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Background: The depth of anesthesia is an essential factor in surgical prognosis. The neurotoxic effect of chemotherapeutic drugs affects the sensitivity to anesthetics. This study was conducted to determine whether the effect-site concentration (Ce) of propofol for loss of consciousness (LOC) differs in patients undergoing preoperative chemotherapy. Methods: A total of 60 patients scheduled for surgery for colorectal cancer under general anesthesia were included in this study. Patients who had received chemotherapy comprised the experimental (C) group, and those without a previous history of chemotherapy comprised the control (N) group. Propofol was administered as an effect-site target-controlled infusion, and the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores were evaluated. When the plasma concentration and Ce were similar, and if the MOAA/S score did not change, the target Ce was increased by 0.2 μg/ml; otherwise, the Ce was maintained for 2 min and then increased. Results: The Ce values of propofol for loss of verbal contact (LVC) in groups C and N were 2.40 ± 0.39 and 2.29 ± 0.39 μg/ml (P = 0.286), respectively, and those for LOC in groups C and N were 2.69 ± 0.43 and 2.50 ± 0.36 μg/ml (P = 0.069), respectively. No significant difference was observed in Ce values between the two groups.Conclusions: Chemotherapy had no effect on the Ce of propofol for LVC and LOC in patients with colorectal cancer. We do not recommend reducing the dose of propofol for the induction of LOC in patients with colorectal cancer undergoing chemotherapy.

Background: Postoperative sore throat (POST) is a complication that decreases patient satisfaction and increases postoperative complaints. The present study was conducted to investigate effects of gargling with dexamethasone, intravenous dexamethasone injection and the combination of the two on the incidence and severity of POST.Methods: Study participants were 96 patients who had undergone laparoscopic cholecystectomy, randomly allocated into three groups. Group G gargled with 0.05% dexamethasone solution and were infused intravenous 0.9% normal saline before general anesthesia; group I gargled with 0.9% normal saline and were infused intravenous 0.1 mg/kg dexamethasone; group GI gargled with 0.05% dexamethasone solution and were infused intravenous 0.1 mg/kg dexamethasone. The incidence and severity of POST, hoarseness and cough were evaluated and recorded at 1, 6, and 24 h after the surgery.Results: There were no significant differences in the total incidence of POST up to 24 postoperative hours among Group G, Group I and Group GI (P = 0.367, Group G incidence = 34.38%, [95% confidence interval, 95% CI = 17.92–50.83], Group I incidence = 18.75%, [95% CI = 5.23–32.27], Group GI incidence = 28.13%, [95% CI = 12.55–43.70]). The other outcomes were comparable among the groups.Conclusions: In patients who had undergone laparoscopic cholecystectomy, gargling with 0.05% dexamethasone solution demonstrated the same POST prevention effect as intravenous injection of 0.1 mg/kg dexamethasone. The incidence and severity of POST were not significantly different between the combination of gargling with 0.05% dexamethasone solution and intravenous injection of 0.1 mg/kg dexamethasone and use of each of the preventive methods alone.

Background Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. Methods Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. Results The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. Conclusions The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.

Background Reduction of intraoperative bleeding is necessary to achieve the ideal surgical field for the endoscopic sinus surgery (ESS). Intraoperative intra nasal bleeding is influenced by various anesthetics. This study compared surgical field condition between propofol/remifentanil (PR) based anesthesia and desflurane/remifentanil (DR) based anesthesia. Methods American Society of Anesthesiologists physical status class I or II patients undergoing ESS were randomly assigned to group PR (n = 36) or group DR (n = 32). The extent of the preoperative surgical lesion was classified as high (> 12) and low (≤ 12) Lund-Mackay (LM) scores according to the computed tomography findings. The target mean blood pressure was maintained at 70-80 mmHg. Only one surgeon was involved in rating the visibility of the surgical field on a numeric rating scale (NRS) every 10 minutes. Results There was a different surgical field grade from PR to DR. The mean (SD) surgical field score of NRS for the PR and DR was 2.3 (0.57) and 2.7 (0.67), respectively (P = 0.006). Especially in the high-LM score patients, the mean (SD) of surgical field score for the PR and DR was 2.4 (0.67) and 3.0 (0.63), respectively (P = 0.012). Conclusions In the high-LM score patients, PR based anesthesia resulted in better surgical field condition for ESS than DR based anesthesia. In ESS, PR based anesthesia is considered to be helpful.

