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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 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.

The serum lactate level is a useful predictor of mortality in critically ill patients. However, little is known about the association between the serum lactate level and mortality in patients admitted to neuro-intensive care units (NCUs). The present study aimed to investigate the association between the initial lactate level and 90-day mortality in NCU patients. This retrospective observational study was conducted by reviewing the medical records of adult (age ≥18 years) patients admitted to the NCU at a single tertiary care academic hospital during 2013–2017. The initial lactate level (mmol L−1) was defined as the serum lactate level measured within 6 h following NCU admission. The final analysis included 2737 patients, of whom 280 (10.2%) died within 90 days of NCU admission. In a receiver operating characteristic (ROC) analysis, the estimated area under the curve (AUC) for the initial lactate level in predicting overall 90-day mortality was 0.55 [95% confidence interval (CI): 0.52–0.59]. The corresponding values for neurologic and non-neurologic disease-related 90-day mortality were 0.76 (95% CI: 0.71–0.82) and 0.49 (95% CI: 0.45–0.53), respectively. In a multivariable Cox regression analysis, a 1-mmol L−1 increase in the initial lactate level was associated with 1.17- and 1.22-fold increases in overall and neurologic disease-related 90-day mortality, respectively, but not with non-neurological disease-related 90-day mortality (P = 0.422). Elevated lactate levels were related with an increase in overall 90-day mortality among NCU patients. This association was specifically attributed to neurologic disease-related 90-day mortality.

Background The present study evaluated the relationships among perioperative hyperchloremic metabolic acidosis (HCA), hyperchloremia, and postoperative acute kidney injury (AKI) in patients who had undergone craniotomy for intracranial hemorrhage (ICH). Methods The present retrospective cohort study included adult patients who had undergone craniotomy for traumatic or spontaneous ICH from January 2005 to December 2017. The association of perioperative hyperchloremia (serum chloride [Cl−] >110 mmol/L during postoperative days 0–3), an increase in Cl− levels (maximum Cl− level in postoperative days 0–3 minus the baseline Cl− level before surgery), and perioperative HCA (Cl− >110 mmol/L; pH Results A total of 968 patients were included. Of these patients, 117 (12.1%) had postoperative AKI. The multivariable logistic regression analysis showed that the development of HCA was associated with a 1.850-fold increase in the incidence of postoperative AKI (odds ratio [OR], 1.850; 95% confidence interval [CI], 1.102–3.106; P = 0.020). However, hyperchloremia was not significantly related to the incidence of postoperative AKI (P = 0.207). Additionally, the presence of hyperchloremia and an increase in Cl− levels were both associated with an increased incidence of HCA (hyperchloremia group: OR, 2.162; 95% CI, 1.490–3.138; P Conclusions Perioperative HCA was independently related to an increased incidence of AKI after craniotomy for ICH. An increase in Cl− levels and perioperative hyperchloremia were associated with increased development of HCA but were not significantly related to the development of postoperative AKI.

Purpose Previous studies have found an increase in in-hospital mortality when trainee physicians rotate. Our retrospective cohort study investigated whether trainee physicians' turnover influenced 30-day mortality in Korean intensive care units (ICUs), which have high-intensity daytime intensivist coverage only on weekdays. Materials and methods Participants were adults over 19 years old admitted to ICUs in a Korean tertiary care academic hospital between 2012 and 2016. Demographic and clinical data were collected on admission, and dates of death recorded. The primary outcome was the association between ICU admission in the turnover periods (March and May) and 30-day mortality after admission to ICUs with high-intensity daytime intensivist coverage. Results Overall, there was no significant correlation between ICU admission during turnover periods and 30-day mortality [hazard ratio (HR), 1.06; 95% confidence interval (CI), 0.83–1.35, P = 0.647]; the same trend was found for ICU admissions when there was no intensivist coverage (HR: 1.24, 95% CI: 0.91–1.69, P = 0.177). Conclusions We found no overall association between physician turnover and 30-day mortality of patients admitted to ICUs with high-intensity daytime intensivist coverage or with no intensivist coverage.

