Bone regeneration with umbilical cord blood mesenchymal stem cells in femoral defects of ovariectomized rats

홍부휘,이선열,고영권,김동운,이준,이원형 대한골다공증학회 2018 Osteoporosis and Sarcopenia Vol.4 No.3

Objectives: Current treatments for osteoporosis were prevention of progression, yet it has been questionable in the stimulation of bone growth. The mesenchymal stem cells (MSCs) treatment for osteoporosis aims to induce differentiation of bone progenitor cells into bone-forming osteoblasts. We investigate whether human umbilical cord blood (hUCB)-MSCs transplantation may induce bone regeneration for osteoporotic rat model induced by ovariectomy. Methods: The ovariectomized (OVX) group (n ¼ 10) and OVX-MSCs group (n ¼ 10) underwent bilateral ovariectomy to induce osteoporosis, while the Sham group (n ¼ 10) underwent sham operation at aged 12 weeks. After a femoral defect was made at 9 months, Sham group and OVX group were injected with Hartmann solution, while the OVX-MSCs group was injected with Hartmann solution containing 1 107 hUCB-MSCs. The volume of regenerated bone was evaluated using micro-computed tomography at 4 and 8 weeks postoperation. Results: At 4- and 8-week postoperation, the OVX group (5.0% ± 1.5%; 6.1% ± 0.7%) had a significantly lower regenerated bone volume than the Sham group (8.6% ± 1.3%; 12.0% ± 1.8%, P < 0.01), respectively. However, there was no significant difference between the OVX-MSCs and Sham groups. The OVX-MSCs group resulted in about 53% and 65% significantly higher new bone formation than the OVX group (7.7% ± 1.9%; 10.0% ± 2.9%, P < 0.05). Conclusions: hUCB-MSCs in bone defects may enhance bone regeneration in osteoporotic rat model similar to nonosteoporotic bone regeneration. hUCB-MSCs may be a promising alternative stem cell therapy for osteoporosis.

Postoperative pain control by ultrasound guided brachial plexus block reduces emergence delirium in pediatric patients

홍부휘,정춘호,조유민,윤수경,김여정,정우석,윤석화,신현대,임채성 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.3

Background: Pediatric patients awakening from general anesthesia may experience emergence delirium (ED), often due to inadequate pain control. Nerve block completely inhibits innervation of the surgical site and is superior to systemic analgesics. This study assessed whether pain control through nerve block relieves ED after general anesthesia. Methods: Fifty patients aged 2–7 years with humerus condyle fractures were randomly assigned to receive ultrasound guided supraclavicular brachial plexus block (BPB group) or intravenous fentanyl (Opioid group). The primary outcome was score on the pediatric anesthesia emergence delirium (PAED) scale on arrival at the postanesthesia care unit (PACU). Secondary outcomes were severity of agitation and pain in the PACU, the incidence of ED, and postoperative administration of rescue analgesics over 24 h. Results: PAED scale was significantly lower in the BPB group at arrival in the PACU (7.2 ± 4.9 vs. 11.6 ± 3.2; mean difference [95% confidence interval (CI)] = 4.4 [2.0–6.8], P < 0.001) and at all other time points. The rate of ED was significantly lower in the BPB group (36% vs. 72%; relative risk [95% CI] = 0.438 [0.219–0.876], P = 0.023). The BPB group also had significantly lower pain scores and requiring rescue analgesics than Opioid group in the PACU. Conclusions: Ultrasound guided BPB, which is a good option for postoperative acute phase pain control, also contributes to reducing the severity and incidence of ED.

Effects of intraoperative low dose ketamine on remifentanilinduced hyperalgesia in gynecologic surgery with sevoflurane anesthesia

홍부휘,Wang Yong Lee,김윤희,Seok Hwa Yoon,이원형 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.3

Background: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used. Methods: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3mg/kg) was injected and followed with a continuous dosage of 3 μl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA. Results: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively. Conclusions: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.

Thoracic interfascial nerve block for breast surgery in a pregnant woman -a case report-

홍부휘,윤석화,윤앤미선,김범준,송승현,윤여명 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.2

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.

Identifying the ideal tracheostomy site based on patient characteristics during percutaneous dilatational tracheostomy without bronchoscopy

홍부휘,박지호,정우석,송승현,김윤희,임채성,고영권,윤상원,박현우,박상일 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.3

Background: We previously reported that percutaneous dilatational tracheostomy (PDT) can be safely performed 2 cm below the cricothyroid membrane without the aid of a bronchoscope. Although our simplified method is convenient and does not require sophisticated equipment, the precise location for tracheostomy cannot be confirmed. Because it is recommended that tracheostomy be performed at the second tracheal ring, we assessed whether patient characteristics could predict the distance between the cricothyroid membrane and the second tracheal ring. Methods: Data from 490 patients who underwent three-dimensional neck computed tomography from January 2012 to December 2015 were analyzed, and the linear distance from the upper part of the cricoid cartilage (CC) to the lower part of the second tracheal ring (2TR) was measured in the sagittal plane. Results: The mean CC-to-2TR distance was 25.26 mm (95% CI 25.02–25.48 mm). Linear regression analysis showed that the predicted CC-to-2TR distance could be calculated as −5.73 + 0.2 × height (cm) + 1.22 × sex (male: 1, female: 0) + 0.01 × age (yr) −0.03 × weight (kg) (adj. R2 = 0.55). Conclusions: These results suggest that height and sex should be considered when performing PDT without bronchoscope guidance.

