Publications by authors named "Jung-Hee Ryu"

90 Publications

Efficacy of quadratus lumborum block for analgesia in adult participants undergoing hip surgery: A meta-analysis of randomized controlled trials.

J Clin Anesth 2021 Dec 19;75:110560. Epub 2021 Oct 19.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea. Electronic address:

Study Objective: This study aimed to identify the benefits of quadratus lumborum block (QLB) in terms of postoperative analgesic effects in adult participants undergoing hip surgery.

Design: Meta-analysis of randomized controlled trials.

Setting: Previous randomized controlled trials that evaluated the analgesic effect of QLB compared to that of no block.

Patients: Nine studies including 616 participants.

Interventions: Participants in the treatment group received QLB, whereas those in the control group received no block.

Measurements: Outcomes were postoperative 24-h opioid consumption (primary), 12-h/24-h visual analog scale (VAS) or numeric rating scale (NRS) pain scores, postoperative nausea and vomiting (PONV), and satisfaction. The effect size was estimated using the standardized mean difference (SMD), mean difference (MD), or risk ratio (RR) with a 95% confidence interval (CI). We used the risk of bias tool (RoB 2) to assess the risk of bias of the included studies and the GRADE approach to determine the level of certainty of the evidence.

Main Results: Compared to no block, the QLB group has less opioid consumption (SMD -1.69, 95% CI -2.54 to -0.84; low level of certainty of the evidence). Estimated MD for morphine consumption was 24 mg. The QLB group had a lower 12-h VAS/NRS pain score (MD -1.16, 95% CI -1.82 to -0.51; moderate level of certainty of the evidence) and 24-h VAS/NRS pain score (MD -0.92, 95% CI -1.42 to -0.43; moderate level of certainty of the evidence). QLB decreased the incidence of PONV (RR 0.43, 95% CI 0.24 to 0.79; moderate level of certainty of the evidence) and increased participants' satisfaction (SMD 1.15, 95% CI 0.63 to 1.67; moderate level of certainty of the evidence). Estimated MD for satisfaction was 1.74 points of Likert scale. There were no significant adverse events associated with the QLB in any of the included trials.

Conclusion: Our meta-analysis showed that QLB when compared to no block clinically decreased opioid requirements, reduced PONV, and improved participants' satisfaction. QLB also seems to be significantly superior to no block in terms of pain score, but its clinical importance remains unclear.
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http://dx.doi.org/10.1016/j.jclinane.2021.110560DOI Listing
December 2021

Blood transfusion had no influence on the 5-year biochemical recurrence after robot-assisted radical prostatectomy: a retrospective study.

BMC Urol 2021 Nov 17;21(1):160. Epub 2021 Nov 17.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea.

Background: Although red blood cells (RBC) transfusion is known to be significantly associated with biochemical recurrence in patients undergoing open prostatectomy, its influence on biochemical recurrence after robot-assisted laparoscopic radical prostatectomy remains unclear. Therefore, this study aimed to validate the effect of RBC transfusion on the 5-year biochemical recurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy.

Methods: This study retrospectively analyzed the medical records of patients who underwent robot-assisted laparoscopic radical prostatectomy at single tertiary academic hospital between October 2007 and December 2014. Univariate and multivariate Cox proportional hazard regression analysis was performed to identify any potential variables associated with 5-year biochemical recurrence.

Results: A total of 1311 patients were included in the final analysis. Of these, 30 patients (2.3%) were transfused with RBC either during robot-assisted laparoscopic radical prostatectomy or during their hospital stay, which corresponded to 5-year biochemical recurrence of 15.7%. Multivariate Cox proportional hazard regression analysis showed that RBC transfusion had no influence on the 5-year biochemical recurrence. Variables including pathologic T stage (Hazard ratio [HR] 3.5, 95% confidence interval [CI] 2.4-5.1 p < 0.001), N stage (HR 2.3, 95% CI 1.5-3.7, p < 0.001), Gleason score (HR 2.4, 95% CI 1.8-3.2, p < 0.001), and surgical margin (HR 2.0, 95% CI 1.5-2.8, p < 0.001) were independently associated with the 5-year biochemical recurrence.

Conclusions: RBC transfusion had no significant influence on the 5-year biochemical recurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy.
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http://dx.doi.org/10.1186/s12894-021-00926-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597221PMC
November 2021

Effect of Neuromuscular Blockade on Intraoperative Respiratory Mechanics and Surgical Space Conditions during Robot-Assisted Radical Prostatectomy: A Prospective Randomized Controlled Trial.

J Clin Med 2021 Oct 29;10(21). Epub 2021 Oct 29.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

The aim of this study was to investigate whether deep neuromuscular blockade (NMB) may affect intraoperative respiratory mechanics, surgical condition, and recovery profiles in patients undergoing robot-assisted radical prostatectomy (RARP). Patients were randomly assigned to the moderate or deep NMB groups. Pneumoperitoneum was maintained with carbon dioxide (CO) insufflation at 15 mmHg during surgery. The primary outcome was peak inspiratory pressure (PIP) after CO insufflation. Mean airway pressure (P) and dynamic lung compliance (C) were also recorded. The surgeon rated the surgical condition and surgical difficulty on a five-point scale (1 = extremely poor; 2 = poor; 3 = acceptable; 4 = good; 5 = optimal). Recovery profiles, such as pulmonary complications, pain scores, and recovery time, were recorded. We included 58 patients in this study. No significant differences were observed regarding intraoperative respiratory mechanics including PIP, P and C, between the two groups. The number of patients with optimal surgical conditions was significantly higher in the deep than in the moderate NMB group (29 vs. 20, = 0.014). We found no differences in recovery profiles. In conclusion, deep NMB had no significant effect on the intraoperative respiratory mechanics but resulted in optimal endoscopic surgical conditions during RARP compared with moderate NMB.
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http://dx.doi.org/10.3390/jcm10215090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584864PMC
October 2021

The novel prognostic value of postoperative follow-up lateral spread response after microvascular decompression for hemifacial spasm.

