Journal of Yeungnam Medical Science

Original articles

Enhancing ketamine anesthesia with midazolam and fentanyl for children’s ear surgery: a prospective randomized study: Seong Min Han, So Young Kwon, Jang Hyeok In, Jin Deok Joo; J Yeungnam Med Sci. 2024;41(3):207-212. Published online May 23, 2024; DOI: https://doi.org/10.12701/jyms.2024.00276

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Abstract PDF: Background
Myringotomy with tympanostomy tube insertion (MTI) is a superficial surgical procedure used to prevent hearing loss in children with serous otitis media. Intravenous anesthesia, often ketamine, is preferred for this procedure because of its ability to induce sedation without compromising airway reflexes. However, ketamine alone may be insufficient and potentially lead to spontaneous movement during surgery. This study evaluated the effectiveness of midazolam and fentanyl as adjuvants to ketamine in reducing spontaneous movement during MTI and enhancing the quality of recovery.
Methods
This study involved two groups of 30 patients each: one group received intravenous ketamine (1.5 mg/kg) with an equal volume of normal saline (K group), while the other received a combination of midazolam, fentanyl, and ketamine (0.05 mg/kg, 1 μg/kg, and 1.5 mg/kg, respectively; MFK group). We assessed side effects, intraoperative patient movement, surgeon satisfaction, and emergence agitation scores.
Results
The MFK group exhibited significantly lower scores for patient movement (p<0.01) and emergence agitation (p<0.01) and markedly higher surgeon satisfaction scores (p<0.01) than the K group.
Conclusion
Administering a midazolam-fentanyl-ketamine combination effectively reduced spontaneous movement during surgery and emergence agitation during recovery without prolonging discharge times in children undergoing MTI.

Effects of propofol-remifentanil versus sevoflurane-remifentanil on acute postoperative pain after total shoulder arthroplasty: a randomized trial: Eun Kyung Choi, Saeyoung Kim, Do young Kim; J Yeungnam Med Sci. 2023;40(3):247-251. Published online March 30, 2022; DOI: https://doi.org/10.12701/jyms.2022.00129

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Background
While some evidence indicates that propofol-based anesthesia has less postoperative pain than sevoflurane-based anesthesia, these results are controversial. We compared acute postoperative pain intensity and opioid consumption after total shoulder arthroplasty between propofol-remifentanil (PR) and sevoflurane-remifentanil (SR) anesthesia.
Methods
Among 48 patients undergoing shoulder arthroscopic surgery anesthetized with PR or SR, postoperative pain intensity was assessed at 30 minutes and at 2, 6, 12, and 24 hours. The total patient-controlled analgesia volume and number of patients requiring rescue analgesics were assessed.
Results
No significant difference in postoperative pain intensity was observed between the two groups. Postoperative opioid consumption and analgesic requirements were also comparable in the first 24 hours after surgery.
Conclusion
PR and SR anesthesia for shoulder arthroscopic surgery provide comparable postoperative analgesia results.

Citations

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Comparison of sevoflurane and propofol in combination with remifentanil on the quality of postoperative recovery in patients undergoing laparoscopic bariatric surgery
Zhuolin Shu, Tiancheng Lin, Dingchen Xu, Shuyuan Zheng
Frontiers in Medicine.2024;[Epub] CrossRef

Case reports

Reverse Takotsubo cardiomyopathy with left bundle branch block after anesthesia induction in a patient with subarachnoid hemorrhage: a case report: Eun Kyung Choi, Jong-Hoon Kim, Minhyun Kim; J Yeungnam Med Sci. 2022;39(2):172-178. Published online October 25, 2021; DOI: https://doi.org/10.12701/yujm.2021.01354

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Abstract PDF

Cardiac dysfunction after subarachnoid hemorrhage (SAH) is described as Takotsubo or reverse Takotsubo cardiomyopathy that shows transient left ventricular wall motion abnormalities with electrocardiogram (ECG) changes. ST change followed by T inversion is a common ECG finding complicated with these disorders, left bundle branch block (LBBB) may be a potential ECG pattern which is seen. In this case, we describe the clinical profile and outcomes of a patient with LBBB and reverse Takotsubo cardiomyopathy after anesthetic induction, which was scheduled as an emergent external ventricular drainage after SAH. This is the first report of an LBBB pattern in reverse Takotsubo cardiomyopathy.

