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Effects of Steroid Administration on the Blood Glucose Level during Spine Surgery in Patients with Metabolic Syndrome.

Hyun Jung KIM ; Dong Won KIM ; Bum Suk KIM ; Kyu Nam KIM ; Jae Chul SHIM ; Jung Kook SUH ; Hyeong Joong YI ; Keon Hee RYU

Anesthesia and Pain Medicine.2008;3(1):44-48.

BACKGROUND: The risk of steroid-induced hyperglycemia is debated, and methylprednisolone is still used during spinal surgery. We have compared the blood glucose level in patients with metabolic syndrome treated with or without methylprednisolone. METHODS: This study was conducted in 68 adult patients who underwent elective spine surgery. Patients were classified into the following groups: methylprednisolone group (n = 39, group M), placebo group (n = 29, group P), group M patients with metabolic syndrome (n = 17, group MM), and group P patients without metabolic syndrome (n = 21, group NMP). Before and after injection of either 125 mg methylprednisolone or a placebo, we consecutively checked the blood glucose level every 30 minutes up to 4 hours. RESULTS: The blood glucose level was significantly increased in group M patients as compared to group P patients. The blood glucose level was more significantly increased in group MM as compared to group NMP patients. The increased blood glucose levels over 4 hours were 50 mg/dl in group MM and 35 mg/dl in group NMP patients. CONCLUSIONS: We recommend that close monitoring of the blood glucose level up to several hours after injection of a steroid should be seriously considered during spine surgery, particularly in patients with metabolic syndrome.
Adult ; Blood Glucose ; Humans ; Hyperglycemia ; Methylprednisolone ; Spine

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Anesthesia for Surgical Fixation of the Fractured Neck of Femur in a Patient with Eisenmenger's Syndrome : A case report.

Eun Sung KIM ; Sang Hyun HONG ; Yoon Ki LEE ; Keon Hee RYU ; Yung Joon YOO

Anesthesia and Pain Medicine.2008;3(1):40-43.

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular, or atrial level. Noncardiac surgery for a patient with this syndrome is challenging because both the perioperative morbidity and mortality are high. We describe the anesthetic management of a 66-year-old female patient with Eisenmenger's syndrome secondary to the tetralogy of Fallot (TOF), who was operated on for the fractured neck of her left femur. Anesthesia was induced with etomidate and sufentanil and was maintained with propofol and sufentanil without any inhalational anesthetics (total intravenous anesthesia). To maintain the systemic vascular resistance, we administered norepinephrine throughout the surgery and the postoperative care. The patient was discharged 20 days after the operation without any complications.
Aged ; Anesthesia ; Anesthetics ; Eisenmenger Complex ; Etomidate ; Female ; Femur ; Humans ; Neck ; Norepinephrine ; Postoperative Care ; Propofol ; Sufentanil ; Tetralogy of Fallot ; Vascular Resistance

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Retrograde Aortic Dissection during Ascending Aortic Aneurysm Surgery : A case report.

Hyeran CHOI ; Bumjin KIM ; Sangseok LEE ; Byunghoon YOO ; Kyemin KIM ; Junheum YEON

Anesthesia and Pain Medicine.2008;3(1):36-39.

Aortic dissection during cardiopulmonary bypass for aortic aneurysm surgery is a rare complication. If unrecognized in early time, it would be a fatal consequence. Neurological sequelae remain a well-recognized complication of cardiac surgery. Monitoring of cerebral oxygenation may be a useful technique for identifying vulnerable periods for the development of neurological injury. We report the experience of the decreasing left radial blood pressure and left rSO2 which caused by retrograde aortic dissection during the ascending aortic aneurysm replacement surgery.
Aortic Aneurysm ; Blood Pressure ; Cardiopulmonary Bypass ; Oxygen ; Thoracic Surgery

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Airway Management of Patient with Ankylosing Spondylitis and Mental Retardation : A case report.

Seung Hye SEONG ; Su Jin KANG ; Hong Seuk YANG

Anesthesia and Pain Medicine.2008;3(1):33-35.

Almost all anesthesiologists are encounter a difficult airway occasionally, which is probably the most important cause of anesthesia related morbidity and mortality. The Intubating Laryngeal Mask Airway (ILMA) is a modified laryngeal mask airway with the capability for guided tracheal intubation while maintaining ventilation. We report the successful use of this device in patient with ankylosing spondylitis, mental retardation and hearing disturbance. This case suggests that ILMA is a safe and useful method for airway management in anesthetic care of uncooperative patients.
Airway Management ; Anesthesia ; Hearing ; Humans ; Intellectual Disability ; Intubation ; Laryngeal Masks ; Spondylitis, Ankylosing ; Ventilation

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Effects of Nitrous Oxide and Remifentanil on Cardiovascular Response to Endotracheal Intubation during Desflurane Anesthesia.