J Neurosurg 2021 Sep 3:1-5. Epub 2021 Sep 3.

Departments of1Neurosurgery.

Objective: The lateral spread response (LSR) is an aberrant electrophysiological response in which a stimulus on one branch of the facial nerve spills over to other branches of the nerve, which can be captured by electrodes near each branch. The authors performed this study to evaluate the prognostic value of the follow-up LSR with a sufficient time interval from intraoperative LSR (IO-LSR) after microvascular decompression (MVD) for hemifacial spasm (HFS), excluding the interference of various intraoperative situations.

Methods: A total of 247 patients treated with MVD for HFS between June 2011 and March 2019 were enrolled in this study. The IO-LSR was routinely evaluated in all patients. The LSR was checked again on postoperative day (POD) 2 after surgery (POD2-LSR). A total of 228 patients (92.3%) were considered cured at the last clinical follow-up.

Results: The IO-LSR disappeared in 189 patients (76.5%), and among them, 181 patients (95.8%) were cured 1 year after surgery. The POD2-LSR disappeared in 193 patients (78.1%), and 185 patients (95.9%) among them were cured. Among the 189 patients in which the IO-LSR disappeared, the POD2-LSR reappeared in 26 patients (13.8%). In contrast, the POD2-LSR disappeared in 30 (51.7%) of 58 patients for whom the IO-LSR continued at the end of surgery. When classified into groups according to the status of the IO-LSR and POD2-LSR, in the group of patients in whom both LSRs disappeared, the cure rate was 98.2%, which was significantly higher than that of the other 3 groups (p < 0.05, Cochran-Armitage trend test). The use of both LSRs was found to be significantly associated with better predictability (p < 0.05, McNemar's test).

Conclusions: Postoperative follow-up LSR examination may be beneficial in predicting clinical outcomes after MVD for HFS, especially when considered together with IO-LSR.
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http://dx.doi.org/10.3171/2021.3.JNS21137DOI Listing
September 2021

Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis.

J Cardiothorac Vasc Anesth 2021 Jun 29. Epub 2021 Jun 29.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address:

Objective: The objective of this study was to determine whether erector spinae plane block (ESPB) can provide an effective analgesia for managing pain after thoracic surgery and compare the efficacy of ESPB with that of other regional analgesic techniques.

Design: Systematic review and meta-analysis of randomized controlled trials.

Setting: PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched.

Participants: Patients undergoing thoracic surgeries.

Intervention: Erector spinae plane block with local anesthetics for postoperative analgesia.

Measurement And Main Results: Seventeen studies, including 1,092 patients, were included in the final analysis. Erector spinae plane block reduced 24-hour postoperative opioid consumption (mean difference [MD] -17.49, 95% CI -26.87 to -8.12), pain score at rest (MD -0.82, 95% CI -1.31 to -0.33), and pain score at movement (MD -0.77, 95% CI -1.20 to -0.3) compared to no block. Compared with other regional blocks, various results have been observed. Although statistical results showed that ESPB is inferior to thoracic paravertebral block and intercostal nerve block and superior to serratus anterior plan block in postoperative analgesia, clinical differences remain unclear. The incidence of hematoma was lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73).

Conclusion: Erector spinae plane block may provide effective analgesia after thoracic surgery. Compared with other techniques, it is a safer method, without clinically important differences, for postoperative pain control. Therefore, ESPB may be considered as a valuable option for postoperative pain management after thoracic surgery.
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http://dx.doi.org/10.1053/j.jvca.2021.06.029DOI Listing
June 2021

Virtual Reality vs. Tablet Video as an Experiential Education Platform for Pediatric Patients Undergoing Chest Radiography: A Randomized Clinical Trial.

J Clin Med 2021 Jun 4;10(11). Epub 2021 Jun 4.

Medical Virtual Reality Research Group, Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gwanak-gu, Seoul 03080, Korea.

Virtual reality (VR), which offers an immersive experience, has been implemented into the education of pediatric patients to reduce peri-procedural anxiety. This randomized clinical trial evaluated the effect of VR, compared with standard video, on reducing anxiety and distress in pediatric patients undergoing chest radiography. A total of 120 children aged 4 to 8 years with scheduled chest radiography appointments were randomized into either the tablet or the VR group. Children in the tablet group experienced chest radiography indirectly with a 3 min tablet video, whereas those in the VR group received the same content via a VR experience. The distress of children was measured using the Observational Scale of Behavioral Distress (OSBD) scale. Parental presence and procedural outcomes were also recorded. The number of less distressed children (OSBD score < 5) was significantly higher in the VR group than in the tablet group (49 [81.7%]) vs. 32 [53.3%]) ( = 0.001). The OSBD scores, the need for parental presence, the procedure time, and the number of repeated procedures were all lower in the VR group. The immersive VR experience appears to decrease the degree of anxiety in children and increase the efficiency of the procedures compared with the tablet video with the same content.
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http://dx.doi.org/10.3390/jcm10112486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200101PMC
June 2021

The Neuroprotective Effect of Thiopental on the Postoperative Neurological Complications in Patients Undergoing Surgical Clipping of Unruptured Intracranial Aneurysm: A Retrospective Analysis.