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Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review
Dorottya Szántó, Péter Luterán, Judit Gál, Endre V. Nagy, Béla Fülesdi, Csilla Molnár
Reviews in Cardiovascular Medicine.2023;[Epub] CrossRef

Anesthetic management during whole-lung lavage using lung ultrasound in a patient with pulmonary alveolar proteinosis: a case report: Jae Wan Jung, Hyunho Lee, Jimi Oh; Yeungnam Univ J Med. 2021;38(4):374-380. Published online September 6, 2021; DOI: https://doi.org/10.12701/yujm.2021.01284

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Abstract PDF

Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by progressive accumulation of lipoprotein material in the lungs due to impaired surfactant clearance. Whole-lung lavage (WLL) is the current standard treatment and consists of sequential lavage of each lung to mechanically remove the residual material from the alveoli. Although WLL is considered safe, unexpected complications can occur. Moreover, due to the rarity of the disease itself, this procedure is unknown to many physicians, and management of intraoperative complications can be challenging for anesthesiologists. Lung ultrasound (LUS) provides reliable and valuable information for detecting perioperative pulmonary complications and, in particular, quantitation of lung water content. There have been reports on monitoring the different stages of controlled deaeration of the non-ventilated lung during WLL using LUS. However, it has been limited to non-ventilated lungs. Therefore, we report the use of LUS in WLL to proactively detect pulmonary edema in the ventilated lung and implement a safe and effective anesthesia strategy. Given the limited diagnostic tools available to anesthesiologists in the operating room, LUS is a reliable, fast, and noninvasive method for identifying perioperative pulmonary complications in patients with PAP undergoing WLL.

Citations

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Effect of Whole Lung Lavage for Pulmonary Alveolar Proteinosis on Circulatory Dynamics: A Case Report
Junichi Sato, Tomohiro Chaki, Chinami Kaga, Mariko Ikeshima, Michiaki Yamakage
Cureus.2025;[Epub] CrossRef
Anesthetic management of broncho- alveolar lavage in pulmonary alveolar proteinosis: A case report
Abinav Sarvesh S P S, Sucheta Gaiwal, Nimitha Prasad
Indian Journal of Clinical Anaesthesia.2024; 11(2): 251. CrossRef

Review article

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging: Sung Mee Jung; Yeungnam Univ J Med. 2020;37(3):159-168. Published online April 17, 2020; DOI: https://doi.org/10.12701/yujm.2020.00171

