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Purpose: Postoperative sore throat (POST) after general anesthesia with endotracheal intubation is a common and undesirable complication. In this study, we evaluated the combined effects of paracetamol and dexamethasone on the prevention of POST in patients after general anesthesia. Methods: A total of 226 patients scheduled for urologic surgery under general anesthesia were randomly assigned to one of two groups. In the DexaPara group ( n = 113), dexamethasone (10 mg) and paracetamol (1000 mg) was infused. In the Dexa group ( n = 113), dexamethasone (10 mg) alone was given. POST, hoarseness, and dysphagia were monitored. The postoperative wound pain score and perioperative opioid requirements were compared. In addition, complications related to opioids were compared between the groups. Results: The overall incidence of POST was lower in the DexaPara group than in the Dexa group [42 (37%) vs. 72 (64%), p < 0.001]. The incidence of POST while resting at postoperative 1 and 6 h was lower in the DexaPara group than in the Dexa group ( p = 0.008 and p = 0.004, respectively). The incidence of postoperative nausea, vomiting, drowsiness, shivering, and headache was comparable between the groups. Conclusions: Paracetamol and dexamethasone infusion reduced the incidence of POST without serious complications in patients for urologic surgery under general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Muscarinic receptors are involved in the mechanism of postoperative catheter-related bladder discomfort (CRBD). Glycopyrrolate and atropine as adjuncts to reversal of neuromuscular blockers have differential inhibitory effects on muscarinic receptors. This study was conducted to compare the effect of glycopyrrolate versus atropine on postoperative CRBD in patients undergoing transurethral resection of a bladder tumor (TURBT). Methods: Seventy-four patients undergoing TURBT were randomly allocated to receive either glycopyrrolate 10 μg/kg (glycopyrrolate group, n = 37) or atropine 15 μg/kg (atropine group, n = 37) in combination with neostigmine 25 μg/kg at the end of surgery for reversal of neuromuscular blockade. The incidence and severity (mild/moderate/severe) of CRBD were assessed at 0, 1, 6, and 24 h postoperatively. Tramadol 50-100 mg was administered intravenously if the patients complained of moderate or severe CRBD. Results: The incidence of CRBD was significantly lower in the glycopyrrolate group than in the atropine group at 0 h (65 % vs. 89 %, p = 0.025) and 1 h (54 % vs. 89 %, p = 0.002) postoperatively. The severity of postoperative CRBD was less severe in the glycopyrrolate group than in the atropine group at 0 h ( p = 0.013) and 1 h ( p = 0.006). Fewer patients required tramadol in the glycopyrrolate group than in the atropine group (3 % vs. 12 %, p = 0.024). Conclusions: Glycopyrrolate as an adjunct to reversal of neuromuscular blockers decreased the incidence of early postoperative CRBD and postoperative tramadol requirements in patients undergoing TURBT when compared to atropine. [ABSTRACT FROM AUTHOR]

Background: Several methods have been used to predict the optimal depth of central venous catheter (CVC) tip position when using the anatomical landmark technique. In the present study, we devised a simple formula to predict CVC depth using ultrasound images and chest X-ray (CXR) in patients undergoing ultrasound-guided subclavian venous catheterization. Methods: Central venous catheterization via the subclavian vein was performed under ultrasound guidance. We measured five parameters to determine the distance between the needle insertion point and the CVC tip: insertion point to vein puncture point ( A), insertion point to a skin point indicating a vertical position above the vein puncture point ( B), insertion point to the clavicular notch ( C), clavicular notch to the carina ( D), and catheter tip to carina ( E). Catheter insertion depth was then determined as follows: calculated catheter insertion depth = A − B + C + D; actual catheter insertion depth = ( A − B + C + D) + E. Results: The calculated CVC insertion depth (mean ± SD) was 15.4 ± 1.5 cm from the needle insertion point to the carina [95 % confidence interval (CI) 15.0-15.9 cm]. Actual depth was 15.4 ± 1.5 cm (95 % CI 15.0-15.9 cm). No significant difference was observed between the calculated CVC insertion depth and the actual distance from the needle insertion point to the carina ( p = 0.940). Conclusions: The appropriate length of a CVC inserted through the subclavian vein can be estimated by a formula using ultrasound images and CXR. [ABSTRACT FROM AUTHOR]