J Clin Med 2021 Mar 12;10(6). Epub 2021 Mar 12.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Although thiopental improved neurological outcomes in several animal studies, there are still insufficient clinical data examining the efficacy of thiopental for patients undergoing surgical clipping of unruptured intracranial aneurysm (UIA). This study validated the effect of thiopental and investigated risk factors associated with postoperative neurological complications in patients undergoing surgical clipping of UIA. In total, 491 patients who underwent aneurysm clipping were included in this retrospective cohort study. Data regarding demographics, aneurysm characteristics, and use of thiopental were collected from electronic medical records. Propensity score matching and logistic regression analysis were used. After propensity score matching, the thiopental group showed a lower incidence of the postoperative neurological complications than non-thiopental group (5.5% vs. 17.1%, = 0.001). In multivariate analysis, thiopental reduced the risk of postoperative neurological complications (odds ratio (OR) 0.26, 95% confidence interval (CI) 0.13 to 0.51, < 0.001) while aneurysm size ≥ 10 mm (OR 4.48, 95% CI 1.69 to 11.87, = 0.003), and hyperlipidemia (OR 2.24, 95% CI 1.16 to 4.32, = 0.02) increased the risk of postoperative neurological complications. This study showed that thiopental was associated with the lower risk of neurological complications after clipping of UIA.
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http://dx.doi.org/10.3390/jcm10061197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999640PMC
March 2021

Anesthetic concerns during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Korean J Anesthesiol 2021 04 22;74(2):89-90. Epub 2021 Mar 22.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

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http://dx.doi.org/10.4097/kja.21099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024208PMC
April 2021

Neurotoxic Effects of Local Anesthetics on Developing Motor Neurons in a Rat Model.

J Clin Med 2021 Feb 25;10(5). Epub 2021 Feb 25.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Neurotoxic effects of local anesthetics (LAs) on developing motor neurons have not been documented. We investigated the neurotoxic effects of LAs on developing motor neurons in terms of cell viability, cytotoxicity, reactive oxygen species (ROS), and apoptosis. Embryonic spinal cord motor neurons were isolated from Sprague-Dawley rat fetuses and exposed to one of the three LAs-lidocaine, bupivacaine, or ropivacaine-at concentrations of 1, 10, 100, or 1000 µM. The exposure duration was set to 1 or 24 h. The neurotoxic effects of LAs were determined by evaluating the following: cell viability, cytotoxicity, ROS production, and apoptosis. In the 1-h exposure group, the motor neurons exposed to lidocaine and bupivacaine had reduced cell viability and increased cytotoxicity, ROS, and apoptosis in a concentration-dependent manner. Lidocaine showed the highest toxicity, followed by bupivacaine. In the 24-h exposure group, all three LAs showed significant effects (decreased cell viability and increased cytotoxicity, ROS, and apoptosis) on the motor neurons in a concentration-dependent manner. The neurotoxic effects of lidocaine were greater than those of bupivacaine and ropivacaine. Ropivacaine appeared to have the least effect on motor neurons. This study identified the neurotoxic effects of lidocaine and bupivacaine on developing spinal cord motor neurons.
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http://dx.doi.org/10.3390/jcm10050901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956179PMC
February 2021

Effects of tranexamic acid on the activity of glutamate transporter EAAT3.

Anesth Pain Med (Seoul) 2020 Jul;15(3):291-296

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Background: Tranexamic acid (TXA) is the most widely used hemostatic agent in surgical patients. However, when used in a high dose, it could cause a seizure in the postoperative period. The exact effector mechanism behind the seizure triggering remains unknown. Therefore, the authors investigated the effects of TXA on the activity of glutamate transporter type 3 (excitatory amino acid transporter 3; EAAT3), which is the main neuronal glutamate transporter type.

Methods: EAAT3 was expressed in oocytes through mRNA injection. Oocytes were incubated with diluted tranexamic acid for 72 h. Two-electrode voltage clamping was used to measure membrane currents before, during, and after applying 30 µM L-glutamate. Responses were quantified by integrating the current traces and reported in microcoulombs (µC). Results were presented as mean ± SEM.

Results: TXA (30 to 1,000 µM) significantly decreased EAAT3 activity. Our kinetic study showed that V was significantly decreased in the TXA group compared with the control group (1.1 ± 0.1 vs. 1.4 ± 0.1 µC, n = 18-23, P = 0.043), but the K did not significantly change (12.7 ± 3.9 µM for TXA vs. 12.8 ± 3.8 for control, n = 18-23, P = 0.986).

Conclusions: Our results suggest that TXA attenuates EAAT3 activity, which may explain its proconvulsant effect.
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http://dx.doi.org/10.17085/apm.20004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713840PMC
July 2020

Dexmedetomidine-remifentanil vs propofol-remifentanil for monitored anesthesia care during hysteroscopy: Randomized, single-blind, controlled trial.

Medicine (Baltimore) 2020 Oct;99(43):e22712

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do.

Background: Although dexmedetomidine has been used as either the anesthetic agent for light sedation or as an adjunct to other sedatives, no study has investigated the usefulness of dexmedetomidine as the main sedative agent for invasive and painful procedures. The purpose of this study was to compare the safety of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anesthesia care (MAC) for hysteroscopy.

Methods: Female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (group D) or the propofol group (group P). The study drug (0.6 ml/kg; dexmedetomidine 2 μg/ml or propofol 4 mg/ml) was loaded for 10 minutes followed by 0.1 to 0.5 ml/kg/hour to maintain a bispectral index of 60 to 80 during the procedure. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml and titrated during the procedure. The incidence rates of intraoperative respiratory depression in both groups were compared. Postoperative pain and patients satisfaction were also compared.

