The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

BACKGROUND: I-gel™ and Streamlined Liner of the Pharynx Airway (SLIPA™) are the second generation supraglottic airway devices characterized by disposability and non-inflatable cuff that provide adequate sealing pressure and easy use. This study was designed to compare oro-pharyngeal leakage pressure of the I-gel™ with the SLIPA™. METHODS: Seventy-eight adult patients were randomly assigned to undergo general anesthesia with either I-gel™ or SLIPA™. Hemodynamic changes and Oro-pharyngeal leakage pressure were assessed at one minute after the insertion. The total insertion time, number of attempts, ease of insertion, and presence of blood staining and regurgitation were recorded. After surgery, postoperative sore throat and other complications (dysphonia, dysphagia or paresthesia of tongue) were evaluated. RESULTS: Oro-pharyngeal leakage pressure after device insertion was higher in the SLIPA™ group than the I-gel™ group. Insertion time was significantly shorter in the I-gel™ group than the SLIPA™ group. Blood staining was presented in 21.1% of the SLIPA™ group vs. 2.6% of the I-gel™ group. In the recovery room, postoperative sore throat measured in visual rating scale (VAS) was significantly higher in the SLIPA™ group than in the I-gel™ group. Ease of insertion, regurgitation, respiratory index and hemodynamic change after insertion showed no significant differences. CONCLUSIONS: In this study, the SLIPA™ devices provided higher oro-pharyngeal leakage pressure than I-gel™. However, the results verified ease of insertion, and safety of ventilation and hemodynamic changes, without any severe complications in both I-gel™ and SLIPA™.
Adult ; Anesthesia, General ; Blood Stains ; Deglutition Disorders ; Hemodynamics ; Humans ; Laryngeal Masks ; Paresthesia ; Pharyngitis ; Pharynx* ; Recovery Room ; Ventilation

BACKGROUND: We hypothesized that induction of general anesthesia using sevoflurane improves the accuracy of non-invasive hemoglobin (SpHb) measurement of Masimo Radical-7(R) Pulse CO-Oximetry by inducing peripheral vasodilation and increasing the perfusion index (PI). The aim of this study is to investigate the change in the SpHb and the PI measured by Rad7 during induction of general anesthesia using sevoflurane. METHODS: The laboratory hemoglobin (Hb(lab)) was measured before surgery by venous blood sampling. The SpHb and the PI was measured twice; before and after the induction of general anesthesia using sevoflurane. The changes of SpHb, Hb(bias) (Hb(bias) = SpHb - Hb(lab)), and PI before and after the induction of general anesthesia were analyzed using a paired t-test. Also, a Pearson correlation coefficient analysis was used to analyze the correlation between the Hb(bias) and the PI. RESULTS: The SpHb and the PI were increased after the induction of general anesthesia using sevoflurane. There was a statistically significant change in the Hb(bias) from -2.8 to -0.7 after the induction of general anesthesia. However, the limit of agreement (2 SD) of the Hb(bias) did not change after the induction of general anesthesia. The Pearson correlation coefficient between the Hb(bias) and the PI was not statistically significant. CONCLUSIONS: During induction of general anesthesia using sevoflurane, the accuracy of SpHb measurement was improved and precision was not changed. The correlation between Hb(bias) and PI was not significant.
Anesthesia, General* ; Perfusion* ; Vasodilation

BACKGROUND: This study was designed to find appropriate lubricant for streamed lined liner of pharyngeal airway(TM) (SLIPA(TM)). We evaluated the incidence of sore throat, nausea, vomiting, hoarseness, paresthesia and blood stain after using saline, water soluble gel and 2% lidocaine gel as a SLIPA(TM) lublicant. METHODS: One hundred twenty three patients scheduled for minor surgery to whom the SLIPA(TM) was considered suitable were randomly allocated to one of three groups which receive normal saline, water soluble gel or 2% lidocaine gel as a SLIPA(TM) lublicant. Patients were interviewed at recovery room, post operation 6-12 hour, post operation 18-24 hour about sore throat and other complications. RESULTS: There were no statistical difference in sore throat and blood stain among three groups. Also there were no statistical differences in hoarseness, nausea, vomiting. The incidence of paresthesia in 2% lidocaine gel group was significantly higher than those of the other two groups immediately after operation, but it was resolved after leaving the recovery room. CONCLUSIONS: Our results suggest that normal saline, water soluble gel and 2% lidocaine gel are all available as a SLIPA(TM) lubricant. Size of SLIPA(TM), insertion technique and difficulty of insertion should be further investigated as the main causes of a sore throat and other complications which can occur after the insertion of SLIPA(TM).
Blood Stains ; Hoarseness ; Humans ; Incidence ; Lidocaine* ; Nausea ; Paresthesia ; Pharyngitis ; Recovery Room ; Rivers ; Surgical Procedures, Minor ; Vomiting

