Journal of Yeungnam Medical Science

Original Articles

Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery: Hyuckgoo Kim, Jisoo Han, Sung Mee Jung, Sang-Jin Park, Nyeong Keon Kwon; Yeungnam Univ J Med. 2018;35(1):54-62. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.54

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Background
The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.
Methods
This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels >180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery.
Results
Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, -27.154 to -2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups.
Conclusion
Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.

Citations

Citations to this article as recorded by

Strategies for intraoperative glucose management: a scoping review
Nathaniel Morin, Sarah Taylor, Danae Krahn, Leyla Baghirzada, Michael Chong, Tyrone G. Harrison, Anne Cameron, Shannon M. Ruzycki
Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2023; 70(2): 253. CrossRef
Impact of total intravenous anesthesia and total inhalation anesthesia as the anesthesia maintenance approaches on blood glucose level and postoperative complications in patients with type 2 diabetes mellitus: a double-blind, randomized controlled trial
Xinghui Xiong, Yong He, Cheng Zhou, Qin Zheng, Chan Chen, Peng Liang
BMC Anesthesiology.2023;[Epub] CrossRef
Current trends in management of hyperglycaemia in surgical patients with diabetes mellitus: a review
Vladimir N. Kuklin, J. Matri, N. P. Barlow, S. H. Tveit, J. E. Kvernberg, E. -M. Ringvold, V. Dahl
Annals of Critical Care.2022; (4): 33. CrossRef
Effects of sevoflurane anesthesia and abdominal surgery on the systemic metabolome: a prospective observational study
Yiyong Wei, Donghang Zhang, Jin Liu, Mengchan Ou, Peng Liang, Yunxia Zuo, Cheng Zhou
BMC Anesthesiology.2021;[Epub] CrossRef

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study: Wangseok Do, Ah-Reum Cho, Eun-Jung Kim, Hyae-Jin Kim, Eunsoo Kim, Heon-Jeong Lee; Yeungnam Univ J Med. 2018;35(1):45-53. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.45

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Abstract PDF

Background
Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.
Methods
Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.
Results
There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p<0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p<0.001).
Conclusion
In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Citations

Citations to this article as recorded by

Outcomes of Dexmedetomidine with Local Regional Anesthesia in Carotid Endarterectomy
Samik H. Patel, Vikram L. Sundararaghavan, Amber M. Pawlikowski, Jeremy Albright, Jason M. Adams, Michael J. Heidenreich, Robert J. Beaulieu, Abdulhameed Aziz
Annals of Vascular Surgery.2023; 89: 174. CrossRef
Anesthetic Management of a Patient Undergoing Cochlear Implantation With Superficial Cervical Plexus Block and Sedation: A Case Report
Natsuki Takemura, Tetsuya Miyashita, Yasuko Baba
A&A Practice.2022; 16(1): e01555. CrossRef
Ultrasound-guided intermediate cervical plexus block for postoperative analgesia in patients undergoing carotid endarterectomy under general anesthesia: a case-control study
Onat BERMEDE, Volkan BAYTAŞ
Journal of Contemporary Medicine.2022; 12(2): 261. CrossRef
Relationship between annular calcification of plaques in the carotid sinus and perioperative hemodynamic disorder in carotid angioplasty and stenting
Qingjie Chi, Zhuo Chen, Li Zhu, Ruifan Yuan, Kaixuan Ren, Tianle Wang, Wenbin Ding
Journal of Stroke and Cerebrovascular Diseases.2022; 31(10): 106634. CrossRef
Cardiac output and cerebral blood flow during carotid surgery in regional versus general anesthesia: A prospective randomized controlled study
Helmuth Tauber, Werner Streif, Jennifer Gebetsberger, Lukas Gasteiger, Eve Pierer, Michael Knoflach, Gustav Fraedrich, Maria Gummerer, Josef Fritz, Corinna Velik-Salchner
Journal of Vascular Surgery.2021; 74(3): 930. CrossRef
Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy
Zoltán Kovács-Ábrahám, Timea Aczél, Gábor Jancsó, Zoltán Horváth-Szalai, Lajos Nagy, Ildikó Tóth, Bálint Nagy, Tihamér Molnár, Péter Szabó
Journal of Clinical Medicine.2021; 10(23): 5479. CrossRef
Plexus anesthesia versus general anesthesia in patients for carotid endarterectomy with patch angioplasty: Protocol for a systematic review with meta-analyses and Trial Sequential Analysis of randomized clinical trials
M. S. Marsman, J. Wetterslev, F. Keus, D. van Aalst, F. G. van Rooij, J. M.M. Heyligers, F. L. Moll, A. Kh. Jahrome, P. W.H.E Vriens, G. G. Koning
International Journal of Surgery Protocols.2020; 19: 1. CrossRef