Povidone-iodine (polyvinylpyrrolidone iodine, PI), which is commonly used as a pre- and postoperative oral antiseptic, has been reported to cause pneumonia secondary to its pulmonary aspiration. Because no studies have yet investigated the underlying mechanisms of PI-induced pneumonia, we conducted an animal study to analyze the effect of PI on the lung following its pulmonary instillation. The lungs of 61 male Sprague–Dawley rats (150–250 g) were instilled with varying volumes of either phosphate-buffered saline or PI solutions varying in strength from 0.01% to 10%. The lungs were harvested from the rats 1 h or 1, 3, 5, 7, 14, or 21 days after instillation for radiologic examination, macroscopic and light and scanning electron microscopic assessment, and an assessment of pulmonary toxicity using an MTT-based cytotoxicity assay. Macroscopically, atelectasis was the primary pulmonary lesion after PI instillation. The primary light and scanning electron microscopic findings were an initial inflammatory phase with edema, alveolar rupture, and leukocyte infiltration into the pulmonary interstitium, which progressed into a phase of lung parenchyma loss, and then resolved itself with scar tissue formation. Lung tissue viability following 1-day exposure to 0.01%, 0.1%, 1%, or 5% PI progressively decreased in a significant dose-dependent manner. PI aspiration can cause lung injury, including pulmonary fibrosis.

Background: Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia. Methods: One hundred twenty patients aged 20 to 65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the group N received normal saline 1 hour before induction and after the resection of gall bladder. The patients in the group S1 received dexamethasone 8 mg 1 hour before induction and normal saline after the resection of gall bladder. The patients in the group S2 received normal saline 1 hour before induction and dexamethasone 8 mg after the resection of gall bladder. Results: VAS scores of group S1 and S2 were lower than that of group N during 48 hours after laparoscopic cholecystectomy. There were no significant differences of VAS scores between the group S1 and the group S2. The analgesic consumption of group S1 and S2 were significantly lower than that of group N. Conclusions: A single dose of dexamethasone (8 mg) intravenously given 1 hour before induction or during operation was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. The analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during surgery was not significantly different. (Korean J Anesthesiol 2011; 61: 315-319)

The use of ketamine may be associated with the recall of unpleasant dreams after sedation. We hypothesized that a positive suggestion before sedation could reduce the incidence of ketamine-induced unpleasant dreams. To test this hypothesis, we randomized 100 patients receiving sedation with ketamine for their procedure into 2 groups with 1 group having an anesthesiologist provide a mood-elevating suggestion to the patient before ketamine administration (suggestion group), whereas in the control group no suggestion was provided. Patients were provided with a pleasantness/unpleasantness scale to rate "the overall mood of the dream" as very unpleasant (grade 1), quite unpleasant (grade 2), neither or mixed (grade 3), quite pleasant (grade 4), and very pleasant (grade 5). In those patients who lost consciousness, the frequencies of grades 1, 2, 3, 4, and 5 were 0%, 0%, 46%, 24%, and 30% in the suggestion group and were 6%, 2%, 70%, 12%, and 10%, respectively, in the control group (P=0.01). In the intent-to-treat population the overall frequency between groups was very similar. This study implies that when administering ketamine as part of a sedation regimen, positive suggestion may help reduce the recall of unpleasant dreaming.

Background Postoperative sore throat (POST) is a complication that undermines patient satisfaction and increases discomfort in the postoperative period. The present study examined the effects of dexamethasone gargle and endotracheal tube cuff soaking on the incidence and severity of POST. Methods Ninety patients undergoing laparoscopic cholecystectomy were randomly allocated into three groups: 0.9% normal saline gargling and tube soaking (group C), 0.05% dexamethasone solution gargling and 0.9% normal saline tube soaking (group G), 0.9% normal saline gargling and 0.05% dexamethasone tube soaking (group S). The incidence and severity of POST were then assessed and recorded at 24 hours after surgery. Results The total incidence of POST was significantly different among the groups (P < 0.05), and group S exhibited a significantly lower incidence of POST than group C (P < 0.0167). In addition, the POST intensity of group G and group S was less severe than those of group C (Both P < 0.0167). Conclusions Among patients undergoing laparoscopic cholecystectomy, those who gargled with 0.05% dexamethasone solution exhibited lower severity of POST than the control group, and those whose endotracheal tube cuff was soaked in the dexamethasone solution before intubation exhibited significantly lower incidence and severity of POST than the control group.

