BACKGROUND: It used to induce hypercarbia that carbon dioxide insufflated into the peritoneum in laparoscopic surgery. It might stimulate sympathetic nervous system, and decrease splanchnic circulation, hepatic function, and metabolism of anesthetics. The purpose of the present study was to examine the influence of hypercarbia on concentrations of propofol at the time of eye opening and recovery of orientation after propofol target controlled infusion (TCI) during a laparoscopic cholecystectomy. METHODS: Fifty patients were divided randomly into a laparoscopic group (group 1, n = 25) and an exploratory group (group 2, n = 25). A propofol infusion was started at a propofol target concentration of 6microgram/ml, and anesthesia was maintained at 4microgram/ml by using a Diprifusor (TM) turing the operation, intraabdominal pressure was maintained automatically at 12 14 mmHg by a CO2 insufflator and controlled ventilation settings were adjusted about 50 mmHg of PaCO2 after peritoneal insufflation. This ventilatory setting was not changed throughout the operation. We evaluated the estimated plasma concentrations of propofol at the time of eye opening and recovery of orientation in each group using user interface of a Diprifusor (TM). RESULTS: In the laparoscopic group, PaCO2, and PetCO2 increased significantly at 5, 15, 30 minutes after carbon dioxide insufflation, but there was no significant difference in concentrations of propofol at eye opening and orientation after propofol TCI between the two groups. CONCLUSIONS: Hypercarbia induced by insufflation of carbon dioxide into peritoneum didn't give rise to an influence on awakening concentrations after propofol TCI during a laparoscopic cholecystectomy.
Anesthesia ; Anesthetics* ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Humans ; Insufflation ; Laparoscopy ; Metabolism ; Peritoneum ; Plasma ; Propofol* ; Splanchnic Circulation ; Sympathetic Nervous System ; Ventilation

BACKGROUND: We evaluated the potentiating effect of anesthetics to vecuronium, and recovery profiles, and cost according to the consumption amounts, and usefulness of newly developed anesthetic agents for ambulatory anesthesia. METHODS: Seventy-five patients undergoing a major gynecological surgery were randomly divided into three groups. Group 1 received isoflurane, group 2 received sevoflurane, and group 3 received desflurane. Clinical duration, recovery index, recovery time in each group, and consumption of volatile anesthetics by weighing the vaporizes were measured. RESULTS: Emergence from anesthesia was more rapid in the group 2 and 3, and there was no significant difference in potentiating effect of anesthetics to a neuromuscular blocker among the three groups. Costs according to the comsumption amount were significantly higher in the group 2 and 3. CONCLUSIONS: Sevoflurane and desflurane clinically represent a more efficient alternative to isoflurane in ambulatory anesthesia because of their rapid emergence without side effects.
Anesthesia* ; Anesthetics ; Female ; Gynecologic Surgical Procedures ; Humans ; Isoflurane* ; Muscle Relaxation* ; Neuromuscular Blockade ; Vecuronium Bromide

BACKGROUND: Midazolam is often used as an anxiolytic premedication before surgery. Although the sedative, anxiolytic, and amnestic properties of midazolam may be desirable before the induction of general anesthesia, respiratory function is impaired frequently by larger doses of midazolam. Therefore, we evaluated the adequate doses of midazolam premedication on anxiolytic and sedation without its serious side effects. METHODS: Eighty ASA I or II adult patients scheduled for elective minor surgery were randomly allocated to four groups according to premedication doses of midazolam. They were group 1: midazolam 0.05 mg/kg IM for lean body mass (LBM); group 2: midazolam 0.075 mg/kg IM for LBM; group 3: midazolam 0.1 mg/kg IM for LBM.; group 4: midazolam 0.125 mg/kg IM for LBM. Blood pressure, heart rate, bispectral index (BIS), oxygen saturation (SpO2), anxiety visual analogue scale (VAS), and observer's assessment of alertness and sedation (OAA/S) scores were measured before and at 30 minutes after midazolam premedication. The frequency of apnea, defined as a cessation of spontaneous respiration for more than 10 seconds, was recorded. Induction time and dose requirements in propofol-induced general anesthesia were recorded at the loss of opening their eyes on verbal command and eyelid reflex after starting the propofol infusion. Following intubation, blood pressure and heart rate were measured. RESULTS: The bispectral index and anxiety VAS was significantly decreaced in group 3 and group 4. However, oxygen saturation were significantly lower in group 4 compared with group 3. CONCLUSIONS: We concluded that group 3 (midazolam 0.1 mg/kg IM for LBM) is the proper premedication dosage for anxiolytic and sedation in Koreans without respiratory side effects.
Adult ; Anesthesia, General ; Anxiety ; Apnea ; Blood Pressure ; Eyelids ; Heart Rate ; Humans ; Intubation ; Midazolam* ; Oxygen ; Premedication* ; Propofol ; Reflex ; Respiration ; Surgical Procedures, Minor