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Abstract PDF

The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infant or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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Is imaging necessary in pediatric patients with isolated tinnitus?
Zainab Balogun, Tracy Cheng, Amber D. Shaffer, David Chi, Dennis Kitsko
International Journal of Pediatric Otorhinolaryngology.2025; 188: 112196. CrossRef
Study on the sedative effect and safety of oral midazolam combined with dexmedetomidine nasal drops in children during magnetic resonance imaging examination
Yuancui Li, Rongzhu Lei
Frontiers in Pediatrics.2025;[Epub] CrossRef
Safety of a higher thiamylal induction dose in pediatric sedation for magnetic resonance imaging scans
Yi-Shiuan Li, Shih-Pin Lin, Wen-Kuei Chang, Ting Chien-Kun
European Journal of Medical Research.2025;[Epub] CrossRef
Prioritisation of data-poor pharmaceuticals for empirical testing and environmental risk assessment
Cristiana Cannata, Thomas Backhaus, Irene Bramke, Maria Caraman, Anna Lombardo, Rhys Whomsley, Caroline T.A. Moermond, Ad M.J. Ragas
Environment International.2024; 183: 108379. CrossRef
Review of pediatric sedation and anesthesia for radiological diagnostic and therapeutic procedures
Mohammed Ageel
Journal of Radiation Research and Applied Sciences.2024; 17(1): 100833. CrossRef
Comparison of airway collapsibility following single induction dose ketamine with propofol versus propofol sedation in children undergoing magnetic resonance imaging: A randomised controlled study
Pooja Bhardwaj, Sakthirajan Panneerselvam, Priya Rudingwa, Kirthiha Govindaraj, M.V.S. Satya Prakash, Ashok S. Badhe, Krishnan Nagarajan
Indian Journal of Anaesthesia.2024; 68(2): 189. CrossRef
A Narrative Review of the Efficacy and Safety of Oral Ketamine in Pediatric Sedation: A Critical Analysis of Current Evidence
Lakshmi Naga Sai Sivani Dasari, Sanjot Ninave
Cureus.2024;[Epub] CrossRef
Evaluating Sedation Strategies for Magnetic Resonance Imaging: A Comprehensive Review of Intravenous Fentanyl, Butorphanol, and Midazolam in Adult and Pediatric Populations
Neeta Verma, Janhavi S Dahake
Cureus.2024;[Epub] CrossRef
Efficacy and Safety of Dexmedetomidine Compared to Other Needle-Free Pharmacological Sedation Methods in Pediatric Patients Undergoing Imaging Procedures
Mohammed Alsabri Hussein Alsabri, Abdelrahman Abdelshafi, Ahmed Bostamy Elsnhory, Noha Samir Selim, Alaa Bostamy Elsnhory, Douaa Albelal, Fatima Akram, Alaa Ahmed Elshanbary
Pediatric Emergency Care.2024; 40(9): e233. CrossRef
Adverse events and sedation characteristics of propofol and dexmedetomidine during magnetic resonance imaging: An observational study in neuropsychiatric population
Shyamala Narayanan, Sriganesh Kamath, Dhritiman Chakrabarti
Journal of Neurosciences in Rural Practice.2024; 15: 545. CrossRef
Sedation and anesthesia for imaging of the infant and neonate—a brief review
Forrest P. Beaulieu, Gabriel Zuckerberg, Kristen Coletti, Emily Mapelli, John Flibotte, Spoorthi Sampath, Misun Hwang, Elizabeth T. Drum
Pediatric Radiology.2024; 54(10): 1579. CrossRef
A Comprehensive Review on the Role of MRI in the Assessment of Supratentorial Neoplasms: Comparative Insights Into Adult and Pediatric Cases
Paritosh N Bhangale, Shivali V Kashikar, Paschyanti R Kasat, Priyal Shrivastava, Anjali Kumari
Cureus.2024;[Epub] CrossRef
Meta-analysis study on anesthetic sedation recovery and onset times in pediatric and elderly patients undergoing CT and MRI
Qiong Zhao, Fei Meng, Huimei Han, Lili Han
Biomedical Papers.2024;[Epub] CrossRef
Anesthesia in PET/MRI. Challenges for the Anesthesiologist: A Narrative Review
Sudhir Venkataramaiah, Ramesh J. Venkatapura, Chandana Nagaraj
