Transient increases in blood pressure and heart rate(HR) at the end of anesthesia and during extubation are common. Tomori and Widdicombe observed that mechanical stimulation of four areas of the upper respiratory tract (nose, epipharynx, laryngopharynx, tracheobnchial tree) induced reflex cardiovascular responses associated with enhanced neuronal activity in the cervical sympathetic efferent fibers. In susceptible patients, even this short period of hypertension and tachycardia can result in myocardial ischemia or increased intracranial pressure. The purpose of present study was to evaluate the effect of esmolol in attenuating cardiovascular responses to extubation under general anesthesia with endotracheal intubation. A sixty healthy patients who underwent elective noncardiac operation under general anesthesia (N2O-O2-enflurane) with endotracheal intubation were randomly divided into two groups : one was placebo group that received intravenous injection of 0.1 cc/kg normal saline, the other was esmolol group that received intravenous injection of 1 mg/kg esmolol. Extubation was performed when the patients could breathe spontaneously and open their eyes on command. In practice extubation was done between 2 and 4 minutes after drug(esmolol or saline) injection. The measurement of systolic blood pressure and heart rate was obtained one minute before extubation and every minute for 5 minutes after extubation, then rate-pressure product was calculated. The results were as follows; 1) When compared to pre-extubation systolic blood pressure, systolic blood pressure for 2 minutes after extubation in both groups increased significantly but systolic blood pressure was more rapidly returned to pre-extubation level in the esmolol group than in the placebo group. When compared to pre-extubation systolic blood pressure, after extubation the number of patients in whom systolic blood pressure increased more than 20% was significantly fewer in the esmolol group than in the saline group. 2) When compared to pre-extubation heart rate, heart rate at 1 minute after extubation in the placebo group increased significantly but heart rate after extubation in the esmolol group did not change significantly. 3) When compared to pre-extubation rate-pressure product, rate-pressure product for 2 minutes after extubation in both group increased significantly. At 4 minutes after extubation, rate-pressure product in the saline group increased significantly when compared to rate-pressure product in the esmolol group. These results suggest that intravenous injection of 1 mg/kg esmolol before extubation blocks heart rate elevation following extubation under general anesthesia and is effective for rapid return to the pre-extubation level of systolic blood pressure.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Heart ; Heart Rate ; Humans ; Hypertension ; Hypopharynx ; Injections, Intravenous ; Intracranial Pressure ; Intubation, Intratracheal ; Myocardial Ischemia ; Neurons ; Reflex ; Respiratory System ; Tachycardia

Purpose: To evaluate the effect of the intense pulsed light (IPL) and meibomian gland (MG) expression (MGX) combination therapy according to the total numbers of sessions in the meibomian gland dysfunction (MGD). Methods: Ninety patients with MGD were included. Patients had maximal five sessions of IPL (Aqua Cel, Jeisys Medical) and MGX combination therapy at 2-week intervals. The ocular surface disease index (OSDI) questionnaire score, MG profile grades, tear matrix metalloproteinase-9 (MMP-9), tear break-up time (BUT), tear osmolarity, tear secretion, and corneal erosions were evaluated. Results: The number of patients who had a total of one to five sessions (1S to 5S) was 10, 25, 17, 20, and 18, respectively. The time-serial decrease of OSDI scores was significant in patients who had three or more sessions (3S, p = 0.002; 4S, p < 0.001; 5S, p < 0.001). The MG expressibility grade decreased with two or more sessions (2S–5S, p < 0.001), but the meibum quality significantly improved with all sessions (1S, p = 0.012; 2S, p = 0.024; 3S, p = 0.015; 4S, p < 0.001; 5S, p < 0.001). Although tear BUT increased even in patients with one session (1S, p = 0.040; 3S, p = 0.005; 4S, p = 0.006; 5S, p = 0.021), tear MMP-9, osmolarity, Schirmer I, and corneal erosions were not improved in every number of sessions. The female sex was the sole contributor to the final symptomatic improvement (p = 0.042), and the MGD stages were not related to the final OSDI decrease. Conclusions The OSDI score, MGD grades, and BUT were improved after the IPL and MGX combination therapy in MGD patients. Unlike MGD grades and tear film instability might be improved just after a few sessions, the overall subjective relief was accomplished in three or more sessions.

OBJECTIVE: The aim of this nationwide study was to analyze the current state of patients with newly diagnosed metastatic spine tumors according to surgical methods.METHODS: Data was extracted from the Korean Health Insurance Review and Assessment Service database. Surgery was categorized into three methods : fusion, decompression, and vertebroplasty. Data included patient age, sex, health insurance type, and co-morbidities. Survival rates of metastatic spine tumor patients according to each surgical method were evaluated.RESULTS: Among 1677 patients who had an operation, 823 patients were treated by fusion, 141 patients underwent decompression, and 713 patients were treated by vertebroplasty. The three most prevalent primary tumor sites were the lung, breast, and liver & biliary. On the other hand, the three most prevalent primary tumor sites of patients who underwent surgery were the lung, liver & biliary, and the prostate. The median survival periods for each surgical method in the metastatic spine tumor patients were 228 days for those who underwent surgery, 249 days for decompression, and 154 days for vertebroplasty. Age, sex, and comorbidities significantly affected survival rate.CONCLUSION: For every primary tumor site, decompression was the least common surgical method during the study period. Although the three surgical methods did not significantly affect the survival period, patients with a poor prognosis tended to undergo vertebroplasty.
Breast ; Comorbidity ; Decompression ; Hand ; Humans ; Insurance, Health ; Liver ; Lung ; Methods ; Neoplasm Metastasis ; Prognosis ; Prostate ; Spine ; Survival Rate ; Vertebroplasty