Results: A total of 69 female patients were included in this study. Dexmedetomidine significantly decrease the incidence of respiratory depression compared with propofol (15/34 [44.1%] vs 5/35 [14.3%], P = .006, group P and D, respectively). Postoperative pain and patients satisfaction score did not differ between the groups.

Conclusion: The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression without increasing hemodynamic complications compared with propofol-remifentanil for MAC during hysteroscopy.
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http://dx.doi.org/10.1097/MD.0000000000022712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581053PMC
October 2020

Profound Hypotension before Aortic Clamping Can Exacerbate Spinal Cord Ischemic Injury after Aortic Surgery in Rats.

J Clin Med 2020 Oct 23;9(11). Epub 2020 Oct 23.

Department of Anesthesiology & Pain medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Spinal cord ischemia is one of the most serious complications of aortic repair in patients with acute aortic syndrome. However, the effect of hypotension before aortic clamping on spinal cord injury has not been documented. A total of 48 male Sprague-Dawley rats were randomly divided into four groups: the sham group; control group (mean arterial pressure (MAP) < 90% of baseline value before aortic clamping); mild hypotension group (MAP < 80%); and profound hypotension group (MAP < 60%). Spinal cord ischemia was induced using a balloon-tipped catheter placed in the descending thoracic aorta. Neurological function of the hind limbs was evaluated for seven days after reperfusion and recorded using a motor deficit index (MDI). The spinal cord was then harvested for histopathological examination and evaluation of oxidative stress and inflammation. The profound hypotension group demonstrated a significantly higher MDI 48 h post-reperfusion and lower number of normal motor neurons than the other groups ( < 0.001). The levels of tissue malondialdehyde and tumor necrosis factor-α (TNF-α) were also significantly increased in the profound hypotension group compared with other groups. Profound hypotension before aortic clamping can aggravate neurologic outcomes after aortic surgery by exacerbating neurologic injury and reducing the number of normal motor neurons.
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http://dx.doi.org/10.3390/jcm9113395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690663PMC
October 2020

The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials.

J Clin Med 2020 Sep 29;9(10). Epub 2020 Sep 29.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Virtual reality (VR), a technology that provides a stimulated sensory experience, has recently been implemented in various fields of medicine. Several studies have investigated the efficacy of VR on preoperative anxiety. The purpose of this meta-analysis was to validate whether VR could relieve preoperative anxiety in patients undergoing surgery. Electronic databases were searched to identify all randomized controlled trials (RCTs) investigating the effect of VR on preoperative anxiety. The primary outcome was defined as the preoperative anxiety scores. We estimated the effect size using the standard mean difference (SMD) with a 95% confidence interval (CI) using a random effect model. Ultimately, 10 RCTs, with a total of 813 patients, were included in the final analysis. Preoperative anxiety was significantly lower in the VR group than in the control group (SMD -0.64, 95% CI -1.08 to -0.20, = 0.004). In a subgroup analysis, the preoperative anxiety scores were lower in the VR group than in the control group in pediatric patients (SMD -0.71, 95% CI -1.14 to -0.27, = 0.002), whereas a significant difference was not observed between the two groups in adult patients ( = 0.226). The results of this meta-analysis indicated that VR could decrease preoperative anxiety, especially in pediatric patients.
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http://dx.doi.org/10.3390/jcm9103151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600416PMC
September 2020

Comparison of Postoperative Renal Function between Non-Steroidal Anti-Inflammatory Drug and Opioids for Patient-Controlled Analgesia after Laparoscopic Nephrectomy: A Retrospective Cohort Study.

J Clin Med 2020 Sep 13;9(9). Epub 2020 Sep 13.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea.

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used as opioid alternatives for patient-controlled analgesia (PCA). However, their use after nephrectomy has raised concerns regarding possible nephrotoxicity. This study compared postoperative renal function and postoperative outcomes between patients using NSAID and patients using opioids for PCA in nephrectomy. In this retrospective observational study, records were reviewed for 913 patients who underwent laparoscopic or robot-assisted laparoscopic nephrectomy from 2015 to 2017. After propensity score matching, 247 patients per group were analyzed. Glomerular filtration rate (GFR) percentages (postoperative value divided by preoperative value), blood urea nitrogen (BUN)/creatinine ratios, and serum creatinine percentages were compared at 2 weeks, 6 months, and 1 year after surgery between users of NSAID and users of opioids for PCA. Additionally, postoperative complication rates, postoperative acute kidney injury (AKI) incidences, postoperative pain scores, and lengths of hospital stay were compared between groups. Postoperative GFR percentages, BUN/creatinine ratios, and serum creatinine percentages were similar between the two groups. There were no significant differences in the rates of postoperative complications, incidences of AKI, and pain scores at 30 min, 6 h, 48 h, or 7 days postoperatively. The length of hospital stay was significantly shorter in the NSAID group than in the opioid group. This study showed no association between the use of NSAID for PCA after laparoscopic nephrectomy and the incidence of postoperative renal dysfunction.
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http://dx.doi.org/10.3390/jcm9092959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563114PMC
September 2020

The Effects of Erector Spinae Plane Block in Terms of Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials.

