Sung Mee Jung

A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation

Background A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. Methods One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patients satisfaction with the anesthetic technique was assessed after surgery. Results There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horners syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patients satisfaction. Conclusions Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

Video Distraction and Parental Presence for the Management of Preoperative Anxiety and Postoperative Behavioral Disturbance in Children: A Randomized Controlled Trial.

BACKGROUND:The anxiolytic efficacy of video watching, in the absence of parents, during the mask induction of anesthesia in young children with high separation anxiety has not been clearly established. We performed this study to determine whether the effect of video distraction on alleviating preoperative anxiety is independent of parental presence and whether a combination of both interventions is more effective than either single intervention in alleviating preoperative anxiety and postoperative behavioral disturbance in preschool children. METHODS:In this prospective trial, 117 children aged 2 to 7 years scheduled for elective minor surgery were randomly allocated to 1 of 3 groups, a video distraction group (group V), a parental presence group (group P), or a combination of video distraction plus parental presence group (group VP) during induction of sevoflurane anesthesia. The Modified Yale Preoperative Anxiety Scale (mYPAS) was used to assess anxiety in the preoperative holding area (baseline), immediately after entry to the operating room, and during mask induction. Compliance during induction, emergence delirium during recovery, and negative behavioral changes at 1 day and 2 weeks postoperatively were also assessed. RESULTS:The mYPAS scores were comparable (P = 0.558), and the number of children exhibiting baseline anxiety (an mYPAS score > 30) were not different among the 3 groups in the preoperative holding area (P = 0.824). After intervention, the changes in mYPAS scores from baseline to induction were not different among the 3 groups (P = 0.049). The proportion of children with increased mYPAS scores was higher in group P compared with group V from baseline to operating room entry (Bonferroni-adjusted 95% confidence interval for difference, 2 to 49) but similar from baseline to induction in all 3 groups. Although children in group V were more cooperative during mask induction than those in the other 2 groups (P < 0.001 versus group P and P = 0.001 versus group VP), no significant intergroup differences were observed in the incidence of emergence delirium or new-onset negative behavioral change after surgery. CONCLUSIONS:Video distraction, parental presence, or their combination showed similar effects on preoperative anxiety during inhaled induction of anesthesia and postoperative behavioral outcomes in preschool children having surgery.

The Effect of Thoracic Epidural Anesthesia on Pulmonary Shunt Fraction and Arterial Oxygenation During One-Lung Ventilation

OBJECTIVE To compare the effect of thoracic epidural local anesthetic, epidural opioid, and intravenous opioid on pulmonary shunt fraction, arterial oxygenation, and hemodynamic changes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. DESIGN A prospective, randomized, double-blind study. SETTING A university hospital. PARTICIPANTS Thirty-nine patients undergoing OLV for pulmonary resection. INTERVENTIONS Patients were randomized into 1 of 3 groups: epidural bupivacaine (TEA-B group, n = 13), epidural sufentanil (TEA-S group, n = 13), or intravenous remifentanil (IV-R group, n = 13) during general anesthesia with propofol. A double-lumen tube was inserted, and mechanical ventilation with 100% oxygen was used in the lateral decubitus position. MEASUREMENTS AND MAIN RESULTS Hemodynamic variables and arterial and mixed venous blood gas analysis from the radial and pulmonary artery catheter were measured and shunt fraction was calculated during two-lung ventilation (TLV), 15, 30, and 60 minutes after the initiation of OLV, and 15 minutes after the reinstitution of TLV. Although mean arterial pressures 15 and 30 minutes after OLV in the IV-R group were significantly higher than the value in TEA-S group, cardiac output and pulmonary vascular resistance were maintained. Decreases in PaO(2), SaO(2), PvO(2), and SvO(2) and an increase in the shunt fraction after OLV were not different among groups and returned to baseline value after the resumption of TLV. CONCLUSIONS Thoracic epidural bupivacaine, epidural sufentanil, and intravenous remifentanil-combined general intravenous anesthesia have comparable effects on shunt fraction and arterial oxygenation during OLV in patients undergoing thoracic surgery.

Pleural effusion and atelectasis during continuous interscalene brachial plexus block -A case report-.

An interscalene brachial plexus block is an effective means of providing anesthesia-analgesia for shoulder surgery. However, it has a multitude of potential side effects such as phrenic nerve block. We report a case of a patient who developed atelectasis of the lung, and pleural effusion manifested as chest discomfort during a continuous interscalene brachial plexus block for postoperative analgesia.