OBJECTIVES: In the treatment of schizophrenia, treatment compliance is an important prognostic factor. As insight has a significant impact on treatment compliance, an appropriate assessment of insight is essential in the treatment of schizophrenia. This study examined the reliability and validity of the Korean version of Birchwood Insight Scale (BIS). METHODS: Fifty seven adult patients diagnosed with schizophrenia according to DSM-5 were recruited from a university hospital. They were evaluated using the Positive and Negative Syndrome Scale (PANSS), The Scale to Assessment Unawareness of Mental Disorder (SUMD) and BIS. Explorative factor analysis was performed to examine the construct validity of the Korean version of BIS. Concurrent validity was evaluated by a comparison with the PANSS G12 item and SUMD. The test-retest correlation was evaluated to examine the test-retest reliability. Multiple regression analysis was performed to examine the variables affecting insight. RESULTS: Explorative factor analysis showed that the Korean version of BIS was composed of 2 factors, which are ‘Awareness of symptoms’ and ‘Awareness of illness and need for treatment.’ The Korean version of BIS was reliable in terms of the internal consistency. Concurrent validity with the PANSS G 12 item and SUMD was statistically significant. The test-retest reliability was also statistically significant. Multiple regression analysis showed that the PANSS negative factor affects the BIS score, indicating that negative symptoms of schizophrenia may impair insight of the illness. CONCLUSION: This study suggests that the Korean version of BIS is a valid and reliable tool for assessing the insight of patients with schizophrenia.
Adult ; Compliance ; Humans ; Mental Disorders ; Psychopathology ; Reproducibility of Results ; Schizophrenia

OBJECTIVE: The aim of this study was to analyze the status of split tablet prescription in South Korea. METHODS: We conducted this analysis using 2016 National Patient Sample data from the Health Insurance Review and Assessment Service. We computed split tablet prescription rates by sex and age and determined which medicine and medical specialties had the highest split tablet prescribing rates. RESULTS: The proportion of prescriptions that included split tablets was 15.6% (n=6,687,35). The proportion of prescriptions that included split tablets was higher for females (56.7%) than for males (43.3%), while that of prescriptions including split tablets versus total prescriptions for each sex was higher for males (16.4%) than for females (14.9%) (p<0.001). In the age group under 19 years, the proportion of prescriptions including split tablets (53.7%) was more than half of the total. The highest tablet splitting rate was found to be 89.9% for formoterol fumarate (40 µg), and pseudoephedrine hydrochloride (60 mg) had the highest number of prescriptions. Pediatrics (65.6%) was the medical field with the highest rate of split tablet prescription. CONCLUSION Split tablets were most prescribed to pediatric patients. To minimize the use of split tablets, it is necessary to develop lower dose tablets and establish a policy that promotes prescription of these lower-dose tablets.