The 5-hydroxytryptamine Type 3 (5-HT3) antagonists are a class of drugs frequently used to prevent and treat nausea and vomiting. It has been shown that a 5-HT3 receptor exists in the spinal nerves and affects pain control in animals [1]. In one study, ondansetron administered to prevent nausea and vomiting interrupted sensory deprivation in spinal anesthesia performed with lidocain [2]. Another study showed that other 5-HT3 antagonists such as granisetron enhanced recovery of the sensory nerves during spinal anesthesia [3]. Palonosetron, a second-generation 5-HT3 receptor antagonist approved in 2003, is known to have the strongest affinity to the 5-HT3 receptor, with a receptor binding affinity about 30 times stronger than that of ondansetron and granisetron. In addition, its elimination half-life is about 40 hours, far longer than that of other 5-HT3 antagonists. Therefore, a small dose, generally 0.075 mg, is rec ommended to prevent nausea and vomiting after general opera tions [4]. However, as the effect of palonosetron on spinal anes thesia has not been studied, it is unclear whether preoperative administration of palonosetron interrupts the anesthetic effect. In this study, we investigated the effect of palonosetron on spinal anesthesia by examining the level of sensory block, the timing of sensory recovery, and the timing of motor recovery in spinal anesthesia performed with bupivacaine 8 mg when palonosetron 0.075 mg or normal saline solution 1.5 ml was intravenously injected preoperatively. This study was conducted with the approval of the Institutional Review Board at our hospital. The subjects were 80 American Society of Anesthesiologists (ASA) class I-II patients who were scheduled to undergo transurethral surgery under spinal anesthesia. The objective and methods of the study were explained to them before the operation, and informed consent was obtained from each patient. The subjects were randomly assigned either to a group in which normal saline solution 1.5 ml was injected 15 minutes before the operation (Group C) or to a group in which palonosetron 0.075 mg (1.5 ml) was intravenously injected 15 minutes before the operation (Group P). Patients who had undergone lumbar surgery or those who had been administered drugs that could affect spinal anesthesia, such as an analgesic, a calcium channel blocking agent, or an alpha 2 agonist, were excluded from the study. An anesthetist performed anesthesia without knowledge of the intravenously injected drug, and the same anesthetist observed the patients in the operating room and the recovery room. Vital signs such as electrocardiography, blood pressure, and oxygen saturation were monitored in the operating room. Before the induction of anesthesia, normal saline solution 300 ml was intravenously injected in all patients. Anesthesia was performed by having the patient lie in the lateral recumbent position and inserting a 25 G Whitacre needle (Becton-Dickinson, Franklin Lakes, NJ, USA) through the midline of the L4-5 intervertebral space. After checking the outflow of the cerebrospinal fluid, 0.5% hyperbaric bupivacaine 8 mg was injected for 10 seconds. After the injection, the patient adopted the supine posi tion. After the sensory block was checked, the patient adopted the lithotomy position. With respect to the sensory block, the level at which the pinprick sensation disappeared was recorded every 10 minutes, and the highest sensory block level was also recorded. The time to

