Publications by authors named "Young-Tae Jeon"

157 Publications

Magnesium Sulfate Enables Patient Immobilization during Moderate Block and Ameliorates the Pain and Analgesic Requirements in Spine Surgery, Which Can Not Be Achieved with Opioid-Only Protocol: A Randomized Double-Blind Placebo-Controlled Study.

J Clin Med 2021 Sep 22;10(19). Epub 2021 Sep 22.

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seong-nam 13620, Korea.

Spine surgery is painful despite the balanced techniques including intraoperative and postoperative opioids use. We investigated the effect of intraoperative magnesium sulfate (MgSO) on acute pain intensity, analgesic consumption and intraoperative neurophysiological monitoring (IOM) during spine surgery. Seventy-two patients were randomly allocated to two groups: the Mg group or the control group. The pain intensity was significantly alleviated in the Mg group at 24 h (3.2 ± 1.7 vs. 4.4 ± 1.8, = 0.009) and 48 h (3.0 ± 1.2 vs. 3.8 ± 1.6, = 0.018) after surgery compared to the control group. Total opioid consumption was reduced by 30% in the Mg group during the same period ( = 0.024 and 0.038, respectively). Patients in the Mg group required less additional doses of rocuronium (0 vs. 6 doses, = 0.025). Adequate IOM recordings were successfully obtained for all patients, and abnormal IOM results denoting warning criteria (amplitude decrement >50%) were similar. Total intravenous anesthesia with MgSO combined with opioid-based conventional pain control enables intraoperative patient immobilization without the need for additional neuromuscular blocking drugs and reduces pain intensity and analgesic requirements for 48 h after spine surgery, which is not achieved with only opioid-based protocol.
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http://dx.doi.org/10.3390/jcm10194289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509453PMC
September 2021

The antioxidant effect of preischemic dexmedetomidine in a rat model: increased expression of Nrf2/HO-1 via the PKC pathway.

Braz J Anesthesiol 2021 Sep 21. Epub 2021 Sep 21.

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

Background: The precise underlying mechanism of antioxidant effects of dexmedetomidine-induced neuroprotection against cerebral ischemia has not yet been fully elucidated. Activation of Nuclear factor erythroid 2-related factor (Nrf2) and Heme Oxygenase-1 (HO-1) represents a major antioxidant-defense mechanism. Therefore, we determined whether dexmedetomidine increases Nrf2/HO-1 expression after global transient cerebral ischemia and assessed the involvement of Protein Kinase C (PKC) in the dexmedetomidine-related antioxidant mechanism.

Methods: Thirty-eight rats were randomly assigned to five groups: sham (n = 6), ischemic (n = 8), chelerythrine (a PKC inhibitor; 5 mg.kg IV administered 30 min before cerebral ischemia) (n = 8), dexmedetomidine (100 µg.kg IP administered 30 min before cerebral ischemia (n = 8), and dexmedetomidine + chelerythrine (n = 8). Global transient cerebral ischemia (10 min) was applied in all groups, except the sham group; histopathologic changes and levels of nuclear Nrf2 and cytoplasmic HO-1 were examined 24 hours after ischemia insult.

Results: We found fewer necrotic and apoptotic cells in the dexmedetomidine group relative to the ischemic group (p < 0.01) and significantly higher Nrf2 and HO-1 levels in the dexmedetomidine group than in the ischemic group (p < 0.01). Additionally, chelerythrine co-administration with dexmedetomidine attenuated the dexmedetomidine-induced increases in Nrf2 and HO-1 levels (p < 0.05 and p < 0.01, respectively) and diminished its beneficial neuroprotective effects.

Conclusion: Preischemic dexmedetomidine administration elicited neuroprotection against global transient cerebral ischemia in rats by increasing Nrf2/HO-1 expression partly via PKC signaling, suggesting that this is the antioxidant mechanism underlying dexmedetomidine-mediated neuroprotection.
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http://dx.doi.org/10.1016/j.bjane.2021.08.005DOI Listing
September 2021

Decreased income, unemployment, and disability after craniotomy for brain tumor removal: a South Korean nationwide cohort study.

Support Care Cancer 2021 Sep 23. Epub 2021 Sep 23.

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

Purpose: We aimed to investigate the prevalence of quality-of-life deterioration and associated factors in patients who underwent craniotomies for brain tumor removal. Additionally, we examined whether deteriorating quality of life after surgery might affect mortality.

Methods: As a national population-based cohort study, data were extracted from the National Health Insurance Service database of South Korea. Adult patients (≥ 18 years old) who underwent craniotomy for excision of brain tumors after diagnosis of malignant brain tumor between January 1, 2011, and December 31, 2017, were included in this study.