Background: Myringotomy with tympanostomy tube insertion (MTI) is a superficial surgical procedure used to prevent hearing loss in children with serous otitis media. Intravenous anesthesia, often ketamine, is preferred for this procedure because of its ability to induce sedation without compromising airway reflexes. However, ketamine alone may be insufficient and potentially lead to spontaneous movement during surgery. This study evaluated the effectiveness of midazolam and fentanyl as adjuvants to ketamine in reducing spontaneous movement during MTI and enhancing the quality of recovery. Methods: This study involved two groups of 30 patients each: one group received intravenous ketamine (1.5 mg/kg) with an equal volume of normal saline (K group), while the other received a combination of midazolam, fentanyl, and ketamine (0.05 mg/kg, 1 μg/kg, and 1.5 mg/kg, respectively; MFK group). We assessed side effects, intraoperative patient movement, surgeon satisfaction, and emergence agitation scores. Results: The MFK group exhibited significantly lower scores for patient movement (p<0.01) and emergence agitation (p<0.01) and markedly higher surgeon satisfaction scores (p<0.01) than the K group. Conclusion Administering a midazolam-fentanyl-ketamine combination effectively reduced spontaneous movement during surgery and emergence agitation during recovery without prolonging discharge times in children undergoing MTI.

BACKGROUND: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. METHODS: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. RESULTS: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). CONCLUSIONS: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.
Analgesia ; Anesthesia ; Anesthesia, Local ; Biopsy ; Breast ; Dizziness ; Humans ; Incidence ; Outpatients ; Piperidines ; Propofol ; Vital Signs

Intracapsular and paraarticular chondroma is a rare benign lesion of the large joints (mostly the knee). We report a case of intracapsular and paraarticular chondroma in the infrapatellar Hoffa's fat pad that presented as a painful palpable mass in 15-yearold woman. A physical examination revealed a firm, movable and tender mass in the infrapatellar area. Magnetic resonance images showed an ovoid, well-defined, soft tissue mass with focal calcification in the infrapatellar fat pad. The final pathology revealed an intracapsular and paraarticular chondroma.
Adipose Tissue ; Chondroma ; Female ; Humans ; Joints ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Physical Examination

Numerous medications have the potential to induce acute pancreatitis. However, isoniazid-induced acute pancreatitis is extremely rare. Drug-induced acute pancreatitis can be diagnosed by improvement after stopping the drug and recurrence of pancreatitis when rechallenged. We present a case of severe acute pancreatitis accompanied by multiple large pseudocysts after isoniazid treatment for pulmonary tuberculosis. We confirmed that isoniazid induced pancreatitis by rechallenging after treatment cessation. Most previous reports of isoniazid-induced pancreatitis have been clinically mild forms, and the patient fully recovered with supportive management. However, this case presents severe and permanent pancreatic damage that developed with 5 weeks of isoniazid treatment. When a patient presents with manifestations of pancreatitis during treatment of tuberculosis that includes isoniazid, the physician should consider isoniazid-induced pancreatitis.
Humans ; Isoniazid ; Pancreatitis ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Withholding Treatment

Purpose: Heart failure (HF) poses significant morbidity and mortality. Recently, the ventriculo-vascular coupling index (VVI) was introduced as an independent prognostic factor reflective of the overall cardiovascular performance index in HF. We aimed to determine the effectiveness of force-titration of valsartan on VVI values in HF patients. Materials and Methods: In this multicenter and prospective observational trial, the effect of valsartan was stratified according to dosages [non-ceiling dose (NCD) vs. ceiling dose (CD)] in HF patients with left ventricular ejection fraction (LVEF) <55%. Biochemical studies, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography with VVI, the treadmill test, and the activity scale index were assessed at baseline and after 24 weeks of treatment. Results: One-hundred thirty-eight patients were force-titrated to either a CD group (n=81) or a NCD group (n=57). The mean age of the study participants was 59 years and 66% were male. After 6 months of follow up, left ventricular mass index (LVMI) values had significantly improved in the CD group but not in the NCD group. Intriguingly, in HF patients with a reduced ejection fraction (HFrEF) (n=52, LVEF <40%), a significant improvement in VVI was only observed in the CD group (from 2.4±0.6 to 1.8±0.5, p<0.001). Conclusion CDs of valsartan for 6 months showed better improvement in VVI, as well as LVMI, in patients with HFrEF, compared with NCDs.