1.Dexmedetomidine: present and future directions
Korean Journal of Anesthesiology 2019;72(4):323-330
Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist, with sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties. Dexmedetomidine induces a unique sedative response, which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Dexmedetomidine may produce less delirium than other sedatives or even prevent delirium. The analgesic effect of dexmedetomidine is not strong; however, it can be administered as a useful analgesic adjuvant. As an anesthetic adjuvant, dexmedetomidine decreases the need for opioids, inhalational anesthetics, and intravenous anesthetics. The sympatholytic effect of dexmedetomidine may provide stable hemodynamics during the perioperative period. Dexmedetomidine-induced cooperative sedation with minimal respiratory depression provides safe and acceptable conditions during neurosurgical procedures in awake patients and awake fiberoptic intubation. Despite the lack of pediatric labelling, dexmedetomidine has been widely studied for pediatric use in various applications. Most adverse events associated with dexmedetomidine occur during or shortly after a loading infusion. There are some case reports of dexmedetomidine-related cardiac arrest following severe bradycardia. Some extended applications of dexmedetomidine discussed in this review are promising, but still limited, and further research is required. The pharmacological properties and possible adverse effects of dexmedetomidine should be well understood by the anesthesiologist prior to use. Moreover, it is necessary to select patients carefully and to determine the appropriate dosage of dexmedetomidine to ensure patient safety.
Adrenergic alpha-Agonists
;
Analgesics
;
Analgesics, Opioid
;
Anesthetics
;
Anesthetics, Intravenous
;
Bradycardia
;
Conscious Sedation
;
Delirium
;
Dexmedetomidine
;
Heart Arrest
;
Hemodynamics
;
Humans
;
Hypnotics and Sedatives
;
Intubation
;
Neurosurgical Procedures
;
Patient Safety
;
Perioperative Period
;
Respiratory Insufficiency
;
Sympatholytics
;
Wakefulness
2.Dexmedetomidine: present and future directions
Korean Journal of Anesthesiology 2019;72(4):323-330
Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist, with sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties. Dexmedetomidine induces a unique sedative response, which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Dexmedetomidine may produce less delirium than other sedatives or even prevent delirium. The analgesic effect of dexmedetomidine is not strong; however, it can be administered as a useful analgesic adjuvant. As an anesthetic adjuvant, dexmedetomidine decreases the need for opioids, inhalational anesthetics, and intravenous anesthetics. The sympatholytic effect of dexmedetomidine may provide stable hemodynamics during the perioperative period. Dexmedetomidine-induced cooperative sedation with minimal respiratory depression provides safe and acceptable conditions during neurosurgical procedures in awake patients and awake fiberoptic intubation. Despite the lack of pediatric labelling, dexmedetomidine has been widely studied for pediatric use in various applications. Most adverse events associated with dexmedetomidine occur during or shortly after a loading infusion. There are some case reports of dexmedetomidine-related cardiac arrest following severe bradycardia. Some extended applications of dexmedetomidine discussed in this review are promising, but still limited, and further research is required. The pharmacological properties and possible adverse effects of dexmedetomidine should be well understood by the anesthesiologist prior to use. Moreover, it is necessary to select patients carefully and to determine the appropriate dosage of dexmedetomidine to ensure patient safety.
3.Factors Associated with Cheyne-Stokes Respiration in Acute Ischemic Stroke.
Yuna KIM ; Seongheon KIM ; Dong Ryeol RYU ; Seo Young LEE ; Kyoung Bin IM
Journal of Clinical Neurology 2018;14(4):542-548
BACKGROUND AND PURPOSE: Cheyne-Stokes respiration (CSR) is frequently observed in patients with acute stroke. There have been conflicting opinions about the associations of CSR with the location and size of the lesion. We aimed to better define the clinical relevance and pathogenesis of CSR in acute stroke. METHODS: We investigated patients who had been admitted with acute ischemic stroke and received an overnight sleep apnea test. We collected data on demographics, risk factors, etiologic subtypes, initial vital signs, clinical course of the stroke, and parameters associated with respiratory events during the sleep apnea test. We performed a multivariate logistic regression analysis to determine the factors associated with CSR. RESULTS: Among 182 patients, 35 patients showed CSR in sleep apnea testing. Large-artery atherosclerosis or cardioembolism, bilateral hemispheric involvement, atrial fibrillation, low left-ventricle ejection fraction (LVEF), and left atrium (LA) enlargement were all associated with the presence of CSR. Multivariate analysis revealed that the previous modified Rankin Scale (mRS) score, bilateral hemispheric involvement, low LVEF, and LA enlargement were significantly associated with CSR. Subgroup analysis with large-artery atherosclerosis without cardiac disease revealed that the previous mRS score is the only independent factor associated with CSR. CONCLUSIONS: CSR frequently occurs in strokes involving large arteries or due to cardioembolism, regardless of the location and severity of the stroke. Predisposing conditions such as preexisting neurologic disability, low LVEF, and LA enlargement are associated with CSR in acute stroke.