J Clin Med 2020 Sep 10;9(9). Epub 2020 Sep 10.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Ultrasound-guided erector spinae plane block (ESPB), a recent regional analgesic technique, has been used to manage acute pain after surgery. The aim of this meta-analysis is to identify the benefits of ESPB in patients undergoing laparoscopic cholecystectomy (LC). The authors searched PubMed, EMBASE, CENTRAL, CINAHL, and Web of Science to identify all randomized controlled trials (RCTs) evaluating the effects of ESPB on postoperative pain after LC. Primary outcome was defined as 24 h cumulative opioid consumption. Secondary outcomes were pain scores and the incidence of postoperative nausea and vomiting (PONV). We estimated mean differences (MD) and odds ratio (OR) using a random-effects model. A total of 8 RCTs, including 442 patients, were included in the final analysis. Postoperative opioid consumption was significantly lower in the ESPB group than in the control group (MD -4.72, 95% CI -6.00 to -3.44, < 0.001). Compared with the control group, the ESPB group also showed significantly lower pain scores and incidence of PONV. A separate analysis of RCTs comparing ESPB with oblique subcostal transversus abdominis plane (OSTAP) block showed that the analgesic efficacy of ESPB was similar to that of OSTAP block. The results of this meta-analysis demonstrated that ESPB may provide effective postoperative analgesia in patients undergoing LC.
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http://dx.doi.org/10.3390/jcm9092928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564953PMC
September 2020

Effects of magnesium on the dose of rocuronium for deep neuromuscular blockade: A randomised controlled trial.

Eur J Anaesthesiol 2021 04;38(4):432-437

From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (JH, Y-TJ, J-HR, C-HK, SWN, S-IC, A-YO) and Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea (Y-TJ, J-HR, A-YO).

Background: Magnesium is known to enhance the effect of rocuronium, but the extent is not quantified.

Objectives: We aimed to quantify the effect of magnesium on the dose of rocuronium for deep neuromuscular blockade.

Design: A randomised controlled study.

Setting: A single tertiary care hospital.

Patients: Seventy males scheduled to undergo robot-assisted laparoscopic prostatectomy, aged between 20 and 80 years with American Society of Anesthesiologists physical status classification 1 or 2, were enrolled.

Interventions: Patients were randomised to either the magnesium group or control group. The magnesium group were infused with 50 mg kg-1 of magnesium, followed by a continuous intra-operative infusion at 15 mg kg-1 h-1 while the control group were infused with the same volumes of 0.9% saline. Deep neuromuscular blockade was maintained with a continuous infusion of rocuronium and was reversed using sugammadex.

Main Outcome Measures: The primary outcome was the dose of rocuronium administered to maintain deep neuromuscular blockade. The secondary outcomes were recovery time, defined as the time from the administration of sugammadex to train-of-four ratio 0.9, and the incidence of postoperative nausea and vomiting.

Results: The dose of rocuronium administered to maintain deep neuromuscular blockade was significantly lower in the magnesium group (7.5 vs. 9.4 μg kg-1 min-1, P = 0.01). There was no difference in recovery time or the incidence of nausea and vomiting.

Conclusion: Magnesium reduced the dose of rocuronium required for deep neuromuscular blockade by approximately 20% without affecting the recovery time after administration of sugammadex.

Trial Registration: ClinicalTrials.gov identifier: NCT04013243.
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http://dx.doi.org/10.1097/EJA.0000000000001329DOI Listing
April 2021

Factors associated with a 30-day unplanned readmission after elective spine surgery: a retrospective cohort study.

Eur Spine J 2021 01 4;30(1):191-199. Epub 2020 Aug 4.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea.

Purpose: The aim of this study was to identify factors that are independently associated with the 30-day unplanned readmission rate of patients who underwent elective spine surgery.

Methods: This study was a retrospective cohort study conducted in a single tertiary academic hospital. The study analyzed the electronic health records of adult patients aged 18 years or older who underwent inpatient elective spine surgery under general anesthesia between January 2010 and March 2018. The primary endpoint was an unplanned readmission within 30 days. The study used uni- and multivariable logistic regression analyses.

Result: A total of 7,025 patients were included in the analysis. Among the patients included in the analysis, 215 patients (3.1%) had unplanned readmission within 30 days after being discharged following elective spine surgery. In the complete-case analysis in the multivariable model, the factors associated with a 30-day unplanned readmission were found to be preoperative ASA physical status of ≥ 3 (vs 1) (OR: 2.21, 95% CI: 1.27, 3.84; P = 0.005), cancer (OR: 4.60, 95% CI: 2.72, 7.77; P < 0.001), and pRBC transfusion (OR: 1.81, 95% CI: 1.20, 2.71; P = 0.004).

Conclusion: The present study showed that preoperative ASA physical status of ≥ 3, diagnosis of cancer, and transfusion of pRBC were associated with an increased 30-day unplanned readmission rate after elective spine surgery.
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http://dx.doi.org/10.1007/s00586-020-06541-1DOI Listing
January 2021

The effects of intravenous dexmedetomidine on hemodynamic response in patients undergoing skull-pin head-holder application during neurosurgery - A meta-analysis of randomized controlled trials.

Clin Neurol Neurosurg 2020 08 20;195:105939. Epub 2020 May 20.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea; Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea. Electronic address:

Objectives: Skull-pin head-holder application during neurosurgery is a highly noxious stimulus that may lead to abrupt hemodynamic change, which is an unfavorable response to maintain hemodynamics stability. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on hemodynamic response (blood pressure and heart rate) resulting from the application of skull-pin head-holder in neurosurgery.