Intravenous patient-controlled analgesia (IV-PCA) using opioids allows the patient to control the amount of analgesic according to the degree of pain. For effective pain reduction and avoidance of opioid-related complications, studies have investigated methods of combining opioid use with drugs such as NSAIDs, ketamine, clonidine, and dexmedetomidine [1]. The highly selective α2-agonist dexmedetomidine is effective in sedating and reducing anxiety. In addition, because it retains a simultaneous analgesic effect, it is expected to be helpful in postoperative pain management [2]. The authors compared ketamine and dexmedetomidine, each in combination with fentanyl, in postoperative IV-PCA for patients scheduled for gynecological abdominal surgery. For each method, we examined the reduction in pain score and opioid consumption as well as whether it was effective in reducing opioid-related complications. After obtaining approval from the Institutional Review Board, and informed consent was obtained. Ninety patients (20 to 60 years, American Society of Anesthesiologists [ASA] physical status I-II) scheduled for gynecological abdominal surgery were divided into three groups: a control group (Group C: n = 30), a ketamine group (Group K: n = 30), and a dexmedetomidine group (Group D: n = 30). Near the end of surgery, all three groups were injected with fentanyl 0.5 µg/kg, ketorolac 30 mg, and ramosetron 0.3 mg for postoperative pain management. PCA was performed using IV-PCA equipment (AutoMed 3000®, Ace Medical, Seoul, Korea). The pharmacological combinations for the three groups were as follows: fentanyl 20 µg/kg, ketorolac 180 mg, and ramosetron 0.6 mg for all three groups; normal saline for Group C; normal saline plus ketamine 40 mg for Group K; and normal saline plus dexmedetomidine (Precedex®, Hospira, Rocky Mount, NC, USA) 500 µg for Group D. Each mixture was made in 100 ml solutions. The basal infusion rate was set at 2 ml/hr, the bolus at 2 ml, and the lockout time at 10 minutes. After the completion of surgery, patients were transferred to the ward. The IV-PCA consumption volume, pain score (VAS; visual analogue scale) and side effects were assessed at postoperative hours 1, 6, 12, 24, 36, and 48. When the patients required pain control, ketorolac 30 mg or tramadol 50 mg was administered. To treat nausea and vomiting, an IV injection of macperan 10 mg or ondansetron 4 mg was administered. If nausea and vomiting continued despite the administration of antiemetics or if the sedation score was more than 2, the IV-PCA background infusion rate and bolus were reduced by 0.4 ml, respectively. If respiration was inhibited (fewer than 8 breaths/min), naloxone 0.1-0.4 mg was administered, and IV-PCA was discontinued until the respiration rate reached 9 breaths/min or higher. Data were analyzed using SAS 9.2 (SAS Institute Inc, Cary, NC, USA). One-way ANOVA was performed for the demographic data, and repeated measures ANOVA was performed for the between-group comparison of VAS pain scores, accumulated consumption of IV-PCA, accumulated consumption using bolus, and patient information. A P value of 0.05 or lower was considered statistically significant. There were no significant differences between the three groups in age, body mass index, ASA class, type of surgery, or surgery time. In Group K, the pain score was lower (in a resting state: 24 and 36 hours after surgery; during movement: 6, 12, 24, 36, and 48 hours after surgery) and there was no significant difference in IV-PCA consumption volume compared with Group C. In Group D, the pain score was significantly lower (in a resting state: 24 and 36 hours after surgery; during movement: 6, 12, 24, 36, and 48 hours after surgery) (Figs. 1A and 1B) and the total IV-PCA consumption volume was lower (26% at 24 hours, 10% at 48 hours) compared with Group C. When Group K and Group D were compared, there were no significant differences in the VAS score in a resting state or during movement. In addition, there were no significant differences in accumulated total consumption and bolus consumption between Group C and Group K. The number of patients that used the entire IV-PCA volume of 100 ml at 24, 36, and 48 hours after surgery was highest in Group C, followed by Group K and Group D, respectively (Fig. 1C). In order of descending frequency, complications (in groups C, K, D) that occurred were nausea (16, 14, 14) vomiting (4, 1, 0), sedation (12, 13, 15), dizziness (2, 8, 2), pruritus (0, 0, 2), and respiratory depression (0, 1, 0). Dizziness was significantly higher in Group K than in the other groups. Fig. 1 (A) Visual analogue scale (VAS) pain score at rest during the 48-hour study, (B) Visual analogue scale (VAS) pain score on movement during the 48-hour study. Values are mean ± SD. *P < 0.05 (group K versus group C), †P < ... The mechanism of the analgesic effect of dexmedetomidine as an α2-agonist is not yet completely understood, but it is thought that the spinal cord is the most important area. The α2-adrenergic receptors of the substantia gelatinosa are activated in the dorsal horn of the spinal cord; this represses the neurotransmission of peripheral Aδ and C fiber, represses wide dynamic range neurons, stimulates the secretion of acetylcholine, stimulates the serotonergic system, and represses the secretion of substance P, resulting in an analgesic effect [3-5]. Lin et al. [1], who conducted a study with patients receiving total abdominal hysterectomy, reported that combined morphine and dexmedetomidine significantly reduced the pain score over 24 hours of observation compared with a group that received only morphine. Furthermore, there was a reduction in morphine consumption of approximately 29%. These findings are similar to ours; in our study, the pain score was significantly reduced and there was an approximately 26% reduction in PCA consumption in IV-PCA up to 24 hours after surgery compared with Group C. Our study also showed a higher frequency of dizziness in Group K compared with Group C and Group D. There were no significant differences in sedation, hypoventilation, and itching between each group. In conclusion, low-dose ketamine added to IV-PCA in gynecological abdominal surgery did not decrease total IV-PCA consumption but reduced the pain score relative to Group C, while dexmedetomidine reduced both total IV-PCA consumption and the pain score relative to Group C.

