Objective: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Methods: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Results: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Conclusion Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Background: Submental intubation is commonly used during general anesthesia for maxillofacial surgeries as it provides a safe unrestricted surgical access compared to tracheostomy. During submental intubation, soft tissues and blood clots can become lodged in the endotracheal tube. To overcome this problem, we used a laparoscopic trocar.Case: A 52-year-old man with maxillofacial injury was scheduled to undergo an open reduction and internal fixation. We performed submental intubation using laparoscopic trocar, which created sufficient space for the insertion of the endotracheal tube. Unlike conventional methods, our method did not require any blunt dissection and caused significantly less soft tissue damage and required significantly less time. Conclusions Submental intubation with laparoscopic trocar is a one-step method and is quick and easy-to-perform technique with less complications.

BACKGROUND: Recently, endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), have been used for treatment of thoracic and abdominal aortic aneurysms. The purpose of this study was to analyze the outcome and predictors for 30-day mortality and complications, in patients that underwent EVAR and/or TEVAR under general anesthesia. METHODS: In this study, 151 cases of EVAR and/or TEVAR under general anesthesia in 140 patients during 2009–2017 were studied. The primary outcome was 30-day mortality after surgery. Multivariate logistic regression analysis was used, to clarify risk for postoperative 30-day mortality. RESULTS: Postoperative 30-day mortality rate was 9.9% in the study population (10.3% in EVAR, and 9.3% in TEVAR, respectively). Seventy-two cases (47.7%) experienced postoperative complications within 30 days. Elderly older than age 76.5 (odds ratio [ORs] = 48.89, 95% confidential interval [95% CI] 1.40–1,710.25, P = 0.032), technically expertness (OR = 0.01, 95% CI 0.00–0.40, P = 0.013), severity of systemic complications (OR = 23.24, 95% CI, 2.27–238.24, P = 0.008), and severity of local-vascular complications (OR = 31.87, 95% CI, 1.29–784.66, P = 0.034) were significantly associated with 30-day mortality. CONCLUSIONS: This study revealed that elderly, technically expertness, and severity of systemic and local-vascular complications were associated with 30-day mortality of EVAR and TEVAR in aortic aneurysm.
Aged ; Anesthesia, General ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Humans ; Length of Stay ; Logistic Models ; Mortality ; Postoperative Complications ; Risk Factors ; Treatment Outcome

BACKGROUND: This study was designed to assess whether pre-anesthetic administration of dexmedetomidine reduces the postoperative consumption of opioids, in patients receiving patient-controlled fentanyl after gynecological laparotomy. METHODS: This was a prospective, randomized, double-blind, controlled study. Ten minutes before induction of anesthesia, 36 patients scheduled for elective gynecological laparotomy were assigned to receive either normal saline (group N) or dexmedetomidine 1 µg/kg (group D). A patient-controlled analgesia (PCA) device was used to administer fentanyl for the postoperative 24 h period. Cumulative fentanyl consumption and pain score were assessed at postoperative 30 min, 6 h and 24 h. Patient's satisfaction for pain control and other side effects (nausea, sedation score) were recorded for all corresponding time points. RESULTS: There was no significant difference between the groups in cumulative fentanyl consumption (Group N: 11.1 ± 3.2 µg/kg, Group D: 10.3 ± 2.9 µg/kg, P value: 0.706). The incidence of side-effects did not differ between the groups. Both groups showed similar blood pressure after anesthesia induction. However, 10 min after anesthesia induction, the heart rates in group D were significantly lower than group N (P = 0.0002). CONCLUSIONS: In patients undergoing gynecological laparotomy, the pre-anesthetic administration of single loading dose dexmedetomidine (1 µg/kg) given 10 min before anesthesia induction did not reduce the PCA consumption of postoperative fentanyl or the pain score.
Adrenergic alpha-2 Receptor Agonists ; Analgesia, Patient-Controlled ; Analgesics, Opioid* ; Anesthesia ; Blood Pressure ; Dexmedetomidine* ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Laparotomy ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies

BACKGROUND: Perioperative hypothermia, defined as a core temperature under 36℃, increases the risk of cardiac complication, bleeding and infection. This study aimed to compare the hypothermia-preventing effects of a warming blanket (Ready-heat®) and one-layer cotton blanket in patients undergoing transurethral resection of the bladder (TURBT) under general anesthesia. METHODS: Patients undergoing TURBT under general anesthesia were allocated to the warming blanket (N = 23) or one-layer cotton blanket (N = 23) groups. Ten minutes before induction of anesthesia, warming blanket or one-layer cotton blanket was applied according to the assigned group. Tympanic temperature was measured just before induction of anesthesia. Esophageal temperature and tympanic temperature were measured from 20 min after induction of anesthesia at 10-min intervals. Tympanic temperature was measured at 10-min intervals over a 30-min period in the post-anesthesia care unit (PACU). In addition, the incidence and intensity of shivering and thermal comfort were also measured. RESULTS: The core temperature during general anesthesia showed no significant intergroup difference. The warming blanket group showed a lower incidence of hypothermia at 1 h after induction of anesthesia. Tympanic temperature, the incidence and intensity of shivering, and thermal comfort in the PACU showed no significant intergroup differences. CONCLUSIONS: Application of the warming blanket or one-layer cotton blanket for 10 min before induction of anesthesia showed no hypothermia-preventing effects. However, at one hour after induction of anesthesia, warming blanket application reduced the incidence of hypothermia to a greater degree than one-layer cotton blanket.
Anesthesia ; Anesthesia, General* ; Hemorrhage ; Humans ; Hypothermia* ; Incidence ; Perioperative Period ; Shivering ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND: Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. METHODS: In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. RESULTS: The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P < 0.05). Postoperative cardiovascular complications were related to frequent intraoperative hypotension (P <0.05). Postoperative respiratory complications were related to age, preoperative renal failure, neurological comorbidities, and bedridden state (P < 0.05). ICU admission was associated with the time from injury to operation, preoperative neurological comorbidities and frequent intraoperative hypotension (P < 0.05). CONCLUSIONS: Adequate treatment of respiratory comorbidities and prevention of cardiovascular complications might be the critical factors in reducing postoperative mortality in elderly patients undergoing hip fracture surgery.
Aged* ; Anesthesia ; Comorbidity ; Hip Fractures ; Hip* ; Humans ; Hypotension ; Incidence ; Intensive Care Units ; Length of Stay ; Logistic Models ; Medical Records ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Risk Factors*

BACKGROUND: The purpose of this study is to examine the usefulness of a combined spinal-epidural set with reinforced catheter (CombiSpeed(R), Ace Medical, Seoul, Korea) as compared with the non-reinforced catheter (PORTEX(R), Smiths medical, Brisbane, Australia) in terms of catheter positioning and clinical aspects of anesthesia. METHODS: One hundred and two patients scheduled for regional anesthesia were enrolled in this study. They were allocated randomly either into group A (CombiSpeed(R)) or group P (PORTEX(R)). Vital signs and the levels of sensory and motor block were measured every 5 minutes. Ease of insertion and the removal of the catheter were assessed, so was the incidence of venous cannulation and paresthesia during epidural catheter insertions. After the placement of epidural catheter, we checked the location of catheter by radiography and measured in a clockwise angle from the midline to catheter tip (angle X). In laboratory, tensile strength of the two products was measured by using tonometry. RESULTS: There were no significant differences between groups in intra-operative vital sign, block level and ease of catheter insertion and removal. No difference was observed in angle X between the groups (group A: 93.6 +/- 129.5degrees, group P: 124.5 +/- 127.7degrees, P = 0.22). There were no complications such as paresthesia or venous cannulation during catheter insertion. The tensile strength was higher in group A (group A: 1.70 +/- 0.05 kg, group P: 1.30 +/- 0.03 kg, P < 0.05). CONCLUSIONS: CombiSpeed(R) is as useful as PORTEX(R) in terms of ease for catheter placement, positioning of catheter tip and clinical aspects of anesthesia.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural ; Catheterization ; Catheters ; Humans ; Incidence ; Paresthesia ; Tensile Strength ; Vital Signs

OBJECTIVE: To evaluate the accuracy of the swallowing kinematic analysis. METHODS: To evaluate the accuracy at various velocities of movement, we developed an instrumental model of linear and rotational movement, representing the physiologic movement of the hyoid and epiglottis, respectively. A still image of 8 objects was also used for measuring the length of the objects as a basic screening, and 18 movie files of the instrumental model, taken from videofluoroscopy with different velocities. The images and movie files were digitized and analyzed by an experienced examiner, who was blinded to the study. RESULTS: The Pearson correlation coefficients between the measured and instrumental reference values were over 0.99 (p<0.001) for all of the analyses. Bland-Altman plots showed narrow ranges of the 95% confidence interval of agreement between the measured and reference values as follows: 0.14 to 0.94 mm for distances in a still image, -0.14 to 1.09 mm/s for linear velocities, and -1.02 to 3.81 degree/s for angular velocities. CONCLUSION: Our findings demonstrate that the distance and velocity measurements obtained by swallowing kinematic analysis are highly valid in a wide range of movement velocity.
Biomechanics ; Deglutition ; Epiglottis ; Mass Screening ; Reference Values ; Reproducibility of Results

We found an error in our published article.

BACKGROUND: Reduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures. METHODS: Sixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups. RESULTS: Intraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV. CONCLUSIONS: MAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.
Analgesia ; Anesthesia, General ; Anesthesia, Local ; Anesthetics, Local ; Dexmedetomidine ; Heart Rate ; Humans ; Incidence ; Nasal Bone ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Vital Signs