Results: A total of 4852 patients were included in the analysis. Among them, 2273 patients (46.9%) experienced a deterioration in quality of life after surgery. Specifically, 595 (12.3%) lost their jobs, 1329 (27.4%) experienced decreased income, and 844 (17.4%) patients had newly acquired disabilities. In the multivariable Cox regression model, a lower quality of life was associated with a 1.41-fold higher 2-year all-cause mortality (hazard ratio: 1.41, 95% confidence interval: 1.27-1.57; P < 0.001). Specifically, newly acquired disability was associated with 1.80-fold higher 2-year all-cause mortality (hazard ratio: 1.80, 95% confidence interval: 1.59-2.03; P < 0.001), while loss of job (P = 0.353) and decreased income (P = 0.599) were not significantly associated.

Conclusions: At 1-year follow-up, approximately half the patients who participated in this study experienced a deterioration in the quality-of-life measures of unemployment, decreased income, and newly acquired disability after craniotomy for excision of brain tumors. Newly acquired disability was associated with increased 2-year all-cause mortality.
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http://dx.doi.org/10.1007/s00520-021-06575-1DOI Listing
September 2021

Depression and mortality after craniotomy for brain tumor removal: A Nationwide cohort study in South Korea.

J Affect Disord 2021 Dec 29;295:291-297. Epub 2021 Aug 29.

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

Background: We aimed to investigate the prevalence and associated factors of newly developed depression in patients who underwent craniotomy for brain tumor removal, as well as its effect on long-term mortality.

Methods: Using a nationwide cohort database in South Korea, we included adult patients diagnosed with brain tumors who underwent craniotomy for brain tumor removal from January 1, 2011, to December 31, 2017. We excluded patients with a preoperative history of depression.

Results: Among 4,275 patients, 727 (17.0%) patients were newly diagnosed with depression within one year, postoperatively. Two-year all-cause mortality and mortality due to brain cancer occurred in 1,233 (28.8%) and 1,099 (25.7%) patients, respectively. In the multivariable logistic regression model, older age, living in rural areas, newly acquired brain disability, underlying other psychiatric disorders, and longer length of hospital stay were associated with a higher incidence of newly developed depression. In the multivariable Cox regression model, newly acquired depression was associated with a 1.58-fold higher 2-year all-cause mortality compared with that in other patients (hazard ratio: 1.58, 95% confidence interval: 1.38-1.80; P < 0.001).

Limitation: Lack of information regarding severity and pathologic tumor type.

Conclusion: Within one follow-up year, 17.0% of patients were newly diagnosed with depression after craniotomy for brain tumor removal. Some factors (old age, living in rural areas, newly acquired brain disability, longer length of hospital stay, and underlying other psychiatric illnesses) could be risk factors for newly diagnosed depression. Furthermore, newly developed depression was associated with an increased 2-year all-cause mortality.
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http://dx.doi.org/10.1016/j.jad.2021.08.058DOI Listing
December 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

Musculoskeletal Disorders, Pain Medication, and in-Hospital Mortality among Patients with COVID-19 in South Korea: A Population-Based Cohort Study.

Int J Environ Res Public Health 2021 06 24;18(13). Epub 2021 Jun 24.

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

We aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with coronavirus disease 2019 (COVID-19). Adult patients (≥20 years old) with a positive COVID-19 diagnosis until 5 June 2020 were included in this study, based on the National Health Insurance COVID-19 database in South Korea. MSDs included osteoarthritis, neck pain, lower back pain, rheumatoid arthritis, and others, while pain medication included paracetamol, gabapentin, pregabalin, glucocorticoid, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (strong and weak opioids), and benzodiazepine. Primary endpoint was in-hospital mortality. A total of 7713 patients with COVID-19 were included, and in-hospital mortality was observed in 248 (3.2%) patients. In multivariate logistic regression analysis, no MSDs ( > 0.05) were significantly associated with in-hospital mortality. However, in-hospital mortality was 12.73 times higher in users of strong opioids (odds ratio: 12.73, 95% confidence interval: 2.44-16.64; = 0.002), while use of paracetamol ( = 0.973), gabapentin or pregabalin ( = 0.424), glucocorticoid ( = 0.673), NSAIDs ( = 0.979), weak opioids ( = 0.876), and benzodiazepine ( = 0.324) was not associated with in-hospital mortality. In South Korea, underlying MSDs were not associated with increased in-hospital mortality among patients with COVID-19. However, use of strong opioids was significantly associated with increased in-hospital mortality among the patients.
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http://dx.doi.org/10.3390/ijerph18136804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295800PMC
June 2021

Blood Pressure and Transient Postoperative Neurologic Deterioration, Following Superficial Temporal-to-Middle Cerebral Artery Anastomosis in Adult Patients with Moyamoya Disease: A Retrospective Cohort Study.