Background: Sugammadex is a novel neuromuscular reversal agent, but its associated hypersensitivity reaction and high cost have been obstacles to its widespread use. In the interest of reducing the necessary dosage of sugammadex, the rever-sal time of the combined use of sugammadex and neostigmine from moderate neuromuscular blockade were investigated. Methods: The patients enrolled ranged in age from 18 to 65 years old with American Society of Anesthesiologists class 1 or 2. The subjects were randomly assigned into one of the four groups (Group S2, S1, SN, and N; n = 30 per group). The reversal agents of each groups were as follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1 mg/kg + neostigmine 50 μg/kg + glycopyrrolate 10 μg/kg, N - neostigmine 50 μg/kg + glycopyrrolate 10 μg/kg. The time to recovery of the train-of-four (TOF) ratio was checked in each group. Results: The time to 90% recovery of TOF ratio was 182.6 ± 88.9, 371.1 ± 210.4, 204.3 ± 103.2, 953.2 ± 379.7 sec in group S2, S1, SN and N, respectively. Group SN showed a significantly shorter recovery time than did group S1 and N (P < 0.001). However, statistically significant differences between the S2 and SN groups were not be observed (P = 0.291). No hyper-sensitivity reactions occurred in all groups. Conclusions: For the reversal from rocuronium-induced moderate neuromuscular blockade, the combined use of su-gammadex and neostigmine may be helpful to decrease the recovery time and can also reduce the required dosage of sugammadex. However, the increased incidence of systemic muscarinic side effects must be considered.

We experienced a case of a 17-year-old patient with genetically proven Prader-Willi syndrome who had left middle cerebral artery-left superficial temporal artery anastomosis surgery under general anesthesia with a non-depolarizing muscle relaxant. Prader-Willi syndrome is a genetic disorder associated with hypotonia. Using general anesthesia with a non-depolarizing muscle relaxant in these patients is difficult due to hypotonia. We, therefore, monitored the status of muscle relaxation with a train of four (TOF, TOF-Watch®, Organon, Ireland) during general anesthesia. Unlike infants, adolescents can have the muscle relaxation monitor on their body surface. Because lengthy, complex microsurgery was required for this vascular surgery, we had to use a muscle relaxant. However, when using a muscle relaxant, predicting the extent of the effect and the recovery time are difficult. The TOF ratio was 0.85 in the preanesthetic state. Anesthetic induction was done using the total intravenous anesthesia of the target concentration infusion method. Propofol target concentration at 4 µg/ml was initially injected. Remifentanil was injected at 0.15 µg/kg/min. Five minutes after an atracurium 15 mg injection, the TOF watch count was still at "2". Therefore, an additional 15 mg of atracurium was injected for intubation. When the TOF watch count was over "4", during the operation, an additional 5 mg of atracurium was injected. For the entire surgery, 65 mg of atracurium was used. The operation lasted for 2 hours and 50 minutes. After the operation, when the TOF ratio was 0.85, glycopyrrolate 0.4 mg and pyridostigmine 15 mg were injected. The endotracheal tube was removed once the patient regained spontaneous respiration and was fully awake. After extubation, the patient was arousable using painful stimulation. In the post anesthetic care unit, the patient had no respiratory problem and his TOF ratio was 0.85. The patient was then transferred to the general ward. Prader-Willi syndrome is a genetic disorder classically characterized by hypotonia, hypomentia, and hypogonadism that is associated with obesity [1]. The cause of hypotonia, muscle weakness, and motor problems in Prader-Willi patients are not clear. The contributing factors may be the abnormal body composition found in Prader-Willi patients, an increase in fat mass and a decrease in muscle mass, and, possibly, some degree of neuromuscular abnormality [2]. It has been reported that the motor problems are still present in childhood and adulthood, which causes the decrease in physical activity in Prader-Willi patients [3]. Thus, the hypotonia makes the choice of muscle relaxant difficult. Anesthetic management using atracurium and rocuronium have been reported [4,5]. However, few reports are available on using the intraoperative monitoring of the neuromuscular blockade for Prader-Willi patients. In this case, though the patient had hypotonia, anesthesia was successfully used with a dose adjusted muscle relaxant using the TOF watch.

