Background: Methods of determining proper endotracheal tube (ETT) cuff pressure to prevent air leakage include the minimal occlusive volume (MOV) technique, which uses auscultation, and the spirometer technique, which directly measures inspiratory and expiratory breathing volumes. Spirometers may measure even small air leakage, therefore, the spirometer technique requires a higher cuff pressure than the MOV technique to completely seal the airway. This study aimed to evaluate the difference in cuff pressure between the two techniques used to seal the airway. Methods: Thirty-five female patients were intubated using an ETT with a cuff, and cuff inflation was performed with both techniques at a 10-min interval in random order—the MOV technique and then the spirometer technique or vice versa. The cuff pressure was measured at each period. Results: The cuff pressures were 16.7 ± 1.2 cm H2O and 18.7 ± 1.3 cm H2O for the MOV and spirometer techniques, respectively. The cuff pressure for the spirometer technique was 2 cm H2O higher than that for the MOV technique and this difference was statistically significant (95% confidence interval, 0.7–3.3; P = 0.003). Considering the upper end (3.3 cm H2O) of the 95% confidence interval and the size of one scale unit (2 cm H2O) of a manometer, the difference in cuff pressure was up to 4 cm H2O in practice. Conclusions Even though the air leakage sound disappears on auscultation, unlike the previous recommendation, the airway sealing would be completed only by increasing the cuff pressure by approximately 4 cm H2O.

Osteoarthritis (OA) is the most common form of arthritis, and its prevalence is expected to further increase as our society ages.Despite many approaches to cure OA, no drugs are currently proven to modulate the progression of OA. Nowadays, new OA treatment options are holistically developed and one of the approaches of treatment option is botanical drugs. Some botanical drugs for OA have shown both therapeutic effect comparable to refined drugs in small studies and fewer side effects. Hence, there are various health functional foods which are known to relieve symptoms of OA. However, since there are many botanical products, clinicians are not familiar to the efficacy of each botanical product, making it challenging to use them appropriately in clinical practice. Here, we summarize the botanical products available for treating OA, including prescription botanical drugs and health functional foods available in Korea. Further studies and the purification of effective molecules from botanical products will be necessary in future.

Osteoarthritis is the most common form of chronic inflammatory arthritis, and its prevalence is steadily increasing owing to its association with aging. Therefore, understanding and implementing appropriate treatments for osteoarthritis in clinical practice is becoming increasingly important. Additionally, there is active research on a new approach for treating osteoarthritis: disease-modifying osteoarthritis drugs (DMOADs).Current Concepts: Several global osteoarthritis treatment guidelines exist; this article introduces the guidelines of the American College of Rheumatology and Osteoarthritis Research Society International, which are among the most widely recognized. A common theme across various guidelines is that exercise and weight loss are the primary recommended treatments. As for pharmacotherapy, the top recommendations include topical nonsteroidal anti-inflammatory drugs (NSAIDs) and oral NSAIDs. Although multiple classes of drugs such as DMOADs are being actively researched to slow the progression of osteoarthritis, no drug has yet been confirmed to be clinically effective or approved for use.Discussion and Conclusion: A deeper understanding of osteoarthritis treatment can help prevent malpractice and improve patient outcomes. While current treatments focus primarily on symptom management, the development of effective DMOADs holds promise for fundamentally altering the disease course and improving joint function and quality of life.

Osteoarthritis (OA) is the most prevalent chronic joint disorder that leads to pain, disability, and functional impairment. The OA prevalence among those aged ≥65 years in Korea was 30.2% between 2017 and 2021. Owing to a rapidly aging population, OA is becoming a significant public health and socioeconomic concern.Current Concepts: The onset of OA is characterized by cartilage injury, which affects the surrounding tissues and progresses to joint destruction. The pathophysiology varies across joints; hand OA is associated with genetic factors, whereas knee and hip OA are associated with mechanical stress. Nonsteroidal anti-inflammatory drugs are the primary treatment; however, considering their adverse effects and limited efficacy in halting disease progression, further research is warranted for more effective therapies. Natural medicines have been investigated; however, their clinical efficacy is inadequate.Discussion and Conclusion: Currently, no disease-modifying treatments are validated for OA. Animal models fail to reflect the slow progression and complexity of human OA; therefore, drug development remains challenging. In view of increasing healthcare costs and rapid population aging, further research and broader socioeconomic strategies are essential to manage the growing burden of OA.

BACKGROUND: Tracheal complications caused by excessive mucosal pressure from an inflated endotracheal tube are major concerns during anesthesia; hence, an intracuff pressure of 20–30 cmH₂O is recommended as a clinically acceptable intracuff pressure. Diffusion of nitrous oxide (N₂O) into the endotracheal tube cuff increases the intracuff pressure, which may also be influenced by the cuff shape. Therefore, we investigated whether the intracuff pressure of a tapered cuff was different from that of a cylindrical cuff in patients undergoing general anesthesia using 60% N₂O. METHODS: Twenty-six patients who underwent general anesthesia using 60% N₂O in supine position were randomly allocated to the cylindrical cuff group (Group C) or tapered cuff group (Group T). The baseline intracuff pressure was set at 20 cmH₂O, and measured every 10 minutes for 60 minutes. RESULTS: The primary outcome was the intracuff pressure at 60 minutes after N₂O exposure, which was 40 cmH₂O in Group C (95% CI 36–44) and 40 cmH₂O (95% CI 35–45) in Group T (P = 0.895). The lower confidence limit of the intracuff pressures in both groups exceeded 30 cmH₂O at 60 minutes of N₂O exposure, which is the upper limit for clinically acceptable intracuff pressure (20–30 cmH₂O). CONCLUSIONS: There was no significant difference in the intracuff pressures between cylindrical and tapered cuffs. Continuous or frequent monitoring is recommended regardless of the duration of the 60% N₂O exposure because the intracuff pressure can exceed 30 cmH₂O within an hour.
Airway Management ; Anesthesia ; Anesthesia, General ; Clinical Study* ; Diffusion ; Humans ; Intubation, Intratracheal ; Nitrous Oxide* ; Supine Position