Arteries
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Atherosclerosis
;
Atrial Fibrillation
;
Cheyne-Stokes Respiration*
;
Demography
;
Heart Atria
;
Heart Diseases
;
Humans
;
Logistic Models
;
Multivariate Analysis
;
Risk Factors
;
Sleep Apnea Syndromes
;
Stroke*
;
Vital Signs
4.A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury
Eunji KIM ; Seongheon KIM ; Jung Hie LEE
Journal of Korean Neuropsychiatric Association 2019;58(3):252-258
Many patients with a traumatic brain injury (TBI) experience a range of sleep problems. Although some studies investigated the pathophysiology of sleep-wake cycle disturbances in TBI patients, it has not been clarified. This paper presents a middle aged female patient who showed sleep deprivation and sleep-wake cycle disturbances for approximately three months after TBI. The improvement in the subjective and objective sleep quality was shown by the sleep diary and actigraphy during this period. Moreover, the dim light melatonin onset (DLMO) had been delayed before returning to the normal range in 3 months. In addition, the patient showed an improvement in the neurocognitive function, including attention, memory and language function, along with a consolidation of the sleep-wake cycle. This case showed that the sleep disturbance following a TBI was probably caused by the disrupted melatonin rhythm based on the abnormality of the DLMO. In addition, the cognitive dysfunction after TBI could be associated with sleep-wake cycle disturbances because its gradual improvement occurred as the sleep disturbance diminished. Further studies on the change in circadian rhythm after a brain injury related to neurocognitive impairment are required.
Actigraphy
;
Brain Injuries
;
Circadian Rhythm
;
Female
;
Humans
;
Melatonin
;
Memory
;
Middle Aged
;
Reference Values
;
Sleep Deprivation
5.Anesthesiologist's satisfaction using between cisatracurium and rocuronium for the intubation in the anesthesia induced by remifentanil and propofol.
Hyunjung LEE ; Sinho JEONG ; Cheolhun CHOI ; Hyejin JEONG ; Seongheon LEE ; Seongwook JEONG
Korean Journal of Anesthesiology 2013;64(1):34-39
BACKGROUND: Although cisatracurium has many advantages in anesthetic practices, the best choice of a nondepolarizing neuromuscular blocking agent that can replace succinylcholine is rocuronium. However, it is reported that remifentanil with propofol might provide reliable intubating condition, even without a neuromuscular blocking agent; therefore, it might improve the intubating condition with cisatracurium. This study examined intubating conditions after administering rocuronium or cisatracurium in a rapid sequence induction with remifentanil-propofol. METHODS: Fifty two ASA physical status 1 or 2 adult patients scheduled for an elective surgery were enrolled in a randomized double-blinded trial. Anesthesia was induced in all patients with propofol 2.0 mg/kg and remifentanil 0.5 microgram/kg, administered over 60 seconds. Rocuronium 0.9 mg/kg (3 x ED95, R group, n = 23) or cisatracurium 0.15 mg/kg (3 x ED95, C group, n = 29) was administered after the induction sequence. Laryngoscopy was attempted when the anesthesiologist thought it was 90 seconds after drug administration and appropriate time for intubation. The examiner, another anesthesiologist, recorded the exact time to intubation and suppression of maximal T1 on TOF. The intubating condition was assessed by the first anesthesiologist, as excellent, good, poor or not possible. RESULTS: The best time to laryngoscopy was predicted by measuring TOF and was found to be significantly longer in the C group (197 +/- 53 s) than in the R group (102 +/- 49 s) (P value < 0.05). However, time to larygoscopy, intubating condition during the laryngoscopy, and hemodynamic changes after intubation was similar in both groups. CONCLUSIONS: Despite fundamentally slower onset time, cisatracurium can provide quite good intubating conditions, which were comparable to those achieved with equipotent doses of rocuronium, which is more expensive in anesthesia inducted with remifentanil and propofol.
