Enhanced recovery after surgery (ERAS) is a multidisciplinary and multimodal evidence-based approach aimed at improving the recovery of surgical patients. Successful implementation of ERAS protocols requires proper perioperative communication and collaboration among surgeons, anesthesiologists, nurses, and other medical personnel.Current Concepts: The anesthesiologist is the clinical leader responsible for the ERAS program. Preoperative patient evaluation, optimization, and patient education are essential components of the ERAS program. The program also involves preoperative fasting and carbohydrate loading to minimize catabolic effects. Selection of an appropriate anesthetic regimen, fluid and temperature management, avoidance of intra/postoperative nausea and vomiting, and multimodal pain management are the key components of ERAS for which the anesthesiologist is responsible.Discussion and Conclusion: Factors that enable the successful implementation of ERAS include the willingness to change to ERAS, formation of multidisciplinary teams to improve cooperation, and support from the hospital management, as well as standardization of order sets and care processes and the appropriate use of audits. As the leader of the ERAS team, the anesthesiologist should be actively involved in comprehensive management of the patient during the perioperative period.

No abstract available.
Dopamine* ; Injections, Spinal*

No abstract available.
Dopamine* ; Injections, Spinal*

Sugammadex is a chemically modified γ-cyclodextrin that is used as a selective reversal agent for steroidal neuromuscular blockade. The use of sugammadex has greatly increased globally; however, little is known about its potential adverse effects in pregnant and lactating women or those using hormonal contraceptives. There are three important theoretical assumptions. Firstly, pregnancy-related physiological changes involve most organs and affect the pharmacokinetic profiles of medications. Considering the physiological changes in pregnant women and the pharmacokinetic properties of sugammadex, alterations in the dosage and safety profiles of sugammadex may occur during pregnancy. Secondly, very large and polarized sugammadex molecules are expected to have limited placental transfer to the fetus and excretion into breast milk. Finally, sugammadex can bind to steroidal neuromuscular blocking agents as well as other substances with similar structures, such as progesterone. As a result of using sugammadex, progesterone levels can be reduced, causing adverse effects such as early pregnancy cessation and failure of hormonal contraceptives. This narrative review aims to demonstrate the correlations between sugammadex and pregnancy, lactation, and reproductive potential based on previously published preclinical and clinical studies. This will bridge the gap between theoretical assumptions and currently unknown clinical facts. Moreover, this review highlights what anesthesia providers should be aware of and what actions to take while administering sugammadex to such patients.

OBJECTIVES: Exposure to light at night has become pervasive in modern society. The impact of dim artificial light at night (dALAN) exposure on sleep and fatigue is not well recognized. We aim to study the impact of dALAN exposure during sleep on human fatigue. METHODS: 30 healthy young male volunteers from 21 to 29 years old were enrolled in the study. They were randomly divided into two groups depending on light intensity (Group A : 5 lux and Group B : 10 lux). Data were gathered from each participant after each night with no light (Night 1) followed by the next night (Night 2) with two different dim light conditions (5 or 10 lux) by means of self-reported fatigue scale. RESULTS: Exposure to dALAN during sleep was significantly associated with increased overall fatigue (F = 19.556, p < 0.001) and ocular discomfort (F = 5.671, p = 0.028). CONCLUSION: We found that dALAN during sleep likely affects human fatigue in some aspects. These findings indicate that dALAN during sleep exerts a negative effect on human fatigue.
Fatigue* ; Humans* ; Male ; Volunteers

BACKGROUND: Pulse wave velocity (PWV) and pulse transit time (PTT) are influenced by the arterial wall stiffness and compliance. Also, the PTT is dependent on blood pressure changes that can be accompanied by the anesthesia. The simply measured PTT has difficult to discriminate the arterial compliance changes from blood pressure changes. Therefore, we investigated that the differences of PTT between toe and finger as an independent parameter on blood pressure. METHODS: Eighteen patients scheduled for elective lower abdominal gynecologic surgery were studied. General anesthesia was achieved with sevoflurane and epidural block was done with 0.2% ropivacaine and fentanyl 100microgram via epidural catheter inserted into L1 - L2 epidural space. PTT was measured in a finger (PTTf) and a toe (PTTt) by the time difference between the ECG R wave and the pulse wave of PPG. Blood pressure and PTT was measured at three instances such as preinduction (Pre), 5 minutes after intubation (Int5) and 30 minutes after injection of epidural dose (Epi). The time delay of PTT between toe and finger (PTTt-f) was measured. RESULTS: PTTf and PTTt was prolonged at Int5 and Epi. But the PTTt-f was not different between the Int5 and Epi because of prolonged PTTf caused by the blood pressure decrement after the epidural block. CONCLUSIONS: PTTf, PTTt and PTTt-f can be a one of the convenient measurement of the arterial compliance but it was suggested that there need to be a parameter less dependent on the blood pressure changes.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure ; Catheters ; Compliance ; Electrocardiography ; Epidural Space ; Female ; Fentanyl ; Fingers* ; Gynecologic Surgical Procedures ; Humans ; Intubation ; Photoplethysmography ; Pulse Wave Analysis* ; Toes*