J Clin Med 2021 Jun 10;10(12). Epub 2021 Jun 10.

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

We investigated whether intraoperative systolic blood pressure (ISBP) is associated with the risk of transient neurologic deficits (TND) following superficial temporal-to-middle cerebral artery (STA-MCA) anastomosis in adult patients with moyamoya disease (MMD). In this retrospective observational study, data from adult patients with MMD who had undergone STA-MCA anastomosis at a single tertiary academic hospital during May 2003-April 2014 were examined. Data on patient characteristics were obtained from electronic medical records, including the details of comorbidities and laboratory findings. TND was the primary outcome of interest. Out of 192 patients (228 hemispheres), 66 (29%) hemispheres had TND after surgery. There were significant differences in ISBP between patients with and without TND. The lowest ISBP quartile was independently associated with TND (odds ratio: 5.50; 95% confidence interval: 1.96-15.46). Low ISBP might lead to TND after STA-MCA anastomosis in adult patients with MMD. In patients with poor perfusion status, low ISBP was associated with an increased risk of TND. Our findings suggest that strict ISBP control might be required to prevent TND after anastomosis in patients with MMD, in particular, in patients with poor perfusion status. Given limitations due to the retrospective design, further studies are needed to clarify these findings.
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http://dx.doi.org/10.3390/jcm10122567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227225PMC
June 2021

Comparison of All-Cause Mortality Between Individuals With COVID-19 and Propensity Score-Matched Individuals Without COVID-19 in South Korea.

Open Forum Infect Dis 2021 Apr 1;8(4):ofab057. Epub 2021 Feb 1.

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

Background: We compared all-cause mortality between individuals in South Korea with and without coronavirus disease 2019 (COVID-19) using propensity score (PS) matching.

Methods: This population-based cohort study used data from the National Health Insurance Service COVID-19 cohort database. In the database, we included individuals (COVID-19 patients, control population, and test-negative individuals) aged 20 years or older, regardless of hospitalization. The primary end point was all-cause mortality between January 1, 2020, and August 27, 2020.

Results: A total of 328 374 adults were included in the study: 7713 and 320 660 in the COVID-19 group and the control group. After PS matching, a total of 15 426 individuals (7713 per group) were included in the analysis. All-cause mortality was 3.2% (248/7713) and 1.6% (126/7713) in the COVID-19 group and the control group, respectively. In Cox regression analysis after PS matching, the risk of death in the COVID-19 group was twice as high (hazard ratio, 2.00; 95% CI, 1.61-2.48;  < .001) as that in the control group. Among patients aged ≥60 years, the COVID-19 group had a 2.32-fold higher all-cause mortality compared with the control group, while statistically significant differences were not observed in the age groups 20-39 years ( = .339) and 40-59 years ( = .562).

Conclusions: In South Korea, all-cause mortality was twice as high among individuals with COVID-19 as among those with similar underlying risks, primarily because of the elevated COVID-19-associated mortality in those aged ≥60 years. Our results highlight the need for prevention of COVID-19 with respect to mortality as a public health outcome.
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http://dx.doi.org/10.1093/ofid/ofab057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928610PMC
April 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

Statin Therapy and the Risk of COVID-19: A Cohort Study of the National Health Insurance Service in South Korea.

J Pers Med 2021 Feb 10;11(2). Epub 2021 Feb 10.

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

We aimed to investigate whether statin therapy is associated with the incidence of coronavirus disease 2019 (COVID-19) among the South Korean population. In addition, we examined whether statin therapy affects hospital mortality among COVID-19 patients. The National Health Insurance Service (NHIS)-COVID-19 database in South Korea was used for data extraction for this population-based cohort study. A total of 122,040 adult individuals, with 22,633 (18.5%) in the statin therapy group and 101,697 (91.5%) in the control group, were included in the analysis. Among them, 7780 (6.4%) individuals were diagnosed with COVID-19 and hospital mortality occurred in 251 (3.2%) COVID-19 cases. After propensity score matching, logistic regression analysis showed that the odds of developing COVID-19 were 35% lower in the statin therapy group than in the control group (odds ratio: 0.65, 95% confidence interval: 0.60 to 0.71; < 0.001). Regarding hospital mortality among COVID-19 patients, the multivariable model indicated that there were no differences between the statin therapy and control groups (odds ratio: 0.74, 95% confidence interval: 0.52 to 1.05; = 0.094). Statin therapy may have potential benefits for the prevention of COVID-19 in South Korea. However, we found that statin therapy does not affect the hospital mortality of patients who are diagnosed with COVID-19.
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http://dx.doi.org/10.3390/jpm11020116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916713PMC
February 2021

Author Correction: Associations between hand function and electrophysiological measurements in hand osteoarthritis patients of different ages with or without carpal tunnel syndrome.