Adult
;
Androstanols
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Anesthesia
;
Atracurium
;
Hemodynamics
;
Humans
;
Intubation
;
Laryngoscopy
;
Neuromuscular Blockade
;
Piperidines
;
Propofol
;
Succinylcholine
6.A Retrospective Cohort Study of Risk of Gallbladder Disease in Acute Cerebral Infarction Patients
Suk-Hee LEE ; Seongheon KIM ; Jae-Won JANG ; Seung-Hwan LEE ; Young-Ju KIM
Journal of the Korean Neurological Association 2020;38(1):16-24
Background:
Gallbladder diseases after acute cerebral infarction are relatively rare, but could have a serious impact on mortality and morbidity of patients. The purpose of this study was to investigate the risk of gallbladder disease in patients with acute cerebral infarction.
Methods:
This study analyzed a population-based matched cohort constructed using National Health Insurance Service-Senior cohort dataset in South Korea. Subjects after acute cerebral infarction during 2002-2015 were identified as the exposed group, and up to four individual matched for age, sex, and index years were as the controls. The difference of the risk of gallbladder disease between the exposed and control group was evaluated using Cox regression adjusting for hypertension, diabetes, liver diseases, and the modified Charlson Comorbidity Index (mCCI). The risk of gallbladder disease of the exposed group was evaluated using Cox regression analyses to identify the risk factors.
Results:
The occurrence of the gallbladder disease was significantly associated with the acute cerebral infarction (p<0.0001). The presence of acute cerebral infarction was associated with a higher risk of gallbladder disease (adjusted hazard ratio=1.44, 95% confidence interval=1.26-1.66). The subjects with higher CCI showed higher risk of gallbladder disease. Among acute cerebral infarction patients, the oldest group, subjects having liver diseases, or subjects with the mCCI higher than two were found significant on the risk of gallbladder disease.
Conclusions
Our study showed that the acute cerebral infarction has a significant association with gallbladder disease. These results suggested that the possibility of developing of gallbladder disease in patients with acute cerebral infarction should be considered.
7.Cheyne-Stokes Respiration and the Outcome of Acute Ischemic Stroke
Su Hyun HAN ; Yuna KIM ; Seongheon KIM ; Seung Hwan LEE ; Seo Young LEE
Journal of Sleep Medicine 2019;16(2):81-87
OBJECTIVES:
Cheyne-Stokes respiration (CSR) is frequently observed in acute stroke patients. In case of heart failure, CSR has been reported to be a poor prognostic factor. However, whether CSR has negative predictive value in stroke is not established yet. We aimed to investigate the relation between the presence of CSR and the outcome of acute stroke.
METHODS:
We investigated the patients who were admitted with acute ischemic stroke and received sleep apnea test. We collected data on demographics, risk factors, etiologic subtypes and the parameters associated with respiratory events in sleep apnea test. Primary outcome was the occurrence of early neurologic deterioration (END) within 3 weeks. Secondary outcome included the modified Rankin Scale (mRS) score at 3 months after stroke. We assessed the risk of poor outcome associated with CSR using multivariate logistic regression.
RESULTS:
Among 182 patients, 35 (19.2%) showed CSR in sleep apnea test. The presence of CSR in acute stroke was not associated with END, but associated with increased risk of 3 or higher mRS score at 3 months (odds ratio, 3.02; 95% confidence interval, 1.39 to 6.55) in univariate analysis. The association was still significant in large artery atherosclerosis group in stratified analysis. However, this association was insignificant in multivariate analysis which revealed that poor outcome at 3 months was associated with obstructive sleep apnea, as well as territory of internal carotid artery or basilar artery, initial National Institutes of Health Stroke Scale, and history of previous stroke.
CONCLUSIONS
The presence of CSR was associated with poor functional outcome after acute stroke. However, large scaled study is needed to confirm the role of CSR as an independent prognostic factor of stroke.
8.New-Onset Neuromyelitis Optica Spectrum Disorder during Pregnancy: A Case Report
So Hee LEE ; Seongheon KIM ; Se Jin LEE ; Sung Hun KIM ; Sunghun NA
Perinatology 2025;36(1):32-36
Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.
9.New-Onset Neuromyelitis Optica Spectrum Disorder during Pregnancy: A Case Report
So Hee LEE ; Seongheon KIM ; Se Jin LEE ; Sung Hun KIM ; Sunghun NA
Perinatology 2025;36(1):32-36
Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.
10.New-Onset Neuromyelitis Optica Spectrum Disorder during Pregnancy: A Case Report
So Hee LEE ; Seongheon KIM ; Se Jin LEE ; Sung Hun KIM ; Sunghun NA
Perinatology 2025;36(1):32-36
Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.