Patients And Methods: A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The protocol was registered with the International Prospective Register of Systematic Reviews (CRD 420119127876). Electronic databases were searched, without discrimination of publication year, language, and region, to identify all randomized controlled trials investigating the effects of dexmedetomidine on hemodynamic response resulting from skull-pin head-holder application during general anesthesia for neurosurgery. The mean arterial pressure and heart rate were analyzed using random-effect model, and the mean difference (MD) was calculated.

Results: Seventeen trials were identified; a total of 878 patients were enrolled. The analysis indicated that dexmedetomidine infusion reduced the mean arterial pressure (MD -11.70, 95% confidence interval [CI] -16.33 to -7.07, p < 0.00001) and heart rate (MD -14.48, 95% CI -23.10 to -5.86, p = 0.001) during skull-pin head-holder application. Subgroup analysis showed that dexmedetomidine was superior to fentanyl for the attenuation of hemodynamic response. Dexmedetomidine infusion also reduced the incidence of hypertension, tachycardia and brain relaxation score.

Conclusion: The result of this analysis indicates that intraoperative dexmedetomidine administration could decrease the hemodynamic response and provide hemodynamic stability during skull-pin head-holder application in neurosurgery.
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http://dx.doi.org/10.1016/j.clineuro.2020.105939DOI Listing
August 2020

Effects of Sugammadex on Post-Operative Pulmonary Complications in Laparoscopic Gastrectomy: A Retrospective Cohort Study.

J Clin Med 2020 Apr 24;9(4). Epub 2020 Apr 24.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea.

The use of sugammadex can reduce post-operative residual neuromuscular blockade, which is known to increase the risk of post-operative respiratory events. However, its effect on post-operative pulmonary complications is not obvious. This study was performed to evaluate the effects of sugammadex on post-operative pulmonary complications in patients undergoing laparoscopic gastrectomy between 2013 and 2017. We performed propensity score matching to correct for selection bias. Post-operative pulmonary complications (i.e., pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. We also evaluated admission to the intensive care unit after surgery, re-admission or an emergency room visit within 30 days after discharge, length of hospital stay, re-operation, and mortality within 90 days post-operatively as secondary outcomes. In the initial cohort of 3802 patients, 541 patients were excluded, and 1232 patients were analyzed after propensity score matching. In the matched cohort, pleural effusion was significantly reduced in the sugammadex group compared to the neostigmine group (neostigmine 23.4% vs. sugammadex 18%, = 0.02). Other pulmonary complications and secondary outcomes were not significantly different between the groups. In comparison to neostigmine, the use of sugammadex was associated with a lower incidence of post-operative pleural effusion in laparoscopic gastrectomy.
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http://dx.doi.org/10.3390/jcm9041232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230613PMC
April 2020

A Meta-Analysis on the Effect of Dexamethasone on the Sugammadex Reversal of Rocuronium-Induced Neuromuscular Block.

J Clin Med 2020 Apr 24;9(4). Epub 2020 Apr 24.

Department of Anesthesiology & Pain medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Sugammadex reverses the rocuronium-induced neuromuscular block by trapping the cyclopentanoperhydrophenanthrene ring of rocuronium. Dexamethasone shares the same steroidal structure with rocuronium. The purpose of this study was to evaluate the influence of dexamethasone on neuromuscular reversal of sugammadex after general anesthesia. Electronic databases were searched to identify all trials investigating the effect of dexamethasone on neuromuscular reversal of sugammadex after general anesthesia. The primary outcome was time for neuromuscular reversal, defined as the time to reach a Train-of-Four (TOF) ratio of 0.9 after sugammadex administration. The secondary outcome was the time to extubation after sugammadex administration. The mean difference (MD) and 95% CI were used for these continuous variables. Six trials were identified; a total of 329 patients were included. The analyses indicated that dexamethasone did not influence the time for neuromuscular reversal of sugammadex (MD -3.28, 95% CI -36.56 to 29.99, = 0.847) and time to extubation (MD 25.99, 95% CI -4.32 to 56.31, = 0.093) after general anesthesia. The results indicate that dexamethasone did not influence the neuromuscular reversal of sugammadex in patients after general anesthesia. Therefore, the dexamethasone does not appear to interfere with reversal of neuromuscular blockade with sugammadex in patients undergoing general anesthesia for elective surgery.
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http://dx.doi.org/10.3390/jcm9041240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230323PMC
April 2020

Association of neuromuscular reversal by sugammadex and neostigmine with 90-day mortality after non-cardiac surgery.

BMC Anesthesiol 2020 02 20;20(1):41. Epub 2020 Feb 20.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Background: Reversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery.

Methods: This retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery.

Results: A total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036).

Conclusions: This retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.
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http://dx.doi.org/10.1186/s12871-020-00962-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033926PMC
February 2020

Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials.

J Clin Med 2020 Feb 11;9(2). Epub 2020 Feb 11.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p < 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p < 0.001) or isobaric lidocaine (p < 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.
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http://dx.doi.org/10.3390/jcm9020493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074456PMC
February 2020

Anesthetic considerations for urologic surgeries.

Korean J Anesthesiol 2020 04 17;73(2):92-102. Epub 2019 Dec 17.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Urologic surgeries are widely performed, and the cases have increased owing to the fact that the elderly population is growing. The narrow and limited surgical space is a challenge in performing most urologic surgeries. Additionally, the elderly population is exposed to the risk of perioperative complications; therefore, a comprehensive understanding and approach are required to provide optimized anesthesia during surgery. We have searched the literature on anesthesia for urologic surgeries and summarized the anesthetic considerations for urologic surgeries.
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http://dx.doi.org/10.4097/kja.19437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113163PMC
April 2020

The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial.

