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Background: The presence of a urinary catheter, postoperative pain, and postoperative nausea and vomiting are risk factors for emergence agitation (EA). Antimuscarinic agents have been the primary agents used for urinary catheter-related bladder discomfort prevention and treatment. Chlorpheniramine has antimuscarinic, antinociceptive, and antiemetic effects. This retrospective study investigated the effect of chlorpheniramine on EA prevention in patients following ureteroscopic stone surgery. Methods: Of 110 adult patients who underwent ureteroscopic stone surgery under general anesthesia between January and December 2019, the medical records of 93 patients were analyzed retrospectively. The patients were divided into control (n = 52) and chlorpheniramine (n = 41) groups according to they receipt of intravenous chlorpheniramine before the induction of anesthesia. The incidence and severity of EA were compared between the groups as primary and secondary endpoints, respectively. The effects of chlorpheniramine on the requirement for inhalation anesthetic (desflurane) during surgery, changes in mean blood pressure and heart rate during emergence, and adverse events were also compared. Results: The incidence (21.2% in the control group, 24.4% in the chlorpheniramine group) and severity of EA did not differ between groups. The intraoperative requirement for desflurane, changes in mean blood pressure and heart rate during emergence, and adverse events were also similar between groups. Conclusion: Chlorpheniramine did not affect EA in patients after ureteroscopic stone surgery.Trial registration: CRiS Registration number KCT0004879. Initial registration date was 3 April 2020 (Retrospectively registered).

Background: The effects of neuromuscular blocking agents on the clinical performance of supraglottic airway devices and surgical condition in elderly patients undergoing hand surgery have not been established. We evaluated the effects of rocuronium on the clinical performance of an i-gel® supraglottic device and surgical condition in elderly patients undergoing orthopedic hand surgery. Methods: Patients aged 65-85 years were randomized to receive either rocuronium (rocuronium group) or saline (control group). We compared the rates of successful insertion of the i-gel on the first attempt as a primary outcome and also assessed the adequacy of i-gel maintenance during controlled ventilation, anesthetic requirement, surgical condition, and recovery time. Results: The rates of successful insertion of the i-gel on a first attempt were 93.1% in the rocuronium group versus 82.1% in the control group (P = 0.423). Peak inspiratory pressure (PIP) was lower in the rocuronium group than in the control group (15.2 vs. 17.9 cmH2O, respectively, P = 0.028). Spontaneous breathing was less common in the rocuronium group (24.1% vs. 57.1%, respectively, P = 0.011). The requirement of additional fentanyl to suppress spontaneous breathing or patient movement was less in the rocuronium group than in the control group (24.1% vs. 50.0%, respectively, P = 0.043). Surgical condition did not differ between the two groups. Recovery time was shorter in the rocuronium group than in the control group (8.4 vs. 9.9 min, respectively, P = 0.030). Conclusions: Rocuronium did not enhance the success rate of inserting the i-gel® or the surgical condition in elderly patients. However, using rocuronium reduced PIP, the frequency of spontaneous breathing, the requirement for additional fentanyl and patients' recovery time.

Background: Catheter-related bladder discomfort (CRBD) is common in patients with a urinary catheter and is a risk factor for emergence agitation (EA). The mainstay of CRBD management is anticholinergics. Dexamethasone inhibits acetylcholine release. This study aimed to evaluate the effects of dexamethasone on postoperative CRBD and EA.Methods: In this prospective study, 90 patients undergoing urological surgery requiring urinary catheterization were allocated randomly to one of two groups (each n = 45). Before induction of anesthesia, the dexamethasone group received 10 mg (2 ml) of dexamethasone intravenously, while the control group received 2 ml of saline in the same manner. The incidence and severity of CRBD were assessed 0, 1, 2, and 6 h after the patient arrived in the post-anesthesia care unit (PACU) as the primary outcomes. The incidence and severity of EA were also compared during emergence and recovery from anesthesia as secondary outcomes.Results: The incidences of CRBD in the control group and dexamethasone group at 0, 1, 2, and 6 h postoperatively were 28.9% and 15.6%, 55.6% and 55.6%, 57.8% and 46.7%, and 53.3% and 51.1%, respectively. The incidence and severity of CRBD assessed at 0, 1, 2, and 6 h postoperatively did not show intergroup differences. The incidence and severity of EA in the operating room and PACU also showed no difference between the groups.Conclusions: Dexamethasone (10 mg) administered before induction of anesthesia did not further reduce the incidence or severity of CRBD or EA in patients undergoing urological surgery.

