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: 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

BACKGROUND: 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone. METHODS: Among the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups. RESULTS: The frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups. CONCLUSIONS: There were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.
Anesthesia, General ; Dexamethasone ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Isoquinolines ; Postoperative Nausea and Vomiting ; Quinuclidines ; Risk Factors ; Serotonin ; Serotonin 5-HT3 Receptor Antagonists ; Thyroidectomy ; Tympanoplasty

BACKGROUND: The pain caused by injection of propofol is known to be related to the concentration of aqueous free propofol. Microemulsion propofol can cause a serious pain because it has 7 times higher concentration of aqueous free propofol. We used ondansetron, lidocaine, ondansetron lidocaine as pretreatment to compare the effect for injection pain of microemulsion propofol. METHODS: 75 patients, ASA physical status I or II were enrolled. We randomly allocated into Group L (n = 25) received 2% lidocaine 40 mg, group O (n = 25) received ondansetron 4 mg and group M (n = 25) received ondansetron 4 mg plus 2% lidocaine 40 mg as pretreatment. After instituting standard monitoring, the venous drainage was occluded using a pneumatic tourniquet at 25 cm proximal to venous line. The patients were pretreated over a period of 15 seconds with one of the pretreatment drug. After releasing the tourniquet, microemulsion propofol was injected. We asked the patient about degree of injection pain until loss of consciousness, by using 0-100 point pain intensity numerical rating scale (PI-NRS). In the recovery room, we asked the patient whether they recall injection pain. RESULTS: There were significant differences in the group L and the group M compared with group O on PI-NRS (P < 0.05). The incidence of injection pain was significantly lower in group L and group M than group O. CONCLUSIONS: Pretreatment of lidocaine and lidocaine + ondansetron is more effective than ondansetron alone for reducing pain on injection of microemulsion propofol.
Drainage ; Humans ; Incidence ; Lidocaine ; Ondansetron ; Propofol ; Recovery Room ; Tourniquets ; Unconsciousness

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.
Efficiency ; Korea ; Occupational Health ; Surveys and Questionnaires ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.
Efficiency ; Korea ; Occupational Health ; Surveys and Questionnaires ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders

BACKGROUND: The development of total intravenous anesthesia in coronary artery bypass graft (CABG) surgery has led to increased interest in the use of combination of propofol and remifentanil. Early extubation in post-cardiac surgery reduces the length of stay in intensive care unit and hospital and costs. The purpose of this study is to evaluate which anesthetic factors affect awakening time after anesthesia. METHODS: We enrolled twenty patients of ASA physical status II or III, scheduled for CABG in this study. All patients received a standardized propofol/remifentanil anesthesia as an effect site target controlled infusion. We recorded times to awakening and tracheal extubation, duration of cardiopulmonary bypass (CPB) period, total time of anesthesia and operation. Also, we recorded dose of propofol, remifentanil, fentanyl and minimum body temperature during CPB. To predict the factors that affect awakening time as a dependent variable, we considered all measured parameters as independent variables, and analyzed multiple linear regressions. RESULTS: The mean time responded to verbal command was 216.5 +/- 124.8 minutes after end of surgery. Among several parameters, minimum body temperature during CPB (P = 0.001) and total time of anesthesia (P = 0.003) were considered as significant factors that influence awakening time after CABG. CONCLUSIONS: Minimum body temperature during CPB and the duration of anesthesia influence awakening time after CABG, significantly.
Airway Extubation ; Anesthesia ; Anesthesia, Intravenous ; Body Temperature ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Fentanyl ; Humans ; Intensive Care Units ; Length of Stay ; Linear Models ; Piperidines ; Propofol ; Transplants

BACKGROUND: There are many studies using propofol-remifentanil target controlled infusion (TCI) for the prevention of adverse hemodynamic changes during tracheal intubation. Most of these studies suggested optimal remifentanil target concentration without considering age. The purpose of this study is to analyze the correlation between concentration of remifentanil and age to blunting adverse hemodynamic responses during tracheal intubation. METHODS: We enrolled ASA physical state I or II 55 patients, aged 12-75 years undergoing elective surgery. Anesthesia was induced using a propofol TCI (Marsh model). A 4micro/ml effect-site concentration of propofol was chosen. Rocuronium 0.6 mg/kg was administered after the patients lost consciousness. Remifentanil TCI (Minto model) was started 1 minute after the propofol injection. Initially, a 3 ng/ml effect-site concentration was chosen. The next concentration was chosen using Dixon's up-and-down method. The non-invasive blood pressure and heart rate were recorded before induction (baseline), after the remifentanil infusion, immediately after intubation as well as 1 and 3 minutes after intubation. RESULTS: Probit analysis revealed a remifentanil effect site EC50 and EC95 in all patients to be 1.768 ng/ml (S.E. +/-0.136) and 2.912 ng/ml (S.E. +/-0.307). Final probit equation was as following consisted with age and remifentanil effect site concentration. Probit = -2.588 + 1.886 remifentanil effect site concentration -0.022 x Age. CONCLUSIONS: The probability of success rate of blunting adverse hemodynamic response is related to the concentration of remifentanil directly and age inversely.
Aged ; Androstanols ; Anesthesia ; Blood Pressure ; Consciousness ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal ; Piperidines ; Propofol