J Clin Med 2019 Oct 25;8(11). Epub 2019 Oct 25.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Scarless remote access endoscopic and robotic thyroidectomy has been recently performed as a safe and feasible method. However, little is known about the laryngo-pharyngeal complications after surgery and the effect of adjusting the endotracheal tube cuff pressure during surgery on laryngo-pharyngeal complications. Patients were randomized into two groups: the control group ( = 52) and adjusted group ( = 52). The initial cuff pressure was set to 25 mmHg and then monitored without adjustment (control group) or with adjustment at approximately 25 mmHg (adjusted group) throughout surgery. The incidences and severity of postoperative sore throat (POST), hoarseness, dysphagia, and cough were recorded at 1, 6, 24, and 48 h after surgery. Cuff pressures of the control group changed significantly over time and were higher than those of the adjusted group. The incidence of POST was lower in the adjusted group at 24 h postoperatively ( = 0.035), and there was a significant difference in the severity of POST at 6 and 24 h postoperatively between the two groups. There were no differences in the incidence of hoarseness, dysphagia, and cough between the two groups, except dysphagia and cough at 6 h postoperatively. Therefore, intraoperative monitoring and adjustment of the cuff pressure can reduce the incidence of laryngo-pharyngeal complications.
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http://dx.doi.org/10.3390/jcm8111787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912494PMC
October 2019

The Effect of Perioperative Intravenous Iron on Hemoglobin in Surgical Patients: A Meta-Analysis.

J Surg Res 2020 02 24;246:42-51. Epub 2019 Sep 24.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address:

Background: Patient blood management aims to maintain hemoglobin level, minimize blood loss, and avoid unnecessary blood transfusion. Ferric carboxymaltose, an intravenous iron agent, was included as a part of surgical patient blood management strategy. However, it is still controversial that ferric carboxymaltose can reduce transfusion requirements. The purpose of this systematic review and meta-analysis is to evaluate the benefits of perioperative ferric carboxymaltose on the postoperative hematological parameters and transfusion requirements.

Methods: Randomized controlled trials evaluating the effects of ferric carboxymaltose were searched through databases: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and KoreaMed. Meta-analysis was performed using random effect models.

Results: A total of 8 studies (n = 471) were included in the final analysis. Postoperative hemoglobin was higher in the ferric carboxymaltose group than in the control group (mean difference [MD], 0.58 g/dL; 95% confidence interval [CI], 0.36 to 0.80; P < 0.00001). Postoperative serum ferritin and transferrin saturation were also higher in the ferric carboxymaltose group (MD, 373.85 μg/L; 95% CI, 298.13 to 449.56; P < 0.00001; MD, 10.35%; 95% CI, 4.59 to 16.10; P < 0.00001, respectively). However, there were no significant differences in the number of transfused patients, length of hospital stay, and adverse events between groups. Subgroup analysis revealed that adverse events were lower in the ferric carboxymaltose group than the oral iron group.

Conclusions: This study supports that ferric carboxymaltose may increase the postoperative hemoglobin level in surgical patients. However, transfusion requirements could not be reduced by ferric carboxymaltose. Optimal dose and time should be further analyzed.
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http://dx.doi.org/10.1016/j.jss.2019.08.023DOI Listing
February 2020

Effect of Immersive Virtual Reality Education Before Chest Radiography on Anxiety and Distress Among Pediatric Patients: A Randomized Clinical Trial.

JAMA Pediatr 2019 Nov;173(11):1026-1031

Department of Anesthesiology and Pain Medicine, Medical Virtual Reality Research Group, Seoul National University College of Medicine, Gwanak-gu, Seoul, Republic of Korea.

Importance: Pediatric patients often encounter anxiety and distress in hospital settings, and virtual reality education, providing a vivid, immersive, and realistic experience, has been introduced to mitigate these anxiety responses.

Objective: To evaluate whether virtual reality education for pediatric patients before chest radiography could reduce anxiety and distress in children and improve the radiographic process.

Design, Setting, And Participants: This prospective randomized clinical trial was conducted in a tertiary academic hospital in Seongnam, Republic of Korea. Participants (n = 112) were children aged 4 to 8 years who underwent chest radiography between July 20, 2018, and September 11, 2018. Analysis was performed from October 2, 2018, to April 23, 2019.

Interventions: Children were randomized to simple verbal instruction (control group) or 3-minute virtual reality education explaining the process of chest radiography in detail and leading to appropriate cooperation (virtual reality group).

Main Outcomes And Measures: The primary outcome was anxiety and distress among pediatric patients based on behavioral observations using the amended version of the Observational Scale of Behavioral Distress scale for radiology procedures (total score of 30, with a score <5 indicating less distressed and a score ≥5 indicating more distressed). Secondary outcomes were the need of parental presence, parental satisfaction score, procedure time, number of repeated images, and process difficulty score.

Results: Of 99 children included in the final analysis, 50 (50.5%) were allocated to the control group (mean [SD] age, 5.6 [1.2] years; 26 boys [52.0%]) and 49 (49.5%) to the virtual reality group (mean [SD] age, 5.8 [1.3] years; 32 boys [65.3%]). The mean (SD) score for anxiety and distress (2.0 [3.7] vs 5.0 [6.1]; mean difference, 3.0 [95% CI, 1.0-5.0]; P = .004), need for parental presence (8 cases with parents present [16.3%] vs 18 cases with parents present [36.0%]), and mean (SD) procedure time (55.1 [21.6] seconds vs 75.0 [42.0] seconds) were lower in the virtual reality group than in the control group. The mean (SD) score for parental satisfaction (9.4 [1.4] vs 8.6 [2.0]) was higher in the virtual reality group than in the control group.