Jeen Wook HONG ; Kyung Yeon YOO ; Cheol Won JEONG ; Seok Jai KIM ; Sung Tae CHUNG ; Hong Beom BAE

Anesthesia and Pain Medicine.2008;3(1):27-32.

BACKGROUND: Desflurane is known to causes hypertension and tachycardia when its inspired concentration is rapidly increased. We determined whether nitrous oxide (N2O) or remifentanil alters cardiovascular responses to intubation and/or inhalation of high concentrations of desflurane during induction of anesthesia. METHODS: Sixty patients were assigned randomly into three groups (n = 20 each). Anesthesia was induced with thiopental 5 mg/kg followed by saline (control and N2O groups) or remifentanil 1microg/kg (remifentanil group). Tracheal intubation was facilitated with intravenous vecuronium 0.12 mg/kg and 12% desflurane was given soon after the intubation. In addition, 75% N2O was given beginning 3 min before the intubation in the N2O group. Systolic arterial pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined. RESULTS: The intubation resulted in an immediate increase and an additional second increase of SAP and HR at 3 to 5 min after intubation in all groups. SAP but not HR in the N2O group and both SAP and HR in the remifentanil group at first and second peak responses were lower than in the control group. Norepinephrine increased at 1 min after intubation and increased further at 5 min in the control and N2O groups but only increased at 5 min in the remifentanil group. CONCLUSIONS: A biphasic pressor and tachycardiac response in response to intubation and desflurane were noted. Although N2O did not affect tachycardiac response, it suppressed the pressor responses and augmented norepinephrine release. However, remifentanil significantly attenuated hemodynamic and catecholamine responses to endotracheal intubation and desflurane.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Inhalation ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Nitrous Oxide ; Norepinephrine ; Piperidines ; Plasma ; Tachycardia ; Thiopental ; Vecuronium Bromide

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Small Dose of Midazolam Added to Fentanyl-Ropivacaine for Patient Controlled Epidural Analgesia after Subtotal Gastrectomy.

Kyunghwa KWAK ; Sioh KIM ; Younghoon JEON ; Jeongwon SUH ; Youngsoo KIM ; Jaehyun HA ; Soohyun LEE

Anesthesia and Pain Medicine.2008;3(1):22-26.

BACKGROUND: Midazolam has been reported to have a spinally mediated antinociceptive effect. In this randomized, double-blind study, we evaluated whether a small dose of midazolam added to fentanyl-ropivacaine mixture for PCEA (patient controlled epidural analgesia) improves epidural analgesia in patients underwent elective subtotal gastrectomy. METHODS: Forty five patients, ASA physical status I and II, undergoing subtotal gastrectomy were randomly allocated to receive 0.2% ropivacaine mixed with fentanyl 4microg/ml or 0.2% ropivacaine mixed with fentanyl 4microg/ml and midazolam 0.2 mg/ml. The infusion rate was set to deliver 4 ml/hr of the study solution, with a bolus of 2 ml per demand and a 20 minutes lockout time. RESULTS: Infused volume (P < 0.05) and VAS scores (P < 0.05) was significantly lower in the patients receiving midazolam. However, there were no differences in requiring rescue analgesics, PONV (postoperative nausea and vomiting), sedation scores, urinary retention, and pruritus between groups. CONCLUSIONS: Small dose of midazolam could augment analgesia without adverse effects when added to thoracic epidural infusion of fentanyl and ropivacaine.
Amides ; Analgesia ; Analgesia, Epidural ; Analgesics ; Double-Blind Method ; Fentanyl ; Gastrectomy ; Humans ; Midazolam ; Nausea ; Postoperative Nausea and Vomiting ; Pruritus ; Urinary Retention

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Hemodynamic Effects of Nicardipine Measured by Esophageal Doppler Monitor during Gynecologic Laparoscopic Surgery.

Haeng Seon SHIM ; Jin Yong CHO ; Myoung Keun SHIN

Anesthesia and Pain Medicine.2008;3(1):17-21.

BACKGROUND: The authors performed this study to investigate the hemodynamic effect of nicardipine using an esophageal Doppler monitor (EDM) during gynecologic laparoscopic surgery. METHODS: Forty patients scheduled to undergo gynecologic laparoscopic surgery, were divided into two groups; the control group (Group C) and the nicardipine group (Group N). Pneumoperitoneum was initiated using CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured using EDM, i.e., before skin incision (T1), 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5). RESULTS: Mean arterial pressure (MAP) was significantly lower in Group N patients than in Group C patients at 5 and 10 min after the initiation of pneumoperitoneum (T2 and T3) (P < 0.05). No significant heart rate (HR) differences were observed between the two study groups. Cardiac output (CO), peak velocity (PV) and corrected flow time (FTC) were significantly higher in Group N at 10 min after the initiation of pneumoperitoneum (T3) (all P < 0.05). CONCLUSIONS: The nicardipine continuous infusion at 0.5?2.0microg/ kg/min is effective at attenuating hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery.
Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy ; Nicardipine ; Organothiophosphorus Compounds ; Pneumoperitoneum ; Skin

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Comparison of Propofol-Remifentanil and Sevoflurane-Remifentanil Anesthesia for Suspension Laryngoscopic Surgery.

