[show abstract][hide abstract] ABSTRACT: This prospective study aimed to evaluate the satisfaction of patients who participated in the decision-making process for selecting an anesthesia method for surgery; the patients' preferred role (active, collaborative or passive) in the decision-making; and the patients' preferred choice of anesthetic method. The study included 257 patients scheduled for simple elective surgeries involving the upper or lower extremities. During the preanesthetic visit, patients were informed regarding two methods of anesthesia for their surgeries, and participated in selecting one option. Of the 257 patients, 69.6% preferred a collaborative role, 18.3% and 12.1% preferred an active and a passive role, respectively. Among patients requiring surgery on an upper extremity and on a lower extremity, 64.3% and 51.3% expressed a preference for general anesthesia over regional anesthesia, respectively. After surgery, the majority of our patients were satisfied (93.4%) and felt respected (97.7%). Furthermore, the patients expressed a change in preference for assuming an active role (49.4%) and a collaborative role (43.6%) in the decision-making process for their future anesthesia needs. This study may help to promote patient centered care in a department of anesthesiology.
Journal of Korean medical science 02/2014; 29(2):287-91. · 0.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to evaluate effect of pulsed radiofrequency (PRF) neuromodulation of suprascpaular nerve (SSN) in patients with chronic shoulder pain due to adhesive capsulitis and/or rotator cuff tear.
The study included 11 patients suffering from chronic shoulder pain for at least 6 months who were diagnosed with adhesive capsulitis (n=4), rotator cuff tear (n=5), or adhesive capsulitis+rotator cuff tear (n=2) using shoulder magnetic resonance imaging or extremity ultrasonography. After a favorable response to a diagnostic suprascapular nerve block twice a week (pain improvement >50%), PRF neuromodulation was performed. Shoulder pain and quality of life were assessed using a Visual Analogue Scale (VAS) and the Oxford Shoulder Score (OSS) before the diagnostic block and every month after PRF neuromodulation over a 9-month period.
The mean VAS score of 11 patients before PRF was 6.4±1.49, and the scores at 6-month and 9 month follow-up were 1.0±0.73 and 1.5±1.23, respectively. A significant pain reduction (p<0.001) was observed. The mean OSS score of 11 patients before PRF was 22.7±8.1, and the scores at 6-month and 9 month follow-up were 41.5±6.65 and 41.0±6.67, respectively. A significant OSS improvement (p<0.001) was observed.
PRF neuromodulation of the suprascapular nerve is an effective treatment for chronic shoulder pain, and the effect was sustained over a relatively long period in patients with medically intractable shoulder pain.
Journal of Korean Neurosurgical Society 12/2013; 54(6):507-10. · 0.56 Impact Factor
[show abstract][hide abstract] ABSTRACT: Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
Journal of Korean medical science 06/2013; 28(6):962-4. · 0.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: An airway-exchange catheter (AEC) can increase the safety of exchanges of endotracheal tubes (ETTs); however, the procedure is associated with potential risks. We describe a case of esophageal misplacement of a single-lumen ETT after switching from a double-lumen tube, despite the use of an AEC as a guidewire. To avoid this, physicians should consider the insertion depth and maintenance depth of the AEC and should verify its position before changing ETTs and should perform, if possible, with simultaneous visualization of the glottis with direct or video laryngoscopy during the exchange. Additionally, the new ETT position should be confirmed by auscultation, end-tidal carbon dioxide, and portable chest X-ray.
Saudi journal of anaesthesia. 04/2013; 7(2):194-6.
[show abstract][hide abstract] ABSTRACT: PURPOSE: The purpose of this study was to evaluate the outcomes of arthroscopy-guided direct suprascapular nerve block performed after arthroscopic rotator cuff repair. METHODS: In the present prospective, randomized, double-blinded clinical study, 30 patients were divided into two groups: 15 patients (group I) were treated with arthroscopy-guided suprascapular nerve block using 10 mL 0.5 % ropivacaine with 1:200,000 epinephrine, and 15 patients (group II) were treated with placebo using 10 mL 0.9 % saline after arthroscopic rotator cuff repair. Patient pain levels were measured using the visual analog scale (VAS) at 1, 3, 6, 12, 18, and 24 h post-operatively. Additionally, the number of boluses and total amount of fentanyl dispensed by patient-controlled analgesia administration during the 24-h post-operative period were evaluated. RESULTS: VAS scores did not differ significantly between groups I and II during the 24-h post-operative period, but mean fentanyl bolus consumption was significantly less in group I compared with group II (p = 0.015). CONCLUSION: Arthroscopy-guided suprascapular nerve block at the end of a rotator cuff repair was safe and less time-consuming than expected. Although this procedure did not significantly reduce the post-operative pain, the post-operative need for fentanyl boluses as analgesia was reduced significantly, and it would be beneficial if this procedure involved a sensory branch of axillary nerve block or was performed at the beginning of the arthroscopic procedure. LEVEL OF EVIDENCE: Prospective, randomized, double-blinded clinical trial, Level I.