Conclusions And Relevance: Virtual reality education before chest radiography improved the radiography experience among pediatric patients by reducing anxiety, distress, and procedure time while increasing parents' satisfaction.

Trial Registration: UMIN Clinical Trials Registry: UMIN000030663.
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http://dx.doi.org/10.1001/jamapediatrics.2019.3000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735421PMC
November 2019

Effects of deep neuromuscular blockade on the stress response during laparoscopic gastrectomy Randomized controlled trials.

Sci Rep 2019 08 27;9(1):12411. Epub 2019 Aug 27.

Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea.

Maintaining deep neuromuscular block during surgery improves surgical space conditions. However, its effects on patient outcomes have not been well documented. We examined whether maintaining deep neuromuscular blockade during surgery could decrease the stress response compared to moderate neuromuscular blockade. Patients undergoing laparoscopic gastrectomy were randomly allocated to either the moderate (train-of-four counts of 1-2) or deep (post-tetanic counts of 1-2) neuromuscular blockade group. The primary outcome variable was the postoperative blood level of interleukin-6, and the secondary outcome variables were intraoperative or postoperative blood levels of tumor necrosis factor-α, interleukin-1β, interleukin-8, and C-reactive protein. A total of 96 patients were recruited and 88 (44 in each group) were included in the analyses. The levels of tumor necrosis factor-α and interleukin-1β measured at the end of surgery, interleukin-6 and interleukin-8 measured at 2 h postoperatively, and C-reactive protein measured at 48 h postoperatively were all significantly increased compared to the preoperative values, but there were no differences between the moderate and deep neuromuscular block groups. We found no differences in surgical stress response measured using determining levels of interleukin-6 and other mediators released between the moderate and deep neuromuscular blockade groups in patients undergoing laparoscopic gastrectomy.
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http://dx.doi.org/10.1038/s41598-019-48919-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711963PMC
August 2019

Ultrasound assessment of the anatomic landmarks for spinal anesthesia in elderly patients with hip fracture: A prospective observational study.

Medicine (Baltimore) 2019 Jul;98(27):e16388

Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul.

Tuffier line is a common landmark for spinal anesthesia. The 10th rib line has been suggested as a new landmark to predict the intervertebral levels. We evaluated the accuracy of these 2 anatomic landmarks for identifying the L4-L5 intervertebral space using ultrasonography in elderly patients with hip fracture.Seventy-nine elderly patients scheduled for hip fracture surgery under spinal anesthesia were included. In the lateral decubitus position with the fracture side up, the L4-L5 intervertebral space was identified alternately using Tuffier line, a line drawn between the highest points of both iliac crests, and the 10th rib line. The 10th rib line, an imaginary line that joints the 2 lowest points of the rib cage, passes through the L1-L2 intervertebral space or the body of L2. The L4-L5 intervertebral space was determined by the counting-down method from the 10th rib line. Then, the estimated intervertebral spaces were evaluated using ultrasonography.The L4-L5 intervertebral space was correctly identified in 47 (59%) patients with Tuffier line and 45 (57%) patients with the 10th rib line (P = .87). The estimation ratio related to the intervertebral levels was not different between the 2 landmarks (P = .40). The wrong identifications of intervertebral level with Tuffier line and the 10th rib line was observed in the following order: L3-L4 intervertebral space: 27% vs 24%, L5-S1 intervertebral space: 9% vs 16%, and L2-L3 intervertebral space: 5% vs 3%, respectively.Tuffier line and the 10th rib line may be unreliable to estimate the intervertebral space for spinal anesthesia in elderly patients with hip fracture.
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http://dx.doi.org/10.1097/MD.0000000000016388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635173PMC
July 2019

The Effects of Intraoperative Inspired Oxygen Fraction on Postoperative Pulmonary Parameters in Patients with General Anesthesia: A Systemic Review and Meta-Analysis.

J Clin Med 2019 Apr 28;8(5). Epub 2019 Apr 28.

Department of Anesthesiology & Pain medicine, Seoul National University College of Medicine, Seoul 03080, Korea.

High intraoperative inspired oxygen concentration is applied to prevent desaturation during induction and recovery of anesthesia. However, high oxygen concentration may lead to postoperative pulmonary complications. The purpose of this study is to compare the postoperative pulmonary parameters according to intraoperative inspired oxygen fraction in patients undergoing general anesthesia. We identified all randomized controlled trials investigating postoperative differences in arterial gas exchange according to intraoperative fraction of inspired oxygen (FiO). A total of 10 randomized controlled trials were included, and 787 patients were analyzed. Postoperative PaO was lower in the high FiO group compared with the low FiO group (mean difference (MD) -4.97 mmHg, 95% CI -8.21 to -1.72, = 0.003). Postoperative alveolar-arterial oxygen gradient (AaDO) was higher (MD 3.42 mmHg, 95% CI 0.95 to 5.89, = 0.007) and the extent of atelectasis was more severe (MD 2.04%, 95% CI 0.14 to 3.94, = 0.04) in high intraoperative FiO group compared with low FiO group. However, postoperative SpO was comparable between the two groups. The results of this meta-analysis suggest that high inspired oxygen fraction during anesthesia may impair postoperative pulmonary parameters. Cautious approach in intraoperative inspired oxygen fraction is required for patients susceptible to postoperative pulmonary complications.
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http://dx.doi.org/10.3390/jcm8050583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572026PMC
April 2019
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