Sci Rep 2021 Feb 1;11(1):3225. Epub 2021 Feb 1.

Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1038/s41598-021-82090-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851381PMC
February 2021

Predictive factors of unacceptable movement and motor-evoked potentials during intraoperative neurophysiological monitoring in adult patients undergoing brain surgery: A retrospective study.

Medicine (Baltimore) 2021 Jan;100(1):e24148

Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.

Abstract: Motor-evoked potential (MEP) monitoring is an essential monitoring for clinicians to improve outcomes. Although unacceptable movement during MEP is a rare complication but it can lead to terrible results. The aim of this study was to evaluate the risk factors associated with unacceptable movements in patients undergoing brain surgery with MEP monitoring.We performed a retrospective observational study of patients who underwent brain surgery with MEP monitoring under general anesthesia while using a partial neuromuscular blocker in a tertiary care hospital from January 2014 to August 2017. Unacceptable movement was defined as a condition in which MEP stimulation induced vigorous movement of patient hindered the smooth progress of the operation. We compared the baseline patient characteristics and laboratory results according to unacceptable movements during surgery to identify factors associated with unacceptable movement during MEP monitoring.768 patients were included in this analysis, and unacceptable movements were observed in 278 patients (36.2%). A multivariate logistic regression analysis revealed that an increase in ionized calcium was associated with the most strongly unpredictable movement during surgery [odds ratio (OR): 1.79, 95% confidence interval (CI): 1.37-2.36, P < .001]. In addition, age (OR, 0.98; 95% CI, 0.96-0.99; P = .001), male sex (OR, 1.59; 95% CI, 1.09-2.33; P = .017), and body mass index (OR, 0.90; 95% CI, 0.86-0.95; P <0.0010) were also associated with unacceptable movement. Serum ionized calcium concentration was the best predictor associated with unacceptable movement with MEP monitoring under general anesthesia.Serum ionized calcium concentration was the best predictor associated with unacceptable movement with MEP monitoring under general anesthesia.
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http://dx.doi.org/10.1097/MD.0000000000024148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793426PMC
January 2021

Associations between hand function and electrophysiological measurements in hand osteoarthritis patients of different ages with or without carpal tunnel syndrome.

Sci Rep 2020 11 6;10(1):19278. Epub 2020 Nov 6.

Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Osteoarthritis is a common degenerative disease that most frequently involves the hand. The objective was to compare clinical functional outcome measures including hand grip, pinch strength, and dexterity with various electrophysiological measures in patients of different ages with hand osteoarthritis with or without the presence of carpal tunnel syndrome (CTS). Patients with hand osteoarthritis (208 patients, 404 hands) who underwent hand-function tests and motor and sensory nerve conduction studies (NCS) between June 2015 and June 2016 were enrolled. The patients' hands were assigned to carpal tunnel syndrome (CTS) (206 hands; mean age, 56.37 ± 10.52; male:female, 46:160) or control groups (198 hands; mean age, 57.88 ± 9.68; male:female, 55:143). The strength of hand grip and lateral pinch, the time required to complete the nine-hole pegboard test (9HPT), and motor and sensory nerve conduction parameters were measured and compared across age groups and between hands with or without CTS. The CTS group showed significantly lower hand grip and lateral pinch strength, and a longer time to complete the 9HPT in comparison with the control group. Female patients showed significantly lower hand grip and lateral pinch strength than male patients. However, there was no difference in the 9HPT completion time between genders. Multivariate regression analysis identified the amplitude of the median compound muscle action potential (CMAP), age, and male gender as independent predictors of grip strength (adjusted R = 0.679), and amplitude of median CMAP and male gender as independent predictors of KP strength (adjusted R = 0.603). Velocity of median CMAP, amplitude of median sensory nerve action potential, and age were identified as independent predictors of 9HPT time (adjusted R = 0.329). Nerve conduction measurements were significantly related to hand-function test results, and CTS induced significant deficits in strength and performance of the affected hand.
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http://dx.doi.org/10.1038/s41598-020-74795-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648779PMC
November 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

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

Comparison of the effects of sugammadex and neostigmine on hospital stay in robot-assisted laparoscopic prostatectomy: a retrospective study.

BMC Anesthesiol 2020 07 21;20(1):178. Epub 2020 Jul 21.

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

Background: Sugammadex reduces postoperative complications. We sought to determine whether it could reduce the length of hospital stay, post-anesthetic recovery time, unplanned readmission, and charges for patients who underwent robot-assisted laparoscopic prostatectomy (RALP) when compared to neostigmine.