Background: The objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge. Methods: The present study, conducted in a single tertiary academic hospital, used a retrospective observational design to investigate discharged ICU survivors who were admitted to ICU. The ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: Medical Aid Program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due poor economic status, and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses. Findings: A total of 18,070 ICU survivors were included in the analysis, with 17,443 in NHI group and 627 in MAP group. After PS matching, a total of 2,429 ICU survivors (1,806 in NHI group and 623 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.32-fold higher in MAP group than in NHI group. Competing risk analysis showed that 1-year mortality due to injury or trauma was significantly higher in MAP group than in NHI group. Interpretation This study showed that 1-year mortality was higher in ICU survivors with low economic status even if financial coverage was provided by the government; this was even more evident in cases involving mortality due to trauma or injury. Funding: None Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: This retrospective cohort study was conducted with approval from the Institutional Review Board (IRB) of Seoul National University Bundang Hospital (SNUBH) (IRB approval number: B-1806/474-105).

Red blood cell (RBC) transfusion, especially with "old" blood, is associated with adverse clinical outcomes. We compared the effects of fresh blood versus old blood transfusion on poor neurologic outcomes and symptomatic vasospasm in patients with ruptured cerebral aneurysms.In this retrospective study, 211 patients with aneurysmal rupture were divided into 3 groups: nontransfusion (n = 136), fresh blood (RBC storage ≤ 14 days) transfusion (n = 39), and old blood (RBC storage14 days) transfusion (n = 36). Unfavorable neurologic outcomes (modified Rankin Scale score ≥ 3) and symptomatic cerebral vasospasm were assessed.The incidence of unfavorable neurologic outcomes was significantly higher in the fresh blood and old blood transfusion groups compared with the nontransfused group (71.8% and 58.3% vs. 21.3%; P0.01); the incidence of symptomatic vasospasm was significantly higher in the old blood group compared with the fresh blood and nontransfusion groups (57.1% vs. 26.7% and 22.2%; P0.05). On binary logistic regression, old age, Hunt and Hess grade 3-4, high postoperative C-reactive protein level, RBC transfusion, delayed infarction, and hydrocephalus were independent predictors of unfavorable neurologic outcomes. Young age, Fisher grade 3-4, old RBC transfusion, and surgical clipping were independent predictors of postoperative symptomatic vasospasm.RBC transfusion itself, regardless of the duration of RBC storage, was associated with unfavorable neurologic outcomes in patients with ruptured cerebral aneurysms. Also, old blood transfusion, but not fresh blood transfusion, was associated with increased symptomatic cerebral vasospasm.

We compared magnesium sulphate with control, ketamine, rocuronium prime, and large-dose rocuronium (0.9 mg/kg) with regard to intubation conditions during rapid-sequence induction.This is a prospective, randomized, double-blinded study.The setting is at an operating room in a university-affiliated hospital.One hundred ten patients scheduled for general anesthesia were randomly allocated to the following 5 groups in equal numbers.The control and rocuronium 0.9 groups received rocuronium 0.6 and 0.9 mg/kg, respectively; the ketamine group was given 0.5 mg/kg ketamine 2 minutes before 0.6 mg/kg rocuronium; the rocuronium prime group received 0.06 mg/kg rocuronium 3 minutes before 0.54 mg/kg rocuronium; and the magnesium group received 50 mg/kg magnesium sulphate. Intubation was initiated 50 seconds after the rocuronium injection.Intubating condition (primary outcome), rocuronium onset, rocuronium duration, train-of-four ratio upon intubation, and hemodynamic variables (secondary outcomes) were recorded.The excellent intubating condition was more frequent in the magnesium group (P.05). Onset of neuromuscular block was shorter in the magnesium group than in the control, ketamine, and rocuronium prime groups (P.05). No difference in onset time was found between the magnesium and rocuronium 0.9 groups. Block duration was longest in the rocuronium 0.9 group. The train-of-four ratio on intubation was lowest in the rocuronium prime group. The only adverse event was a burning or heat sensation reported by 5 patients in the magnesium group.Magnesium sulphate pretreatment was most likely to provide excellent intubating condition for rapid-sequence intubation compared with the control, ketamine pretreatment, rocuronium prime, and large-dose rocuronium. However, magnesium sulphate administration is associated with a burning or heat sensation.