Ji Young KHIL ; Yoon Ji CHOI ; Sung Uk CHOI ; Hye Won SHIN ; Hye Won LEE ; Hae Ja LIM ; Suk Min YOON ; Seong Ho CHANG

Anesthesia and Pain Medicine.2008;3(1):12-16.

BACKGROUND: Suspension laryngoscopic surgery may cause acute hemodynamic changes such as hypertension and tachycardia and requires rapid recovery. The purpose of this study was to compare the hemodynamic responses, and emergence and recovery profiles between propofol-remifentanil and sevoflurane-remfentanil anesthesia. METHODS: Forty patients (ASA I, II) undergoing suspension laryngoscopic surgery were randomly allocated to either a propofol group (Group P) or sevoflurane group (Group S). Anesthesia was induced with target concentration of 5microg/ml using propofol target controlled infusion (TCI) in group P and thiopental sodium 5 mg/kg in group S, respectively. In both groups, after succinylcholine 1 mg/kg IV bolus injection, remifentanil was infused with a target concentration 5 ng/ml using remifentanil TCI for tracheal intubation. Anesthesia was maintained with N2O 2 L/min, O2 2 L/min, remifentanil (2.5-7.0 ng/ml), succinylcholine infusion (0.15 mg/kg/ min) in both groups, with propofol (2.0microg/ml) was used in group P and sevoflurane 3.0 vol% in group S. We compared hemodynamic status, and emergence and recovery profiles during and after operation. RESULTS: MAP and HR after tracheal intubation and suspension laryngoscopy insertion showed significantly smaller changes in group P and were more stable compared with group S. The suction time of the catheter response was shorter in group P compared with group S, and sedation was less deeper in group P than group S. Other recovery profiles were comparable between groups. CONCLUSIONS: During propofol-remifentanil anesthesia, hemodynamics were not increased by intubation or suspension laryngoscopy, and the early emergence and good recovery profiles of patients were appeared favorably compared with sevofluraneremifentanil anesthesia.
Anesthesia ; Catheters ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Laryngoscopy ; Methyl Ethers ; Piperidines ; Propofol ; Succinylcholine ; Suction ; Tachycardia ; Thiopental

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Incidental Intraspinal Tumor Detection during Treatment of Myofascial Pain Syndrome : A case report.

Jin Sun YOON ; Woo Seok SIM ; Young Hee SHIN ; Tae Hyeong KIM ; Sang Min LEE ; Yong Ho LEE ; Keon Hee RYU

Anesthesia and Pain Medicine.2008;3(1):7-11.

Differential diagnosis of posterior neck and occipital pain is difficult based on symptoms and physical examination only. We report a case of patient who complained of pain in the posterior neck and occiput, with the initial diagnosis of myofascial pain syndrome, but who did not improve with conventional treatments. Magnetic resonance imaging revealed a cervical intraspinal tumor, and the patient developed subsequent motor weakness and sensory changes. Comprehensive diagnostic approaches are strongly recommended when the patient manifests symptoms unresponsive to treatment.
Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Myofascial Pain Syndromes ; Neck ; Neck Pain ; Physical Examination

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Regional Anesthesia for Cesarean Delivery.

Hyo Seok KANG

Anesthesia and Pain Medicine.2008;3(1):1-7.

During the last 2 decades, there has been an increasing impetus to avoid general anesthesia in women undergoing cesarean delivery because of the increased of failed endotracheal intubation in pregnant women compared with nongravid patients. The past decade has seen major changes in the practice of obstetric anesthesiology, as evidenced by an improved understanding by anesthesiologists of many disease entities seen in obstetric patients, as well as by the enhancements of new techniques and drugs. Recent advances in the practice of this specialty include the refinement of the combined spinal-epidural technique for both labor analgesia and cesarean delivery, the use of continuous infusions of dilute solution of local anesthetics combined with opioids, the development of multiorifice epidural catheters, the dramatic increase in the use of subarachnoid anesthesia for elective cesarean delivery, and the introduction of new amide local anesthetics. Because of the tremendous increase in the application of neuraxial techniques, the administration of general anesthesia for cesarean delivery has dramatically decreased. Also the number of deaths associated with regional anesthesia declined markedly with the withdrawal of 0.75% bupivacaine and probably due to increasing awareness of local anesthetic toxicity and increased use of test dosing. The discussion includes new methods and drugs associated with regional anesthesia for cesarean delivery and highlight their benefits and risks.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesiology ; Anesthetics, Local ; Bupivacaine ; Catheters ; Female ; Humans ; Intubation, Intratracheal ; Pregnant Women ; Risk Assessment

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