Background Although the average age of patients undergoing surgical procedures or anesthesia is increasing, differences in anesthesia-related injuries among different age groups have been not reported. This study compared older and younger patients on the basis of disputes regarding anesthesia-related injuries referred to the Korean Society of Anesthesiologists (KSA). Methods We retrospectively analyzed disputes regarding anesthesia-related injuries referred to the KSA between 2009 and 2018. After excluding duplicates, incomplete data, local anesthesia cases, and patients aged ≤18 or 55–64 years, the subjects were divided into older (≥65 years) and younger (19–54 years) age groups. The parameters included in the KSA database were compared between these two groups. Results The 115 cases included in the study included 28 and 87 cases from the older and younger groups, respectively. The proportions of preventable cases of anesthesia-related adverse events differed significantly between the older (25%) and younger groups (48.3%). The most common medical disputes in the older group were related to general anesthesia, orthopedic surgery, local hospitals, and anesthesiologist, whereas those in the younger group were related to sedation, plastic surgery, local clinics, and non-anesthesiologists. Conclusion In addition to understanding the differences in anesthesia characteristics according to age group, it is also necessary to develop means for reducing preventable anesthesia-related adverse events. Furthermore, we must continue to register anesthesia-related disputes, and a voluntary reporting system should be established to prevent anesthesia-related accidents.

Background Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA SupremeTM) in geriatric patients. Methods The subjects were American Society of Anesthesiologists physical status classification I-III geriatric (65-85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA SupremeTM group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. Results Insertion time was significantly shorter for the i-gel® than the LMA SupremeTM (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA SupremeTM (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA SupremeTM (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. Conclusions Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA SupremeTM in geriatric patients.

BackgroundSugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia.MethodsForty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; eachn = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared.ResultsThe incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7;P = .006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4;P = .045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3;P = .001).ConclusionSuccinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture.Trial registrationCRiS Registration numberKCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).

Emergence agitation (EA) is common after nasal surgery. Strong opioids and N-methyl-D-aspartate (NMDA) receptor antagonists prevent EA. Tramadol also acts as an opioid receptor agonist and an NMDA receptor antagonist, but few studies have evaluated the effects of tramadol on EA. This retrospective study investigated whether tramadol is effective for reducing EA in adult patients undergoing nasal surgery.Of 210 adult patients undergoing a nasal surgical procedure under general anesthesia, the medical records of 113 were analyzed retrospectively. The patients were divided into 2 groups: patients who received tramadol during the operation (tramadol group, n = 52) and patients who did not (control group, n = 61). The incidence of EA, recovery time, changes in hemodynamic parameters, postoperative pain scores, and adverse events were compared between the 2 groups.The incidence of EA was higher in the control group than in the tramadol group (50.8% [31/61] vs 26.9% [14/52]; odds ratio 2.805; 95% confidence interval, 1.3 to 6.2; P = .010). Changes in systolic blood pressure in the 2 groups were similar, whereas changes in heart rate during emergence differed depending on the group (P = .020), although pairwise comparisons did not reveal any differences between the groups. Recovery time, postoperative pain scores, and adverse events were similar in the 2 groups.In adult patients undergoing nasal surgery, tramadol infusion decreases the incidence of EA after sevoflurane anesthesia without delaying recovery or increasing the number of adverse events.

Background: The epidural steroid injection is commonly used in the management of chronic low back pain and radiating pain. We compared the efficacy of 40, 60, and 80 mg of methylprednisolone acetate in patients with lumbar herniated disc disease treated with caudal epidural block. Methods: Seventy-two patients with lumbar herniated nucleus purposes on magnetic resonance imaging were included. All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle. After confirming the catheter tip position at the affected nerve root, contrasts were injected until patients felt discomfort in their site of pain. 24 patients in each group received 40 mg, 60 mg, 80 mg of methylprednisolone acetate, respectively. We evaluated the improvements by pain relief scale (0−100%) after 2 weeks. Results: There are no significant differences in the pain improvement between three groups (P = 0.537 ). Conclusions: Sixty and 80 mg methylprednisolone acetate injection during caudal epidural block showed no further benefit compared to 40 mg injection. (Korean J Anesthesiol 2008; 54: 427∼30)

접수일:2006년 10월 9일, 승인일:2006년 12월 1일 책임저자:김태형, (135-710) 서울시 강남구 일원동 50번지, 삼성서울병원 마취통증의학과 Tel: 02-3410-0366, Fax: 02-3410-0361, E-mail: bluecar@smc.samsung.co.kr Received October 9, 2006, Accepted December 1, 2006 Correspondence to: Tae Hyeong Kim, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-0366, Fax: +82-2-3410-0361, E-mail: bluecar@smc.samsung.co.kr 추간판 탈출증 환자에서 길잡이철사가 삽입된 경막외카테터를 이용한 미추경막외조영술