This study investigated the neuroprotective effect of pravastatin administration after forebrain ischemia in rats. Forebrain ischemia was induced by bilateral common carotid artery occlusion and systemic hypotension for 8min. Pravastatin at 1mg/kg (pravastatin group, n=10), or an identical volume of normal saline (control group, n=10), was injected 10min, and 1-4 days after reperfusion. Arterial blood gas was analyzed 10min before ischemia onset and 10min after ischemia completion. Viable and apoptotic neuronal cells were evaluated 7 days after ischemia by hematoxylin and eosin (HE) staining and terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuracil triphosphate biotin in situ nick-end labeling (TUNEL) staining of the hippocampal Cornu Ammonis area (CA1). Expression of Bcl-2 and Bax proteins was quantified by Western blot analysis. The proportion of viable neuronal cells after ischemia was greater in the pravastatin vs. control group (p0.01), with greater expression of apoptotic cells in the control vs. pravastatin group (p0.05). Bax protein expression was significantly decreased in the pravastatin group (p0.05), whereas, Bcl-2 expression was increased, but not significantly (p0.05). Our findings suggest that pravastatin administration after forebrain ischemia confers neuroprotection in rats by inhibiting Bax protein expression.

Catheter-related bladder discomfort (CRBD) secondary to intraoperative catheterization of urinary bladder is one of the most distressing symptoms during recovery from anaesthesia. Butylscopolamine, a peripheral antimuscarinic agent, is effective for relieving the pain, which is because of smooth muscle contraction. The aim of this study was to assess the efficacy and safety profiles of butylscopolamine in treating CRBD after urological surgeries.Adult male patients undergoing urological surgery requiring urinary bladder catheterization intraoperatively were enrolled. Induction and maintenance of anaesthesia were standardized. Patients were randomized into two groups after complaining of CRBD in the post-anaesthesia care unit. The control group (n=29) received normal saline and the butylscopolamine group (n=28) was administered butylscopolamine 20 mg i.v. The severity of CRBD, postoperative pain, and adverse effects were assessed at baseline, 20 min, 1, 2, and 6 h after administration of the study drug.The severity of CRBD observed in the butylscopolamine group was significantly lower than that of the control group at 1, 2, and 6 h after administration of the study drug [59 (12), 50 (16), 40 (21) in the control group vs 41 (22), 32 (25), 23 (18) in the butylscopolamine group, P0.01]. Rescue analgesics were required less in the butylscopolamine group than in the control group (P=0.001). Adverse events were comparable between the two groups.Butylscopolamine 20 mg administered i.v. after complaining CRBD during recovery reduced both the severity of CRBD and the need for rescue analgesics without adverse effects in patients undergoing urologic surgeries.

The aim of this study was to compare the cross-sectional area (CSA) of the right internal jugular vein (IJV) with that of the left IJV and to evaluate the anatomic location of the IJV in relation to the common carotid artery, utilizing computed tomography scans of the neck.Retrospective observational study.A tertiary care hospital.Eighty patients with neck computed tomography scans scheduled for thyroid surgery.No.Mean CSA of the right and left IJV were 165±81 and 119±57 mm(2), respectively (p0.01). A relatively larger CSA of the right IJV, compared with that of the left , was seen in 63 (79%) patients. A larger CSA of the right IJV was shown in more right-handed subjects than left-handed subjects (82 v 43%, p0.05). Small CSA (50 mm(2)) of the right or left IJV were seen in 4 patients. Both IJVs were located commonly either laterally or anterolaterally to their common carotid arteries. A posterolateral position of the IJV was seen in 4 patients.This study suggested one advantage of using the right IJV compared with the left for central venous cannulation. However, anatomic variations of the IJV, such as a small CSA and a medial or posterior position, are not associated with demographic data. Although right-handedness was well-correlated with a larger ipsilateral IJV, a possibility of a larger contralateral IJV should be considered. Therefore, central venous cannulation with ultrasonography is recommended to avoid complications and repeated needling.