Background: Ketamine and dexmedetomidine are commonly used for sedation and analgesia in patients. We tried to compare the effects of intravenous ketamine and dexmedetomidine infusion on spinal block with bupivacaine. Methods: Ninety American Society of Anesthesiologists physical status class I or II patients, who were scheduled to spinal anesthesia were randomly assigned to one of three groups (n = 30). Normal saline 10 ml, 5 ml/hr (loading dose for 10 minutes, infusion) (Group NS), dexmedetomidine 1 μg/kg, 0.5 μg/kg/hr (Group DEX), or ketamine 0.2 mg/kg, 0.5 mg/ kg/hr (Group KET) was infused intravenously before spinal anesthesia. We recorded the time to highest sensory block level, sensory and motor regression, and hemodynamic changes. Results: Patients in Groups KET had a significantly faster onset time of sensory block than patients in Group NS. The highest sensory block levels were not significantly different between groups. Average time of sensory regression and knee flexion, was significantly longer in the Group KET and Group DEX than the Group NS. Conclusions: Intravenous dexmedetomidine and ketamine were found to have a similar synergistic effect with intrathe cal bupivacaine. Hemodynamic stability showed better results in Group KET. (Korean J Anesthesiol 2014; 67: 85-89)

Background: The main disadvantage of rocuronium is the pain associated with vascular injection. We evaluated the ef ficacy of palonosetron for reducing pain after rocuronium injection. Methods: Eighty patients scheduled for elective surgery were randomly divided into two groups: Group C (normal saline 1.5 ml, n = 40) and Group P (palonosetron 0.075 mg, n = 40). Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds. Thirty seconds after the injection of the test drug, rocuronium 0.6 mg/kg was in jected over 30 seconds and the response was recorded. Injection pain was graded using a 4-point scale. The grade was 0 points for no movement, 1 point for wrist movement, 2 points for elbow or shoulder movement, and 3 points for whole body movement. Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection. Results: There was no significant difference in the grade 1 response between the two groups; however, the grade 2 and 3 responses in Group P were 5 (12.5%) and 4 (10%), respectively, which were significantly lower than in Group C, with 13 (32.5%) responses for each grade. There were no significant differences in hemodynamic changes within each group. However, the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P. Conclusions: Pretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration. (Korean J Anesthesiol 2014; 66: 23-27)

