Sun-Joon Bai

Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms.

Objectivesu2002–u2002 Athough acupuncture therapy has demonstrated itself to be effective in several clinical areas, the underlying mechanisms of acupuncture in general and the analgesic effect in particular are, however, still not clearly delineated. We, therefore, have studied acupuncture analgesic effect through fMRI and proposed a hypothesis, based on the obtained result, which will enlighten the central role of the brain in acupuncture therapy.

Total Intravenous Anesthesia with Propofol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Trial

Purpose We investigated the effect of total intravenous anesthesia (TIVA) with propofol on postoperative nausea and vomiting (PONV) after robot-assisted laparoscopic radical prostatectomy (RLRP) in patients at low risk of developing PONV, in comparison to balanced anesthesia with desflurane. Materials and Methods Sixty two patients were randomly assigned to the Des or TIVA group. Propofol and remifentanil were used for induction of anesthesia in both groups and for maintenance of the anesthesia in the TIVA group. In the Des group, anesthesia was maintained with desflurane and remifentanil. In both groups, postoperative pain was controlled using fentanyl-based intravenous patient controlled analgesia, and ramosetron 0.3 mg was administered at the end of surgery. The incidence of PONV, severity of nausea and pain, and requirements of rescue antiemetics and analgesics were recorded. Results The incidence of nausea in the post-anesthetic care unit was 22.6% in the Des group and 6.5% in the TIVA (p=0.001) group. The incidence of nausea at postoperative 1-6 hours was 54.8% in the Des group and 16.1% in the TIVA group (p=0.001). At postoperative 6-48 hours, there were no significant differences in the incidence of nausea between groups. Conclusion In order to prevent PONV after RLRP in the early postoperative period, anesthesia using TIVA with propofol is required regardless of patient-related risk factors.

Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep Trendelenburg position

BackgroundIntraocular pressure is increased during laparoscopic surgeries performed in a steep Trendelenburg position. This study compared the effects of propofol with those of sevoflurane on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy in a 30° Trendelenburg position.MethodsSixty-six patients were randomly allocated to a maintenance anesthetic consisting of remifentanil and sevoflurane (Sevoflurane Group) or remifentanil and propofol (Propofol Group). Intraocular pressure (IOP) was measured at nine predefined time points, including baseline (T0), five minutes after establishing pneumoperitoneum (T2), 30xa0min after establishing the Trendelenburg position with pneumoperitoneum (T3), five minutes after returning to the horizontal position (T4), and immediately after tracheal extubation (T6). The primary outcome was the change in intraocular pressure from T0 to T3.ResultsThe results of linear mixed model analysis showed that intraocular pressure differed between the two groups (Pxa0=xa00.0039). At T3, the mean (SD) IOP was greater in the Sevoflurane Group [23.5 (4.3) mmHg] than in the Propofol Group [19.9 (3.8) mmHg] (Pxa0=xa00.0019). At T2 and T6, IOP was also greater in the Sevoflurane Group than in the Propofol Group (Pxa0=xa00.038 and Pxa0=xa00.009, respectively). There was a statistically significant increase in intraocular pressure from baseline to T3 (pneumoperitoneum and steep Trendelenberg) in the Sevoflurane Group [6.0 (5.0) mmHg; Pxa0<xa00.001] but not in the Propofol Group [2.1 (5.1) mmHg; Pxa0=xa00.136]. None of the patients experienced ocular complications.ConclusionsIntraocular pressure increases after pneumoperitoneum and the steep Trendelenburg position are established. This increase is less with propofol than with sevoflurane anesthesia. This trial was registered at ClinicalTrials.gov: NCT01744262.RésuméContexteLa pression intraoculaire augmente pendant les chirurgies par laparoscopie réalisées en position de Trendelenburg fortement inclinée. Cette étude a comparé les effets du propofol à ceux du sévoflurane sur la pression intraoculaire chez des patients subissant une prostatectomie radicale par laparoscopie assistée par robot dans une position de Trendelenburg inclinée à 30°.MéthodeUne anesthésie de maintien consistant en rémifentanil et sévoflurane (groupe sévoflurane) ou en rémifentanil et propofol (groupe propofol) a été aléatoirement attribuée à soixante-six patients. La pression intraoculaire (PIO) a été mesurée à neuf moments prédéterminés, notamment au début de l’intervention (T0), cinq minutes aprèsxa0la mise en place du pneumopéritoine (T2), 30xa0min après le positionnement en position de Trendelenburg avec le pneumopéritoine (T3), cinq minutes après le retour en position horizontale (T4), et immédiatement après l’extubation trachéale (T6). Le critère d’évaluation principal était le changement de pression intraoculaire entre T0 et T3.RésultatsLes résultats de l’analyse de modèle linéaire mixte ont démontré que la pression intraoculaire différait entre les deux groupes (Pxa0=xa00,0039). Au point T3, la PIO moyenne (ÉT) était plus élevée dans le groupe sévoflurane [23,5 (4,3) mmHg] que dans le groupe propofol [19,9 (3,8) mmHg] (Pxa0=xa00,0019). Aux points T2 et T6, la PIO était également plus élevée dans le groupe sévoflurane que dans le groupe propofol (Pxa0=xa00,038 et Pxa0=xa00,009, respectivement). Une augmentation statistiquement significative de la pression intraoculaire a été observée entre les mesures au début de l’intervention et celles au point T3 (pneumopéritoine et Trendelenburg fortement inclinée) dans le groupe sévoflurane [6,0 (5,0) mmHg; Pxa0<xa00,001], mais pas dans le groupe propofol [2,1 (5,1) mmHg; Pxa0=xa00,136]. Aucun des patients n’a souffert de complications oculaires.ConclusionLa pression intraoculaire augmente après la mise en place du pneumopéritoine et d’une position de Trendelenburg fortement inclinée. Cette augmentation est moindre avec une anesthésie au propofol qu’avec une anesthésie au sévoflurane. Cette étude est enregistrée sous ClinicalTrials.govxa0: NCT01744262.