Methods: This was a retrospective observational study of patients who underwent RALP between July 2012 and July 2017, in whom rocuronium was used as a neuromuscular blocker. The primary outcome was the length of hospital stay after surgery in patients who underwent reversal with sugammadex when compared to those who underwent reversal with neostigmine. The secondary outcomes were post-anesthetic recovery time, hospital charges, and unplanned readmission within 30 days after RALP.

Results: In total, 1430 patients were enrolled. Using a generalized linear model in a propensity score-matched cohort, sugammadex use was associated with a 6% decrease in the length of hospital stay (mean: sugammadex 7.7 days vs. neostigmine 8.2 days; odds ratio [OR] 0.94, 95% confidence interval [CI] [0.89, 0.98], P = 0.008) and an 8% decrease in post-anesthetic recovery time (mean: sugammadex 36.7 min vs. neostigmine 40.2 min; OR 0.92, 95% CI [0.90, 0.94], P < 0.001) as compared to neostigmine use; however, it did not reduce the 30-day unplanned readmission rate (P = 0.288). The anesthesia charges were higher in the sugammadex group than in the neostigmine group (P < 0.001); however, there were no significant differences between the groups in terms of postoperative net charges (P = 0.061) and total charges (P = 0.100).

Conclusions: Compared to the reversal of rocuronium effects with neostigmine, reversal with sugammadex after RALP was associated with a shorter hospital stay and post-anesthetic recovery time, and was not associated with 30-day unplanned readmission rates and net charges.
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http://dx.doi.org/10.1186/s12871-020-01088-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372771PMC
July 2020

Pre-operative chronic opioid or glucocorticoid use and mortality after noncardiac surgery: A retrospective cohort study.

Eur J Anaesthesiol 2020 Oct;37(10):926-933

From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (TKO, SK, I-AS, Y-TJ) and Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea (Y-TJ).

Background: The chronic use of opioids and glucocorticoids is associated with serious side effects. Moreover, both medications are related to poor long-term postoperative outcomes.

Objective: The study aimed to investigate the association between pre-operative chronic opioid and glucocorticoid use and 90-day mortality after noncardiac surgery.

Design: Retrospective, population-based cohort study.

Setting: Single tertiary academic hospital.

Patients: The study enrolled adult (≥18 years of age) patients admitted to Seoul National University Bundang Hospital, between January 2012 and December 2018 for planned, elective, noncardiac surgery.

Main Outcome Measures: The study compared the 90-day mortality for patients using opioids or glucocorticoids chronically (≥3 months) prior to surgery and for opioid-naïve and glucocorticoid-naïve patients.

Results: A total of 112 606 patients were included in the study. Among them, 107 843 (95.9%) were opioid-naïve and glucocorticoid-naïve patients; 3373 (3.0%), 1199 (1.1%) and 191 patients (0.2%) were chronic users of opioids, glucocorticoids or both, respectively. In the multivariable model, compared with opioid-naïve and glucocorticoid-naïve patients, the odds of dying within 90 days were significantly higher for chronic users of opioids [3.56-fold; 95% confidence intervals (CIs) 2.36 to 5.38; P < 0.001], glucocorticoids (4.17-fold; 95% CI 3.28 to 5.29; P < 0.001) and combined opioids and glucocorticoids (7.66-fold; 95% CI 3.91 to 15.01; P < 0.001).

Conclusion: Chronic pre-operative use of opioids and glucocorticoids, together or individually, were associated with increased 90-day mortalities after noncardiac surgery, compared with opioid-naïve and glucocorticoid-naïve patients. Our results suggest that chronic pre-operative use of opioids and glucocorticoids should be managed carefully.
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http://dx.doi.org/10.1097/EJA.0000000000001212DOI Listing
October 2020

Effects of body weight support and gait velocity via antigravity treadmill on cardiovascular responses early after total knee arthroplasty.

Medicine (Baltimore) 2020 Apr;99(14):e19586

Department of Rehabilitation Medicine.