Propofol causes pain during vascular injection. Dexmedetomidine, an α2-adrenoceptor agonist, has an analgesic effect as well as a sedative effect. Several studies have examined whether the analgesic effect of dexmedetomidine can reduce pain associated with propofol injection [1], but these studies were not helpful in clarifying the appropriate dosage of dexmedetomidine for minimizing hemodynamic changes from the drug while maximizing the reduction of propofol injection pain. In this study, we evaluated the efficacy of dexmedetomidine in reducing pain and hemodynamic changes during propofol injection. The study was approved by the Institutional Review Board of our hospital, and informed consent was obtained from the subject patients after sufficient explanation regarding general anesthesia and our study. One hundred sixty American Society of Anesthesiologists physical status 1 or 2 patients (20 to 60 years old) who were scheduled for elective surgery were enrolled. They were randomly divided into four groups; group 1 (propofol 120 mg and normal saline, n = 40), group 2 (propofol 120 mg and dexmedetomidine 0.25 μg/kg, n = 40), group 3 (propofol 120 mg and dexmedetomidine 0.5 μg/kg, n = 40), and group 4 (propofol 120 mg and dexmedetomidine 0.75 μg/kg, n = 40). The volume of the drug mixture 1% propofol (long-chain triglyceride) and saline or dexmedetomidine was 15 ml in all patients. Injection pain was graded using a 4-point scale. A 20 gauge catheter was mounted on the dorsal hand or wrist area. The drug mixture was injected for 25 seconds through the catheter in order to induce anesthesia. From the start of the injection until the loss of consciousness, each patient was asked, “Does it hurt?” every 5 seconds to measure the degree of pain. The pain was evaluated as 0 when there was no discomfort in the injection area (no pain), 1 when the patient simply answered “Yes” without any change in behavior (slight), 2 when there was a change in behavior or voluntary complaint of pain (intermediate), and 3 when the patient made a loud sound, grimaced, withdrew his or her arm, or shed tears (severe). SAS 9.2 (SAS Institute Inc., Cary, NC, USA) was used to perform a one way ANOVA for age, height, weight, and hemodynamic changes. The degree of pain was analyzed with a χ 2 -test, and the results were considered statistically significant

Background: Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post­laparoscopy pain. Dexmedetomidine, an α2 agonist, has well­known anesthetic and analgesic­sparing effects. We evaluated the analgesic effect of perioperative dexmedetomidine infusion during laparoscopic cholecystectomy with multimodal analgesia. Methods: Forty­ two patients aged 20 to 60 years old were allocated randomly into one of 2 groups (n = 21, in each). All patients underwent laparoscopic cholecystectomy under multimodal analgesia. The patients in group P received dexmedetomidine 1 μg/kg during 10 min before induction and then 0.5 μg/kg/h continuously until the removal of the gall bladder while the patients in the group C received saline by the same methods as group P. Total analgesic consumption and VAS score were recorded for the first 24 hr. Results: There were no significant differences in VAS scores between group P and group C during 24 hr after laparoscopic cholecystectomy. VAS scores of group P were lower than that of group C during the 1st hr after operation. The amount of ketorolac required during the 24 hr after the operation was significantly less in group P compared to group C. Conclusions: The administration of dexmedetomidine during laparoscopic cholecystectomy with multimodal analgesia has minimal benefits on the reduction of the postoperative pain score. The amount of ketorolac requirements during 24 hr after the operation showed significant difference. Dexmedetomidine might be helpful for the postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. (Korean J Anesthesiol 2012; 63: 436­440)

Background This study was designed to compare the effect of dexmedetomidine and remifentanil used in anesthetic induction on hemodynamic change after direct laryngoscopy and tracheal intubation. Methods A total of 90 ASA class 1 or 2 patients were randomly assigned to one of 3 groups to receive one of the following treatments in a double-blind manner: normal saline (Group C, n = 30), dexmedetomidine 1 µg/kg (Group D, n = 30), remifentanil 1 µg/kg (Group R, n= 30). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.6 mg/kg and maintained with 2 vol% sevoflurane and 50% nitrous oxide in oxygen. In group D, dexmedetomidine 1 µg/kg was infused for 10 min before tracheal intubation. Patients in group R was received 1 µg/kg of remifentanil 1 minute before tracheal intubation. The systolic blood pressure, diastolic blood pressure and heart rate were recorded from entrance to operation room to 5 min after tracheal intubation. Results The percent increase in systolic and diastolic blood pressure due to tracheal intubation in group D and R were significantly lower than that of group C (P < 0.05). The heart rate 1 min after tracheal intubation was lower in groups R and D than in the group C (P < 0.05). Conclusions In healthy normotensive patients, the use of dexmedetomidine during anesthetic induction suppressed a decrease in blood pressure due to anesthetic induction and blunted the hemodynamic responses to endotracheal intubation.

Background: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. Methods: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25g/kg/min (Group 0.25), or remifentanil 0.5g/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. Result: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P 0.2 mg/kg, 1.07 0.2 mg/kg and 0.9 0.1 mg/kg, respectively. Conclusions: A combined injection of 0.5g/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.