ORIGINAL ARTICLE: Ultrasonographic evaluation of the femoral vein in anaesthetised infants and young children

We investigated the cross‐sectional area of the femoral vein and its relationship to the femoral artery at two anatomical levels, in infants and children. Sixty‐six subjects were allocated to one of two groups: infants (<u20031u2003year, nu2003=u200331) or children (1–6u2003years, nu2003=u200335). After induction of general anaesthesia, the femoral vein was evaluated by ultrasound with the patients’ legs at 30° and 60° of abduction and their hips externally rotated. In each position, measurements were taken at the level of the inguinal crease and 1u2003cm below the crease. Hip rotation with 60° leg abduction decreased femoral artery overlap at the level of the inguinal crease in both infants (pu2003=u20030.013) and children (pu2003=u20030.003). Thus, the optimal place for femoral vein cannulation in paediatric patients seems to be at the level of the inguinal crease with 60° leg abduction and external hip rotation.

The Duration of Intrathecal Bupivacaine Mixed with Lidocaine

BACKGROUND:Although spinal bupivacaine may have too long duration to be useful in the ambulatory setting, recent animal data suggest that lidocaine added to spinal bupivacaine may reduce the duration of bupivacaine spinal anesthesia. We explored whether lidocaine added to spinal bupivacaine could shorten the duration of bupivacaine spinal anesthesia in humans similarly to what has been reported in animals. METHODS:Ninety patients presenting for transurethral resection of bladder tumor or prostate were assigned to one of three groups by double blind randomization to receive intrathecal 1.5 mL of hyperbaric 0.5% bupivacaine, plus 0.6 mL of one of three solutions: saline (Group I, n = 30, control), 1% lidocaine (Group II, n = 30), and 2% lidocaine (Group III, n = 30). Peak sensory block level, time to peak sensory block, times to two-segment, L1, and S2 regressions from peak sensory block, motor blocks at peak sensory block, L1, and S2 regressions, and postanesthesia care unit stay time (PACU time) were measured. RESULTS:Times to peak sensory block were similar in all three groups. Times to two-segment, L1, and S2 regressions from peak sensory block, and PACU time were significantly reduced in Group II compared to Group I. Times to L1, S2 regressions, and PACU times in Group III were significantly prolonged. CONCLUSIONS:We conclude that lidocaine (6 mg) mixed to spinal bupivacaine (7.5 mg) can shorten the duration of bupivacaine spinal anesthesia, therefore provide more rapid recovery from the spinal anesthesia compared to the same dose of bupivacaine (7.5 mg) alone.

The Intraocular Pressure under Deep versus Moderate Neuromuscular Blockade during Low-Pressure Robot Assisted Laparoscopic Radical Prostatectomy in a Randomized Trial.

Background This study aimed to determine whether continuous deep neuromuscular blockade (NMB) improves the surgical conditions and facilitates robotic-assisted laparoscopic radical prostatectomy (RALRP) under low intra-abdominal pressure (IAP) to attenuate the increase in intraocular pressure (IOP) during CO2 pneumoperitoneum in the steep Trendelenburg (ST) position. Methods Sixty-seven patients undergoing RALRP were randomly assigned to a moderate NMB group (Group M), including patients who received atracurium infusion until the end of the ST position, maintaining a train of four count of 1–2; and the deep NMB group (Group D), including patients who received rocuronium infusion, maintaining a post-tetanic count of 1–2. IOP was measured in all patients at nine separate time points. All RALRPs were performed by one surgeon, who rated the overall and worst surgical conditions at the end of the ST position. Results The highest IOP value was observed at T4 (60 min after the ST position) in both Group M (23.3 ± 2.7 mmHg) and Group D (19.8 ± 2.1 mmHg). RALRP was accomplished at an IAP of 8 mmHg in 88% Group D patients and 25% Group M patients. The overall surgical condition grade was 4.0 (3.0–5.0) in Group D and 3.0 (2.0–5.0) in Group M (P < 0.001). Conclusion The current study demonstrated that continuous deep NMB may improve surgical conditions and facilitate RALRP at a low IAP, resulting in significant attenuation of the increase on IOP. Moreover, low-pressure pneumoperitoneum, facilitated by deep NMB still provided acceptable surgical conditions. Trial Registration ClinicalTrials.gov NCT02109133