Case Reports

Suddenly fixed upward ocular deviation under general anesthesia: Won Jae Kim, Sang Jin Park, Myung Mi Kim; Yeungnam Univ J Med. 2017;34(2):290-292. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.290

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Abstract PDF: Various changes in ocular position are possible during general anesthesia as opposed to the awakening state. However, unexpected ocular deviation under general anesthesia is a disconcerting event as it can lead to difficult complications intraoperatively. To date, sudden fixed upward ocular deviation has been rarely reported previously. This phenomenon was observed in an 8-year-old boy during strabismus surgery. Suddenly fixed upward ocular deviation occurred when the speculum was inserted into the right eye. When the eyeball was pulled down, using forceps, there was some resistance, such as contracture of superior rectus. The eyeball sprang back into the upward position when the forceps was released. These changes could hamper the good exposition of the surgical field, leading to significant intraoperative difficulties and complications. Surgeons should be aware of this possibility, despite general anesthesia; if it occurs, proceed with the surgery as planned preoperatively, and both ophthalmic and anesthetic interventions should be used to solve this problem.

Anesthesia for Cesarean Section in a Parturient with Dilated Cardiomyopathy: A Case Report.: Sae Yeon Kim, Su Jeong Heo, Sun Ok Song; Yeungnam Univ J Med. 2010;27(1):52-56. Published online June 30, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.1.52

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Abstract PDF: Idiopathic peripartum cardiomyopathy is an uncommon malady disease. Making the diagnosis is often difficult and it is always necessary to exclude other prior heart disease and other causes of left ventricular dysfunction in pregnant women. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are further amplified when the common complications of pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy. This may be aggravated by making a late diagnosis and providing inappropriate treatment. We experienced a 38-year-primigravida who has diagnosed with idiopathic peripartum cardiomyopathy and underwent elective cesarean section with general anesthesia.

Anesthetic Experience for Trans-Sphenoidal Surgery of Pituitary Adenoma on a Patient with Brugada Syndrome: A Case Report.: Min Jung Heo, Sae Yeon Kim; Yeungnam Univ J Med. 2009;26(2):148-155. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.148

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Abstract PDF: Brugada syndrome is characterized by an ECG pattern of right bundle branch block and ST segment elevation in the right precordial leads (V(1)-V(3)) without structural heart disease. It is also characterized by sudden cardiac death that's caused by ventricular fibrillation. This is a familial syndrome with an autosomal dominant inheritance pattern and it may be considerably more common in Southeast Asia. Many factors during anesthesia can precipitate malignant dysrrhythmia in these patients, so careful choice of anesthetics is required. We experienced a case of Brugada syndrome in a 59-year-old male patient who was under general anesthesia for trans-sphenoidal surgery to treat a pituitary adenoma, and the patient was diagnosed as having Brugada syndrome without any untoward cardiovascular events.

Anesthetic Induction in a Sitting Position for a Patient with Congestive Heart Failure.: Seung Dong Kim, Gul Jung, Dae Lim Jee; Yeungnam Univ J Med. 2008;25(2):150-153. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.150

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Abstract PDF: A 67-year-old woman with severe congestive heart failure (New York Heart Association, NYHA class IV) was set to receive general anesthesia for cardiac surgery. For several months, she had been in a constant sitting position from which the slightest change evoked dyspnea. A patient in such a condition is rarely considered a candidate for general anesthesia, because such patients are never eligible for any type of surgery other than that used to fix the heart problem itself. We report this case to explain how anesthesia was induced with the patient sitting in a crouching position and discuss other methods of induction that can probably be used in similar situations.

