BACKGROUND: Compared with blockers mounted on the endotracheal tube, (a conjugated blocker), studies about blockers that are independent of a single-lumen tube, (a separated blocker) are rare. This study's object was to find several characteristics about these new blockers. METHODS: We compared the peak and plateau airway pressures in intubated patients (n = 30) with, (group EB) and without, (group E) blockers. We measured the depth of the blockers and the pressures of the balloon of the blockers. Balloon pressures were measured twice outside and inside of the E-tube with 7 ml of air. All of these measurements were done in the supine position with 1 L/min flow rate. The frequency of malposition, the score of the lung collapse, and bronchial mucosa change were checked thereafter. RESULTS: The peak airway pressures of group EB were significantly higher than those of group E (p < 0.05). However, the plateau pressures of both groups were not different. The depth of the blockers was 52.0 +/- 1.8 cm, and the balloon pressures of the blockers were 124 +/- 22 and 139 +/- 20 mmHg, respectively. Six patients needed additional bronchoscopy because of malposition. The lung collapse score was good in 17 patients, fair in 10 patients, and poor in 3 patients. There was not any severe bronchial mucosa damage. CONCLUSIONS: Understanding the characteristics of these new blockers, we can consider the use of them in some situations in which the use of a double-lumen tube is impossible or inconvenient.
Bronchoscopy ; Humans ; Mucous Membrane ; Pulmonary Atelectasis ; Supine Position

The breakage of an epidural catheter is a rare complication during the removal of a thoracic epidural catheter. There are many causes to breakage of an epidural catheter, such as the characteristics of the catheter itself, patient's factors (anatomy, position during insertion and removal of the catheter, and the BMI), and the difficulty of the procedure. Surgical removal is considered if there is a possibility that the retained catheter might cause neurological problems. We experienced a breakage of an epidural catheter during its removal, which led to surgical intervention. To prevent the catheter breakage during its removal, the catheter should be withdrawn without excessive tension. In addition, an understanding of the patient's anatomy is essential.
Catheters

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.
Adult ; Aged ; Amides/therapeutic use ; Analgesia, Epidural/methods ; Analgesia, Patient-Controlled/*methods ; Analgesics, Opioid/therapeutic use ; Anesthesia, Intravenous/methods ; Anesthetics, Local/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Female ; Fentanyl/therapeutic use ; Humans ; Ketorolac/therapeutic use ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/*drug therapy/prevention & control ; Prospective Studies ; Thoracoscopy

Objective: The risk of suicide is assessed by identifying the relationship between alcohol-use patterns and suicidal ideation in Korean employees. Methods: The study involved 13,858 employees who underwent workplace mental health screening at the Workplace Mental Health Institute of Kangbuk Samsung Hospital over a 6-year period between 2014 and 2019. Analysis was performed separately for Alcohol Use Disorders Identification Test-Korea (AUDIT-K) items related to the frequency/volume of alcohol consumption (items 1 to 3, AUDIT-C) and those regarding alcohol dependence/related problems (items 4 to 10, AUDIT-D/P). Subjects were then classified into three groups on the basis of the presence or absence of clinical depression and suicidal ideation. The groups’ sociodemographic factors and clinical features of depression, anxiety, and alcohol-use patterns were analyzed with a chi-square test as well as one-way analysis of variance, followed by a post hoc test using the Bonferroni correction. Results: AUDIT-K and AUDIT-D/P scores were significantly associated with the presence or absence of clinical depression as well as the presence or absence of suicidal ideation (p<0.05). However, no significant differences were found among the three groups with regard to the AUDIT-C score (p=0.054). Conclusion Identifying or treating alcohol dependence/related problems can help lower the occurrence of mental health problems, and suicidal ideation in particular, in employees and reduce social costs.

BACKGROUND: Preemptive analgesia is known to decrease the sensitization of the central nervous system and reduce subsequent amplification of nociceptive stimuli. We investigated whether preemptive thoracic epidural analgesia (TEA) demonstrated intraoperative and postoperative short and long term clinical advantages. METHODS: Thirty patients scheduled for open thoracotomy were randomly allocated to one of two groups to receive continuous TEA (0.15% bupivacaine and 8 microg/ml hydromorphone) either before surgical incision (preemptive group) or at the end of the operation (nonpreemptive group). Incidence of hypotension during surgery was recorded. Numerical rating scales (NRS) and the incidence of side effects such as nausea, pruritus, sedation, hypotension, and respiratory depression were recorded at 2, 6, 24, and 48 hours postoperatively. Pulmonary function test (PFT) was performed before, 24 and 48 hours after the operation. Persistence of pain control was investigated at 6 months postoperatively. RESULTS: The NRS score, side effects, and PFT changes were comparable between the two groups. TEA and intravenous rescue morphine consumed at 2, 6, 24, and 48 hours postoperatively were not different between the two groups. During surgery, the incidence of hypotension was significantly higher in the preemptive group (P = 0.027). At 6-month follow up, two patients in the nonpreemptive group complained of persistent pain at wound and none in the preemptive group. CONCLUSIONS: Preemptive TEA with hydromorphone and bupivacaine during surgery may cause unnecessary intraoperative hypotension without a prominent advantage in reducing acute or chronic pain or enhancing pulmonary function after thoracotomy. The advantageous concept of preemptive TEA may be dubious and may not provide perioperative clinical benefits.
Analgesia ; Analgesia, Epidural* ; Bupivacaine* ; Central Nervous System ; Chronic Pain ; Follow-Up Studies ; Humans ; Hydromorphone* ; Hypotension ; Incidence ; Lung* ; Morphine ; Nausea ; Pruritus ; Respiratory Function Tests ; Respiratory Insufficiency ; Tea ; Thoracotomy* ; Weights and Measures ; Wounds and Injuries