Fresh Frozen Plasma in Pump Priming for Congenital Heart Surgery: Evaluation of Effects on Postoperative Coagulation Profiles Using a Fibrinogen Assay and Rotational Thromboelastometry

Purpose In this prospective study, the effects of fresh frozen plasma (FFP) included in pump priming for congenital heart surgery in infants and children on post-bypass coagulation profiles were evaluated. Materials and Methods Either 20% albumin (50-100 mL) or FFP (1-2 units) was added to pump priming for patients randomly allocated into control or treatment groups, respectively. Hematologic assays, including functional fibrinogen level, and rotational thromboelastometry (ROTEM®) were measured before skin incision (baseline), after weaning from cardiopulmonary bypass (CPB) and heparin reversal, and at 24 hours (h) in the intensive care unit (ICU). Results All the baseline measurements were comparable between the control and treatment groups of infants and children. After heparin reversal, however, significantly higher fibrinogen levels and less reduced ROTEM parameters, which reflect clot formation and firmness, were demonstrated in the treatment groups of infants and children. At 24 h in the ICU, hematologic assays and ROTEM measurements were comparable between the control and treatment groups of infants and children. Transfusion requirements, excluding FFP in pump prime, and postoperative bleeding were comparable between the control and treatment groups of infants and children. Conclusion Although clinical benefits were not clearly found, the inclusion of FFP in pump priming for congenital heart surgery in infants and children was shown to improve the hemodilution-related hemostatic dysfunction immediately after weaning from CPB and heparin reversal.

Ultrasonographic evaluation of the femoral vein in anaesthetised infants and young children

We investigated the cross‐sectional area of the femoral vein and its relationship to the femoral artery at two anatomical levels, in infants and children. Sixty‐six subjects were allocated to one of two groups: infants (<u20031u2003year, nu2003=u200331) or children (1–6u2003years, nu2003=u200335). After induction of general anaesthesia, the femoral vein was evaluated by ultrasound with the patients’ legs at 30° and 60° of abduction and their hips externally rotated. In each position, measurements were taken at the level of the inguinal crease and 1u2003cm below the crease. Hip rotation with 60° leg abduction decreased femoral artery overlap at the level of the inguinal crease in both infants (pu2003=u20030.013) and children (pu2003=u20030.003). Thus, the optimal place for femoral vein cannulation in paediatric patients seems to be at the level of the inguinal crease with 60° leg abduction and external hip rotation.

Detection of Mycobacterium kansasii Using DNA-DNA Hybridization with rpoB Probe

A microtiter well plate DNA hybridization method using Mycobacterium kansasii-specific rpoB DNA probe (kanp) were evaluated for the detection of M. kansasii from culture isolates. Among the 201 isolates tested by this method, 27 strains show positive results for M. kansasii, but the other 174 isolates were negative results for M. kansasii. This result was consistent with partial rpoB sequence analysis of M. kansasii and the result of biochemical tests. The negative strains by this DNA-DNA hybridization method were identified as Mycobacterium tuberculosis (159 strains), Mycobacterium avim (5 strains), Mycobacterium intracellulare (8 strains), and Mycobacterium flavescens (2 strain) by rpoB DNA sequence analysis. Due to high sensitivity and specificity of this test result, we suggest that DNA-DNA hybridization method using rpoB DNA probes of M. kansasii could be used for the rapid and convenient detection of M. kansasii.

Comparison of 2 cuff inflation methods before insertion of laryngeal mask airway for safe use without cuff manometer in children

PURPOSEnThis prospective, randomized trial was conducted to establish whether the pediatric laryngeal mask airway (LMA) could be used without any concerns for abnormally high intra-cuff pressure when a cuff of the LMA was inflated with half the maximum recommended inflation volume or the resting volume before insertion.nnnBASIC PROCEDURESnEighty children 0 to 9 years of age and weighing of 5 to 30 kg scheduled for general anesthesia were included. Before insertion, the cuff of the LMA was filled with half the maximum recommended inflation volume in the Half volume group, or the resting volume by opening the pilot balloon valve to atmospheric pressure in the Resting volume group. After insertion of the LMA, intra-cuff pressure, oropharyngeal leak pressure, and leakage volume were investigated.nnnMAJOR FINDINGSnThe Half volume group showed lower mean intra-cuff pressure than the Resting volume group (49.6 ± 12.1 cm H(2)O vs 58.1 ± 13.8 cm H(2)O, P = .005). There was no difference in oropharyngeal leak pressure (22.1 ± 5.8 vs 21.7 ± 5.1 cm H(2)O, P = .757) or leakage volume between the Half volume group and the Resting volume group (0.13 ± 0.13 ml/kg vs 0.11 ± 0.12 ml/kg, P = .494) under spontaneous respiration.nnnCONCLUSIONSnBoth methods of the LMA cuff inflation before insertion provided an acceptable range of intra-cuff pressure with adequate pharyngeal sealing without any intervention after insertion.