General Anesthesia for Extracorporeal Shockwave Lithotripsyin Child with Lesch-Nyhan Syndrome.: Sang Jin Park, Il chi Kwon, Won Ki Lee, Deok Hee Lee; Yeungnam Univ J Med. 2008;25(1):78-83. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.78

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Abstract PDF: Lesch-Nyhan syndrome is an inborn error of purine metabolism resulting from hypoxanthine-guanine-phosphoribosyltransferase (HGPRT) deficiency and leading to excess purine production and uric acid over-production. It is a very rare X-linked recessive disorder, characterized by movement disorder, cognitive deficits, and self-injurious behavior. However, because of the high incidence of calculi, patients may present for surgery of urinary tract, and have increased risk of difficult intubation, aspiration pneumonia, renal insufficiency or sudden death. We report the case of a 5-year-old boy with Lesch-Nyhan syndrome who underwent successive extracorporeal shockwave lithotripsy under general anesthesia.

Treatment of Atelectasis Dectected in the Recovery Room after General Anesthesia: Chang jae Hwang, Heung dae Kim, Dae pal Park, Il suk Seo, Sun ok Song, Sae yeon Kim, Dae lim Jee, Deok hee Lee; Yeungnam Univ J Med. 2007;24(2 Suppl):S696-701. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S696

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Abstract PDF: Atelectasis is a relatively common complication following surgery in anesthetized patient with respiratory symptoms, but rarely occur in normal healthy patient. Anesthesiologists must be wary to prevent atelectasis, because it may lead to hypoxia during and after the operation. This case reports a healthy patient without previous respiratory symptoms who developed left lower lobar atelectasis after general anesthesia. Vigorous chest physiotherapy including intended coughing, deep breathing, chest percussion and vibration under postural change was effective. Therefore, vigorous chest physiotherapy is essential part of early treatment modalities for atelectasis in postoperative recovery room.

Original Article

Comparisons of Gas Analysis in Arterial, Venous and Warmed Venous Blood During Inhalation General Anesthesia: Heung Dae Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S519-526. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S519

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Abstract PDF: Background
：We determine whether venous blood, when sampled under carefully controlled conditions, was an acceptable alternative to arterial blood for the measurement of arterial blood gas analysis during inhalation general anesthesia. Materials and Methods：The arterial blood values of the carbon dioxide tension (PCO₂), pH, base excess (BE), oxygen tension (PO₂) and oxygen saturation (SO₂) were compared with the values of venous blood drawn from the cephalic vein as non controlled routine method and as localized warmed method during inhalation general anesthesia with sevoflurane and N₂O (50%) in 20 cases.
Results
：The blood gas analysis values of non controlled cephalic venous blood were close to those of arterial blood. They was similar between the PCO₂ (42.5 ± 0.97 vs. 38.7 ± 0.92 mmHg), pH (7.35 ± 0.01 vs. 7.39 ± 0.01) and BE (-3.13 ± 0.62 vs. -0.18 ± 0.13 mEq/l) of non controlled cephalic venous and of arterial blood. Although the PO₂ in non controlled cephalic venous blood was significantly less than that in arterial blood(130.8 ± 8.1 vs. 245.3 ± 6.8 mmHg), the difference in SO₂ was small(98.9 ± 2.1 vs. 99.7 ± 0.4%). The blood gas values of warmed cephalic venous blood were more similar to those of arterial blood (PCO₂, 41.2 ± 0.91 vs. 38.7 ± 0.92 mmHg; pH, 7.37 ± 0.01 vs. 7.39 ± 0.01; BE, -2.30 ± 0.62 vs. -0.18 ± 0.13 mEq/l; PO₂, 157.3 ± 11.4 vs. 245.3 ± 6.8 mmHg; SO₂, 99.2 ± 1.3 vs. 99.7 ± 0.4%) than to those of non controlled cephalic venous blood.
Conclusion
：We found that warmed cephalic venous blood during inhalation general anesthesia can be arterialized and PCO₂, pH, BE and SO₂ of warmed cephalic venous blood were not significantly different to those of arterial blood. Therefore we conclude that it is reliable to use localized warmed cephalic venous blood for the measurement of arterial blood gas analysis during inhalation general anesthesia.

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