The purpose of this study was to investigate whether combined administration of celecoxib and sevoflurane after ischaemia produces additive neuroprotection against transient global cerebral ischaemia in rats.Cerebral ischaemia was induced by bilateral common carotid artery occlusion with haemorrhagic hypotension for 8 min. After ischaemia, no drugs were administered in the sham (n=4) and control (n=10) groups. In the celecoxib group (n=10), celecoxib 2 mg kg(-1) was administered after reperfusion. In the sevoflurane group (n=10), after reperfusion, sevoflurane 2.4% was inhaled two times for 5 min each at an interval of 10 min to achieve postconditioning. In the celecoxib+sevoflurane group (n=10), administration of celecoxib 2 mg kg(-1) and the sevoflurane postconditioning were performed simultaneously. Necrotic or apoptotic cells were examined in the hippocampus 7 days after ischaemia. Serum levels of proinflammatory cytokines including tumour necrosis factor-α and interleukin-1β were measured 2 h, and 3 and 7 days after ischaemia.Necrotic or apoptotic cells were observed more frequently in the control group than in the celecoxib or sevoflurane groups 7 days after ischaemia (P0.05). Cytokine levels were higher in the control group when compared with the celecoxib or sevoflurane groups 2 h after ischaemia (P0.05). However, the histological outcomes and cytokine levels were similar in all three groups treated with celecoxib or sevoflurane.Combined treatment with celecoxib and sevoflurane after global cerebral ischaemia has no additive neuroprotective effects in rats.

Phosphoric acid-doped sulfonated poly(tetra phenyl phthalazine ether sulfone) (PA-SPTPPES) copolymers were successfully synthesized by the 4,4′-dihydroxydiphenylsulfone with 1,2-bis(4-fluorobenzoyl)-3,4,5,6-tetraphenylbenzene (BFBTPB) and 4,4′-difluorodiphenylsulfone in sulfolane. Poly(tetra phenyl phthalazine ether sulfone)s (PTPPESs) were prepared via an intramolecular ring-closure reaction of dibenzoylbenzene of precursor and hydrazine. The sulfonated poly(tetra phenyl phthalazine ether sulfone) (SPTPPES) membranes were obtained by sulfonation under concentrated sulfuric acid, and followed phosphoric acid-doped by immersion in phosphoric acid. Different contents of doped and sulfonated unit of PA-SPTPPES (10, 15, 20 mol% of BFBTPB) were studied by FT-IR, 1 H NMR spectroscopy, and thermo gravimetric analysis (TGA). The ion exchange capacity (IEC) and proton conductivity of SPTPPESs and PA-SPTPPESs were evaluated with increase of degree of sulfonation and doping level. The PA-SPTPPESs membranes exhibit proton conductivities (80 °C, relative humidity 30%) of 41.3 ∼ 74.1 mS/cm and the maximum power densities of PA-SPTPPES 10, 15, and 20 were about 294, 350, and 403 mW/cm 2 .

