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Jaewoo Yi - One of the best experts on this subject based on the ideXlab platform.

  • non intubated thoracoscopic surgery for decortication of empyema under thoracic Epidural anesthesia a case report
    Korean Journal of Anesthesiology, 2017
    Co-Authors: Eunjin Moon, Yoonju Go, Junyoung Chung, Jaewoo Yi
    Abstract:

    General anesthesia is the main strategy for almost all thoracic surgeries. However, a growing body of literature has reported successful cases of non-intubated thoracic surgery with regional anesthesia. This alternative strategy not only prevents complications related to general anesthesia, such as lung injury, incomplete re-expansion and intubation related problems, but also accords with trends of shorter hospital stay and lower overall costs. We experienced a successful case of non-intubated thoracoscopic decortication for a 68-year-old man who was diagnosed as empyema while the patient kept spontaneously breathing with moderate sedation under thoracic Epidural anesthesia. The patient showed a fast recovery without concerns of general anesthesia related complications and effective postoperative Analgesia through thoracic Epidural Patient-Controlled Analgesia device. This is the first report of non-intubated thoracoscopic surgery under thoracic Epidural anesthesia in Korea, and we expect that various well designed prospective studies will warrant the improvement of outcomes in non-intubated thoracoscopic surgery.

In-cheol Choi - One of the best experts on this subject based on the ideXlab platform.

  • Preoperative dexamethasone for acute post-thoracotomy Analgesia: a randomized, double-blind, placebo-controlled study
    BMC Anesthesiology, 2018
    Co-Authors: Kyoung-woon Joung, In-cheol Choi
    Abstract:

    Background The analgesic effects of dexamethasone have been reported previously, and the present study determined the effects of preoperative dexamethasone on postoperative pain in patients who received thoracotomy. Methods Forty patients participated in this randomized, double-blind study. All patients received either dexamethasone via a 0.1 mg/kg intravenous bolus before anesthetic induction or an equal volume of saline. Postoperative Analgesia was provided to both groups via Epidural Patient-Controlled Analgesia (PCA), which consisted of 250 μg of sufentanil in 250 mL of ropivacaine (0.18%) for 72 h. The primary outcome was the cumulative consumption of Epidural PCA at postoperative 24 and 72 h. The secondary outcomes were the pain intensity scores during resting and coughing at postoperative 24 and 72 h, quality of recovery, total amount of rescue analgesics required, and length of hospital stay. Results No significant differences was observed in the consumption of Epidural PCA between the control and dexamethasone infusion groups at 24 h (63.6 [55.9–72.7] vs. 68.5 [60.2–89.0] ml, P  = 0.281) and 72 h (199.4 [172.4–225.1] vs. 194.7 [169.1–252.2] ml, P = 0 .890). Moreover, there was no significant difference in the pain intensity scores during resting and coughing at postoperative 24 and 72 h, quality of recovery, total amount of rescue analgesics required, and length of hospital stay. Conclusion A single intravenous administration of dexamethasone during the preoperative period does not reduce opioid consumption and post-thoracotomy pain. Trial registration The study was registered at http://cris.nih.go.kr ( KCT0000359 ) and was conducted from December 2011 to October 2012.

  • Preoperative dexamethasone for acute post-thoracotomy Analgesia: a randomized, double-blind, placebo-controlled study.
    BMC Anesthesiology, 2018
    Co-Authors: Kyoung-woon Joung, In-cheol Choi
    Abstract:

    The analgesic effects of dexamethasone have been reported previously, and the present study determined the effects of preoperative dexamethasone on postoperative pain in patients who received thoracotomy. Forty patients participated in this randomized, double-blind study. All patients received either dexamethasone via a 0.1 mg/kg intravenous bolus before anesthetic induction or an equal volume of saline. Postoperative Analgesia was provided to both groups via Epidural Patient-Controlled Analgesia (PCA), which consisted of 250 μg of sufentanil in 250 mL of ropivacaine (0.18%) for 72 h. The primary outcome was the cumulative consumption of Epidural PCA at postoperative 24 and 72 h. The secondary outcomes were the pain intensity scores during resting and coughing at postoperative 24 and 72 h, quality of recovery, total amount of rescue analgesics required, and length of hospital stay. No significant differences was observed in the consumption of Epidural PCA between the control and dexamethasone infusion groups at 24 h (63.6 [55.9–72.7] vs. 68.5 [60.2–89.0] ml, P = 0.281) and 72 h (199.4 [172.4–225.1] vs. 194.7 [169.1–252.2] ml, P = 0.890). Moreover, there was no significant difference in the pain intensity scores during resting and coughing at postoperative 24 and 72 h, quality of recovery, total amount of rescue analgesics required, and length of hospital stay. A single intravenous administration of dexamethasone during the preoperative period does not reduce opioid consumption and post-thoracotomy pain. The study was registered at http://cris.nih.go.kr ( KCT0000359 ) and was conducted from December 2011 to October 2012.

  • Reply to Chen et al.
    European Journal of Cardio-Thoracic Surgery, 2012
    Co-Authors: Jun-gol Song, In-cheol Choi
    Abstract:

    We would like to thank Chen et al. for their careful reading of, and comments [1] regarding, our manuscript [2]. We completely agree that diagnostic pain is mainly dependent on the patient’s description and lacks an objective assessment. This is one of the limitations of our study that was mentioned in the discussion. We also agree that our results demonstrate that pain intensity, analgesic use and the incidences of the principal pain characteristics of the two groups were not significantly different during the early phase or at 3-months and 6-months after thoracic surgery. Our results do show, however, that the incidence of newly developed pain at 6 months was significantly less common in the TIVA (total intravenous anaesthesia) group, which is an important factor that can help understand the transition of pain to chronicity. In addition, although allodynia-like pain was not a main feature, it was significantly more common in the inhaled-anaesthesia group. However, we do not agree with the comments regarding the role TIVA plays in reducing the prevalence of CPTS (chronic postthoracotomy pain syndrome) because we compared the prevalence of CPTS in the TIVA group with the inhalation group, which demonstrated a statistically significant difference between the two groups. It would be of little significance or importance to compare it with the prevalence of CPTS reported in previous studies. We apologize for the error we made in Table 4 and thank Chen et al. for helping us to correct this mistake, as well as the editor for giving us the opportunity to do so. We have amended Table 4 as follows: in group II, burning has been changed from 5 (2.9%) to 15 (8.8%; P = 0.38), pins and needles have been changed from 17 (10%) to 27 (15.9%; P = 0.24) and aching has been changed from 19 (11.2%) to 29 (17.1; P = 0.35) at 6 months. We have also changed the percentage of aching in group I at 6 months from 1.2 to 12.7%. At our institution, the use of inhalation anaesthetics (such as sevoflurane) with the continuous infusion of thoracic Epidural Analgesia has been the routine anaesthetic technique for thoracic surgery. As mentioned in the methods section, we maintained sevoflurane with the continuous infusion of thoracic Epidural patient controlled Analgesia to a bispectal index (BIS, XP version 4.1; Aspect Medical Systems, Newton, MA, USA) level of 50 when performing on the inhalation group. Using this method, we performed anaesthesia for thoracic surgery without weak analgesic problems during the operation. Another major limitation of our study is that we did not include a sevoflurane and remifentanil group, which was also mentioned in the discussion. Further studies are needed to verify which drug may play pivotal roles in lowering the incidence of CPTS.

Do Joong Park - One of the best experts on this subject based on the ideXlab platform.

  • Multimodal Enhanced Recovery After Surgery (ERAS) Program is the Optimal Perioperative Care in Patients Undergoing Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Prospective, Randomized, Clinical Trial
    Annals of Surgical Oncology, 2018
    Co-Authors: So Hyun Kang, Young Suk Park, Do Joong Park
    Abstract:

    Background The application of ERAS protocol has widely gained acceptance after gastrointestinal surgery. Well-designed, randomized, control trials are needed to evaluate fully its safety and efficacy in the field of gastric cancer. This study aims to compare the enhanced recovery after surgery (ERAS) protocol and the conventional perioperative care program after totally laparoscopic distal gastrectomy (TLDG) in gastric cancer. Methods Patients with gastric cancer indicated for TLDG were randomly assigned to either the ERAS group or the conventional group. The ERAS protocol included short fasting time, fluid restriction, early oral feeding, immediate mobilization, and use of Epidural Patient-Controlled Analgesia. Primary endpoint was recovery time, which was defined with the criteria of tolerable diet, safe ambulation, no requirement of additional analgesics, and afebrile state. Hospital stay, pain score, complications, and readmission rate were secondary endpoints. Results A total of 97 patients who underwent TLDG from October 2012 to August 2014 were enrolled (ERAS = 46, conventional = 51). The ERAS group had faster recovery time (111.6 ± 34.3 vs. 126.7 ± 30.7 h; p  = 0.026) and significantly less pain through postoperative days 1–4. Possible hospital stay also was faster in the ERAS group (5.0 ± 1.9 vs. 5.7 ± 1.6 days, p  = 0.038), but there was no difference in actual hospital stay. No difference was found in complication, and there was no mortality or readmission in both groups. Conclusions ERAS is safe and enhances postoperative recovery after TLDG in gastric cancer. Trial Registration The trial was registered in ClinicalTrials.gov (NCT01938313).

Eunjin Moon - One of the best experts on this subject based on the ideXlab platform.

  • non intubated thoracoscopic surgery for decortication of empyema under thoracic Epidural anesthesia a case report
    Korean Journal of Anesthesiology, 2017
    Co-Authors: Eunjin Moon, Yoonju Go, Junyoung Chung, Jaewoo Yi
    Abstract:

    General anesthesia is the main strategy for almost all thoracic surgeries. However, a growing body of literature has reported successful cases of non-intubated thoracic surgery with regional anesthesia. This alternative strategy not only prevents complications related to general anesthesia, such as lung injury, incomplete re-expansion and intubation related problems, but also accords with trends of shorter hospital stay and lower overall costs. We experienced a successful case of non-intubated thoracoscopic decortication for a 68-year-old man who was diagnosed as empyema while the patient kept spontaneously breathing with moderate sedation under thoracic Epidural anesthesia. The patient showed a fast recovery without concerns of general anesthesia related complications and effective postoperative Analgesia through thoracic Epidural Patient-Controlled Analgesia device. This is the first report of non-intubated thoracoscopic surgery under thoracic Epidural anesthesia in Korea, and we expect that various well designed prospective studies will warrant the improvement of outcomes in non-intubated thoracoscopic surgery.

T. Yilmazlar - One of the best experts on this subject based on the ideXlab platform.

  • The beneficial effects of preperitoneal catheter Analgesia following colon and rectal resections: a prospective, randomized, double-blind, placebo-controlled study
    Techniques in Coloproctology, 2011
    Co-Authors: E. Ozturk, A. Yilmazlar, F. Coskun, O. Isik, T. Yilmazlar
    Abstract:

    Background Preperitoneal catheter Analgesia following abdominal surgery has attracted interest in the last decade. We conducted this study to evaluate the benefits of preperitoneal catheter Analgesia in managing pain after abdominal colon and rectal resections. Methods A total of 50 patients undergoing colon and rectal resections for benign and malignant diseases received analgesic medicines via an Epidural catheter placed just prior to surgery and a preperitoneal catheter placed at the end of the surgical procedure. Patients were instructed to use the Epidural Patient-Controlled Analgesia (PCA) device freely and were randomized into two groups after obtaining the approval of the Institutional Review Board: Group A received 10 ml of levobupivacaine twice a day postoperatively via preperitoneal catheter and group B received only 10 ml of saline. Demographics, surgical characteristics, pain scores recorded four days following surgery, analgesic volume used from the Epidural PCA, clinical outcomes (length of stay, time to first bowel movement, time to first passage of gas or stool, time to first oral intake) and respiratory function test results (preoperative vs. postoperative) were compared. Results There were no significant differences in demographics or surgical characteristics between both groups. Pain scores were similar. Clinical outcomes and respiratory functions were comparable. The use of analgesic volume via Epidural catheter was significantly lower in group A than in group B ( P  = 0.032). Conclusions Preperitoneal catheter Analgesia significantly decreased the need for Epidural drug consumption and proved to be a beneficial adjunct for postoperative pain management of patients who underwent colon and rectal resections.