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Effect of ramosetron on shivering during spinal anesthesia.

Min Soo KIM ; Dong Won KIM ; Seung Hoon WOO ; Jun Heum YON ; Sangseok LEE

Korean Journal of Anesthesiology.2010;58(3):256-259. doi:10.4097/kjae.2010.58.3.256

BACKGROUND: Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. The aim of this study is to evaluate the effect of ramosetron, a serotonin-3 receptor antagonist, on the prevention of shivering during spinal anesthesia. METHODS: We enrolled 52 patients who were ASA I or II and who had undergone knee arthroscopy under spinal anesthesia. Warmed (37degrees) lactated Ringer's solution was infused over 15 minutes before spinal anesthesia. Patients were randomly allocated to a control group (group S, N = 26) or study group (group R, N = 26). Spinal anesthesia was performed with a 25-G Quincke-type spinal needle between the lumbar 3-4 interspace with 2.2 ml 0.5% hyperbaric bupivacaine. For patients allocated in groups S and R, 2 ml 0.9% saline and 0.3 mg ramosetron, respectively, was intravenously injected immediately before intrathecal injection at identical times. Shivering and spinal block levels were assessed immediately after the completion of subarachnoid injection, as well as 5, 10, 15, 20, 25, 30, 60, and 120 minutes after spinal anesthesia. Systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation were also recorded. Core temperatures were measured by tympanic thermometer and recorded before and during spinal anesthesia at 30-minute intervals. RESULTS: Shivering was observed in 2 patients in group R and 9 patients in group S (P = 0.038, odds ratio = 6.14, 95% C.I. = 1.08-65.5). The difference in core temperature between the groups was not significant. CONCLUSIONS: Compared to control, ramosetron is an effective way to prevent shivering during spinal anesthesia.
Anesthesia, Spinal ; Arthroscopy ; Benzimidazoles ; Body Temperature Regulation ; Bupivacaine ; Heart Rate ; Humans ; Injections, Spinal ; Isotonic Solutions ; Knee ; Needles ; Odds Ratio ; Oxygen ; Shivering ; Thermometers

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A comparison of Bonfils intubation fiberscopy and fiberoptic bronchoscopy in difficult airways assisted with direct laryngoscopy.

Soo Hwan KIM ; Su Jin WOO ; Jong Hoon KIM

Korean Journal of Anesthesiology.2010;58(3):249-255. doi:10.4097/kjae.2010.58.3.249

BACKGROUND: To evaluate the usefulness of Bonfils intubation fiberscope assisted by direct laryngoscopy (BIF-DL) and flexible fiberoptic bronchoscope assisted by direct laryngoscopy (FOB-DL) using video recording in cases of unanticipated difficult intubation with respect to the time required to visualize the vocal cords and place the endotracheal tube. We compared two fiberscopes in patients with authentic difficult airways. METHODS: In this randomized, controlled clinical trial, 40 patients (grade 3 according to grades of difficulty in laryngoscopy), scheduled for surgery under general anesthesia were randomly allocated to BIF-DL group or FOB-DL group. Number of attempts, time required for visualization of the vocal cord (T1) and placement of the endotracheal tube (T2) from insertion of instrument during the last successful attempt, and duration of scope manipulation during all attempts (T(total)) were recorded. If intubation failed with one method, the other method was tried; these cases were then excluded. The incidence of sore throat and hoarseness was assessed. RESULTS: T1, T2, and T(total) were significantly shorter in BIF-DL group (T1: 21.9 +/- 8.2 sec vs. 80.4 +/- 29.9 sec, P < 0.001, Ttotal: 77.9 +/- 41.2 sec vs. 145.5 +/- 83.9 sec, P = 0.003). In two cases, it was impossible to intubate with BIF-DL, but the procedure was subsequently successful using fibreoptic bronchoscope. CONCLUSIONS: Intubation of difficult airways can be performed more rapidly with BIF-DL, but sometimes it may not be possible to intubate with the scope.
Anesthesia, General ; Bronchoscopes ; Bronchoscopy ; Hoarseness ; Humans ; Hypogonadism ; Incidence ; Intubation ; Laryngoscopy ; Mitochondrial Diseases ; Ophthalmoplegia ; Pharyngitis ; Video Recording ; Vocal Cords

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The influence of age and gender on remifentanil EC(50) for preventing rocuronium induced withdrawal movements.