Journal of Neuroanaesthesiology and Critical Care.2024;[Epub] CrossRef
Clinical Efficacy of Dexmedetomidine and Propofol in Children Undergoing MRI for Urological Diseases: A Systematic Review
Pakeeza Shafiq, Muhammad Umer Iqbal Butt, Hafiz Wajih Ul Hassan, Saba Maqsood, Syed Imtiaz Ali Zaidi, Aftab Ahmed, Ehsan Ul Haq
Pakistan Journal of Health Sciences.2024;[Epub] CrossRef
Comparison of oral triclofos and intranasal midazolam and dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an open-label, three-arm, randomized trial
Shyam Chandrasekar, Bhagirathi Dwibedi, Rashmi Ranjan Das, Biswa Mohan Padhy, Bikram Kishore Behera
European Journal of Pediatrics.2023; 182(3): 1385. CrossRef
Correlation between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients in South Korea: a prospective cohort study
Mijung Park, Ji Um, So Hyun Kim, Jiseon Yoon, Yeonjae Lee, Jiyeong Kwon, Seonhee Baek, Dong Yeon Kim
Child Health Nursing Research.2023; 29(1): 51. CrossRef
COMPARISON OF INTRAMUSCULAR VERSUS INTRAVENOUS KETAMINE FOR SEDATION IN CHILDREN UNDERGOING MAGNETIC RESONANCE IMAGING EXAMINATION
Jasim M. Salman, Jasim N. Al-Asadi, Husham H. Abdul-Ra’aoof, Jawad H. Ahmed, Ali H Reshak
Wiadomości Lekarskie.2023; 76(1): 198. CrossRef
Does sevoflurane sedation in pediatric patients lead to “pseudo” leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?
Kiran Hilal, Kumail Khandwala, Saima Rashid, Faheemullah Khan, Shayan Sirat Maheen Anwar
World Journal of Radiology.2023; 15(4): 127. CrossRef
Intranasal dexmedetomidine versus intranasal midazolam as sole sedative agents for pelviabdominal magnetic resonance imaging in pediatrics: A randomized double-blind trial
TaysserM Abdelraheem, HamdyA Hendawy, AmiraM Elkeblawy
Bali Journal of Anesthesiology.2023; 7(2): 99. CrossRef
Prospective, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial comparing the safety and efficacy of intranasal dexmedetomidine to oral midazolam as premedication for propofol sedation in pediatric patients undergoing magnet
Olivia Nzungu Wabelo, Denis Schmartz, Mario Giancursio, Françoise De Pooter, Giulia Caruso, Jean-François Fils, Philippe Van der Linden
Trials.2023;[Epub] CrossRef
The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam
Xiaqing Zhou, Jialian Zhao, Haiya Tu, Kunwei Chen, Yaoqin Hu, Yue Jin
European Journal of Pediatrics.2023; 183(1): 169. CrossRef
Determination of the normal conus medullaris level in term infants: the role of MRI in early infancy
Mengchun Sun, Benzhang Tao, Gan Gao, Hui Wang, Aijia Shang
Journal of Neurosurgery: Pediatrics.2022; 29(1): 100. CrossRef
Patient background related to success and adverse event in pediatric sedated MRI
Yutaka Konda, Hajime Mihira, Louis Akiyama, Yuki Shiko, Yoshihito Ozawa, Yohei Kawasaki, Katsunori Fujii, Ryugo Hiramoto
Pediatrics International.2022;[Epub] CrossRef
Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis
Yu Cui, Langtao Guo, Qixia Mu, Lu Kang, Qin Chen, Qunying Wu, Yani He, Min Tang
Pediatric Drugs.2022; 24(4): 403. CrossRef
Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study
Bi Lian Li, Hao Luo, Jun Xiang Huang, Huan Huan Zhang, Joanna R. Paquin, Vivian M. Yuen, Xing Rong Song
Frontiers in Pediatrics.2022;[Epub] CrossRef
A Novel Propofol Dosing Regimen for Pediatric Sedation during Radiologic Tests
Ji-Young Min, Jeong-Rim Lee, Hye-Mi Lee, Ho-Jae Nam, Hyo-Jin Byon
Journal of Clinical Medicine.2022; 11(17): 5076. CrossRef
Psychiatric outcomes following ketamine administration for orthopedic surgical anesthesia
Alec E. Mansour, Elijah W. Hale, Daniel S. Saks
Frontiers in Anesthesiology.2022;[Epub] CrossRef
Artificial intelligence in paediatric radiology: Future opportunities
Natasha Davendralingam, Neil J Sebire, Owen J Arthurs, Susan C Shelmerdine
The British Journal of Radiology.2021;[Epub] CrossRef

