Currently, sedation anesthesia is increasingly used in many medical fields, from gastroscopy to medical imaging. The demand for sedation anesthesia is expected to increase gradually with increasing number of day surgeries and increased expectations from medical services. The demand for sedation anesthesia is considerably higher than the available pool of anesthesiologists; therefore, in a significant number of cases, sedation anesthesia is induced by non-anesthesiologists. However, there is no systematic provision of education or expertise for non-anesthesiologists in delivering sedation anesthesia. In cases of non-anesthesiologists inducing anesthesia, social controversy is often caused by medical accidents and substance abuse. In this review, I have briefly summarized what non-anesthesiologists should know about sedation anesthesia and have presented guidelines simplifying sedation anesthesia for non-anesthesia medical personnel.
Ambulatory Surgical Procedures ; Anesthesia ; Dexmedetomidine ; Diagnostic Imaging ; Education ; Etomidate ; Gastroscopy ; Hypnotics and Sedatives ; Ketamine ; Propofol ; Substance-Related Disorders

Currently, sedation anesthesia is increasingly used in many medical fields, from gastroscopy to medical imaging. The demand for sedation anesthesia is expected to increase gradually with increasing number of day surgeries and increased expectations from medical services. The demand for sedation anesthesia is considerably higher than the available pool of anesthesiologists; therefore, in a significant number of cases, sedation anesthesia is induced by non-anesthesiologists. However, there is no systematic provision of education or expertise for non-anesthesiologists in delivering sedation anesthesia. In cases of non-anesthesiologists inducing anesthesia, social controversy is often caused by medical accidents and substance abuse. In this review, I have briefly summarized what non-anesthesiologists should know about sedation anesthesia and have presented guidelines simplifying sedation anesthesia for non-anesthesia medical personnel.

Currently, sedation anesthesia is increasingly used in many medical fields, from gastroscopy to medical imaging. The demand for sedation anesthesia is expected to increase gradually with increasing number of day surgeries and increased expectations from medical services. The demand for sedation anesthesia is considerably higher than the available pool of anesthesiologists; therefore, in a significant number of cases, sedation anesthesia is induced by non-anesthesiologists. However, there is no systematic provision of education or expertise for non-anesthesiologists in delivering sedation anesthesia. In cases of non-anesthesiologists inducing anesthesia, social controversy is often caused by medical accidents and substance abuse. In this review, I have briefly summarized what non-anesthesiologists should know about sedation anesthesia and have presented guidelines simplifying sedation anesthesia for non-anesthesia medical personnel.

No abstract available.
Colonic Neoplasms* ; Humans ; Hydromorphone* ; Intercellular Adhesion Molecule-1*

BACKGROUND: Nuss surgery is preferred in pectus excavatum repair because this procedure produces excellent cosmetic results and prevents postoperative distressed pulmonary function. However, the procedure causes severe pain due to thoracic expansion. This study was designed to investigate the analgesic effect of small doses of ketamine on an intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and ketorolac for pain control after Nuss surgery. METHODS: Forty-four patients undergoing elective Nuss surgery were randomly assigned to receive hydromorphone 3 microg/kg/hr, ketorolac 0.05 mg/kg/hr and ondansetron 0.1 mg/kg/day (Group HO, n = 22) or hydromorphone 3 microg/kg/hr, ketorolac 0.05 mg/kg/hr, ondansetron 0.1 mg/kg/day and ketamine 0.15 mg/kg/hr (Group HK, n = 22) via an IV-PCA pump after surgery. A blind observer evaluated each patient using the Modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for the assessment of pain control. The total administered PCA volume, side effects and parents satisfaction with pain control were assessed at postoperative 1, 4, 8, 12, 24, and 48 hours. RESULTS: There were no significant differences in Modified CHEOPS between the groups during postoperative 48 hours. The total PCA volume in group HK was significantly lower than that in group HO (P < 0.05). The side effects in both groups did not significantly differ except for pruritus. The levels of satisfaction from the parents were not significantly different between the groups. CONCLUSIONS: A small dose of ketamine on IV-PCA reduced the total administered dose of IV-PCA with hydromorphone and ketorolac and reduced the incidence of pruritus after the Nuss procedure in pediatric patients.
Analgesia, Patient-Controlled ; Cosmetics ; Funnel Chest ; Humans ; Hydromorphone ; Incidence ; Ketamine ; Ketorolac ; Ondansetron ; Ontario ; Parents ; Passive Cutaneous Anaphylaxis ; Pruritus

