Young Kyoo Choi

Intraoperative mild hypothermia does not increase the plasma concentration of stress hormones during neurosurgery.

PurposeTo determine how mild hypothermia (34°C) affects the hemodynamic and the stress hormonal responses intraoperatively and during extubation in patients undergoing cerebral aneurysm surgery.MethodsAfter induction, anesthesia was maintained with 1.2% isoflurane and 50% nitrous oxide. For the normothermia and the hypothermia groups, the body temperature was maintained at 36.9 ± 0.3°C and 34.2 ± 0.2°C respectively up to the recovery room. Hemodynamic changes were recorded continuously. Stress hormones comprising epinephrine, norepinephrine, ADH, ACTH, and cortisol were measured at the awake control, intraoperative, and extubation periods.ResultsVital signs of the intraoperative and postextubation time periods were not significantly different between the normothermia and hypothermia groups except for a statistically lower pulse rate intraoperatively in the hypothermia group (P < 0.05). In the control awake state, all five hormonal concentrations were similar between the two groups. Intraoperatively, all of the hormonal levels tended to be lower in the hypothermia group compared to the normothermia group, but only the epinephrine level decreased sufficiently to reach statistical significance (P < 0.05). During extubation, all stress hormone concentrations, except norepinephrine, were lower in the hypothermia group (epinephrine:P < 0.05; ADH:P < 0.05; ACTH:P < 0.05; cortisol:P < 0.05).ConclusionsOur data suggest that intraoperative mild hypothermia neither significantly affects the blood pressure response nor increases the concentrations of stress hormones intraoperatively. Furthermore, mild hypothermia significantly decreased the plasma concentrations of stress hormones during the extubation period.RésuméObjectifDéterminer comment l’hypothermie bénigne (34°C) modifie les réponses hémodynamiques et celles des hormones du stress pendant l’opération et l’extubation chez des patients qui subissent une intervention pour anévrisme cérébral.MéthodeLanesthésie a été maintenue avec l’isoflurane à 1,2 % et du protoxyde d’azote à 50 %. Sous normothermie et hypothermie, la température du corps a été de 36,9 ± 0,3 °C et 34,2 ± 0,2 °C respectivement jusqu’au transfert en salle de réveil, L’enregistrement des données hémodynamiques a été continu. Les hormones du stress (épinéphrine, norépinéphrine, ADH, ACTH et cortisol) ont été mesurées à l’état d’éveil, pendant l’opération et à l’extubation.RésultatsLes signes vitaux peropératoires et post-extubation n’ont pas été significativement différents sous normothermie ou hypothermie sauf pour une fréquence cardiaque peropératoire statistiquement plus faible sous hypothermie (P < 0,05). À la mesure vigile témoin, les cinq concentrations hormonales ont été semblables dans les deux groupes. Les niveaux hormonaux peropératoires tendaient à rester plus bas sous hypothermie, comparée à la normothermie, mais seule la baisse d’épinéphrine a été statistiquement significative (P < 0,05). À l’extubation, les concentrations hormonales, sauf celle de la norépinéphrine, étaient plus faibles sous hypothermie (épinéphrine :P < 0,05; ADH :P < 0,05; ACTH :P < 0,05; cortisol :P < 0,05).ConclusionNos données permettent de dire que l’hypothermie peropératoire bénigne ne modifie pas la tension artérielle et n’augmente pas les concentrations d’hormones du stress de façon significative pendant l’opération. En outre, l’hypothermie bénigne fait baisser sensiblement les concentrations d’hormones du stress après l’extubation.

Effect of beach chair position on bispectral index values during arthroscopic shoulder surgery

Background Bispectral index (BIS) monitoring reduces the cases of intraoperative awareness. Several factors can alter BIS readings without affecting the depth of anesthesia. We conducted a study to assess the impact of beach chair position (sitting position) on BIS readings. Methods General anesthesia was administered to 30 patients undergoing arthroscopic shoulder surgery. Patients were kept in neutral position (supine) for 10 minutes and BIS readings, mean arterial blood pressure, heart rate, end-tidal carbon dioxide, and end-tidal sevoflurane were recorded. Patients were then shifted to beach chair position. After 15 minutes, data were recorded. Results A significant decrease in BIS values (P < 0.01) associated with a position change from neutral position to beach chair position was evident. Conclusions BIS values are significantly decreased in the beach chair position compared with the neutral position and might affect interpretation of the depth of anesthesia.

Effects of esomeprazole premedication on gastric pH during laparoscopic surgery

BACKGROUND The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.

Correlations between the Changes of Pain and Temperature by Infrared Thermography in Central Poststroke Pain

Central poststroke pain can occur as a result of lesion or dysfunction of the brain from stroke, and may influence the autonomic nervous system to regulate the vasomotor activity which could result in the lowered skin temperature. In order to assess CPSP objectively, seventy patients with CPSP were evaluated as their pain with VAS pain score and the skin temperature of pain site by infrared thermography before and after pain treatment. And evaluated correlation between changes of temperature and VAS. The skin temperature of pain site was significantly lower than non-pain before treatment and improved after treatment(p<0.05), in accordance with significant improvement of VAS pain scores after treatment(p<0.05). And there was highly correlation between the changes of temperature and VAS(p<0.05). Therefore, it is suggested that the infrared thermography is very useful device for the evaluation of CPSP and its treatment.

Anesthetic Management of Patients during Carotid Balloon Angioplasty and Stenting: A case report

Carotid balloon angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy for the management of carotid artery stenosis, especially in high risk patients or poor candidates for standard carotid endarterectomy. We conducted anesthetic management in patients receiving carotid balloon angioplasty and stenting. General anesthesia was performed in 2 cases and anesthesia care was monitored in 5 cases to ensure hemodynamic stability. No severe complications such as major stroke occurred during the procedures. One case with monitored anesthesia care showed a rapid decrease in arterial pressure and transient bradycardia during balloon inflation, but these immediately resolved.