Knee Surgery Sports Traumatology Arthroscopy 03/2013; · 2.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE: Dexmedetomidine, a selective α2-adrenoceptor agonist, has analgesic and sedative effects. The purpose of this study was to investigate the effects of small, single-dose intravenous dexmedetomidine administration after hyperbaric bupivacaine spinal anesthesia. METHODS: Sixty adult patients classified as American Society of Anesthesiologists physical status 1 or 2 and scheduled for lower extremity surgery under spinal anesthesia were studied. Patients were randomly assigned to one of three groups and administered hyperbaric intrathecal bupivacaine 12 mg. 5 min after spinal anesthesia, patients in groups 1, 2, and 3 received normal saline 10 ml, dexmedetomidine 0.25 μg/kg, and dexmedetomidine 0.5 μg/kg, respectively, over 10-min intravenous administration. The onset time, maximum block level, two-dermatome sensory regression time, duration of motor and sensory anesthesia, and side effects were assessed. RESULTS: The two-dermatome sensory regression time was significantly increased in groups 2 and 3. The duration of motor and sensory anesthesia was significantly increased in group 3. Onset time, maximum block level, level of sedation, and incidence of hypotension and treatment-needed bradycardia were no different among the groups. CONCLUSION: Single-dose intravenous dexmedetomidine 0.25-0.5 μg/kg, administered 5 min after intrathecal injection of hyperbaric bupivacaine, improved the duration of spinal anesthesia without significant side effects. This method may be useful for increasing the duration of spinal anesthesia, even after intrathecal injection of local anesthetics.
Journal of Anesthesia 01/2013; · 0.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: This prospective study evaluated the effects of continuous sedation using midazolam, with or without remifentanil, on postoperative nausea and vomiting (PONV) in patients undergoing myringoplasty.
Sixty patients undergoing myringoplasty were sedated with midazolam in the presence of remifentanil (group MR), or after saline injection instead of remifentanil (group M).
Three patients (10%) in group M complained of nausea; two vomited. Four patients (13%) in group MR complained of nausea and vomited within 24 h after surgery. Rescue drugs were given to the six patients who vomited. No significant difference was detected between the two groups regarding the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.
Midazolam-based continuous sedation can reduce PONV after myringoplasty. Compared with midazolam alone, midazolam with remifentanil produced no difference in the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.
Yonsei medical journal 09/2012; 53(5):1010-3. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report a difficult case of tracheostomy in a 34-year-old obese woman with a short neck. The tracheostomy tube placement repeatedly failed because of anatomical changes due to obesity and a short neck, tracheal mucosal swelling due to prolonged intubation, and unexpected false passage; however, it was successfully performed using an endotracheal tube exchanger as a guidewire.
Korean journal of anesthesiology 06/2011; 60(6):434-6.
[show abstract][hide abstract] ABSTRACT: Histologically, Schmorl's nodes are defined as the loss of nuclear material through the cartilage plate, growth plate, and end plate into the vertebral body. Most Schmorl's nodes are asymptomatic, although there are some reports of symptomatic Schmorl's nodes, which should be treated similarly to vertebral compression fractures, with conservative treatment as the first choice. We report the case that we reduced the pain by blocking the ramus communicans nerve in a patient with Schmorl's node.