Laryngoscopy and tracheal intubation (LTI) after induction of general anesthesia often cause hypertension and tachycardia. Labetalol and nicardipine have been used to prevent and treat acute cardiovascular responses to LTI.The goal of this study was to compare the preventive and therapeutic effects of labetalol 0.4 mg/kg IV and nicardipine 20 μg/kg IV on hypertensive responses to LTI during induction of general anesthesia.Patients undergoing general anesthesia were randomly allocated to 4 groups. In part I (prevention), 80 patients were randomized to receive either 0.4 mg/kg of labetalol (n = 40) or 20 μg/kg of nicardipine (n = 40) 4 minutes before LTI. In part II (treatment), patients were randomized to receive 0.4 mg/kg of labetalol (n = 40) or 20 μg/kg of nicardipine (n = 40) after LTI if hypertension occurred. The number of additional study drug doses required by patients with hypertension (parts I and II) and time to return to normotension (part II) were recorded. Mean arterial pressure and heart rate were monitored, and rate-pressure product was calculated. Adverse events were also monitored.A total of 130 patients (72 patients in part I and 58 patients in part II) were included in the analysis. In parts I and II, the number of patients who required additional doses of the study drug because of persistent hypertension was lower in the nicardipine groups than in the labetalol groups (P0.05). Mean arterial pressure was lower and heart rate was significantly higher over time in the nicardipine groups compared with the labetalol groups (P0.05) in parts I and II. In part II, time to return to normotension was shorter in the nicardipine treatment group than in the labetalol treatment group (61 [21] vs 130 [46] seconds; P = 0.01). No statistical differences were observed in the incidence of adverse events except for tachycardia in part I (2 cases in the labetalol prevention group vs 18 cases in the nicardipine prevention group; P = 0.01).Patients who received nicardipine were less likely to require additional doses for either the prevention or treatment of hypertensive responses to LTI and responded to the study drug more rapidly than patients who received labetalol for the treatment of hypertensive responses to LTI. However, labetalol was associated with a lower incidence of tachycardia and less of an increase in rate-pressure product when used for the prevention of hypertension during LTI.

Background Patients undergoing general anesthesia for laparoscopic cholecystectomy have a high risk of postoperative nausea and vomiting (PONV) with incidences up to 75%. Ramosetron, a serotonin subtype 3 (5-HT 3 ) antagonist, has been shown to be effective as an antiemetic after chemotherapy and surgery. Consensus guidelines recommend a combination of antiemetic therapies in high-risk groups. Until now, no published data have been available on the use of combination oral plus intravenous ramosetron. Objective The goal of this prospective, randomized, double-blind study was to compare the efficacy and tolerability of intravenous, oral, and the combination of oral and intravenous ramosetron for PONV prophylaxis in patients undergoing laparoscopic cholecystectomy. Methods Patients scheduled for laparoscopic cholecystectomy were double-randomly allocated to 1 of 3 groups. Patients were randomly allocated to receive either 0.3 mg of intravenous ramosetron (group A), 0.1 mg of oral ramosetron (group B), or the combination of 0.1 mg of oral ramosetron and 0.3 mg of intravenous ramosetron (group C). All patients received standardized balanced anesthesia with desflurane and remifentanil. Postoperative nausea, retching, vomiting, pain, and adverse effects were assessed at 0 to 2, 2 to 24, and 24 to 48 hours after surgery. Results A total of 124 Korean patients (67 women, 57 men; age range, 25–65 years) were randomized to 1 of 3 study groups (42 in group A [mean age, 49.8 years], 41 in group B [mean age, 47.4 years], and 41 in group C [mean age, 48.9 years]). No statistical differences were observed among the 3 groups with regard to patient characteristics and information on surgery and anesthesia. During postoperative period 0 to 2 hours, complete response occurred in 31 (74%) patients in group A, 27 (66%) in group B, and 37 (90%) in group C. During the postoperative period of 2 to 24 hours, complete response was observed in 36 (86%), 33 (80%), and 40 (98%) patients in groups A, B, and C, respectively; there was a statistically significant difference in group C compared with group A or group B. During the postoperative period of 0 to 48 hours, incidences of rescue antiemetic use were 13 (31%), 14 (34%), and 3 (7%) in groups A, B and C, respectively. Common adverse effects (headache, dizziness, and drowsiness) were observed, but there was no significant difference in the incidences of adverse effects among the 3 groups ( P > 0.05). Conclusions The combination of 0.1-mg oral and 0.3-mg intravenous ramosetron was more effective than either 0.3-mg intravenous ramosetron or 0.1-mg oral ramosetron alone for the prophylaxis of nausea and vomiting after laparoscopic cholecystectomy during the first 24 hours after surgery. In addition, differences did not reach the level of statistical significance between 0.1 mg of oral ramosetron and 0.3 mg of intravenous ramosetron for the prevention of PONV in this patient population. Oral, intravenous, and combined oral and intravenous ramosetron appears well tolerated in the population studied. ClinicalTrials.gov identifier: NCT 01041183.