To investigate the effects of body weight support (BWS) and gait velocity on cardiovascular responses during walking on an antigravity treadmill early after unilateral and bilateral total knee arthroplasty (TKA).This study was a cross-sectional study design. Fifty patients (7 males and 43 females; average age, 72.0 ± 5.1 years) at 4 weeks after unilateral (n = 25) and bilateral (n = 25) primary TKA were enrolled in the study. Subjects walked on an antigravity treadmill at speeds of 2.5 km/hour and 3.5 km/hour with 3 levels (50%, 25%, and 0%) of BWS. Cardiovascular responses were monitored by measuring oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), the respiratory exchange ratio (RER), and rate pressure product (RPP). Borg rating of perceived exertion (RPE) and a visual analog scale (VAS) of knee pain were recorded immediately after each trial.There were no significant differences in cardiovascular responses between the unilateral and bilateral TKA groups. In the repeated measures Analysis of Variance, VO2 levels, HR, RPP, RPE, RER, and VAS were significantly increased in proportion to 3 levels (50%, 25%, and 0%) of BWS for unilateral and bilateral TKA groups, respectively. Meanwhile, SBP and DBP were unaffected by differences in BWS. At 3.5 km/hour, VO2, RPE, and RER values were statistically greater than those at 2.5 km/hour under the same BWS conditions.We found that the reduction in the metabolic demand of activity, coupled with positive pressure on the lower extremities, reduced VO2 and HR values as BWS increased.Cardiovascular responses vary according to BWS and gait velocity during antigravity treadmill walking. BWS rather than gait velocity had the greatest effect on cardiovascular responses and knee pain.
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http://dx.doi.org/10.1097/MD.0000000000019586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220790PMC
April 2020

Effects of sevoflurane on neuronal cell damage after severe cerebral ischemia in rats.

Korean J Anesthesiol 2020 Feb 28;73(1):85. Epub 2020 Jan 28.

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

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http://dx.doi.org/10.4097/kjae.2011.61.4.327.e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000274PMC
February 2020

The Effect of a Transdermal Scopolamine Patch on Postoperative Nausea and Vomiting after Retromastoid Craniectomy with Microvascular Decompression: A Preliminary Single Center, Double-Blind, Randomized Controlled Trial.

J Clin Med 2020 Jan 7;9(1). Epub 2020 Jan 7.

Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea.

We performed this prospective double-blind randomized controlled trial to identify the effect of a preoperative prophylactic transdermal scopolamine (TDS) patch on postoperative nausea and vomiting (PONV) after retromastoid craniectomy with microvascular decompression (RMC-MVD). We recruited 38 patients undergoing RMC-MVD and randomized them into two groups: the TDS group ( = 19, application of the TDS patch) and placebo group ( = 19, application of a sham patch). Nausea (as a self-reported 100-mm visual analog scale (VAS) score; range, 0 (no nausea) to 10 (worst nausea)), vomiting, and the use of antiemetics were the primary endpoints. There was no significant difference in terms of the incidence of PONV (73.7% in the TDS group and 78.9% in the placebo group; = 1.00) between the groups. However, the mean nausea VAS score was significantly different at arrival to the general ward (0.93 ± 1.71 in the TDS group vs. 2.52 ± 2.85 in the placebo group; p = 0.046), and throughout the study period (0.03 ± 0.07 in the TDS group vs. 0.44 ± 0.71 in the placebo group; p = 0.029). Rescue antiemetics were more frequently used in the placebo group than in the TDS group (9 (47.4%) vs. 2 (10.5%), respectively; = 0.029). The mean number of antiemetics used throughout the study period was significantly higher in the placebo group than in the TDS group (1.37 ± 2.19 vs. 0.16 ± 0.50, respectively; p = 0.029). The preoperative prophylactic use of a TDS patch was safe and effective in the management of PONV after RMC-MVD in terms of the severity of PONV and the use of rescue antiemetics.
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http://dx.doi.org/10.3390/jcm9010156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019292PMC
January 2020

Preoperative Statin Use and 90-Day Mortality after Noncardiac Surgery: A Hospital Registry Study.

Ann Surg 2019 Dec 10. Epub 2019 Dec 10.

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

Objective: The aim of this study was to investigate the association between preadmission statin use and 90-day mortality after planned elective noncardiac surgery in adult patients.

Summary Background Data: Statin therapy is known to have pleiotropic effects, which improve the outcomes of various diseases. However, the effect of perioperative statin therapy on postoperative mortality remains controversial.

Methods: This retrospective cohort study analyzed the medical records of adult patients who were admitted to a single tertiary academic hospital for elective noncardiac surgery between January 2012 and December 2018. The primary endpoint was 90-day mortality, which was defined as any mortality within 90 days after surgery. The secondary endpoint was overall survival.

Results: After propensity score matching, a total of 33,514 patients (16,757 patients in each group) were included in the analysis. The logistic regression analysis of the propensity score-matched cohort indicated that the odds ratio (OR) of 90-day mortality in the statin group was 26% lower than that of the nonstatin group [OR: 0.74; 95% confidence interval (CI): 0.59 to 0.92; P = 0.009]. The sensitivity analysis indicated that the high-dose intensity statin group had a 61% lower 90-day mortality rate than the nonstatin group (OR: 0.39; 95% CI: 0.18-0.84; P = 0.016). The overall survival time was significantly longer in the statin group than in the nonstatin group after propensity score matching (P < 0.001 by log-rank test).