Case report

Awareness during general anesthesia despite simultaneous bispectral index and end-tidal anesthetic gas concentration monitoring: Jungwon Lee, Chorong Park, Saeyoung Kim; Yeungnam Univ J Med. 2019;36(1):50-53. Published online December 14, 2018; DOI: https://doi.org/10.12701/yujm.2019.00010

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Abstract PDF

Awareness during general anesthesia occurs in approximately 0.1–0.2% of cases; nevertheless, particular attention is required because it can lead to critical complications including insomnia, depression, anxiety, and post-traumatic stress disorder. To prevent these complications, bispectral index (BIS) and end-tidal anesthetic gas (ETAG) concentration monitoring are commonly used to examine patient consciousness during surgery. In the present case, an 80-year-old man was scheduled for total gastrectomy. Anesthesia was maintained using desflurane 4.0–5.0% vol, oxygen, and nitrous oxide. The authors simultaneously monitored BIS, which was maintained between 37 and 43, and ETAG, which was maintained between 0.9 and 1.2 minimum alveolar concentration (MAC). After the operation, however, the authors were surprised to learn that the patient complained of awareness during anesthesia. Although BIS and ETAG concentration monitoring are useful in preventing awareness during anesthesia, they cannot be completely trusted. Even though BIS was maintained at approximately 40 and ETAG at 0.7–1.3 MAC, awareness during anesthesia occurred.

Citations

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Depth of anaesthesia monitoring: updated evidence. Comment on Br J Anaesth 2023; 131: 196–9
Paul S. Myles
British Journal of Anaesthesia.2023; 131(5): e145. CrossRef
Impact of bispectral index monitoring on critical incidents rate in high-risk patients: a randomised controlled trial
N. V. Trembach
Kuban Scientific Medical Bulletin.2022; 29(1): 48. CrossRef
A Crossover Comparison of the Sensitivity and the Specificity between BIS and AEP in Predicting Unconsciousness in General Anesthesia
Haitao Yang, Guan Wang, Jinxia Gao, Jie Liu, Liang Zhao
Scientific Programming.2020; 2020: 1. CrossRef

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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Abstract PDF

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

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Propofol-Induced Hyperglycemia in the Critically Ill: An Unfamiliar Side Effect of a Common Anesthetic
Muhammad A Qureshi, Greeshma A Thomas, Tijin Mathew, FNU Anshul
Cureus.2024;[Epub] CrossRef
The Maternal and Neonatal Glycemic Stress Response in Normal Vaginal Delivery: A Comparative Study Between Epidural and Parenteral Opioids Analgesia
Ala”a Alhowary, Omar Altal, Diab Bani Hani, Anas Alrusan, Yaser Ba Jusair, Rania Al-Bataineh, Ahmed Al Sharie, Abdelwahab Aleshawi
Local and Regional Anesthesia.2024; Volume 17: 117. CrossRef
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

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Evaluating Anesthesia Guidance for Rescue Analgesia in Awake Patients Undergoing Carotid Endarterectomy with Cervical Plexus Blocks: Preliminary Findings from a Randomized Controlled Trial
Michał Jan Stasiowski, Nikola Zmarzły, Beniamin Oskar Grabarek
Journal of Clinical Medicine.2024; 14(1): 120. CrossRef
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.

An Unexpected Vapor Leakage from Locked Vaporizer.: Hyun Seok Seong, Sang Jin Park, In Seong Kim; Yeungnam Univ J Med. 2011;28(1):94-98. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.94

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Abstract PDF: One of the most popular types of vaporizer mounting sytems is Selectatec, as it possesses a simple detachment mechanism. Detachable units can loosen between the vaporizer and anesthetic machine, which can cause vapor leakage. A locking system was subsequently developed to prevent this issue; however, we report a case of an unexpected vapor leakage from a locked vaporizer.

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 Management of a Patient with Alexander's Disease: Case Report.: Bum Soo Kim, Dae Lim Jee, Sun Ok Song; Yeungnam Univ J Med. 2010;27(1):47-51. Published online June 30, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.1.47

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Abstract PDF: We present here the case of a 13-year-old male patient with Alexander's disease who underwent surgical correction of a femur fracture. Alexander's disease is a rare and fatal disorder that affects the white matter in the brain and it causes developmental delay, psychomotor regression, spasticity, megaloencephaly and seizure. The patient had the possibility of a seizure attack during the perioperative period. We discuss the anesthetic management of a patient with Alexander's disease and we review the relevant literature.

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.