Processors in embedded systems mostly employ cache architectures in order to alleviate the access latency gap between processors and memory systems. Caches in embedded systems usually occupy a major fraction of the implemented chip area. The power dissipation of cache system thus constitutes a significant fraction of the power dissipated by the entire processor in embedded systems. In this paper, we propose the compressed tag architecture to reduce the power dissipation of the tag store in cache systems. We introduce a new tag-matching mechanism by using a locality buffer and a tag compression technique. The main power reduction feature of our proposal is the use of small tag space matching instead of full tag matching, with modest additional hardware costs. The simulation results show that the proposed model provides a power and energy-delay product reduction of up to 27.8% and 26.5%, respectively, while still providing a comparable level of system performance to regular cache systems.

Background In this prospective, randomized, double-blind study, we evaluated and compared the incidence of postoperative nausea and vomiting (PONV) after paediatric strabismus surgery with two different anaesthetic methods, sevoflurane or remifentanil–sevoflurane. Methods In total, 78 paediatric patients (aged 6–11 yr) undergoing strabismus surgery were enrolled and randomly assigned to two groups, sevoflurane (Group S) and remifentanil–sevoflurane (Group R). Anaesthesia was maintained with 2–3% sevoflurane in Group S (n=39) or with a continuous infusion of remifentanil combined with 1% sevoflurane in Group R (n=39), both using 50% N2O/O2. Arterial pressure and heart rate before induction, after tracheal intubation, after skin incision, and at the end of surgery were recorded. The incidence of PONV in the post-anaesthesia care unit, the day surgery care unit, and at home 24 h after surgery was recorded. Results Arterial pressure and heart rate were stable throughout the surgery, but were significantly lower in Group R than in Group S after tracheal intubation and skin incision. The incidence of PONV and postoperative vomiting was 17.9%/17.9% and 12.8%/10.2% (Group S/Group R) at the respective time points; values were comparable between the groups. Conclusions The incidence of PONV after paediatric strabismus surgery under sevoflurane anaesthesia was relatively low, and combining remifentanil with sevoflurane did not further increase the incidence.

Background. In this double-blind, randomized, placebo-controlled study, we evaluated the effects of magnesium sulphate on neuromuscular blocking agent requirements and analgesia in children with cerebral palsy (CP). Methods. We randomly divided 61 children with CP undergoing orthopaedic surgery into two groups. The magnesium group (Group M) received magnesium sulphate 50 mg kg 21 i.v. as a bolus and 15 mg kg 21 h 21 by continuous infusion during the operation. The control group (Group S) received the same amount of isotonic saline. Rocuronium was administered 0.6 mg kg 21 before intubation and 0.1 mg kg 21 additionally when train-of-four counts were 2 or more. I.V. fentanyl and ketorolac were used to control postoperative pain. Total infused analgesic volumes and pain scores were evaluated at postoperative 30 min, and at 6, 24, and 48 h. Results. The rocuronium requirement of Group M was significantly less than that of Group S [0.29 (0.12) vs 0.42 (0.16) mg kg 21 h 21 , P,0.05]. Cumulative analgesic consumption in Group M was significantly less after operation at 24 and 48 h (P,0.05), and pain scores in Group M were lower than in Group S during the entire postoperative period (P,0.05). Serum magnesium concentrations in Group M were higher until 24 h after operation (P,0.05). The incidence of postoperative nausea and vomiting and rescue drug injections was similar in the two groups. No shivering or adverse effects related to hypermagnesaemia were encountered. Conclusions. I.V. magnesium sulphate reduces rocuronium requirements and postoperative analgesic consumption in children with CP. Br J Anaesth 2010; 104: 344‐50