BACKGROUND: Static parameters such as central venous pressure and pulmonary artery occlusion pressure, have limitation in evaluation of patients' volume status. Dynamic parameters such as stroke volume variation (SVV), have been used to evaluate intraoperative hemodynamic volume status, in various operations. We examined if SVV is also effective for patients undergoing operation with prone position for fluid management. METHODS: Eighteen patients that received spinal surgery under prone position November 2015 to May 2016, were enrolled. Patients were kept at an SVV value less than 14% during surgery. Changes of pre-, post-operative volume status were evaluated, using transthoracic echocardiography. RESULTS: Mean fluid administered was 1,731.97 ± 792.38 ml. Left ventricular end-diastolic volume was 72.85 ± 13.50 ml before surgery, and 70.84 ± 15.00 ml after surgery (P value = 0.594). Right ventricular end-diastolic area was 15.56 ± 1.71 cm² before surgery, and 13.52 ± 2.65 cm² after surgery (P value = 0.110). Inferior vena cava diameter was 14.99 ± 1.74 mm before surgery, and 13.57 ± 2.83 mm after surgery (P value = 0.080). CONCLUSIONS: We can confirm that fluid management based on SVV is effective, even in prone position surgery. So, SVV, that can be measured by continuous arterial pressure, can be considered a guideline for effective fluid management in spinal surgery.
Arterial Pressure ; Central Venous Pressure ; Echocardiography ; Fluid Therapy ; Hemodynamics ; Humans ; Prone Position ; Pulmonary Artery ; Stroke Volume ; Stroke ; Vena Cava, Inferior

A large reservoir of bacterial lipopolysaccharide (LPS) is available in the colon and this could promote colon cancer metastasis by enhancing tumor cell adhesion, intravasation, and extravasation. Furthermore, adhesion molecules like ICAM-1, VCAM-1, and E-selectin play important roles in the adhesion of tumor cells to endothelium. This study was designed to determine whether morphine can attenuate the expressions of adhesion molecules up-regulated by the supernatant of LPS-stimulated HCT 116 colon cancer cells (LPS-Sup). In this study, we divided to three groups by cell-growth medium of human umbilical vascular endothelial cells (HUVECs): the control group was incubated in growth factor-free endothelial medium, the Sup group was incubated in the supernatant of HCT 116 cells (Sup), and the LPS-Sup group was incubated in LPS-Sup. To observe effect of morphine to the adhesion molecules expressions in the LPS-Sup group, we co-treated morphine with LPS or added it to LPS-Sup. Adhesion molecule expressions on HUVECs in all three groups were measured during incubation period. Consquentially, ICAM-1, VCAM-1, and E-selectin expressions on HUVECs were significantly lower when morphine was co-treated with LPS than not co-treated. Thus, we suggest that morphine affects the expressions of adhesion molecules primarily by attenuating LPS stimuli on tumor cells.
Cell Adhesion Molecules/*metabolism ; Cell Line, Tumor ; Cell Survival/drug effects ; Colonic Neoplasms/*metabolism ; E-Selectin/metabolism ; Endothelial Cells/drug effects/metabolism ; Endothelium, Vascular/cytology ; Humans ; Intercellular Adhesion Molecule-1/metabolism ; Lipopolysaccharides/toxicity ; Morphine/*pharmacology ; Vascular Cell Adhesion Molecule-1/metabolism