So Jin PARK ; Hye Jin PARK ; Ju Youn CHOI ; Hyo Seok KANG ; Hong Seok CHOI

Korean Journal of Anesthesiology.2010;58(3):244-248. doi:10.4097/kjae.2010.58.3.244

BACKGROUND: Rocuronium-induced withdrawal movements can be harmful to patients during the induction period. Remifentanil has been reported to reduce these movements effectively. In this study, we determined the EC(50) of remifentanil for the prevention of rocuronium induced withdrawal movements in male, female, old and child group. METHODS: We included patients scheduled for general anesthesia and assigned them into 4 groups depending on their age and gender: male group (20-60 yr), female group (20-60 yr), old group (>65 yr) and child group (6-12 yr). Remifentanil was administered by target controlled infusion. Propofol 2 mg/kg was then administered after equilibration between the effect and plasma concentration of remifentanil was reached. After loss of consciousness, rocuronium 0.6 mg/kg was administered. Patient's response to the rocuronium was graded using a 4 point scale in a blinded manner. The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was determined using Dixon's up-and -down method. RESULTS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was 1.8 +/- 0.5 ng/ml [95% confidence interval 1.3-2.2] in the male group, 2.3 +/- 1.0 ng/ml [1.3-3.2] in the female group, 0.5 +/- 0.4 ng/ml [0.2-0.8] in the old group and 2.8 +/- 0.8 ng/ml [2.1-3.5] in the child group. CONCLUSIONS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was lowest in the elderly and higher in children than male adult patients. No difference in the EC(50) of remifentanil was seen between male and female adult patients.
Adult ; Aged ; Androstanols ; Anesthesia, General ; Child ; Female ; Humans ; Male ; Piperidines ; Plasma ; Propofol ; Unconsciousness

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Clinical factors affecting the pain on injection of propofol.

Hye Joo KANG ; Mi Young KWON ; Byoung Moon CHOI ; Min Seok KOO ; Young Jae JANG ; Myoung Ae LEE

Korean Journal of Anesthesiology.2010;58(3):239-243. doi:10.4097/kjae.2010.58.3.239

BACKGROUND: Pain on propofol injection is a well-known adverse effect. We evaluated the clinical factors that affect the pain on injection of propofol to develop a strategy to prevent or reduce pain. METHODS: We conducted a prospective, observational study of 207 adult patients (ASA I-II), and the patients were classified according to gender, age, the body mass index (BMI), the IV site and the side of the IV site. During the 10 seconds after propofol injection, pain intensity was measured on an 11-point numerical rating scale (0 = no pain and 10 = worst possible pain). Pain in excess of 3 on the numerical scale was regarded as moderate to severe pain. RESULTS: The subgroups of gender (female: 55.6% vs. male: 25.0%; P < 0.01) and the IV site (dorsum of hand: 61.2% vs. wrist: 40.0% vs. antecubital fossa: 22.5%; P < 0.01) had significantly different frequencies for the incidence of pain on injection on the univariate and multivariate analyses. For the subgroup of females, the incidence of pain was statistically different according to the age group (20-40 yr: 71.0% vs. 41-60: 54.8% vs. 61-80: 38.5%; P = 0.014). CONCLUSIONS: Our results showed that the younger age patients, the patients with a peripheral IV site and female patients are more sensitive to pain on the injection of propofol.
Adult ; Body Mass Index ; Clinical Medicine ; Female ; Humans ; Incidence ; Multivariate Analysis ; Propofol ; Prospective Studies ; Sex Characteristics

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Titration of the plasma effect site equilibrium rate constant of propofol; a link method of 'Concentration-Probability-Time'.