We examined in a rabbit model of transient spinal cord ischemia (SCI) whether isoflurane (Iso) preconditioning induces ischemic tolerance to SCI in a dose-response manner, and whether this effect is dependent on mitochondrial adenosine triphosphate-dependent potassium (K(ATP)) channel. Eighty-six rabbits were randomly assigned to 10 groups: Control group (n=8) received no pretreatment. Ischemic preconditioning (IPC) group (n=8) received 5 min of IPC 30 min before SCI. The Iso 1, Iso 2 and Iso 3 groups (n=10, 9, 8) underwent 30 min of 1.05, 2.1 and 3.15% Iso inhalation commencing 45 min before SCI. The Iso 1HD, Iso 2HD and Iso 3HD groups (n=9, 9, 8) each received a specific mitochondrial K(ATP) channel blocker, 5-hydroxydecanoic acid (5HD, 20mg/kg), 5 min before each respective Iso inhalation. The 5HD group (n=8) received 5HD without Iso inhalation. The sham group (n=9) had no SCI. SCI was produced by infra-renal aortic occlusion via the inflated balloon of a Swan-Ganz catheter for 20 min. The Iso 1, Iso 2 and Iso 3 groups showed a better neurologic outcome and more viable motor nerve cells (VMNCs) in the anterior spinal cord 72 h after reperfusion than the control group (p0.05). Iso 3 group showed a better neurologic outcome and more VMNCs than Iso 1 group (p0.05). And, the Iso 1, Iso 2 and Iso 3 groups showed a better neurologic outcome and higher VMNC numbers than the corresponding Iso 1HD, Iso 2HD and Iso 3HD groups (p0.05). This study demonstrates that Iso preconditioning protects the spinal cord against neuronal damage due to SCI in a dose-response manner via the activation of mitochondrial K(ATP) channels.

Background: Epidural morphine produces prolonged analgesia but has many side effects including pruritus. Naloxone is an antagonist that can reverse the side effects of morphine. Method: We studied the effects of continuously administered epidural naloxone mixed with morphine on side effects and analgesia in a randomized, double blind, two-armed study. Fifty-eight pregnant women undergoing cesarean section were enrolled. All patients received a 4-mg epidural bolus of morphine in the post-anesthetic care unit. After this, patients in group M (n=28) received continuous epidural morphine (6 mg over 48 h) in 0.1% bupivacaine; patients in group N (n=30) received an epidural infusion containing naloxone (1.2 mg over 48 h) and morphine (6 mg over 48 h) in 0.1% bupivacaine. The infusion rate was 2 mL/h. Results: The incidence (82% versus 47%) and severity of pruritus were lower in group N than group M ( P =0.001). There were no significant differences in pain score or in the incidence of nausea, vomiting or urinary disturbance between groups. Conclusion: Continuous epidural infusion of naloxone combined with morphine is effective in reducing the incidence and severity of pruritus induced by epidural morphine.

We investigated the safety and efficacy of the bilateral periarticular multimodal drug injection (PMDI) at a reduced dosage in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). In total, 45 patients undergoing SBTKA received 65 mL PMDI in each knee (reduced-dose group). The incidence of drug-related adverse effects and wound complications were evaluated. Pain levels during the night of the operation and postoperative day 1 and opioid consumption during the first 24 hours after surgery were compared with the regular-dose group of 55 patients undergoing SBTKA who received 100 mL of PMDI in 1 knee. No patient experienced a serious drug-related adverse effect or wound complication. Blood levels of ropivacaine were observed to be lower than a toxic level throughout the monitored period in all patients examined. Patients in the reduced-dose group experienced less pain during the night of operation, but a similar pain level at postoperative day 1.