Conclusions: Preoperative statin use was associated with lower 90-day mortality and longer overall survival for adult patients who underwent elective noncardiac surgery. This association was more evident for high-intensity statin users.
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http://dx.doi.org/10.1097/SLA.0000000000003737DOI Listing
December 2019

Impact of Glasgow Coma Scale scores on unplanned intensive care unit readmissions among surgical patients.

Ann Transl Med 2019 Oct;7(20):520

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

Background: Physiological instability at discharge from intensive care units (ICU) is known to increase readmission rates among critically ill patients. However, associations between consciousness levels at discharge and readmission rates remain unclear. This study aimed to investigate the association between the Glasgow Coma Scale (GCS) score at discharge and unplanned ICU readmissions in surgical patients.

Methods: This retrospective cohort study in a single tertiary academic hospital analyzed the electronic health records of adults aged 18 years or older, who were discharged from the ICU between January 2012 and December 2018. The primary endpoint was unplanned readmission within 48 hours after discharge. Multivariable logistic regression analysis was performed.

Results: Among 9,512 patients, unplanned readmissions occurred in 161 (1.7%). At discharge, GCS and verbal response scores of ≤13 ( ≥14) were associated with 2.28-fold higher unplanned readmissions within 48 hours [odds ratio (OR): 2.35, 95% confidence interval (CI): 1.51-3.65, P<0.001]. Sensitivity analysis showed that verbal response scores of ≤4 ( 5) at ICU discharge were associated with 2.21-fold higher unplanned readmissions within 48 hours (OR: 2.21, 95% CI: 1.49-3.29, P<0.001), whereas eye or motor responses at time of ICU discharge were not significantly associated with unplanned readmissions (P>0.05).

Conclusions: In this surgical ICU population cohort, GCS scores at ICU discharge were significantly associated with unplanned readmissions within 48 hours. This association was stronger with GCS scores of ≤13 and with verbal response scores of ≤4 at time of discharge. These findings suggest that surgical ICU patients with GCS scores of ≤13 or verbal response scores of ≤4 should be monitored carefully for discharge in order to avoid unplanned ICU readmissions.
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http://dx.doi.org/10.21037/atm.2019.10.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861751PMC
October 2019

Association of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery: A Retrospective Cohort Study.

Anesth Analg 2019 12;129(6):1494-1501

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

Background: Postoperative hyperchloremia is known to be related to increases in mortality and morbidity after surgery. However, the relationship between preoperative hyperchloremia and hypochloremia and postoperative mortality and morbidity is not well established. Our aim was to evaluate the relationship between preoperative hyperchloremia or hypochloremia, as assessed using preoperative serum chloride tests, and 90-day mortality and morbidity after noncardiac surgery.

Methods: In this retrospective cohort study, we reviewed the medical records of patients >20 years of age who underwent noncardiac surgery between January 2010 and December 2016. Patients were categorized into one of the following groups on the basis of the results of serum chloride testing performed within 1 month before surgery: normochloremia, 97-110 mmol·L; hyperchloremia, >110 mmol·L; and hypochloremia, <97 mmol·L. The primary end point of this study was the difference in postoperative 90-day mortality among the preoperative serum chloride groups. The secondary end point was the difference in postoperative acute kidney injury incidence among the preoperative serum chloride groups.

Results: A total of 106,505 patients were included in the final analysis (2147 were allocated to the preoperative hypochloremia group and 617 to the hyperchloremia group). Multivariable Cox regression analysis revealed significantly increased 90-day mortality in the hypochloremia (hazard ratio, 1.46; 95% CI, 1.16-1.84; P = .001) and hyperchloremia (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .013) groups when compared with the normochloremia group. In addition, multivariable logistic regression analysis revealed a 1.83-fold increased odds of acute kidney injury in the preoperative hypochloremia group when compared with the normochloremia group (odds ratio, 1.83; 95% CI, 1.53-2.19; P < .001).

Conclusions: Preoperative hypochloremia and hyperchloremia were related to increased 90-day mortality after noncardiac surgery. In addition, preoperative hypochloremia was related to an increased risk for postoperative acute kidney injury.
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http://dx.doi.org/10.1213/ANE.0000000000003958DOI Listing
December 2019

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

Distant metastasis of follicular thyroid carcinoma to the mandible: a rare case report.

J Korean Assoc Oral Maxillofac Surg 2019 Oct 30;45(5):294-298. Epub 2019 Oct 30.

Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea.