No abstract available.
Analysis of Variance* ; Anesthesiology*

No abstract available.
One-Lung Ventilation

BACKGROUND: Carbetocin is a long-acting synthetic analogue of oxytocin that is used to prevent postpartum hemorrhage. Cardiovascular effects of oxytocin include tachycardia and hypotension. We investigated hemodynamic changes induced by carbetocin during spinal anesthesia. METHODS: Carbetocin 100 microg was infused over 5 min in 40 women undergoing cesarean delivery. Hemodynamic parameters were measured noninvasively using the Finometer(R) device. The hemodynamic values were analyzed using multivariate analysis of variance followed by Bonferroni test for multiple comparisons. RESULTS: Statistically significant hemodynamic effects were seen with a maximal effect at about 75 seconds after infusion start compared with those of baseline: Mean arterial pressure (MAP) decreased 21.6 +/- 8.8 mmHg, systemic vascular resistance (SVR) decreased 28.6 +/- 11.1% and heart rate (HR) increased 15.3 +/- 7.9 beats/min. Following the maximal effect, MAP and SVR remained almost constant at this decreased level until the end of study period. However, HR was slowly recovered after the peak, approaching the baseline value. CONCLUSIONS: We observed that the maximal hemodynamic changes were occurred at about 75 seconds after administration of carbetocin. Therefore, careful observation is required during this early period.
Anesthesia, Spinal ; Arterial Pressure ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Multivariate Analysis ; Oxytocin ; Postpartum Hemorrhage ; Tachycardia ; Vascular Resistance

Sugammadex is a specific antagonist of aminosteroidal neuromuscular blocking agents with 1:1 binding to guest molecules. Sugammadex can also bind to other drugs having a steroid component in its chemical structure. In this in vivo experiment, we investigated the differences in the recovery of rocuronium-induced neuromuscular blockade using sugammadex pre-exposed with two different concentrations of hydrocortisone. Methods: The sciatic nerves and tibialis anterior muscles of 30 adult Sprague–Dawley rats were prepared for the experiment. The sciatic nerves were stimulated using a train-of-four (TOF) pattern with indirect supramaximal stimulation at 20 s intervals. After 15 min of stabilization, a 250 μg loading dose and 125 μg booster doses of rocuronium were serially administered until > 95% depression of the first twitch tension of TOF stimulation (T1) was confirmed. The study drugs were prepared by mixing sugamadex with the same volume of three different stock solutions (0.9% normal saline, 10 mg/ml hydrocortisone, and 100 mg/ ml hydrocortisone). The recovery of rats from neuromuscular blockade was monitored by assessing T1 and the TOF ratio (TOFR) simultaneously until T1 was recovered to > 95% and TOFR to > 0.9. Results: In the group injected with sugammadex premixed with a high concentration of hydrocortisone, statistically significant intergroup differences were observed in the recovery progression of T1 and TOFR (P < 0.050). Conclusions: When sugammadex was pre-exposed to a high dose of hydrocortisone only, recovery from neuromuscular blockade was delayed. Delayed recovery from neuromuscular blockade is not always plausible when sugammadex is pre-exposed to steroidal drugs.

BACKGROUND: Although the prevalence of e-cigarette smoking is increasing worldwide, the harmfulness of e-cigarette is not obvious. A previous study reported that e-cigarette smoking is associated with depressive symptoms in college students irrespective of tobacco smoking. However, there has been no research that has addressed this issue in the general population to date. This study was conducted to clarify the association between e-cigarette smoking and depressive symptoms in Korean adults.METHODS: The cross-sectional study collected raw data from the 7th Korea National Health and Nutrition Examination Survey (2016) and included 5,742 adults, who were ≥19 years and responded to the survey of smoking and mental health section. Multivariate logistic regression analysis was used to determine the odds ratio of depressive symptoms by e-cigarette smoking experience and included sex, age, educational level, marital status, household income level, self-rated health, activity restriction, obesity, tobacco smoking experience, alcohol drinking experience, and stress perception level as covariates. Depressive symptoms were assessed using the patient health questionnaire-9, Korean edition.RESULTS: The rate of depressive symptoms in subjects was 5.6% (n=354) in total. Individuals with depressive symptoms were more likely to have used e-cigarettes (15.6%) than those without depressive symptoms (8.6%; P=0.001). The e-cigarette experienced group showed a higher risk of depressive symptoms (odds ratio, 1.71; 95% confidence interval, 1.004–2.924) than the e-cigarette unexperienced group. The result was adjusted based on the abovementioned covariates.CONCLUSION: In Korean adults, a significant association between e-cigarette smoking experience and depressive symptoms was observed.
Adult ; Alcohol Drinking ; Cross-Sectional Studies ; Depression ; Electronic Cigarettes ; Family Characteristics ; Humans ; Korea ; Logistic Models ; Marital Status ; Mental Health ; Nutrition Surveys ; Obesity ; Odds Ratio ; Prevalence ; Smoke ; Smoking