Jong Yeop KIM ; Sung Yong PARK ; Sun Kyung PARK ; Jin Soo KIM ; Sang Kee MIN

Korean Journal of Anesthesiology.2010;58(3):231-238. doi:10.4097/kjae.2010.58.3.231

BACKGROUND: The plasma effect-site equilibrium rate constant (k(e0)) of propofol has been reported in various pharmacodynamic studies; however, it is not desirable to apply k(e0) for the link with pharmacokinetic models that were separately investigated. Thus, we titrated k(e0) for the pharmacokinetic model, which is known as the multiple covariates adjusted model of propofol. METHODS: Ninety female patients scheduled for gynecologic surgery were randomly assigned to three groups targeting different plasma concentrations of 5.4, 8.1, and 10.8 microgram/ml. Target-controlled infusions (TCI) were provided by a computer-assisted continuous infusion system. Time to loss of responsiveness (LOR) was measured by a blind investigator; effect-site concentrations (C(e)) for LOR were then calculated with simulation of TCI using different k(e0)s. We determined the k(e0) minimizing total discrepancy (TD) between the inputted and calculated k(e0) from the t(1/2)k(e0)s for a given probability of LOR of the C(e), and also obtained the k(e0) for the minimal TD between the median Ce, which were compared to the known k(e0). RESULTS: k(e0)s from these two methods were 0.3692 and 0.3788/min. C(e)s for LOR with these k(e0)s were significantly different from those with Schnider's k(e0). CONCLUSIONS: We proposed a method for titration of the k(e0) of propofol. The k(e0)s of propofol was lower than Schnider's k(e0). An adequate k(e0) for the specific pharmacokinetic model and a certain population would be useful for prediction of an accurate C(e), and could be used for calculation of accurate dosing during targeting of the effect site.
Aluminum Hydroxide ; Anesthesia ; Carbonates ; Female ; Gynecologic Surgical Procedures ; Humans ; Plasma ; Propofol

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Cardioprotection and ageing.

Yon Hee SHIM

Korean Journal of Anesthesiology.2010;58(3):223-230. doi:10.4097/kjae.2010.58.3.223

With an increase in the elderly population and an increase in the prevalence of age-related cardiovascular disease, anesthesiologists are increasingly being faced with elderly patients with known or suspected ischemic heart disease in the perioperative period. Although early reperfusion remains the best strategy to reduce ischemic injury, reperfusion may damage the myocardium. Adjuvant therapy to revascularization is therefore necessary. To develop better strategies to prevent ischemia-reperfusion injury in older patients, we need to understand the aged myocardium, which has undergone structural and functional changes relative to the normal myocardium, resulting in reduced functional capacity and vulnerability to ischemia-reperfusion injury. In addition, innate or acquired cardioprotection deteriorates with aging. These changes in the aged myocardium might explain why there is poor translation of basic research findings from young animals to older patients. In this review, I discuss changes in intracellular signaling associated with myocardial ageing that have an effect on ischemia-reperfusion injury, and I discuss the efficacy of cardioprotection afforded by ischemic and pharmacologic pre-and post-conditioning in the aged myocardium. Finally, I outline strategies to restore protection in the aged myocardium.
Aged ; Aging ; Animals ; Cardiovascular Diseases ; Diet ; Humans ; Myocardial Ischemia ; Myocardium ; Perioperative Period ; Prevalence ; Reperfusion ; Reperfusion Injury

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The success of periclavicular brachial plexus block.

Jeong Uk HAN

Korean Journal of Anesthesiology.2010;58(3):221-222. doi:10.4097/kjae.2010.58.3.221

No abstract available.
Brachial Plexus

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Anaphylaxis by atracurium on a cardiac surgery patient: A case report.