Review Article

Delayed Complications of Regional Anesthesia: Sun Ok Song; Yeungnam Univ J Med. 2007;24(2 Suppl):S96-107. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S96

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Abstract PDF: Regional anesthesia, an attractive choice of anesthesia for the patients with systemic illness such as pulmonary/heart diseases or endocrine dysfunctions, is generally accepted as a safe anesthetic method. However, there are various kinds of complication annoying the physician and the patient following a regional anesthesia. Therefore, physicians and patients must understand the risks in addition to the benefits of regional anesthesia to make an informed consent of anesthetic technique. 1) This review will give an overview of delayed complications following a regional anesthesia.

Case Report

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.

Review

Pediatric Outpatient Anesthesia.: Il Sook Seo; Yeungnam Univ J Med. 2001;18(2):145-169. Published online December 31, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.2.145

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Abstract PDF: In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.

Original Articles

Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section.: Bon Up Koo; Yeungnam Univ J Med. 1991;8(1):72-78. Published online June 30, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.1.72

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Abstract PDF: Ephedrine sulfate was administrated 30 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Fifteen patients received ephedrine infusion (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the baseline systolic blood pressure (mean dose of ephedrine 31.6 mg). Fifteen patients (control group) received 20mg of ephedrine as an intravenous bolus, and additional 10mg increments, if necessary, when systolic blood pressure decreased to 80% of the baseline systolic blood pressure (mean dose of ephedrine 26.8 mg). Nausea and/or vomiting occurred in seven women in the control group and on patient in the infusion group (p<0.001). Apgar scores, fetal blood gas tension, and time for onset of respiration was comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.

Effect on the management of postherpetic neuralgia.: Bon Up Koo, Dae Pal Park; Yeungnam Univ J Med. 1991;8(1):136-141. Published online June 30, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.1.136

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Abstract PDF: Fifteen patients was analyzed on effect of the management of postherpetic neuralgia by local anesthesia on the special region at pain clinic in Youngnam University Hospital. The results were on follows: 1) The frequency of occurrence of sex and the lesion side were similar in all patients. 2) The age of incidence was between 50 and 70 years old. 3) The most frequent site of lestons was the neck. 4) There was no relationship between age and treatment time. 5) Whole patients was done average 7-10 time local injection.

Spinal Anesthesia for Lower Extremities : Comparison of Plain 0.5% Bupivacaine and Hyperbaric 0.5% Tetracaine.: Sun Ok Song, Bon Up Koo; Yeungnam Univ J Med. 1990;7(2):121-130. Published online December 31, 1990; DOI: https://doi.org/10.12701/yujm.1990.7.2.121

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Abstract PDF: Plain 0.5% bupivacaine and hyperbaric 0.5% tetracaine were compared for spinal anesthesia in 40 patients undergoing operation of lower extremities. Lumbar puncture was performed with a 22 gauge spinal needle with the patient in the lateral recumbent position. The third lumbar interspace was chosen for the puncture, when a free flow of clear CSF was obtained, the local anesthetic solution (2.5 ml of 0.5% bupivacaine or 2.0 ml of hyperbaric 0.5% tetracaine) was injected at a rate of 0.1ml/sec without barbotage. After injection of anesthetics, clinical features were observed and compared between the two groups. The results were as follows: 1. The two groups were well matched for age, sex, height and weight. 2. In both groups, sensory block to T₁₂ dermatome was obtained within 4 minutes, mean maximal level of analgesia was T₆₋₇, and the mean time for maximal level was around 20 minutes. 3. The onset times of motor block were similar in both groups and complete motor block was obtained in all cases within 20 minutes. 4. The duration of analgesia above the T₁₂ dermatome was 3 hours, postoperative analgesia was 7 hours. These value were significantly prolonged than those of the tetracaine group (p<0.05). 5. The changes in systolic pressure in the bupivacaine group were significantly less than those of the tetracaine group (p<0.05). 6. The complications after spinal anesthesia were headache, numbness, urinary retention and backpain, and were no significant difference in both groups. From the obtained results, we concluded that plain 0.5% bupivacaine was a relatively satisfactory agent for spinal anesthesia for operation of lower extremities. The time of onset, height of block and the complications of postoperative period were similar in both groups. The advantages of plain 0.5% bupivacaine were less hypotension and long duration of analgesia.

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