A Randomized Comparison of Ropivacaine 0.1% and 0.2% for Continuous Interscalene Block After Shoulder Surgery

BACKGROUND:The optimal concentration of ropivacaine for continuous interscalene block after shoulder surgery is currently unknown. METHODS:Fifty-six patients received a perineural infusion of either ropivacaine 0.1% or 0.2% for 48 hours after shoulder surgery. We assessed pain scores as primary end points and supplemental analgesia, ropivacaine consumption, motor block, side effects, and patient satisfaction as secondary end points. RESULTS:Pain scores were not statistically different during the infusion periods; however, supplemental analgesia consumption was higher in the group receiving ropivacaine 0.1% during the first 24 hours (64% vs 28%, P = 0.022). Other secondary end points were statistically inconclusive. CONCLUSIONS:These results suggest that ropivacaine 0.2% provides more effective analgesia than ropivacaine 0.1% during the first 24 hours for continuous interscalene block after shoulder surgery.

Predicted effect-site concentration of propofol and sufentanil for gynecological laparoscopic surgery.

Background: This study was to estimate the predicted effect‐site concentration of propofol administered by a target‐controlled infusion (TCI) for maintenance of anesthesia based on the bispectral (BIS) index as a measure of hypnosis in laparoscopic surgery.

The effects of deep and light propofol anesthesia on stress response in patients undergoing open lung surgery: a randomized controlled trial.

Background This prospective, randomized controlled study was undertaken to compare stress hormone response to open thoracotomy for lung resection at different anesthetic depths, as determined by bispectral index (BIS) monitoring, in patients under propofol-remifentanil anesthesia. Methods Forty-eight adult patients scheduled for lung resection surgery using one-lung ventilation were randomly assigned to either a deep anesthesia group (BIS score of 40 ± 5, n = 24) or a light anesthesia group (BIS score of 60 ± 5, n = 24) by adjusting propofol infusion rates. Blood norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol levels were measured before the induction of anesthesia, at the end of surgery, and at 2 hours postoperatively. Blood glucose, hemodynamic, and oxygenation-ventilation variables, and postoperative outcomes were also measured. Results Norepinephrine and epinephrine levels remained unchanged over time in the deep group, but norepinephrine levels significantly increased in the light group at 2 h after surgery than at baseline (P = 0.007 and 0.004, respectively). Temporal changes in norepinephrine, but not in epinephrine, were significantly different between the two groups (P = 0.036). Plasma glucose levels in the light group increased with time and were significantly higher than in the deep group at the end of surgery (P = 0.002). Conclusions A deep level of anesthesia achieved using high propofol infusion rates during lung surgery provided lower perioperative norepinephrine and glucose responses than light level of anesthesia during the early postoperative period but failed to affect immediate postoperative outcomes.

Transient hemidiaphragmatic paresis after ultrasound-guided lateral sagittal infraclavicular block

As compared with medial approaches for the infraclavicular brachial plexus block, lateral approaches generally have no impact on the phrenic nerve or pulmonary function. A patient experienced transient hemidiaphragmatic paresis after ultrasound-guided lateral sagittal infraclavicular block for lower arm surgery. An accessory phrenic nerve, ie, an anatomical variation, may have been the mechanism of transient hemidiaphragmatic paresis in this patient.

Comparison of vertical infraclavicular brachial plexus block with 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery

BACKGROUND We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. METHODS We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. RESULTS There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. CONCLUSIONS Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.

A comparison of posterior and medial cord stimulation for neurostimulation-guided vertical infraclavicular block: a randomized noninferiority clinical trial.

BACKGROUND:We investigated whether medial cord stimulation is inferior to posterior cord stimulation for vertical infraclavicular block with respect to block success. METHODS:Ninety-six patients scheduled for upper limb surgery were randomly elicited a medial or posterior cord response for infraclavicular block using 40 mL of 0.5% ropivacaine. We assessed block success (complete sensory block of the 5 nerves in the forearm at 50 minutes) as the primary end point and block procedure characteristics and adverse events as secondary end points. RESULTS:The block success rates did not differ significantly between medial and posterior cord stimulation (95.7% [44/46] vs 91.7% [44/48], 95% CI of difference, –7.4% to 15.6%), while the secondary end points were comparable in both groups. CONCLUSIONS:Needle manipulation to elicit medial cord response is noninferior to posterior cord response of block success during neurostimulation-guided vertical infraclavicular block.