration of remifentanil was reached. After loss of consciousness, rocuronium 0.6 mg/kg was administered. Patients response to the rocuronium was graded using a 4 point scale in a blinded manner. The EC50 of remifentanil for preventing rocuronium induced withdrawal movements was determined using Dixons up-and -down method. Results The EC50 of remifentanil for preventing rocuronium induced withdrawal movements was 1.8 ± 0.5 ng/ml [95% confidence interval 1.3-2.2] in the male group, 2.3 ± 1.0 ng/ml [1.3-3.2] in the female group, 0.5 ± 0.4 ng/ml [0.2-0.8] in the old group and 2.8 ± 0.8 ng/ml [2.1-3.5] in the child group. Conclusions The EC50 of remifentanil for preventing rocuronium induced withdrawal movements was lowest in the elderly and higher in children than male adult patients. No difference in the EC50 of remifentanil was seen between male and female adult patients.

Effects of preoxygenation with the three minutes tidal volume breathing technique in the elderly

Background Preoxygenation with tidal volume breathing for 3 min is commonly used technique. An end tidal expiratory oxygen concentration greater than 90% is considerd to be adequate for preoxygenation. The aim of this study was to check the effects of preoxygenation on elderly patients through the comparison with young patients during the 3 min tidal volume breathing technique. Methods Sixty patients from ASA class I or II who were scheduled for elective orthopedic general surgery were divided into an elderly (>65 yr) group and a control (25-65 yr) group. Patients were instructed in the technique of preoxygenation. Preoxygenation was accomplished with an appropriately sized face mask connected to an anesthesia machine with 100% oxygen during 3 min with patients in both groups. Expired O2, CO2 concentration and oxygen saturation were recorded simultaneously for 3 min. Results The elderly group showed significantly lower end tidal oxygen concentration than the control group from 50 sec to the end of study (180 sec) with the 3 min tidal volume breathing technique (P < 0.05). In 180 sec, the control group had over 90% (91.5%) end tidal oxygen concentration, but in the elderly group end tidal oxygen concentration could not reach 90% (86.2%). In oxygen saturation, the elderly group showed a significantly lower level until 40 sec from the start of study, and then two groups showed a similar levels of oxygen saturation until the end of study. Conclusions End tidal oxygen concentration did not reach 90% in 180 sec in the elderly group during preoxygenation with the 3 min tidal volume breathing technique.

Abstract 1702: High-throughput cell-based screening of drug library identifies albendazole as a sensitizer with combination of bortezomib for treatment multiple myeloma

Background: Multiple myeloma (MM) is a fatal disease characterized by clonal proliferation of plasma cells in the bone marrow. Recently novel therapeutic drugs such as bortezomib and lenalidomide have been improved survival of MM. However, we still need to find out new drugs for treatment MM. Here we performed a high-throughput cell-based screening using a FDA-approved 380 drug library (Selleckchem, USA) to find out sensitizer in combination with bortezomib. Materials and methods: We carried out high-throughput screening using cell counting kit-8 (CCK-8, Dojindo, USA). RPMI8226 MM cells were plated 1x104 cells/well in 96-well assay plates then treated with 0.25 nM bortezomib and combination with 1 uM drug libraries for 48 hours. Analysis was done by four different methods (non-controls-based normalization, median-based activities, Z scores, and B scores). Then we selected 30 high ranking drugs for inhibition of proliferation and albendazole was selected through literature review. To investigate of albendazole effect, we performed cell proliferation assay using 0, 0.1, 1, 10 uM of albendazole and combination with 0, 0.25, 0.5, 1 nM of bortezomib at 24, 48, 72 hr in four MM cell lines (RPMI8226, MM.1S, MM.1R and U266). Inhibitory concentration 50 (IC50) and combination index (CI) calculated by compusyn software (Combosyn, USA). Cell cycle and apoptosis was analyzed by flow cytometry using the PI and Annexin V/7AAD staining kit (BD Biosciences, USA) with 0, 0.1, 1, 10 uM of albendazole at 24, 48, 72 hr in RPMI8226 and MM.1S cells. Results: Total of 180 drugs showed inhibitory effects compared with that of single treatment with bortezomib. High ranking drugs belonged to anthracycline, cytotoxic antibiotic, antihelmintic, target DNA topoisomerase I, II and microtubule function inhibitor. For albendazole, IC50 values in RPMI8226, MM.1S, MM.1R, and U266 were 0.63, 2.78, 7.26, and 5.93 uM, respectively. Peripheral blood mononuclear cells from blood donor separated by ficoll density gradient were treated by albendazole represented IC50 over 9000 uM which implicated high therapeutic index. MM cells of treatment with 1 uM albendazole for 24 hr were induced G2/M phase cell cycle arrest and increased significantly late stages of apoptosis. Finally, combination treatments with albendazole and bortezomib synergistically induced cytotoxicity against MM cell lines. Conclusions: This study showed that albendazole had potent anti-myeloma activities and enhanced the activity of bortezomib. These results indicate that albendazole may have therapeutic potential in multiple myeloma and provide the framework for future studies of albendazole in multiple myeloma. Citation Format: Min Kyeong Kim, Sunshin Kim, So Jin Park, Hyewon Lee, Tae Sik Kim, So Youn Jung, Hyun Guy Kang, Hyeon-Seok Eom, Kong Sun-Young. High-throughput cell-based screening of drug library identifies albendazole as a sensitizer with combination of bortezomib for treatment multiple myeloma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1702. doi:10.1158/1538-7445.AM2014-1702

The optimal preemptive dose of gabapentin following gynecologic surgery

BACKGROUND Gabapentin decreases acute nociceptive pain in animal and human studies when given before surgical incision. Various doses of gabapentin have been used (300-1,200 mg) to measure this preemptive effect. Here, we evaluated the optimal dose of gabapentin for reducing fentanyl consumption and the adverse effects of gabapentin following gynecologic surgery. METHODS We recruited 100 patients who underwent laparotomy for gynecologic surgery. Patients were randomly divided into 4 groups and received a placebo (control), gabapentin 300 mg (G 300), gabapentin 600 mg (G 600), or gabapentin 1,200 mg (G 1200) 2 h before surgery. Postoperatively, patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses were recorded 2, 6, 12, 24 h, and 48 h postoperatively, and the sedation scale was recorded in the post anesthetic care unit (PACU). RESULTS The postoperative fentanyl requirement was lower with gabapentin treatment, but there was no significant differences for the different doses. PACU sedation scores were not different in any group. CONCLUSIONS Gabapentin has a preemptive effect in gynecologic surgery, but there were no additional fentanyl-sparing benefits at doses above 300 mg. Thus, 300 mg is an optimal dose for decreasing fentanyl consumption following gynecologic surgery.

Common peroneal nerve palsy after robotic assisted laparoscopic colectomy - A case report -

Common peroneal nerve palsy after surgery with lithotomy position has been widely reported, but it is an unexpected complication after surgery with supine position. We report a patient who developed common peroneal nerve palsy after surgery with supine position. A 55-year old man is planed for robotic assisted laparoscopic right hemicolectomy because of colon cancer. The patient was placed supine with Trendelenburg position at an angle about 5 degrees and tilted left about 15 degrees. The operation is uneventful, but he developed common peroneal nerve palsy on the first postoperative day. The patient was fully recovered with conservative treatment after 2 months. We consider that nerve palsy as a result of compression of common peroneal nerve related to patient positioning. So we should be careful not to develop common peroneal nerve palsy even if the patient was placed in the supine position during robotic assisted surgery.