Treatment of metastatic carcinoma of the oral cavity can be a challenge due to its rarity. The current case report details metastatic carcinoma of the mandible originating from follicular thyroid carcinoma, which is the second most prevalent tumor of the thyroid. As the mandibular lesion developed, the primary thyroid lesion of thyroid. Here, we report a case of metastatic carcinoma of the mandible in a 67-year-old female that was treated with partial mandibulectomy and fibular free flap.
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http://dx.doi.org/10.5125/jkaoms.2019.45.5.294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838357PMC
October 2019

Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU: A retrospective association study.

Eur J Anaesthesiol 2020 Jan;37(1):31-37

From the Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (TKO, I-AS, Y-TJ) and Department of Anaesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea (Y-TJ).

Background: There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients.

Objective: To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU.

Design: Retrospective cohort study.

Setting: ICUs in single tertiary academic hospital.

Patients: Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.

Intervention: None.

Main Outcome Measures: Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used.

Results: Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1 mmol l, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P < 0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P < 0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P = 0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis.

Conclusion: In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.
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http://dx.doi.org/10.1097/EJA.0000000000001117DOI Listing
January 2020

Impact of Socioeconomic Status on 30-Day and 1-Year Mortalities after Intensive Care Unit Admission in South Korea: A Retrospective Cohort Study.

Acute Crit Care 2018 Nov 13;33(4):230-237. Epub 2018 Nov 13.

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

Background: Socioeconomic status (SES) is closely associated with health outcomes, including mortality in critically ill patients admitted to intensive care unit (ICU). However, research regarding this issue is lacking, especially in countries where the National Health Insurance System is mainly responsible for health care. This study aimed to investigate how the SES of ICU patients in South Korea is associated with mortality.

Methods: This was a retrospective observational study of adult patients aged ≥20 years admitted to ICU. Associations between SES-related factors recorded at the time of ICU admission and 30-day and 1-year mortalities were analyzed using univariable and multivariable Cox regression analyses.

Results: A total of 6,008 patients were included. Of these, 394 (6.6%) died within 30 days of ICU admission, and 1,125 (18.7%) died within 1 year. Multivariable Cox regression analysis found no significant associations between 30-day mortality after ICU admission and SES factors (P>0.05). However, occupation was significantly associated with 1-year mortality after ICU admission.

Conclusions: Our study shows that 30-day mortality after ICU admission is not associated with SES in the National Health Insurance coverage setting. However, occupation was associated with 1-year mortality after ICU admission.
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http://dx.doi.org/10.4266/acc.2018.00514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849033PMC
November 2018

Post-operative Physical Performance Factors Associated With Gait Speed in Patients Surgically Treated for Hip Fracture: A Cross-Sectional Study.

Ann Rehabil Med 2019 Oct 31;43(5):570-580. Epub 2019 Oct 31.

Department of Rehabilitation Medicine, Jeju National University College of Medicine-Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Korea.

Objective: To determine post-operative physical performance factors associated with gait speed in patients surgically treated for hip fracture.

Methods: Cross-sectional data from 59 patients (16 males and 43 females; mean age, 79.2±9.1 years) who underwent hip fracture surgery were enrolled. Patients completed a 10-meter walk test (10MWT) to assess gait speed. Additional physical performance tests included the Timed Up and Go test (TUG), the Berg Balance Scale (BBS), maximum voluntary isometric contraction (MVIC) of the knee extensors and flexors on the operated and non-operated sides as well as of the hip abductors (all tested using air-resistance weight machines), and analysis of spatio-temporal gait parameters at about 6 weeks after hip surgery.

Results: Bivariate analyses revealed a significant positive correlation between the post-operative 10MWT and the post-operative TUG, age, swing phase duration, and gait cycle duration along with a significant negative correlation between post-operative BBS score, MVIC of the knee extensors and flexors on the operated and non-operated sides, MVIC of the hip abductors, and cadence and stance phase duration. Linear regression analyses revealed that the post-operative TUG (β=0.85, p<0.01), gait cycle duration (β=0.17, p=0.02), and osteoporosis (β=-0.18, p=0.02) were associated with the post-operative 10MWT.

Conclusion: The presence of osteoporosis, post-operative balance, and isometric muscle strength in the operated and non-operated legs were statistically associated with post-operative gait speed early after hip fracture surgery.
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http://dx.doi.org/10.5535/arm.2019.43.5.570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835134PMC
October 2019

Correction to: Admission to the surgical intensive care unit during intensivist coverage is associated with lower incidence of postoperative acute kidney injury and shorter ventilator time.

J Anesth 2019 Dec;33(6):707

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

In the original publication of the article, under the abstract, the last sentence of results was published incorrectly. The correct sentence should be as below.
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http://dx.doi.org/10.1007/s00540-019-02693-7DOI Listing
December 2019
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