BACKGROUND: In thoracic anesthesia with one lung ventilation (OLV), end-tidal CO2 (PeTCO2) monitoring may not be accurate to estimate PaCO2 mainly due to ventilation/perfusion mismatching.This study aimed to asses the clinical usefulness and accuracy of a transcutaneous CO2 (PtCCO2) monitoring in thoracic anesthesia, compared with PeTCO2. METHODS: 18 patients of ASA physical status 1 or 2, required a long period of OLV were researched.The lungs were mechanically ventilated in the lateral decubitus position.We measured PaCO2, PeTCO2, PtCCO2 during two lung ventilation (TLV) and 15 min, 30 min, 60 min after OLV.For comparing the differences of PtCCO2/PaCO2 and PtCCO2/PaCO2, we figured out bias (mean difference between values) and precision (standard deviation of bias) by using Bland-Altman plot.We compared the differences of each value, PeTCO2/PaCO2, PtCCO2/PaCO2, using the student's t-test. RESULTS: The bias +/- precision of PeTCO2/PaCO2 and PtCCO2/PaCO2 was each 7.82 mmHg +/- 3.98 mmHg, 1.95 mmHg +/- 2.66 mmHg during TLV and that of mean value of PeTCO2/PaCO2 and PtCCO2/PaCO2 was each 6.93 mmHg +/- 2.6 mmHg, 2.35 mmHg +/- 1.66 mmHg during OLV.PtCCO2/PaCO2 differences were significantly less than PeTCO2/PaCO2 differences (P < 0.05). CONCLUSIONS: During one lung ventilation, PtCCO2 monitoring is more useful and accurate than PeTCO2 monitoring for assessing PaCO2 levels.
Anesthesia ; Bias (Epidemiology) ; Blood Gas Monitoring, Transcutaneous ; Capnography ; Equidae ; Humans ; Lung ; One-Lung Ventilation ; Thoracic Surgery ; Ventilation

BACKGROUND: Tracheal intubation induces clinically adverse hemodynamic changes. Various pharmacological strategies for controlling these reponses have been suggested with opioids being widely used. The purpose of this study was to determine the effect site concentration of remifentanil in blunting the cardiovascular responses to tracheal intubation according to gender. METHODS: Eighty ASA physical status I or II patients, aged 20-40 years undergoing elective surgery, were classified into a male group (n = 40) and a female group (n = 40). Anesthesia was induced using a propofol target controlled infusion (TCI: Marsh model). A propofol target effect-site concentration of 4microgram/ml was chosen. Rocuronium 0.6 mg/kg was administered after the patients lost consciousness. Remifentanil TCI (Minto model) was started 1 min after the propofol injection. Initially, an effect-site concentration of 3 ng/ml was chosen. The next concentration was chosen using the up-and-down method reported by Dixon. The non-invasive blood pressure and heart rate were recorded before induction (baseline), after the remifentanil injection, immediately after intubation as well as 1 and, 3 minutes after intubation. RESULTS: Probit analysis revealed a remifentanil effect-site EC50 and EC95 in the male group to be 1.94 ng/ml (95% CI, 1.60-2.27 ng/ml ), 3.07 ng/ml (95% CI, 2.65-4.06 ng/ml), respectively. The EC50 and EC95 in the female group were 1.69 ng/ml (95% CI, 1.35-2.01 ng/ml), 2.81 ng/ml (95% CI, 2.39-3.81 ng/ml), respectively. There were no significant differences between the two groups. CONCLUSIONS: The effect-site concentration of remifentanil blunting the cardiovascular responses to tracheal intubation during propofol TCI anesthesia was between 2 and 3 ng/ml. There were no gender differences.
Analgesics, Opioid ; Anesthesia ; Blood Pressure ; Consciousness ; Female ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Male ; Propofol* ; Wetlands