Background: The effect of the Mega Acer kit, a new heated and humidified breathing circuit (HHBC) containing a fluid-warming device, was investigated on intraoperative core temperature ( T). Methods: A total of 102 patients undergoing elective craniotomies were randomly divided into three groups based on the breathing circuit used: a conventional breathing circuit (group C, n = 34), a Fisher & Paykel HHBC (group F, n = 34), and the Mega (group M, n = 34). From baseline to the end of the surgery, T and infusion fluid temperature ( T) were recorded at 15-min intervals. If T became lower than 35.5 °C, a forced-air warmer was used. Results: Baseline temperatures were 36.7 ± 0.3, 36.6 ± 0.2, and 36.6 ± 0.2 °C in groups C, M, and F, respectively. T at the end of surgery dropped from baseline values by 1.0 ± 0.4, 0.5 ± 0.5, and 0.8 ± 0.5 °C in groups C, M, and F, respectively. From 60 min of post-induction to the end of surgery, T was higher in group M than group C ( p < 0.05). From 105 min of post-induction to the end of surgery, T was higher in group M than group F ( p < 0.05). The number of patients receiving forced-air warmer and total forced-air warmer using time were significantly lower in group M than groups C and F ( p < 0.05). T was higher in group M than groups C and F throughout the study period (31.0 ± 1.0 vs. 23.5 ± 0.5 and 24.0 ± 0.4 °C; p < 0.01). Conclusions: The Mega significantly reduced the drop in intraoperative T by delivering warm fluids, compared with the other breathing circuits tested. Trial Registration: Clinicaltrials.gov identifier: NCT01831843. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine is a useful anesthetic adjuvant for general anesthesia. We determined whether preoperative dexmedetomidine administration could reduce the half maximal effective concentration (EC) of propofol for successful i-gel insertion without muscle relaxants. Methods: Thirty-seven patients were randomly allocated to one of two groups. In the dexmedetomidine group ( n = 19), dexmedetomidine (1 µg/kg) was loaded for 10 min preoperatively. In the control group ( n = 20), the same volume of 0.9 % normal saline was administered in the same manner. The EC of propofol for successful i-gel insertion was determined using Dixon's up-and-down method. The EC of propofol was calculated as the midpoint concentration after at least six crossover points had been obtained. For successful i-gel insertion, all of the following four factors were required-(1) no major movement of the body within 1 min of insertion, (2) no significant resistance to mouth opening, (3) cough ≤2, and (4) visible square wave capnogram without air leakage at a peak airway pressure of <10 cmHO. Mean blood pressure (MBP) and heart rate (HR) were monitored during the peri-insertion period of i-gel. Results: The EC of propofol for successful i-gel insertion was 3.18 μg/mL in the dexmedetomidine group and 6.75 μg/mL in the control group ( p < 0.001). The incidence of hypotension (MBP <80 % of the baseline) during the peri-insertion period of i-gel was higher in the control group ( p = 0.001), whereas the incidence of bradycardia (HR <80 % of the baseline) was higher in the dexmedetomidine group ( p = 0.001). Conclusions: Preoperative dexmedetomidine reduced the EC of propofol for successful i-gel insertion without muscle relaxants. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous tunneling (hydrodissection) in the neck and anterior chest in patients undergoing robotic thyroidectomy leads to significant hemodynamic responses such as increases in blood pressure and heart rate. We evaluated whether a single preoperative dexmedetomidine injection attenuated hemodynamic responses to hydrodissection by reducing the half-maximal effective concentration (EC50) of remifentanil needed to maintain hemodynamic stability during hydrodissection. Methods: Forty-one patients undergoing robot-assisted endoscopic thyroidectomy were randomly allocated to one of the two groups-group D ( n = 22) and group C ( n = 19) patients received dexmedetomidine 1 µg/kg and normal saline for 10 min before anesthetic induction, respectively. The EC50 of remifentanil for hemodynamic stability during hydrodissection was determined using Dixon's up-and-down method with initial dose (4 and 5 ng/mL in groups D and C, respectively). The concentration of remifentanil for consecutive patients in each group was determined by the response of the previous patient, using increments or decrements of 0.5 ng/mL. Hemodynamic stability during hydrodissection was defined as increased systolic blood pressure <20 % of baseline. Results: The EC50 of remifentanil for maintaining hemodynamic stability during hydrodissection was 0.8 ng/mL in group D and 7.3 ng/mL in group C ( p = 0.002). Conclusions: A single preoperative dexmedetomidine injection attenuated hydrodissection-induced hemodynamic responses in patients undergoing robotic thyroidectomy. [ABSTRACT FROM AUTHOR]

Purpose: Minimizing hemodynamic changes during the peri-intubation period is a concern for anesthesiologists. We investigated the effect of lidocaine sprayed on the laryngoscope blade and trachea on hemodynamics during direct laryngoscopic intubation. Methods: Seventy-two patients were randomly allocated to one of four groups: 10 % lidocaine was sprayed either on the laryngoscope blade (group L), on the trachea (group V), or on the laryngoscope blade and the trachea (group LV). No lidocaine was used in group C. Anesthesia was induced in all patients with remifentanil (effect site concentration: 4.0 ng/ml) and propofol (effect site concentration 4.0 μg/ml) continuous infusion using a target control infusion (TCI) device. Mean arterial pressure (MAP) and heart rate (HR) were recorded during the peri-intubation period. Results: Changes in MAP and HR over time were markedly different among the four groups ( P < 0.05). MAP at 1 min post-intubation was significantly lower in groups L, V, and LV than in group C (86.1 ± 12.7, 85.3 ± 12.6, and 83.7 ± 13.1 vs 106.3 ± 22.9 mmHg, P < 0.01). Maximum MAP values were lower in groups L and LV than in group C ( P < 0.05). HRs at 1, 2, and 3 min post-intubation were lower in group LV than in group C (70.4 ± 9.0 vs 84.2 ± 15.3; 64.0 ± 8.1 vs 79.2 ± 15.4; 61.6 ± 8.3 vs 77.2 ± 14.5 beats/min, P < 0.01, respectively). Conclusions: Lidocaine sprayed on the laryngoscope blade and/or trachea reduced the hemodynamic response to laryngoscopic intubation during the post-intubation period following anesthetic induction with remifentanil and propofol using a TCI device. [ABSTRACT FROM AUTHOR]