Lung isolation in a neonate can be a challenge for the anesthesiologist. We report on our anesthetic experience with a neonate who had giant bronchopulmonary sequestration (BPS). The BPS was large enough to shift the mediastinum to the contralateral hemithorax. The trachea was immediately intubated after delivery and the lungs were mechanically ventilated in the neonatal intensive care unit. To prevent desaturation during the attempt of lung isolation, a 3 Fr Fogarty catheter was inserted into the trachea alongside the endotracheal tube without extubation. A fiberscope was then passed through the blocker port of a multiport adapter instead of the bronchoscopy port to minimize leakage by tightening the Touhy-Borst valve. Hypoxemia or leakage did not occur during the procedure. For early extubation, we provided caudal analgesia with ropivacaine and morphine. The giant BPS was successfully resected and the neonate was in excellent condition for early extubation. However, reintubation was needed for the pneumothorax caused by the inadequate placement of a chest drain 9 hours after extubation.
Amides ; Analgesia ; Analgesia, Epidural ; Anoxia ; Bronchopulmonary Sequestration ; Bronchoscopy ; Catheters ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Lung ; Mediastinum ; Morphine ; One-Lung Ventilation ; Pneumothorax ; Thorax ; Trachea

BACKGROUND: Both the Trendelenburg position and pneumoperitoneum with carbon dioxide have been reported to increase intracranial pressure (ICP) and to alter cerebral blood flow or cerebral blood volume. Also anesthetic agents have variable effects on cerebral hemodynamics and ICP. The present study was conducted to determine whether regional cerebral oxygen saturation (rSO2) values differ between propofol and sevoflurane anesthesia during laparoscopic surgery in the Trendelenburg position. METHODS: Thirty-two adult women undergoing gynecological laparoscopic surgery were divided into sevoflurane and propofol groups. rSO2 values were recorded at 10 min after induction in the neutral position (Tpre), 10 min after the pneumoperitoneum in the Trendelenburg position (Tpt) and 10 min after desufflation in the neutral position (Tpost). For analysis of rSO2, we did ANOVA and univariate two-way ANCOVA with covariates being mean arterial pressure and end tidal carbon dioxide tension. RESULTS: Between sevoflurane and propofol groups, the change in rSO2 was significantly different even after ANCOVA. rSO2 at Tpt (76.3 +/- 5.9% in sevoflurane vs 69.4 +/- 5.8% in propofol) and Tpost (69.5 +/- 7.1% in sevoflurane vs 63.8 +/- 6.6% in propofol) were significantly higher in the sevoflurane group compared with the propofol group. In the propofol group, rSO2 at Tpost was significantly lower than at Tpre (71.1 +/- 4.8%) and cerebral oxygen desaturation occurred in two patients (14.3%). CONCLUSIONS: Significantly lower rSO2 values were observed in the propofol group during gynecological laparoscopic surgery. The possibility of cerebral oxygen desaturation should not be overlooked during propofol anesthesia even after desufflation of the abdomen in the neutral position.
Abdomen ; Adult ; Anesthesia ; Anesthetics ; Antigens, Ly ; Arterial Pressure ; Blood Volume ; Carbon Dioxide ; Female ; Head-Down Tilt ; Hemodynamics ; Humans ; Hypoxia, Brain ; Intracranial Pressure ; Isoantigens ; Laparoscopy ; Methyl Ethers ; Oxygen ; Pneumoperitoneum ; Propofol ; Prostaglandins, Synthetic ; Spectroscopy, Near-Infrared

PURPOSE: Chronic kidney disease (CKD) and obesity are the worldwide public health problem. Obesity is an already well-established risk factor for CKD. The objective of this study is to evaluate the relationship between high BMI and increased risk for nephropathy by clinical data. METHODS: Study group were 26 patients who had BMI> or =25 kg/m2 and control group were 49 patients with BMI<25 kg/m2. Both groups received renal biopsy in Kyung Hee Medical Center between 2003. Jan.-2007. Dec. BMI was calculated from measured weight and height when they were admitted to the hospital. We collected laboratory data such as CBC and blood chemistry. RESULTS: Our hypothesis was that overweight and obesity are associated with incidence and progression of CKD. From kidney biopsy, we found IgAN 17, MesPGN 5, HSPN 2, Intestitial nephritis 1, IgMN 1 (total 26) in the study group whereas IgAN 22, MesPGN 17, HSPN 3, MGN 3, benign hematuria 2, MPGN 1, Intestitial nephritis 1, (total 49) were found in the control group. There was no significant difference between the two groups. Overweight patients demonstrated significantly higher platelet, TG, ALT, and uric acid level compared to control group. CONCLUSION: We identified a significant relationship between overweight and development of CKD. These results suggest that overweight children have an increased risk for CKD than those who are not obese. So, we should pay attention to children with overweight who have CKD and earlier weight management is crucial to prevent aggravation of CKD.
Biopsy ; Blood Platelets ; Child ; Glomerulonephritis, Membranoproliferative ; Hematuria ; Humans ; Incidence ; Kidney ; Nephritis ; Obesity ; Overweight ; Public Health ; Renal Insufficiency, Chronic ; Risk Factors ; Uric Acid

Survival sepsis campaign recommends that vasopressor therapy is required to maintain mean arterial pressure (MAP) > or = 65 mmHg. However, the absolute maximum dose of vasopressor is difficult to determine. Herein, we report 2 cases of severe skin necrosis after high dose vasopressor infusion to maintain the recommended MAP in septic shock. In our first case, norepinephrine 1.0-2.0 microg/kg/min and vasopressin 0.03-0.1 U/min were infused for 5 days; in the second case, dopamine 10-20 microg/kg/min and norepinephrine 0.25-2.5 microg/kg/min were infused for 7 days. Severe ischemic skin lesions, which required amputations, developed in both cases. The clinical appearance of the skin lesions in the 2 cases was different because of the unique distribution of target receptors for different vasopressors. Thus, when high dose vasopressors are required to achieve recommended MAP, extra vigilance is required. Further studies for dose adjustment are needed.
Amputation ; Arterial Pressure ; Dopamine ; Gangrene ; Necrosis ; Norepinephrine ; Sepsis ; Shock, Septic ; Skin ; Vasoconstrictor Agents ; Vasopressins