Jae Kwang KIM ; Yun Seok JEON ; Deok Mann HONG ; Tae Wan LIM ; Jae Hyon BAHK ; Hyuk AHN

Korean Journal of Anesthesiology.2008;55(3):380-382. doi:10.4097/kjae.2008.55.3.380

Effective treatment of hypotension during induction of general anesthesia depends onhow well the many causes of the hypotension are understood. However, differential diagnosis of hypotension is by no means easy, especially when the prevalenceof hypotension is low or when the patient is asymptomatic. A 75 year-old female, upon induction of general anesthesia for open thoracic surgery, became hypotensive and showed generalized erythematous papules, therefore having to postpone the surgery. Upon further evaluation through skin prick tests, the hypotensive event was concluded to be caused by anaphylactic side effects of atracurium. Hence, atracurium was avoided and the surgery was successfully performed.
Anaphylaxis ; Anesthesia, General ; Atracurium ; Diagnosis, Differential ; Female ; Humans ; Hypotension ; Skin ; Thoracic Surgery

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Aspiration pneumonitis after a 10-hour fast in a patient who had undergone subtotal gastrectomy: A case report.

Tae Hyung KANG ; Kun Moo LEE ; Sang Eun LEE ; Young Whan KIM ; Se Hun LIM ; Jeong Han LEE ; Soon Ho CHEONG ; Young Kyun CHOE ; Young Jae KIM ; Chee Mahn SHIN

Korean Journal of Anesthesiology.2008;55(3):376-379. doi:10.4097/kjae.2008.55.3.376

A patient who had previously undergone a subtotal gastrectomy was scheduled for removal of a brain tumor under general anesthesia. Anesthesia was induced with lidocaine and propofol with rocuronium for neuromuscular blockade. She had fasted for 10 hours, but after mask ventilation, she aspirated gastric juice and materials. The oral cavity was suctioned promptly and the trachea was intubated. Intraoperative high FiO2 and dopamine were administrated to maintain the oxygen saturation and blood pressure. She received postoperative ventilatory care in the intensive care unit for 2 weeks. An upper gastrointestinal series and fiber endoscopy were performed but she had no obstruction and reflux esophagitis except delayed passage of the contrast media. She had no risk factors for pulmonary aspiration. As in this case, patients with previous gastrointestinal surgery should be considered preoperative workup for GI motility or pathology, and adequate premedication.
Androstanols ; Anesthesia ; Anesthesia, General ; Blood Pressure ; Brain Neoplasms ; Contrast Media ; Dopamine ; Endoscopy ; Esophagitis, Peptic ; Gastrectomy ; Gastric Juice ; Humans ; Intensive Care Units ; Lidocaine ; Masks ; Mouth ; Neuromuscular Blockade ; Oxygen ; Pneumonia ; Premedication ; Propofol ; Risk Factors ; Suction ; Trachea ; Ventilation

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Anesthetic management for a patient with aberrant right subclavian artery: A case report.

Sol Mon YANG ; Jin Tae KIM ; Ji Young BAE ; Hyun Jung KIM ; Hee Soo KIM ; Chong Sung KIM ; Seong Deok KIM

Korean Journal of Anesthesiology.2008;55(3):371-375. doi:10.4097/kjae.2008.55.3.371

Aberrant right subclavian artery (ARSA) is a congenital anomaly that usually does not produce symptoms. However, patients with symptoms may require surgical intervention. Surgical procedures consist of division of ARSA from the descending aorta and reimplantation to the right common carotid artery or ascending aorta. Specific anesthetic management includes invasive monitoring of blood pressure in both radial arteries, monitoring of adequate cerebral perfusion, and ventilatory strategy to facilitate surgical exposure. Although many reports are available regarding its surgical treatment, there are few reports, to the author's best knowledge, that describe anesthetic management for its surgical correction. This case report will focus on important aspects of the anesthetic management of patients with ARSA.
Anesthesia ; Aneurysm ; Aorta ; Aorta, Thoracic ; Blood Pressure ; Cardiovascular Abnormalities ; Carotid Artery, Common ; Deglutition Disorders ; Humans ; Perfusion ; Radial Artery ; Replantation ; Subclavian Artery

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