Postherpetic neuralgia (PHN) is one of the most difficult pain syndromes to treat. Invasive treatments may be considered when patients fail to obtain adequate pain relief from noninvasive treatment approaches. Here, we present three cases of PHN in the mandibular branch treated with ultrasound-assisted mental nerve block and pulsed radiofrequency treatment. None of the patients had adequate pain relief from the medical therapy, so we performed the mental nerve block on the affected side under ultrasound assistance. Two patients showed satisfactory pain relief continuously over 12 months without any further interventions, whereas one patient only had short-term pain relief. For the patient had short-term pain relief we performed pulsed radiofrequency treatment (PRFT) on the left mental nerve under ultrasound assistance. After PRFT, the patient had adequate pain relief for 6 months and there was no need for further management.
Humans ; Nerve Block* ; Neuralgia, Postherpetic* ; Pulsed Radiofrequency Treatment* ; Ultrasonography

Hemifacial spasm is defined as unilateral, involuntary, irregular twitching of all or parts of the muscles innervated by facial nerves. Here, we present a case of recurrent hemifacial spasm after microvascular decompression (MVD) treated with pulsed radiofrequency (PRF) treatment with good results. A 35-year-old woman suffered from recurrent hemifacial spasm after MVD that was refractory to medical treatment and botulinum toxin injections. We attempted a left facial nerve block twice. Then, we applied PRF at a maximum temperature of 42degrees C for 120 sec. Some response was observed, so we applied PRF two additional times. The frequency of twitch decreased from 3-4 Hz to < 0.5 Hz, and subjective severity on a visual analogue scale also decreased from 10/10 to 2-3/10. PRF treatment might be an effective medical treatment for refractory hemifacial spasm and has fewer complications and is less invasive compared with those of surgery.
Botulinum Toxins ; Facial Nerve ; Female ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Muscles ; Pulsed Radiofrequency Treatment

BACKGROUND: We made a comparative study on the antiemetic effect of midazolam and ondansetron added to intravenous patient-controlled analgesia (PCA) using fentanyl with gynecologic patients undergoing pelviscopic surgery. METHODS: The PCA using 20 microg/kg of fentanyl was started in all groups postoperatively. A dose of 16 mg of ondansetron was added to the PCA of group O (n = 30). A dose of 5 mg of midazolam was added to the PCA of group M (n = 30). While 16 mg of ondansetron and 5 mg of midazolam were added to the PCA of group MO (n = 30). Total volume of the PCA was 60 ml, and the PCA system was programmed to deliver 0.5 ml/h of continuous doses and a 0.5 ml bolus on demand, with a 15 minutes lockout interval. The incidence of postoperative nausea and vomiting (PONV), sedation score, visual analog scale (VAS) for pain, and rescue drug dose for PONV were investigated at the postanesthesia care unit (PACU), 6 hours, and 24 hours after recovery. RESULTS: The incidence of PONV in group MO was significantly lower than in group O at PACU, 24 hours after recovery (P < 0.05). The sedation score and VAS pain score showed no differences among all groups. CONCLUSIONS: Midazolam added to PCA using fentanyl proved more effective than ondansetron in preventing PONV without adverse effects.
Analgesia, Patient-Controlled ; Antiemetics ; Fentanyl ; Humans ; Incidence ; Midazolam ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting

Seizure associated with antiemetics is rare. We report seizure associated with a 5-HT3 receptor antagonist in a 38 years old female. The patient underwent ureterorenoscopic lithotripsy due to left upper ureter stone. After operation, the patient complained of nausea in the postanesthetic recovery unit. In order to subside symptom, the patient was administrated 5-HT3 receptor antagonist, palonosetron, 0.075 mg intravenously. Shortly after administration of that, the patient developed generalized tonic-clonic seizures. The symptom was subsided after midazolam and thiopental sodium were injected. But 40 minutes later, seizure recurred and subsided with midazolam again. The patient recovered completely without any specific sequelae.
Antiemetics ; Female ; Humans ; Injections, Intravenous ; Isoquinolines ; Lithotripsy ; Midazolam ; Nausea ; Quinuclidines ; Receptors, Serotonin, 5-HT3 ; Seizures ; Thiopental ; Ureter

BACKGROUND: In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. METHODS: Twenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were placed in the prone position. The needle entry point was located at the junction between midline of the pedicle paralleled to the midline of the T7 vertebral body (VB) and the lower border of T7 VB on anteroposterior view of the fluoroscope. The needle touched and walked up the lamina, and the interlaminar space (ILS) was sought near the midline of the VB at the height of the pedicle. RESULTS: The authors could not insert an epidural needle at T6-7 ILS in two patients and it was instead inserted at T5-6 ILS. However, other patients showed easy insertion at T6-7 ILS. The mean inward and upward angulations were 25degrees and 55degrees respectively. The mean actual depth and calculated depth from skin to thoracic epidural space were 5.1 cm and 6.1 cm respectively. Significant correlation between actual needle depth and body weight, podendal index (kg/m) or calculated needle depth was noted. CONCLUSIONS: The fluorposcope guided epidural block by Nagaro's method was useful in the midthoracic region. However, further study for the caudal shift of needle entry point may be needed.
Analgesia ; Body Weight ; Epidural Space ; Fluoroscopy ; Humans ; Needles ; Prone Position ; Skin ; Thoracic Vertebrae