흰쥐의 포르말린 유발 통증반응에 미치는 vitamin E의 항통각 효과

홍부휘,고영권,이영재,한규철,김윤희,이원형 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.1

Background:Reactive oxygen species (ROS) are critically involved in generating pain in various painful conditions, including neuropathic and inflammatory pain. This experiment was conducted in order to assess the antinociceptive effects of vitamin E in the modulation of pain in rats subjected to the formalin test. Methods:Five percent formalin was injected into the hind paw after intraperitoneal injection of either vitamin E 1 g/kg dissolved in olive oil or olive oil alone. The Number of flinches were measured in a 5 minute interval for 1 hour. Results:Formalin injected into the left hind paw induced a biphasic nociceptive behavior. Intraperitoneal injection of vitamin E diminished the nociceptive behavior during phase 1 and 2. Conclusions:Systemic administration of vitamin E produces analgesia in a rat model of formalin-induced hyperalgesia. Furthermore, vitamin E affects pain of peripheral origin.(Anesth Pain Med 2011; 6: 59∼62)

Thoracic interfascial plane block for multimodal analgesia after breast lumpectomy

홍부휘,김여정,오차현,윤수경,윤상원,박현우,이원형,김윤희,고영권 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.2

Background: Thoracic interfascial plane block is useful as a component of multimodal analgesia in patients undergoing mastectomy. However, multimodal analgesia tends not to be provided during lumpectomy as it is one of the less aggressive procedures among breast cancer surgeries. Therefore, we investigated the effects of thoracic interfascial plane block as more effective analgesia after breast lumpectomy. Methods: Forty six patients (20–80 years old, female) with breast cancer scheduled to undergo lumpectomy were randomly assigned to two groups. Postoperative pain control in the control group consisted only of intravenous patient-controlled analgesia (PCA). In the block group, intravenous PCA was used after serratus intercostal fascial plane block and pecto-intercostal fascial plane block. The primary outcome was the 24 h cumulative postoperative fentanyl consumption. Pain severity, additional rescue analgesic requirement, side effects, and patient satisfaction were also evaluated. Results: Postoperative fentanyl consumption in the block group was significantly reduced compared with the control group (median, 88.8 [interquartile range, 48.0, 167.6] vs. 155.2 [88.8, 249.2], P = 0.022). The pain score was significantly lower in the block group only in the post-anesthesia care unit (2.9 ± 1.8 vs. 4.3 ± 2.3, P = 0.022). There were no differences in the incidence of postoperative nausea and vomiting and the requirement for additional analgesics between the groups. The satisfaction score was significantly higher in the block group. Conclusions: Thoracic interfascial plane block after lumpectomy reduces opioid usage and increases patient satisfaction with postoperative pain control. Thoracic interfascial plane block is useful for multimodal analgesia after lumpectomy.

Cardiac Arrest from Patient Position Change after Spine Surgery on a Jackson Table

홍부휘,윤석화,Ann Misun Youn,Seunghyun Song,Soo-Yong Park,JaGyung Hwang 대한중환자의학회 2019 Acute and Critical Care Vol.34 No.1

The Jackson table has minimal effects on cardiac function because it does not elevate abdominal and thoracic pressures. In addition, it decreases venous congestion and increases exposure of the surgical field. However, the hips and knees are flexed with inappropriate padding, and venostasis is promoted and increased. Pulmonary thromboembolism (PTE) is fatal; thus immediate diagnosis and treatment are essential. However, clinical signs of intraoperative PTE are difficult to discern. Thrombolytic therapy can be considered as first-line therapy, but bleeding limits its use. The authors report a case of PTE resulting from patient positional change after spine surgery, and the use of immediate postoperative recombinant tissue-type plasminogen activator.

요추부 디스크 탈출증으로 오인된 좌골 신경병증과 연관된 국소 탈신경 근육염

이승훈,노찬,홍부휘,이선열,고영권,김여정 조선대학교 의학연구원 2019 The Medical Journal of Chosun University Vol.44 No.1

Focal myositis is a rare disease associated with inflammatory changes invading the skeletal muscles and may be triggered by nerve lesion. We describe a case of 33-year-old woman who was diagnosed focal denervation myositis of piriformis and gluteal muscles associated with sciatic neuropathy because of severe uterine enlargement due to twin pregnancy misdiagnosed as lumbar herniated nucleus pulposus. MRI is one of the key diagnostic tools in the assessment of focal denervation myositis for differential diagnosis. Nonsteroidal anti-inflammatory drugs are commonly used for treatment of focal myositis. Spontaneous regression is obtained in numerous cases.

Trigeminocardiac reflex: sudden severe bradycardia during open reduction for temporomandibular joint dislocation - A case report -

김여정,고영권,홍부휘,신용섭,노찬,이승훈,홍석환 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.3

Background: The trigeminocardiac reflex (TCR), which occurs after stimulation of the territory of the trigeminal nerve, is very rarely reported to be caused by stimulation of the mandibular branch. We report a case of TCR in open reduction for temporomandibular joint (TMJ) dislocation. Case: A 74-year-old female presented for TMJ dislocation. During open reduction of TMJ under general anesthesia, severe bradycardia (15 beats/min) occurred. Immediately 0.5 mg atropine was administered intravenously, and the surgical manipulation was stopped. After 30 seconds, heart rate normalized. During surgery, severe bradycardia occurred one more time. It disappeared spontaneously as soon as surgical manipulation was stopped. The surgery was completed uneventfully. Conclusions: Because of the possibility of profound bradycardia, asystole, or even death when evoked, it is important to be aware of the trigeminocardiac reflex during manipulation of the mandibular divisions, especially during surgical stimulation of the TMJ.