[show abstract][hide abstract] ABSTRACT: This report presents the case of a 63-year-old man who had a myocardial infarction leading to coronary artery bypass graft 2 years earlier who subsequently underwent elective laparoscopic cholecystectomy. After an uneventful operation, the patient developed an acute postoperative myocardial infarction in the recovery room and died 19 days postoperatively. Anesthesiologists should be aware of the rare possibility of acute, fatal postoperative myocardial infarction and consider this complication when they perform the preoperative risk evaluation, anesthesia, and postoperative care for cardiac patients undergoing noncardiac surgery.
Korean journal of anesthesiology 12/2010; 59 Suppl:S110-3.
[show abstract][hide abstract] ABSTRACT: Spinal myoclonus is an unusual, self-limiting, adverse event that may occur during spinal anesthesia. The exact cause and underlying biochemical mechanism of spinal myoclonus remain unclear. A few cases of spinal myoclonus have been reported after administration of intrathecal bupivacaine. We report a case in which spinal myoclonus recurred after two episodes of spinal anesthesia with bupivacaine at a 1-year interval in a 35-year-old woman. The myoclonus was acute and transient. The patient recovered completely, with no neurologic sequelae.
Korean journal of anesthesiology 12/2010; 59 Suppl:S62-4.
[show abstract][hide abstract] ABSTRACT: This prospective study evaluated the use of continuous sedation using propofol and remifentanil when carpal tunnel release (CTR) was performed under local anesthesia.
We sedated 60 patients undergoing CTR using local anesthesia with remifentanil at loading and continuous doses of 0.5 µg kg(-1) and 0.05 µg kg(-1)min(-1), respectively, and propofol, using a target controlled infusion (TCI) pump set to a target of 2 µg mL(-1) (group A), or with the same drug doses except that the continuous remifentanil dose was 0.07 µg kg(-1)min(-1) (group B) or 0.1 µg kg(-1)min(-1) (group C).
In group B, the levels of pain when local anesthetics were administered (p = 0.001), intraoperative pain (p < 0.001) and anxiety (p = 0.001) were significantly lower than those of group A. Furthermore, the incidence of adverse events, including desaturation (p < 0.001) and vomiting (p = 0.043), was significantly lower in group B than in group C.
Continuous sedation using an appropriate dose of remifentanil and propofol can be used as safe, efficacious ambulatory anesthesia in cases of CTR under local anesthesia, performed using only 2 mL of local anesthetic, with a high degree of patient satisfaction.
Journal of Korean Neurosurgical Society 11/2010; 48(5):429-33. · 0.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the effect and safety of the immediate postoperative continuous infusion of remifentanil at two doses in patients undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) with alfentanil-based patient-controlled analgesia (PCA).
The study enrolled 50 ASA physical status 1 or 2 patients scheduled to undergo LAVH. Anesthesia was maintained with sevoflurane-remifentanil-air. At the last skin suture, the sevoflurane was discontinued, and patients were randomized to receive remifentanil 0.05 microg/kg/min (group I) or 0.1 microg/kg/min (group II). PCA was started at the time of eye opening and response to a verbal command. In the recovery room, we monitored the mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), SpO(2), and bispectral index (BIS) at 5-minute intervals. Thirty minutes after starting PCA, the remifentanil was discontinued. Pain was assessed using a visual analog scale (0 = no pain; 100 = the worst possible pain) at 0, 5, 10, and 30 minutes after stopping the remifentanil infusion.
The eye opening time, BIS, MAP, and HR did not differ significantly between the two groups, and pain scores were similar between the two groups. Respiratory depression (SpO(2) < 90% or RR < 8/min) did not occur in group I but did occur in three patients in group II.
Continuous remifentanil infusion (0.05 microg/kg/min) immediately postoperatively with alfentanil-based PCA had a similar effect as a 0.1 microg/kg/min infusion with respect to pain control without side effects. However, special attention must be given to respiratory depression.
Korean journal of anesthesiology 06/2010; 58(6):537-41.
[show abstract][hide abstract] ABSTRACT: Various complications of central venous catheterization have been reported, some of which are well-known, while others are described as a sporadic events. We experienced a case of left subclavian venous catheterization complicated by extravascular knotting, kinking, and entrapment of the guidewire and the guidewire was removed surgically. Although minimal resistance was encountered during guidewire insertion, the guidewire was advanced approximately 30 cm. Physicians should be aware of these rare potential complications when a guidewire is advanced if any resistance is encountered.
Korean journal of anesthesiology 03/2010; 58(3):296-8.