BACKGROUND: Ischemic insult during operation could cause ischemic-reperfusion injuries in brain and memory impairments. Total intravenous anesthesia (TIVA) is preferred in brain surgery to promote the use of motor evoked potential monitoring and the use of opioids is common in TIVA. However there were few studies about ischemic protective effect of opioids to astrocytes. METHODS: We used astrocytes, which were derived from human brain. We divided groups by conditioning period; i) pre-culture, ii) post-culture, or iii) pre + post-culture. All groups were treated 100 nM hydromorphone. We measured reactive oxygen species (ROS) by flow cytometry with 2',7'-dichloroflurorescin diacetate. Then ROS in astrocytes which treated by opioid receptor antagonist were measured after treating 100 nM hydromorphone. RESULTS: ROS was reduced in hydromorphone treated group, as compared to the control group (only tert-butyl hydroperoxide [TBH] treated). There was no difference in pre-conditioned group and post-conditioned group. However, ROS was much more reduced in pre + post-conditioned group compared to pre-conditioned only or post-conditioned only group. Furthermore each selective micro-, delta- and kappa-opioid receptor antagonists partially negated the effect of hydromorphone. CONCLUSIONS: This study provides evidence that hydromorphone has both preconditioning and postconditioning effects on TBH-induced oxidative stress. Furthermore we proved each micro-, delta- and kappa-opioid receptor relates to protective mechanism of hydromorphone to astrocytes.
Analgesics, Opioid ; Anesthesia, Intravenous ; Astrocytes ; Brain ; Brain Ischemia* ; Evoked Potentials, Motor ; Flow Cytometry ; Humans ; Hydromorphone* ; Memory ; Oxidative Stress ; Reactive Oxygen Species ; Receptors, Opioid ; tert-Butylhydroperoxide

The daily insertion of endotracheal tubes, laryngeal mask airways, oral/nasal airways, gastric tubes, transesophageal echocardiogram probes, esophageal dilators and emergency airways all involve the risk of airway structure damage. In the closed claims analysis of the American Society of Anesthesiologists, 6% of all claims concerned airway injury. Among the airway injury clams, the most common cause was difficult intubation. Among many other causes, esophageal stethoscope is a relatively noninvasive monitor that provides extremely useful information. Relatively not many side effects that hardly is ratable. Some of that was from tracheal insertion, bronchial insertion resulting in hypoxia, hoarseness due to post cricoids inflammation, misguided surgical dissection of esophagus. Also oropharyngeal bleeding and subsequent anemia probably are possible and rarely pharyngeal/esophageal perforations are also possible because of this device. Careful and gentle procedure is necessary when inserting esophageal stethoscope and observations for injury and bleeding are needed after insertion.
Anemia ; Anoxia ; Bivalvia ; Bronchoscopes ; Emergencies ; Esophagus ; Foreign Bodies* ; Hemorrhage ; Hoarseness ; Inflammation ; Insurance Claim Review ; Intubation ; Laryngeal Masks ; Stethoscopes

The purpose of this study is to determine 1) whether morphine postconditiong (MPostC) can attenuate the intercellular adhesion molecules-1 (ICAM-1) expression after reoxygenation injury and 2) the subtype(s) of the opioid receptors (ORs) that are involved with MPostC. Human umbilical vein endothelial cells (HUVECs) were subjected to 6 hr anoxia followed by 12 hr reoxygenation. Three morphine concentrations (0.3, 3, 30 microM) were used to evaluate the protective effect of MPostC. We also investigated blockading the OR subtypes' effects on MPostC by using three antagonists (a micro-OR antagonist naloxone, a kappa-OR antagonist nor-binaltorphimine, and a delta-OR antagonist naltrindole) and the inhibitor of protein kinase C (PKC) chelerythrine. As results, the ICAM-1 expression was significantly reduced in the MPostC (3, 30 microM) groups compared to the control group at 1, 6, 9, and 12 hours reoxygenation time. As a consequence, neutrophil adhesion was also decreased after MPostC. These effects were abolished by coadministering chelerythrine, nor-binaltorphimine or naltrindole, but not with naloxone. In conclusion, it is assumed that MPostC could attenuate the expression of ICAM-1 on endothelial cells during reoxygenation via the kappa and delta-OR (opioid receptor)-specific pathway, and this also involves a PKC-dependent pathway.
Animals ; Benzophenanthridines/pharmacology ; Endothelial Cells/cytology/*drug effects/*metabolism ; Endothelium, Vascular/cytology ; Humans ; Intercellular Adhesion Molecule-1/genetics/*metabolism ; Morphine/*pharmacology ; Naloxone/pharmacology ; Naltrexone/analogs & derivatives/pharmacology ; Narcotic Antagonists/pharmacology ; Narcotics/*pharmacology ; Protein Isoforms/metabolism ; Protein Kinase C/antagonists & inhibitors/metabolism ; Receptors, Opioid/metabolism ; Reperfusion Injury/*metabolism ; Signal Transduction/physiology ; Umbilical Veins/cytology